ABSTRACT

Objective:

Surgical techniques utilizing six arm synthetic meshes for apical prolapse repair has been established, and debated in the last few years. Such vaginal hysteropexy (HPX) has several advantages over abdominal or laparoscopic HPX, although even through transsacrospinous fixation the apical reinforcement is not perfect. Our aim was to achieve optimal apical support by multivectoral apical suspension with the use of eight arm polypropylene vaginal mesh.

Methods:

In a prospective preliminary study design, 29 patients with pelvic organ prolapse quantification (POP-Q) system stage II-IV anterior and central compartment prolapse were included. They underwent the implantation of an eight arm polypropylene mesh, through a single anterior vaginal incision. The fixation has been achieved through dual transobturator and dual apical (sacrospinous and sacrotuberal) sutureless anchoring.

Results:

we experienced significant improvement in the prolapse after surgery in all patients. The mean Aa point was ascended from 1.1 cm to –2.9 cm, consequently the mean Ba point changed from 2.5 cm to –2.9 cm, and the mean C point climbed from 0.6 cm to –7.5 cm after the surgery. All patients were subjectively satisfied after the intervention. During the 12 week follow up period no mesh extrusion and no dyspareunia were noted.

Conclusions:

the vaginal implantation of the eight arm mesh comes with high patient satisfaction rates, and achieves vertical vector stabilization of the vaginal apex through sacrotuberal fixation, although further studies with more participants are required to assess the effectiveness of the approach.