Various surgical procedures for female pelvic organ prolapse (POP) exist. One of the most frequently performed surgical management of symptomatic POP consists of vaginal hysterectomy (vag. HE) with apical fixation. However, uterine-preserving procedures such as vaginal sacrospinous hysteropexy (SSHP) have become an increasingly utilized surgical option for the primary treatment of POP. To assess the efficacy of primary SSHP in comparison to primary vag. HE with apical fixation we compared perioperative complications rates and outcomes.

A retrospective data analysis was conducted. Women who received a surgical treatment by primary SSHP (study group) for symptomatic POP at our tertiary hospital from November 2004 up to December 2021 were eligible for inclusion. All included patients were matched 1:1 by age and BMI with a patient, who received a primary vaginal hysterectomy (control group) with apical fixation by either uterosacral ligament suspension (USLS) or sacrospinous ligament fixation (SSLF). Clinical information including confirmation of pelvic organ prolapse stage of 2 or higher according to the Pelvic Organ Prolapse Quantification system (POP-Q system) [1], clinical assessment of pelvic floor muscles scored according to the Oxford scale [2] and operative records were obtained from the patients’ electronic hospital chart. All patient records were anonymized and de-identified prior to analysis. Only non-emergency patients and patients with planned elective reconstructive pelvic floor procedures were included. Emergency cases, all non-urogynaecologic issues or malignant results, as well as patients with previous pelvic floor surgeries were excluded. Postoperative complications were assessed through the standardized classification of surgical complications according to Clavien-Dindo [3]. 
Descriptive statistics were performed using contingency tables with absolute and relative distribution for categorial variable with mean and standard deviation or median and interquartile ranges for continuous variables. Endpoints were analyzed using Chi-square-test/Fisher-exact-test (categorial variables) and Mann-Whitney U-test/Kruskal-Wallis-test (continuous variables). A p-value < 0.05 was considered statistically significant. Analysis was performed using SPSS® (IBM, Armonk, NY, USA, Version 27).

A total of 154 patients were included with 77 patients in each group. There were no statistically significant differences in menopausal stage, parity, vaginal births, caesarean sections, nicotine consumption, urinary stress incontinence, overactive bladder, Oxford scale score, diarrhea, obstipation, or fecal incontinence between the two study groups. Furthermore, there was no statistically significant difference in preoperative POP-Q stage, nor in concomitant performed colporrhaphies between the two groups. Both groups also showed no statistically significant difference in preoperative health issues such as: cardiovascular disease, high blood pressure, diabetes, diseases of the respiratory system, neurological disease, orthopedic issues, metabolic diseases, or renal problems.
The SSHP group showed a significantly shorter mean operation time (67.0 vs 97.1 min; p < 0.001), fewer hospitalization days (2.94 vs 4.87 days p < 0.001) and less intraoperative blood loss (SSHP: 120.00 ml vs. vag. HE: 186.18 ml; p= 0.035) in comparison to the control group. Neither group had any intraoperative complication, nor an intraoperative conversion to other surgical management options. Regarding postoperative complications no statistically significant difference was found, with 2 patients experiencing grade 3b complications (one in each group) as categorized by the Clavien-Dindo classification.
Furthermore, we assessed the postoperative difference between the study and control group for issues such as urinary tract infections, de-novo incontinence, residual urine, voiding disorders, vaginal infection, infection of the wound, bleeding, required blood transfusions and pain – no statistically significant differences were found for any of these issues.

Our findings align with previously published studies that point towards SSHP being a safe alternative to vag. HE with apical fixation. In this study SSHP was associated with shorter operating time, shorter hospital stays and less intraoperative blood loss, while retaining similar short-term outcomes.

These results demonstrated that sacrospinous hysteropexy is an effective and safe alternative to vaginal hysterectomy with apical fixation for patients who wish to retain their uterus.

Bump, R.C. The POP-Q System: Two Decades of Progress and Debate. Int. Urogynecology J. 2014, 25, 441–443, doi:10.1007/s00192-013-2262-0
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Clavien, P.A.; Barkun, J.; de Oliveira, M.L.; Vauthey, J.N.; Dindo, D.; Schulick, R.D.; de Santibañes, E.; Pekolj, J.; Slankamenac, K.; Bassi, C.; et al. The Clavien-Dindo Classification of Surgical Complications: Five-Year Experience. Ann. Surg. 2009, 250

Continence 2S2 (2022) 100237
DOI: 10.1016/j.cont.2022.100237