Laxity of the anterior vaginal wall leads to the funnelling of the bladder neck and triggering inappropriate micturition reflexes and thus might lead to urinary incontinence. In the upright body position the anatomical support of the anterior vaginal wall (on which urethra and bladder base rest) is mainly ensured by the cervix / uterus, thus an intact apical suspension is mandatory.

Sacrocolpopexy (SCP) is the gold-standard for apical reconstruction. The technical performance of each SCP varies according to the surgeon ́s discretion, and comparison of clinical outcomes may be hampered. Therefore, a comprehensible surgical technique for bilateral apical fixation with a minimum amount of synthetic material was developed. Evaluation of the clinical 1-year results after cervicosacropexy (either abdominal or laparoscopic) and its safety and efficacy are presented for the first time.

Retrospective analysis in a tertiary center of women with POP-Q stages I-IV and urinary incontinence. All patients received a standardized bilateral uterosacral ligament (USL) replacement using polyvinylidene-fluoride tapes (PVDF) either open abdominal or laparoscopic cervicosacropexy. These PVDF tapes were identical in shape, that is 0.4 cm width and 8.8 cm length (Fig. 1). Clinical outcome was assessed at 12 months.

145 patients were evaluable, 75 patients were operated with the abdominal, 70 patients with the laparoscopic approach. No major complications occurred intraoperatively, and no mesh erosions were detected within 1-year postoperatively. There was no significant difference in clinical outcome one year after surgeries. Apical support (POP-Q stage 0) was restored in 100% of patients and urinary continence restored in 59% of patients (59% after laparotomy vs 62% after laparoscopy, respectively). After laparoscopy, patients stayed 3 days in mean compared to 5 days after laparotomy. Regarding the operating time, a laparotomy lasted in mean 120 minutes (89 - 168 minutes), whereas a laparoscopy lasted in mean 89 minutes (58 - 128 minutes).

In contrast to many other apical fixations, both USL were replaced using a clearly defined surgical technique (in term of type of material, size, shape of mesh, and positioning). This standardization ensured comparable and reproducible clinical outcomes, despite different surgical access paths.

This bilateral cervicosacropexy shows a very good anatomical result even one year after surgery, without any mesh complications. Beside the anatomical correction of the prolapse, the anterior vaginal wall (and its vesico-urethral junction) is emphasized and urinary continence could be restored. This surgical procedure is one alternative option in women with apical prolapse and urinary incontinence, especially since only a minimum of synthetic material is used.

Continence 2S2 (2022) 100241
DOI: 10.1016/j.cont.2022.100241