title: The hybrid technique of pelvic organ prolapse treatment: apical sling and subfascial colporrhaphy.
abstract: OBJECTIVE
  The majority of patients with cystocele undergoing reconstructive surgery have combined defects of pubocervical fascia and uterosacral/cardinal ligament complex. In this regard, the simultaneous correction of both defects is rational. Furthermore, decreasing the use of synthetic materials in pelvic floor surgery is an important goal. The aim was to evaluate the objective and subjective cure rate of a hybrid technique: bilateral sacrospinous fixation using modern monofilament synthetic tape (apical sling) combined with the original technique of subfascial colporrhaphy.
  
  
  METHODS
  This prospective study involved 148 women suffering from cystocele combined with apical prolapse. We used the following criteria to evaluate the results of surgical treatment: results of the vaginal examination (POP-Q system), urodynamic tests, bladder ultrasound, special questionnaires (Pelvic Floor Distress Inventory [PFDI-20], Pelvic Floor Impact Questionnaire [PFIQ-7], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire [PISQ-12], International Consultation on Incontinence Modular Questionnaire Short Form [ICIQ-SF]). All listed parameters were determined before the surgery and at control examinations at 1, 6, and 12 months after the treatment.
  
  
  RESULTS
  At the 1-year follow-up, the objective cure rate for prolapse was 97.8%. The rate of anatomical recurrence was 2.2% (3 out of 138). The following long-term complications were noted: de novo urgency and stress urinary incontinence de novo in 2 (1.4%) and 4 (2.9%) patients, respectively. Comparison of the scores by the questionnaires also revealed a significant improvement in the quality of life in the postoperative period. Patient satisfaction rate was 97.1%.
  
  
  CONCLUSIONS
  The hybrid technique is an effective and safe uterus-sparing method for patients with advanced forms of cystocele combined with apical prolapse. This technique improves voiding function, quality of life, and provides a high satisfaction rate.
authors.affiliation: Department of Urology, Saint-Petersburg State University Clinic, 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Shkarupa
authors.affiliation: Department of Urology, Saint-Petersburg State University Clinic, 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia.
authors.forename: Nikita
authors.initials: N
authors.lastname: Kubin
authors.affiliation: Department of Urology, Saint-Petersburg State University Clinic, 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia.
authors.forename: Alexey
authors.initials: A
authors.lastname: Pisarev
authors.affiliation: Department of Urology, Saint-Petersburg State University Clinic, 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia.
authors.forename: Anastasiya
authors.initials: A
authors.lastname: Zaytseva
authors.affiliation: Department of Gynecology, Saint-Petersburg State University Clinic, 154, Fontanka Embankment, Saint-Petersburg, 190103, Russia. katerina_andmed@mail.ru.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Shapovalova
mesh_terms: D000368:Aged; D020884:Colpotomy / Q000379:methods*; D052858:Cystocele / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D017060:Patient Satisfaction; D017773:Pelvic Floor / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000150:complications / Q000628:therapy*; D011184:Postoperative Period; D011446:Prospective Studies; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*
keywords: Apical sling; Hybrid technique; Subfascial colporrhaphy