Original Article

Long term results of modified posterior intravaginal slingplasty (P-IVS) in patients with pelvic organ prolapse


Pelviperineology 2015;34(3):94-100


Existing POP surgery methods repair vagina and ignore ligaments. The 1993 Integral Theory created a new strategy for pelvic floor surgery, site specific ligament repair


The objective of this study was to evaluate the anatomical and symptomatic success rates of a modified infracoccygeal sling procedure (P-IVS) for apical prolapse.


267 patients with symptomatic POP in various grades, underwent P-IVS operation between October 2009 and January 2014 modified by suturing each side of the tape to the sacrospinous ligament. Where required a modified anterior transobturator mesh (ATOM) procedure was performed for cystocele. All had follow-up for at least 1 year.


Mean age was 54.9 (28-88) years, mean operation time 149.8 (95-225) minutes, mean hospital stay 2.9 (1-10) days and mean follow up time 28.7 (12-63) months. Preoperatively 86.5% of the patients had anterior, 99% had posterior and 100% had apical prolapse. When surgical success was defined as grade 0 or grade 1 according to Baden-Walker, success rates for anterior, posterior and apical compartments at 3rd month were 92.1%, 98.1% and 97.3%; and 82.4%, 96.2% and 95.4% after ≥1 year, respectively. There was a statistically high improvement (p<0001) in all symptoms, such as urinary stress and urge incontinence, nocturia, urgency, pad use, fecal incontinence, difficulty in defecation, pelvic pain and quality of life.


Total pelvic reconstruction with bilateral SSLF of P-IVS tape in combination with ATOM and TOT, if necessary, has a high success and low complication rate. Experience and strict attention to surgical principles are important for good symptomatic and anatomical results.

Keywords: Integral theory; Pelvic organ prolapse (POP); Posterior intravaginal slingplasty (P-IVS); Rectocele; Sacrospinous ligament fixation (SSLF); Cystocele.