title: Iliococcygeus fixation for the treatment of apical vaginal prolapse: efficacy and safety at 5 years of follow-up.
abstract: OBJECTIVE
  Sacrocolpopexy is considered the gold standard treatment for vaginal vault prolapse. However, the vaginal approach is very common, with 80-90 % of procedures being performed via this route. The aim of this study was to evaluate the safety and efficacy of iliococcygeus (ICG) fixation in the treatment of vaginal vault prolapse, with a minimum follow-up of 5 years.
  
  
  METHODS
  We prospectively enrolled women with symptomatic vaginal vault prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage ≥2) who were treated with ICG fixation. Subjective success was defined in the case of Patient Global Impression of Improvement ≤ 2 and an absence of bulging symptoms. Objective success was defined as stage of prolapse < 2 in all compartments. Overall success rate was defined as women without prolapse symptoms, PGI-I ≤ 2, stage of prolapse < 2, and no need for other surgery. All women filled in the Prolapse Quality of Life (P-QOL) questionnaire both at the preoperative visit and at every follow-up visit. Multiple logistic regression was performed to identify factors involved in the risk of recurrent POP.
  
  
  RESULTS
  After a median (range) follow-up of 68.8 (60-92) months the subjective, objective, and overall cure rates were 88.6 % (39 out of 44), 84.1 % (37 out of 44), and 84.1 % (37 out of 44) respectively. Only preoperative stage IV vault descensus independently predicted POP recurrence after iliococcygeus fixation (OR: 8.78 [95 % CI: 1.31-9.42]; p < 0.001).
  
  
  CONCLUSIONS
  Iliococcygeus fixation is a safe and effective surgical technique for the treatment of vaginal vault prolapse with long-lasting effectiveness.
authors: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
authors: Maurizio
authors: M
authors: Serati
authors: Andrea
authors: A
authors: Braga
authors: Giorgio
authors: G
authors: Bogani
authors: Umberto
authors: U
authors: Leone Roberti Maggiore
authors: Paola
authors: P
authors: Sorice
authors: Fabio
authors: F
authors: Ghezzi
authors: Stefano
authors: S
authors: Salvatore
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*
references: Am J Obstet Gynecol. 1993 Jun;168(6 Pt 1):1669-74; discussion 1674-7
references: 8317507
references: Int Urogynecol J. 2013 Nov;24(11):1815-33
references: 24142057
references: Am J Obstet Gynecol. 1988 Apr;158(4):872-81
references: 3364499
references: Am J Obstet Gynecol. 2003 Jul;189(1):98-101
references: 12861145
references: Am J Obstet Gynecol. 2011 Jul;205(1):69.e1-8
references: 21545996
references: Am J Obstet Gynecol. 1996 Dec;175(6):1418-21; discussion 1421-2
references: 8987919
references: Int Urogynecol J. 2010 May;21(5):515-22
references: 20186392
references: Yonsei Med J. 2005 Feb 28;46(1):112-8
references: 15744813
references: Eur J Obstet Gynecol Reprod Biol. 2003 Feb 10;106(2):184-92
references: 12551790
references: Am J Obstet Gynecol. 1996 Jul;175(1):10-7
references: 8694033
references: Am J Obstet Gynecol. 1994 Dec;171(6):1444-52; discussion 1452-4
references: 7802052
references: Eur Urol. 2014 Aug;66(2):303-18
references: 24631406
references: Am J Obstet Gynecol. 2000 Dec;183(6):1365-73; discussion 1373-4
references: 11120498
references: Int Urogynecol J. 2013 Nov;24(11):1783-90
references: 24142054
references: Br J Obstet Gynaecol. 1989 Jan;96(1):15-23
references: 2923839
references: Acta Obstet Gynecol Scand. 2011 May;90(5):429-36
references: 21306342
references: Int Urogynecol J. 2014 Feb;25(2):279-84
references: 24030216
references: Am J Obstet Gynecol. 2004 Jan;190(1):20-6
references: 14749629
references: Int Urogynecol J. 2010 Mar;21(3):299-302
references: 19936593
references: Br J Obstet Gynaecol. 1997 May;104(5):579-85
references: 9166201
references: Obstet Gynecol. 2001 Jul;98(1):40-4
references: 11430954
references: Am J Obstet Gynecol. 2004 Nov;191(5):1533-8
references: 15547521
references: South Med J. 1963 Jun;56:577-82
references: 13956565
references: Int Urogynecol J Pelvic Floor Dysfunct. 2005 May-Jun;16(3):176-81; discussion 181
references: 15875234
references: Cochrane Database Syst Rev. 2013 Apr 30;(4):CD004014
references: 23633316
references: Neurourol Urodyn. 2009;28(4):301-4
references: 19214994