Long-term results of apical prolapse correction by unilateral pectineal suspension: A clinical trial

INTRODUCTION: Unilateral pectineal suspension (UPS) is a novel method for mesh-free apical prolapse correction. Short-term follow-up results 6 months after isolated UPS have been very encouraging, resulting in excellent apex stability and high patient satisfaction in a cohort of 47 patients with mostly advanced prolapse.

METHODS: In order to assess the long-term outcome after isolated UPS, all 47 patients from the original patient cohort treated with isolated UPS were invited for a scheduled follow-up examination after a minimum follow-up period of two years to determine whether the result of the primary surgery remained stable. We analyzed the outcome with regard to apex stability, residual defects, and procedure-related morbidity.

RESULTS: UPS as a stand-alone procedure showed high stability at the apex. Throughout the two-year follow-up period, only two patients (4.3%) required secondary surgery for apical recurrence. Increasing age correlated significantly with apical recurrence. Six patients became symptomatic in the anterior and/or the posterior compartment while the apex remained stable (13.0%). With increasing age, the probability of secondary surgery also appeared to rise, however, this was not statistically significant. There was no method-related morbidity.

CONCLUSION: UPS is a valuable concept for mesh-free apical prolapse correction. Two-year follow-up after isolated UPS shows stable results at the apex. A combined approach may be valuable to reduce the potential necessity of secondary surgery in the anterior / posterior compartment.