Extraperitoneal Uterosacral Ligament Hysteropexy: A Novel Treatment for Apical Compartment Prolapse

To treat mild-to-moderate apical compartment prolapse while preserving the uterus, our extraperitoneal uterosacral ligament hysteropexy repair technique was developed. Hysterectomy for prolapse accounted for 13% of all benign hysterectomies, which is the third most common reason.¹ Although concomitant hysterectomy risks at time of prolapse surgery are not well defined, risks associated with hysterectomy have been well described in the literature. Additionally, it is well known that anterior compartment prolapse often has an apical component.² Benefits of hysteropexy in prolapse surgery consistently cited in the literature include reduced surgical time, blood loss, and morbidity.³ A study by Frick et al, reported more than 60% of women would decline a concomitant hysterectomy if offered an equally efficacious surgical option.⁴ Our primary aim was to achieve anatomical success as defined as apical POP-Q less than or equal to Stage 1, resolution of subjective bulge and no reoperation for recurrent prolapse.

We performed a retrospective case series of extraperitoneal uterosacral ligament hysteropexy (EPUSLH) procedures from 2017 to 2019.

In our case series, the objective cure rate (POP-Q apical prolapse stage ≤1) and the subjective cure rate at 5 months follow up was 100%, refer to Table 1. The mean length lost in total vaginal length compared to baseline was 0.5 cm, refer to Table 2. Mean surgical time for EPUSLH with combined procedures was 110 minutes. The mean EBL was 101 mL.

EPUSLH demonstrated good short-term success with a low rate of complications in this small cohort. Being a tertiary referral center with many patients traveling long distances or internationally has limited follow-up. Although larger numbers and long-term follow-up are needed to better understand the success of this procedure, the early results are encouraging that this technique could be a simple alternative hysteropexy method.