UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

POSTERIOR INTRAVAGINAL SLINGPLASTY

Tuna Ayas

Mersin City Training and Research Hospital, Department of Gynecology and Obstetrics, Mersin, Türkiye

Ayas T. Posterior Intravaginal Slingplasty. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.297-302.

ABSTRACT

Pelvic organ prolapse is a urogynecological disease that is common in older women and significantly impacts quality of life. Advanced age, vaginal delivery, obesity, and multiparity play a role in the etiology. Vaginal vault prolapse is seen in 1-2% of hysterectomized patients and 10% of patients who have undergone hysterectomy for prolapse. Vault prolapse can be a serious health problem. Posterior intravaginal slingplasty (infracoccygeal sacropexy) is a minimally invasive surgical procedure developed specifically for apical prolapse by P. E. Petros in 1997. In this procedure, the vaginal canal and vaginal vault are supported by a tension-free polypropylene tape, creating a uterosacral ligament-like effect. Posterior intravaginal slingplasty has gained a place in pelvic organ prolapse surgery thanks to its easy learning curve, high surgical success rate, and rapid surgical recovery. It does not require laparoscopy or laparotomy, and the peritoneum is not opened. It has also been observed to improve lower urinary tract symptoms such as stress urinary incontinence and nocturia. Mesh-related complications (rupture or erosion), bleeding, hematoma, rectal injury, bladder injury, chronic pelvic pain, dyspareunia, sciatica, infection, and abscess formation can occur. Other frequently used surgical procedures for vaginal vault prolapse include sacrocolpopexy (abdominal, laparoscopic, robotic) and sacrospinous ligament fixation. Sacrocolpopexy is a challenging surgical technique with a high success rate. Sacrocolpopexy requires longer recovery and hospital stay than the other two procedures. Sacrospinous ligament fixation can be performed without the use of mesh, eliminating the complications that may arise from it. Buttock pain, sciatica, and dyspareunia may be more common with vaginal posterior intravaginal slingplasty and sacrospinous ligament fixation compared to sacrocolpopexy. Of the three methods, posterior intravaginal slingplasty is the most common complication of mesh. Mesh complication rates have been observed as high as 20%. Over time, due to the high rates of mesh complications seen with this method, other pelvic organ prolapse surgical methods have been preferred. Currently, it is only applicable to a limited number of patients.

Keywords: Pelvic organ prolapse; Posterior intravaginal slingplasty; Infracoccygeal sacropexy

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