Comparison of high uterosacral ligament suspension and sacrospinous ligament fixation for apical prolapse: Two-year outcomes.

Abstract

Objective Pelvic organ prolapse is a prevalent condition that significantly impacts women's quality of life. This study aimed to compare anatomical and patient-reported outcomes after high uterosacral ligament suspension (HUS) and sacrospinous ligament fixation (SSLF) performed during vaginal hysterectomy for apical pelvic organ prolapse. Materials and Methods This retrospective study included 46 women who underwent total vaginal hysterectomy with either HUS (n=20) or SSLF (n=26) between 2022 and 2023. Patient characteristics, surgical outcomes, and quality-of-life data were evaluated. Validated patient-reported outcome measures were used: Pelvic Pain Impact Questionnaire (PPIQ) and Pelvic Floor Disability Index (PFDI-20). Follow-up was conducted at 1, 6, 12, and 24 months postoperatively. Results Both HUS and SSLF improved prolapse stage, Pelvic Organ Prolapse Quantification System C point, and pelvic floor symptoms after 24 months (p<0.01). Both HUS and SSLF improved anatomical and quality-of-life outcomes. In adjusted analyses, HUS was associated with lower PFDI-20 scores (β: -4.37, p=0.015) and showed a similar trend for PPIQ scores (β: -1.33, p=0.059). No major intraoperative complications were observed, and recurrence rates were low and similar between groups. Conclusion Both procedures provided satisfactory anatomical correction and quality-of-life improvement at two years. HUS was associated with lower PFDI-20 scores after adjustment, whereas the difference in PPIQ scores did not reach statistical significance.