Anterior needle-guided mesh in advanced pelvic organ prolapse: apical fixation on sacrospinous ligaments

To evaluate whether anterior-apical compartment mesh implants for pelvic floor reconstruction might be safely and effectively anchored to the sacro-spinous (SS) ligaments instead of the arcus tendineus fascia pelvis (ATFP). The SS ligaments as anchoring structures for centro-apical support mesh fixation are thought to be stronger than the ATFP and we presumed that anterior mesh fixation to the SS ligament might be feasible, safe and effective.

Patients with advanced anterior-apical pelvic floor prolapse, referred for mesh reconstruction and having poor ATFP were enrolled to this study. For these patients the posterior arms of the anterior mesh were fixed to the SS ligaments. Data regarding cure, complications and patient's satisfaction were collected prospectively: patients were interviewed and examined at the end of the first and third post-operative months, and interviewed again at the study conclusion.

Of 72 patients who were asked to participate in this study, 44 had rather un-palpable ATFP, and SS ligament fixation was performed. The mean follow-up duration was 12 months (range: 10-43). No significant intra- or post-operative complications were recorded. The POP-Q points measurements showed marked improvements: the average delta for the Ba point was 7.4cm, for the Bp point 4.7cm, and for the C point 7.9cm. These differences were all statistically significant. Bladder overactivity symptoms, namely urgency, frequency and nocturia, were all found to be reduced significantly, and so was the sexual discomfort rate. Fecal incontinence, pelvic pain and constipation rates were reduced as well, but these did not reach statistical significance.

This rather small study suggests that anterior pelvic floor meshes might be anchored safely and successfully to the SS ligament, aiming to achieve improved centro-apical support of the vaginal apex and the anterior wall by an anterior pelvic floor approach.