Combined anterior trans-obturator mesh (Surelift-A) and sacrospinous ligament fixation for advanced urogenital prolapse: Surgical and functional outcomes at 1 year

Abstract

Objective

To determine the objective and subjective outcomes of a Combined anterior trans-obturator mesh (Surelift-A) and sacrospinous ligament fixation (SSF) for advanced pelvic organ prolapse (POP), along with the evaluation of surgical complications, postoperative impact on quality of life (QoL), and lower urinary tract symptoms.

Methods

Retrospective cohort study in a tertiary center from May 2021–December 2022 included 150 patients with symptomatic anterior or apical POP stage III and IV, who underwent pelvic reconstructive surgery with Surelift-A mesh combined with SSF. All completed a 72-h voiding diary, urodynamic study (UDS), and multiple validated QoL questionnaires at baseline, 6 and 12 months postoperatively. Primary outcomes were the development of post operative de novo stress urinary incontinence (SUI), objectively via cough stress test and UDS, and subjectively by evaluation of UDI-6, question 3 score >1 and IIQ-7, QoL and surgical complications. Secondary outcomes were the objective cure of POP, defined as anterior and apical prolapse Pelvic Organ Prolapse Quantification System ≤ stage I, and subjective cure based on negative answers to Pelvic Organ Prolapse Distress Inventory 6, quality of life, sexual function, major and minor complications.

Result

At one-year follow-up, the objective cure rate was 96.7 %, whereas the subjective cure rate was 93.3 %, with favorable anatomical outcomes. Significant QoL improvements were observed. Among those without mid-urethral sling (MUS), a (60.0 %) improvement in SUI occurred. De novo SUI emerged in 10.5 % objectively and 12 % subjectively. Mesh exposure rate was 1.3 %.

Conclusion

The Combined Surelift-A and SSF approach shows effective cure rates with minimal complications, and a slight risk of de novo SUI.