Abstract
Author(s): Hossam Abdou, Fady M. Shawky Moiety, Hend Elhossary, Sabah Shaban Elsayed, Wafaa B. Basta and Mohamed Adel Kamal Eldin*
Background and Objectives: Apical pelvic organ prolapse (POP) is a clinically important pelvic floor disorder associated with pelvic pressure, urinary symptoms, bowel symptoms, sexual dysfunction, reduced self-image and impaired quality of life. Surgical correction aims to restore apical support, reduce recurrence and preserve vaginal and sexual function. Vaginally assisted laparoscopic lateral suspension (LLS) and transvaginal sacrospinous ligament fixation (SSLF) are established reconstructive approaches, but direct comparative randomized evidence remains limited. This study compared perioperative, anatomical and patient-reported outcomes after LLS versus SSLF in women with symptomatic apical POP. Materials and Methods: This multicentre randomized interventional clinical trial included 80 women with symptomatic apical POP stage >=2 according to the Pelvic Organ Prolapse Quantification (POP-Q) system. Participants were allocated in a 1:1 ratio to vaginally assisted LLS (n = 40) or unilateral right-sided SSLF (n = 40). Preoperative evaluation included history, general and pelvic examination, POP-Q assessment, transvaginal ultrasonography, laboratory work-up and urodynamic testing when urge incontinence symptoms were present. Primary outcomes were operative time, perioperative complications, length of admission, postoperative analgesic requirement, patient satisfaction and quality-of-life outcomes. Secondary outcomes were recurrence, POP-Q anatomical outcomes and sexual-function outcomes. Results: The LLS and SSLF groups were comparable in age (51.5+/-6.9 vs. 51.7+/-7.4 years; p = 0.90), parity and number of vaginal deliveries, but differed significantly in BMI (28.0+/-1.1 vs. 29.1+/-1.2 kg/m2; p <0.001), obesity prevalence (12% vs. 42%; p = 0.003), menstrual status (p = 0.006) and baseline POP-Q category (p <0.001). Mean operative time was similar between groups (70.0+/-7.8 vs. 70.6 +/- 8.0 min; p = 0.70). General anaesthesia was used in all LLS cases, whereas spinal anaesthesia was used in 95% of SSLF cases (p <0.001). No intraoperative complications were reported. Recurrence was lower after LLS at 6 months (5.0% vs. 18%; p = 0.043) and at 12 months (2.9% vs. 18.2%; p = 0.045, available-case analysis). Patient satisfaction was high in both groups. Sexual-function and quality-of-life domains improved significantly after both procedures, with greater improvement after LLS in social limitations, negative emotions, fear of urinary incontinence during intercourse and frequency of urinary incontinence during intercourse. Conclusions: Both LLS and SSLF were safe and effective for apical POP repair. LLS was associated with lower recurrence and greater improvement in selected functional and sexual domains, while SSLF offered the advantage of a vaginal approach usually feasible under spinal anaesthesia. These findings support individualized procedure selection based on patient characteristics, surgical expertise, anaesthetic suitability and counselling regarding mesh-related risks.