Long-term clinical outcomes of ischial spine fascia fixation compared with sacrospinous ligament fixation: a prospective cohort study over 10 years

PURPOSE: To compare the long-term effects of ischial spine fascia fixation (ISFF) and sacrospinous ligament fixation (SLFF). METHODS: In a single-center prospective cohort study of 42 patients, 22 patients underwent ISFF and 20 patients underwent SSLF. The follow-up period of more than 10 years included a total of 32 patients. The main outcomes are the subjective failure and retreatment rates. RESULTS: Fifteen of twenty patients (75%) in the SSLF group and seventeen of twenty-two patients (77.3%) in the ISFF group completed the last follow-up with a median follow-up time of 133 (120-156) months. The ISFF and SSLF groups achieved estimated subjective failure rate of 40.35% and 31.62%, respectively, at the postoperative period of 10 years. The retreatment rates for both the ISFF and SSLF groups remained consistent at 5 and 10-year intervals after surgery, with corresponding percentages of 16.49% and 11.11%. While the ISFF group exhibited marginally elevated subjective failure rates and re-treatment rates compared to the SSLF group, no statistically significant difference was observed. No patients had pain in the leg or hip over 10-year follow-up. CONCLUSION: ISFF is a safe approach that showed no statistically significant difference in recurrence results and improved quality of life scores compared to SSLF. Due to the relatively small sample size (N = 42), this study is underpowered to definitively claim equivalence or non-inferiority between the two procedures. This long-term study on native tissue transvaginal repair for POP indicates the clinical use of ISFF is safe and long-lasting.