Risk factors for failure of transvaginal sacrospinous uterine suspension in the treatment of uterovaginal prolapse.
OBJECTIVE
The purpose of this study was to elucidate the risk factors for failure of transvaginal sacrospinous uterine suspension (SSUS) in the treatment of uterine prolapse and to examine methods for controlling these risk factors.


METHODS
Sixty patients with second degree uterine prolapse or greater were included in this 2-stage study, with 33 in the risk factor assessment and 27 in the clinical study of a modified treatment to eliminate identified risk factors. Patients were followed for at least 5 years. The first part of the study evaluated the risk factors for operative failure and the efficacy of the operative procedure. The second part of the study evaluated a modified treatment plan to eliminate risk factors identified in the first part of the study.


RESULTS
The failure rate for those with an elongated cervix (3 of 4, 75%) and those with third degree uterine prolapse (3 of 4, 75%) was significantly higher than for patients without either of these risk factors (6.9%, 2/29) [p = 0.007]. Concomitant partial trachelectomy for those with elongated cervix significantly reduced the failure rate from 75% to 0% (0/7) [p = 0.024]. In the risk factor study, SSUS was successful in 84.8% (28/33) of patients. In the clinical study of modified therapy to prevent significant risk factors, the success rate was 96.3% (26/27).


CONCLUSIONS
This study found that an elongated cervix and third degree uterine prolapse were the 2 main risk factors for recurrent uterine prolapse after SSUS. Concomitant partial trachelectomy as an adjuvant treatment of SSUS for treatment of uterovaginal prolapse in patients with an elongated cervix significantly reduces the rate of failure in these patients.
Lin
Tzu-Yin
TY
Urodynamic Unit, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
Su
Tsung-Hsien
TH
Wang
Yeou-Lih
YL
Lee
Mei-Yu
MY
Hsieh
Ching-Hung
CH
Wang
Kuo-Gon
KG
Chen
Gin-Den
GD
D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D017211:Treatment Failure; D014596:Uterine Prolapse / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000473:pathology; D014621:Vagina / Q000601:surgery