SACROSPINOUS LIGAMENT FIXATION WITH TRANSVAGINAL NEEDLE SUSPENSION FOR ADVANCED PELVIC ORGAN PROLAPSE AND STRESS-INCONTINENCE

Objective: To assess the results of sacrospinous ligament fixation wit h transvaginal needle suspension for the correction of advanced pelvic organ prolapse and stress incontinence. Methods: Ninety-six women who had pelvic organ prolapse to or beyond the hymen with or without stre ss incontinence were surgically managed over 3.5 years. Objective foll ow-up was available on 75 women. The subject group comprised 54 of the se women who had stress incontinence and underwent sacrospinous ligame nt fixation with transvaginal needle suspension. The remaining 21 wome n who did not have stress incontinence underwent sacrospinous ligament fixation and served as controls. Appropriate vaginal repairs were per formed as needed in both groups. Results: The mean duration of follow- up was 24 months (range 7-72) for the subjects compared with 24.3 mont hs (range 3-53) for the controls. Eighteen subjects (33%) developed re current prolapse to or beyond the hymen. Additionally, five (9%) subje cts developed recurrent stress incontinence and nine (17%) complained of urge incontinence. Four (19%) controls developed recurrent prolapse , two of whom also have urge incontinence. There was no statistical di fference in the mean duration of follow-up or the incidence of recurre nt prolapse between subjects and controls. Conclusion: Despite the abs ence of statistical significance, we believe that the 33% recurrent pr olapse rate associated with sacrospinous ligament fixation and transva ginal needle suspension is clinically important. Copyright (C) 1997 by The American College of Obstetricians and Gynecologists.