title: [Long-term outcomes of the high vaginal uterosacral ligament suspension in treatment of the severe pelvic organ prolapse].
abstract: OBJECTIVE
  To investigate the long-term objective and subjective outcomes of the transvaginal high uterosacral ligament suspension(HUS) in treatment of severe pelvic organ prolapse (POP) .
  
  
  METHODS
  From Jun. 2003 to Mar.2013, 136 patients with severe POP quantitation (POP-Q) stage III-IV underwent transvaginal hysterectomy and HUS operation in the First Affiliated Hospital, General Hospital of People's Liberation Army. And 125 patients (91.9%, 125/136) were followed up at a mean of 5.4 years (range of 4.2-9.2 years) . Anterior colporrhaphy (79.2%, 99/125), posterior colporrhaphy (64.0%, 80/125), the perineorrhaphy (96.0%, 120/125) and tension-free suburethral slings (37.6%, 47/125) were performed concurrently, in which 53 (65%, 53/81) patients with severe cystocele and 5 patients (15%, 5/34) with rectocele were augmented with mesh, respectively. Concurrent operation and complications were studied. The objective success of the operation was defined as the leading vaginal edge above hymen.Subjective results were obtained quality-of-life questionnaires, including pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7).
  
  
  RESULTS
  The mean interval of following up was (5.4 ± 1.2) years.Four patients presented mild anterior vaginal wall prolapse, and the recurrence rate were 3.2% (4/125), but no reoperation and pessary treatment were needed. Therefore, the subjective and objective satisfaction rate was 94.4% (118/125) and 96.8% (121/125). The mean scores of PFDI-20 and PFIQ-7 at 5 years after the operations were 8, 7, significantly lower than 62, 64 (P < 0.01). There were 3 cases of ureter obstruction. Tension-free vaginal tape was performed on 47 cases with stress urinary incontinence (SUI) as indicated. The symptom of 2 patients was not improved significantly after the operation, but one was improved after 6 months. The rate of denovo SUI was in 2(1.6%, 2/125) patients, but no further treatment was needed.
  
  
  CONCLUSIONS
  The transvaginal HUS was then conformed to be a safe, minimal traumatic, highly successful and durable procedure for severe POP, so it is worthy of being popularized for clinical application.
authors.affiliation: Department of Obstetrics and Gynecology, First Affiliated Hospital,General Hospital of People's Liberation Army, Beijing 100048, China. Email:yongxianlu@sina.com.
authors.forename: Yong-xian
authors.initials: YX
authors.lastname: Lu
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
authors.forename: Wen-jie
authors.initials: WJ
authors.lastname: Shen
authors.forename: Ying-hui
authors.initials: YH
authors.lastname: Zhang
authors.forename: Jing-xia
authors.initials: JX
authors.lastname: Liu
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhao
authors.forename: Jing
authors.initials: J
authors.lastname: Ge
authors.forename: Ke
authors.initials: K
authors.lastname: Niu
authors.forename: Wen-ying
authors.initials: WY
authors.lastname: Wang
mesh_terms: D000368:Aged; D003558:Cystoscopy; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011788:Quality of Life; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D012720:Severity of Illness Index; D053825:Suburethral Slings; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000473:pathology / Q000601:surgery; D014621:Vagina / Q000601:surgery*