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

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.