gms | German Medical Science

Introduction: There is an increasing trend in uterine-preserving surgical techniques in POP repair. Clinical investigations identified that 36 – 60% of women prefer preservation of the uterus if surgical repair for symptomatic apical prolapse is required. Reasons for uterine preservation include the belief of the uterus and ovaries have an impact on sexual function and activity or sense of identity and the surgical risks of hysterectomy itself. There are several hysteropexy techniques that may be differentiated in regard to the route of surgical access (vaginal vs. transabdominal) and the utilization of sutures or a mesh for uterine fixation. Splentis (Promedon, Cordoba, Argentina) is a lightweight, type I polypropylene mesh used in uterine-preserving techniques via the vaginal route for women with apical POP. It is designed in a sling-like configuration; the mesh is fixed anteriorly to the cervix and suspended to the sacrospinous ligaments (SSLs) bilaterally. The theoretical benefits include preservation of the physiological axis of the vagina. Furthermore, direct fixation to the vaginal wall is avoided, which might preserve mobility of the vagina and thus normal pelvic floor function. The current investigation evaluated the performance and safety of anterior bilateral hysteropexy Splentis (Promedon, Argentina) via the vaginal route in non-fertile women undergoing surgery for primary uterine prolapse.

Methods: This was a single-center, retrospective cohort study including non-fertile women who underwent transvaginal repair of primary uterine descent using Splentis with a minimum follow-up of time of 12 months which was approved by the local ethics comittee. The primary endpoint was defined by the number of patients with apical and anterior compartment POP-Q≤1. Medical records were studied to collect data regarding the perioperative course and follow-up, including the results of validated quality of life (QoL) questionnaires. Furthermore, the results of a telephone interview which are part of the quality assurance system of the study center has been included. Descriptive analysis was applied. McNemar or Wilcoxon signed-rank test was performed to compare paired samples. The significance level was set at 5%.

Results: stage of 3 were included. The median operative duration was 22 [IQR 12] minutes. There were no intraoperative complications. Anatomical success was met by 98.6% of patients. After a median follow-up time of 17 months, 97.1% of patients reported improvement with respect to prolapse symptoms and QoL improved significantly (p<0.001). Mesh exposure occurred in 3 (2.9%) patients. Of these, two patients required surgical revision, and one patient was treated conservatively. One patient required partial mesh removal due to dyspareunia. No patients required repeat surgery due to prolapse recurrence. One (0.9%) patient received a midurethral sling due to persistent stress urinary incontinence (SUI) three months after Splentis implantation. A total of 99 (97.1%) patients reported subjective treatment success. The absence of vaginal bulge symptoms was reported by 91 (89.2%) patients. QoL and prolapse-related symptoms according the validated Questionnaire decreased significantly on follow-up compared with baseline (p<0.001).

Conflict of interest: Bilateral anterior sacrospinous hysteropexy with Splentis offers an efficacious and safe alternative for apical compartment prolapse, incorporating the advantages of pelvic floor reconstruction via the vaginal route.