The presacral-uterosacral hysteropexy - a novel native tissue repair for pelvic organ prolapse.

Abstract

<h4>Background</h4>Uterine-preserving procedures for pelvic organ prolapse (POP) are favoured and are becoming increasingly popular. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) presacral-uterosacral hysteropexy is a novel native tissue repair for POP.<h4>Objectives</h4>This study aimed to evaluate the safety of this uterine-preserving procedure and its midterm efficacy in treating POP.<h4>Methods</h4>Between December 2020 and December 2022, patients with symptomatic POP who underwent vNOTES presacral-uterosacral hysteropexy at a tertiary teaching hospital were retrospectively analysed. The patient characteristics, follow-up outcomes, and complications were recorded and analysed.<h4>Main outcomes measures</h4>We investigated anatomical success, subjective improvement, perioperative parameters, and operative complications.<h4>Results</h4>Fifty-eight patients (median age 41 years) completed a mean 24.4-month (± 6.8) follow-up. There were two women (3.4%) who experienced recurrence. There was a significant improvement in POP-Q scores in all compartments at the last follow-up compared to the baseline (<i>P</i><0.001). 94.8% of patients were satisfied with their operations. The urinary and prolapse symptoms improved significantly (<i>P</i><0.001), and sexual function was significantly improved (<i>P</i><0.001). There were no intraoperative complications, and one patient experienced fever and delayed haemorrhage after surgery.<h4>Conclusions</h4>vNOTES presacral-uterosacral hysteropexy may be a safe and feasible technique for women with POP who desire to preserve their uterus. This procedure demonstrates promising medium-term anatomical and subjective outcomes in treating POP.<h4>What is new?</h4>This is a new mesh-free surgical procedure that combines the benefits of laparoscopic sacrohysteropexy and vNOTES uterosacral ligament hysteropexy to treat women with POP who desire uterine preservation, aiming to gain long-term anatomical success and minor complications.