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Rapid Fire Oral Presentations 04: Urinary Incontinence & Prolapse

The Long-term Outcomes of vNOTES High Uterosacral Ligament Suspension

Friday, October 25, 2024
4:03 PM – 4:06 PM EDT
Location: Independence Ballroom E-H (Meeting Level 4)
Table 1 – Surgical and postoperative outcomes
Table 1.docx
Table 2- Postoperative Patient Global Impression of Improvement (PGI-I) questionnaire score and satisfactory rate
Table 2.docx
Objectives: We aimed to evaluate the long-term outcomes of high uterosacral ligament suspension (HUSLS) by vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) in patients who had the surgery for the treatment of apical pelvic organ prolapse (POP) and who had the surgery as routine prophylaxis to prevent post-hysterectomy vaginal vault prolapse.

Methods: This multicenter prospective cohort study was conducted in three tertiary care centers between 1 January 2021 and 1 January 2023. The data collected included the duration of surgery, decrease in hemoglobin levels, postoperative hospital stay, intraoperative and postoperative complications, postoperative visual analog scores (VAS), and Female Sexual Function Index (FSFI) pain subdomain scores. The changes in prolapse levels were measured with modified POP-Q scores, including the C, Ba, and Bp scores recorded before surgery and on the postoperative control examination. Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGI-I) questionnaire.

Results: The final analysis involved 108 women who underwent vNOTES-HUSLS procedure. Sixty-two patients (57.4%) had the surgery for the treatment of apical prolapse, while the rest (42.6%) underwent vNOTES-HUSLS as a prophylactic procedure to prevent possible vaginal vault prolapse following hysterectomy. The median follow-up was 23 months, with a range of 12–37 months (Inter Quantile Range (IQR)=4.25). Ba, C, and Bp points were significantly improved in the patients who underwent surgery for prolapse (p < 0.001). There was no recurrence in the prolapse of the apical compartment following the procedure. Intraoperative complications were detected in three (2.7%) patients, with two (1.8%) bladder injuries and one (0.9%) bleeding from the colpotomy incision. Throughout the 23 months of follow-up, the overall satisfaction rate was 97.2% and sexual pain/discomfort rate was significantly improved (FSFI pain subdomain score, p< 0.001).
Table 1 – Surgical and postoperative outcomes
Table 2- Postoperative Patient Global Impression of Improvement (PGI-I) questionnaire score and satisfactory rate

Conclusions: vNOTES-HUSLS technique was successful both in the treatment and prophylaxis of the apical prolapse, with high anatomical success and minor intraoperative complication rates. Due to the growing concerns about the use of mesh, vNOTES-HUSLS may be a promising option with native tissue repair to treat apical prolapse and as a prophylactic technique for possible vaginal vault prolapse following hysterectomy.
Disclosure(s):
Sema S. Baghaki: No financial relationships to disclose
pınar Birol Ilter, MD: No financial relationships to disclose
Murat Yassa, MD: No financial relationships to disclose
Ozan Dogan, n/a: No financial relationships to disclose
Arzu Bilge Tekin: No financial relationships to disclose
Samet O. Gunkaya, 0000-0002-2188-2503: No financial relationships to disclose
Mahmut Yassa, n/a: No financial relationships to disclose
Bayda Alsannan: No financial relationships to disclose
Cihan Kaya: No financial relationships to disclose

    Rapid Fire Presenter(s)

  • Sema S. Baghaki, MD (she/her/hers)

    MD
    Istanbul University of Health Sciences
    {, Pennsylvania, United States

    Disclosure(s): No financial relationships to disclose

    • Co-Author(s)

  • pB

    pınar Birol Ilter, MD (she/her/hers)

    Specialist in Obstetrics and Gynecology
    Kartal Dr. Lütfi Kırdar City Hospital
    istanbul, Istanbul, Turkey

    Disclosure(s): No financial relationships to disclose

  • MY

    Murat Yassa, MD

    Head of the Obstetrics and Gynecology Department
    Bahcesehir University
    istanbul, Istanbul, Turkey

    Disclosure(s): No financial relationships to disclose

  • OD

    Ozan Dogan, n/a

    Prof.
    Private Clinic
    İstanbul, Istanbul, Turkey

    Disclosure(s): No financial relationships to disclose

  • AT

    Arzu Bilge Tekin (she/her/hers)

    Assoc Prof
    SBÜ Sancaktepe Şehit Prof Dr İlhan Varank EAH
    Istanbul, Istanbul, Turkey

    Disclosure(s): No financial relationships to disclose

  • SG

    Samet O. Gunkaya, 0000-0002-2188-2503

    Specialist in Obstetrics and Gynecology
    University of Health Sciences Turkey, Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
    Istanbul, Istanbul, Turkey

    Disclosure(s): No financial relationships to disclose

  • MY

    Mahmut Yassa, n/a

    Obstetrics and gynecology specialist
    Başakşehir Çam Sakura City Hospital
    İstanbul, Istanbul, Turkey

    Disclosure(s): No financial relationships to disclose

  • BA

    Bayda Alsannan (she/her/hers)

    Assistant professor
    Kuwait University faculty of medicine
    Kuwait, Al Asimah, Kuwait

    Disclosure(s): No financial relationships to disclose

  • CK

    Cihan Kaya

    Md
    Acibadem
    Bakırköy, Istanbul, Turkey

    Disclosure(s): No financial relationships to disclose