Bilateral transvaginal sacrospinous colpopexy: preliminary experience

OBJECTIVE: Our goal was to determine how often a transvaginal sacrospinous colpopexy procedure can be done bilaterally. STUDY DESIGN: Between August 1993 and July 1996, 66 patients were prospectively evaluated for uterine prolapse (19 patients) and posthysterectomy vaginal vault prolapse (47 patients). Twenty-six patients (25 with posthysterectomy vaginal vault prolapse) underwent an abdominal sacral colpopexy. The remaining 40 patients (18 with uterine prolapse, 22 with posthysterectomy vaginal vault prolapse) were preoperatively and intraoperatively assessed for a bilateral sacrospinous colpopexy. All patients with uterine prolapse underwent hysterectomy. RESULTS: In 10 of the 18 (56%) patients with uterine prolapse and in 16 of the 22 (73%) patients with posthysterectomy vaginal vault prolapse, bilateral suspension to the sacrospinous ligament was carried out. Follow-up has ranged from 6 to 40 months, and no recurrent vaginal cuff prolapses have been detected in any patients. In 3 patients, however, all in the bilateral fixation categories, distention cystoceles have developed; one patient has undergone a successful anterior colporrhaphy. CONCLUSIONS: The bilateral suspension is different from the unilateral suspension in that the former requires significant intraoperative judgment in its feasibility and in maintaining the width of the vaginal cuff to allow a bilateral suspension without tension. A bilateral fixation appears more attainable in a patient with posthysterectomy vaginal vault prolapse than in one with uterine prolapse.