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Recurrence After Anterior Versus Posterior Approach to Sacrospinous Hysteropexy
Christina M Mezes1, Martha K Coghlan2, Isuzu Meyer2
1Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC.
Urogynecology (Philadelphia, Pa.)
|February 2, 2026
Summary
The posterior approach to sacrospinous hysteropexy (SSH) may lead to earlier bulge symptoms, while the anterior approach has higher short-term complications. Longer-term outcomes require further investigation for this common pelvic organ prolapse surgery.
Area of Science:
- Urogynecology
- Pelvic Floor Surgery
- Female Pelvic Medicine
Background:
- Sacrospinous hysteropexy (SSH) is a common surgical procedure for pelvic organ prolapse.
- Limited evidence compares anterior versus posterior surgical approaches for SSH regarding outcomes and complications.
Purpose of the Study:
- To evaluate if anterior versus posterior approaches to SSH impact short-term postoperative bulge symptoms.
- To assess differences in intraoperative and 30-day postoperative complication rates between the two approaches.
Main Methods:
- Retrospective cohort analysis of 316 women undergoing transvaginal native tissue SSH (2016-2024).
- Primary outcome: presence of bulge symptoms.
- Secondary outcomes: retreatment rates, operative data, and Clavien-Dindo classified complications.
Main Results:
- The posterior approach group experienced earlier bulge symptoms (P = 0.002).
- The anterior approach group had a higher proportion of short-term complications (Clavien-Dindo I/II: 21.6% vs 7.1%, P = 0.0002).
- Women in the anterior approach group were older and had more severe prolapse preoperatively.
Conclusions:
- An anterior approach to SSH may offer protection against bulge symptom recurrence and retreatment.
- The anterior approach is associated with increased short-term complications.
- Further prospective studies are needed to understand long-term outcomes.
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