UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

SACROHYSTEROPEXY

Erkan Şimşek

Gaziantep City Hospital, Department of Gynecology and Obstetrics, Gaziantep, Türkiye

Şimşek E. Sacrohysteropexy. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.251-260.

ABSTRACT

Pelvic organ prolapse (POP) is a medical disorder that profoundly affects the quality of life in women, predominantly occurring in those of middle to advanced age. With the aging population, a rise in the need for pelvic reconstructive surgery is anticipated. Pelvic organ prolapse (POP) refers to the displacement of one or more pelvic organs, including the uterus, vaginal apex, or bowels, due to the deterioration of connective tissue support. The prevalence of pelvic organ prolapse is escalating due to aging demographics, rising obesity levels and elevated parity. Pelvic organ prolapse adversely affects women’s quality of life as it is linked to physical, psychological, and sexual disabilities. In patients with prolapse, the absence of apical support is typically observed, and adequate support for the vaginal apex is essential for a lasting surgical intervention. Apical support is fundamental to pelvic organ support, and there is a dominant tendency in gynecologic surgery to retain the uterus. Sacrohysteropexy is a surgical technique that preserves the uterus in women undergoing surgical intervention for pelvic organ prolapse, in contrast to conventional approach. Research indicates that women who undergo prolapse surgery and uterine-preserving sacrohysteropexy exhibit elevated scores on sexual function and body image assessment scales. This surgical technique was initially executed in 1957 by laparotomy utilizing mesh. In patients undergoing uterus-preserving pelvic organ prolapse surgery, the suspicion of potential endometrial and cervical cancer serves as a contraindication for the procedure. In addition, this procedure is deemed unsuitable for patients with total prolapse where sacrouterine ligament function is compromised, those with cervical elongation, and individuals with a high body mass index (BMI) due to the elevated risk of recurrence. The application of sacrohysterospexy mesh is contingent upon the mesh configuration (anterior, posterior, or bilateral application), the type of mesh (synthetic or biological graft), the surgical techniques employed (laparotomy, laparoscopic, or robotic), and the inclusion of peritonization in conjunction with these methods. Each technique exhibits variations concerning surgical proficiency, patient eligibility, facility resources, and risk of complications. This section intends to delineate the surgical procedures, along with their respective advantages and disadvantages, substantiated by contemporary literature.

Keywords: Sacrohysteropexy; Uterine prolapse; Uterus-preserving surgery; Laparoscopic surgery; Robotic surgery

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