title: Transvaginal uterosacral ligament hysteropexy: a retrospective feasibility study.
abstract: OBJECTIVE
  Uterine-sparing procedures could be attractive in patients concerned about preservation of fertility and change in corporeal image and sexuality. Transvaginal uterosacral hysteropexy can provide an alternative mesh-free technique for uterine suspension. This study aimed to evaluate the feasibility of transvaginal uterine suspension to uterosacral ligaments in terms of operative data, complications, midterm efficacy, and patient satisfaction.
  
  
  METHODS
  This retrospective study analyzed the first 20 cases of transvaginal hysteropexy through bilateral high uterosacral ligaments (modified Shull technique) performed in our Institution.
  
  
  RESULTS
  Mean follow-up was 33.2 months. The procedure was performed in 84 ± 19 min ,and blood loss was 228 ± 139 ml. Three mild complications (15 %) were observed. Recurrence [Pelvic Organ Prolapse Quantification system (POP-Q) stage ≥ II was observed in five patients (25 %), and three of them (15 %) required reintervention. Mean Patient Global Impression of Improvement score was "much improved." Two woman (40 %) who had not fulfilled their childbearing desire obtained a pregnancy. Both underwent elective caesarean section at term.
  
  
  CONCLUSIONS
  Transvaginal uterosacral hysteropexy appears a feasible mesh-free technique for apical support. This procedure can be indicated in women with the desire of preserving fertility or who prefer a uterine-sparing surgical option.
authors.affiliation: Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
authors.affiliation: Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Frigerio
authors.affiliation: Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy. stefano.manodoro@gmail.com.
authors.forename: Stefano
authors.initials: S
authors.lastname: Manodoro
authors.affiliation: Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Cola
authors.affiliation: Department of Obstetrics and Gynaecology, San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza, MB, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Spelzini
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods*; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery
keywords: Fascial repair; Hysteropexy; Pelvic organ prolapse; Transvaginal route; Uterosacral ligaments