title: Anterior needle-guided mesh in advanced pelvic organ prolapse: apical fixation on sacrospinous ligaments.
abstract: OBJECTIVE
  To evaluate whether anterior-apical compartment mesh implants for pelvic floor reconstruction might be safely and effectively anchored to the sacro-spinous (SS) ligaments instead of the arcus tendineus fascia pelvis (ATFP). The SS ligaments as anchoring structures for centro-apical support mesh fixation are thought to be stronger than the ATFP and we presumed that anterior mesh fixation to the SS ligament might be feasible, safe and effective.
  
  
  METHODS
  Patients with advanced anterior-apical pelvic floor prolapse, referred for mesh reconstruction and having poor ATFP were enrolled to this study. For these patients the posterior arms of the anterior mesh were fixed to the SS ligaments. Data regarding cure, complications and patient's satisfaction were collected prospectively: patients were interviewed and examined at the end of the first and third post-operative months, and interviewed again at the study conclusion.
  
  
  RESULTS
  Of 72 patients who were asked to participate in this study, 44 had rather un-palpable ATFP, and SS ligament fixation was performed. The mean follow-up duration was 12 months (range: 10-43). No significant intra- or post-operative complications were recorded. The POP-Q points measurements showed marked improvements: the average delta for the Ba point was 7.4cm, for the Bp point 4.7cm, and for the C point 7.9cm. These differences were all statistically significant. Bladder overactivity symptoms, namely urgency, frequency and nocturia, were all found to be reduced significantly, and so was the sexual discomfort rate. Fecal incontinence, pelvic pain and constipation rates were reduced as well, but these did not reach statistical significance.
  
  
  CONCLUSIONS
  This rather small study suggests that anterior pelvic floor meshes might be anchored safely and successfully to the SS ligament, aiming to achieve improved centro-apical support of the vaginal apex and the anterior wall by an anterior pelvic floor approach.
authors.forename: Neuman
authors.initials: N
authors.lastname: Menahem
authors.affiliation: Urogynecology Unit, Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Research and Development in Urogynecology, The CEO's Office, Shaare-Zedek Medical Center, Jerusalem, Israel. Electronic address: mneuman@netvision.net.il.
authors.forename: Neuman
authors.initials: N
authors.lastname: Meuman
authors.affiliation: Moscow State Medical Stomatological University, Urology Department, Russia.
authors.forename: Sumerova
authors.initials: S
authors.lastname: Natalia
authors.affiliation: Urogynecology Unit, Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel.
authors.forename: Sosnovski
authors.initials: S
authors.lastname: Vladimir
authors.affiliation: Urogynecology Unit, Department of Obstetrics and Gynecology, Western Galilee Hospital, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
authors.forename: Bornstein
authors.initials: B
authors.lastname: Jacob
mesh_terms: D000368:Aged; D052858:Cystocele; D005260:Female; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D009339:Needles; D017773:Pelvic Floor / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D020047:Rectocele / Q000601:surgery; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery
keywords: Centro-apical vaginal support; Needle guided mesh; Pelvic floor reconstruction; Sacro-spinous ligament