Comparison of unilateral and bilateral sacrospinal fixation using a mesh prosthesis for apical pelvic organ prolapse

Increasing life expectancy in women and maintaining social activity in older age groups necessitate improving surgical correction methods for apical pelvic organ prolapse (POP), with an emphasis on reducing the morbidity of the procedure and the incidence of specific complications. Objective. To compare the efficacy and safety of two modifications of sacrospinal fixation (SSF) using a mesh prosthesis (uni- and bilateral) for the correction of apical POP. Material and methods. A single-center, non-randomized, prospective study was conducted. It included 94 patients with apical POP stages II—IV according to the Pelvic Organ Prolapse Quantification (POP-Q) classification. They underwent unilateral (UniL) and bilateral (BiL) SSF using a Dallop NM synthetic prosthesis. Results. Forty-six patients were included in the UniL group, and 48 in the BiL group. Preoperatively, the BiL group was characterized by more severe prolapse: POP-Q stages III—IV — 85.5% versus 39.1% in the UniL group; p<0.001. When using the UniL technique, pain syndrome on the first postoperative day was less 3 [2; 4] points on the visual analog scale versus 5 [4; 5.5] points in the BiL group; (p<0.001). No differences were found between the groups in the frequency of vaginal mucosal erosion (12.5% in the BiL group versus 2.2% in the UniL group), dyspareunia, de novo pelvic pain, or any late complications (35.4% versus 17.4%), including in subgroups by POP-Q stages. The frequency of de novo stress urinary incontinence was approximately 4% in both groups. Both techniques provided comparable improvements in quality of life according to the validated PFDI-20 and PFIQ-7 questionnaires. Conclusion. UniL SSF is a less invasive alternative to BiL SSF, comparable in functional outcomes and quality of life with less pain. BiL SSF may be preferable for severe forms of prolapse. The choice of surgical correction method for apical prolapse should be individualized.