Long-Term Comparison of Patient-Reported Outcomes Following Six Surgical Procedures for Apical Suspension

INTRODUCTION AND HYPOTHESIS: To assess long-term patient-reported outcomes across six surgical procedures for first-time vaginal vault suspension (VVS) for apical prolapse. METHODS: A nationwide cohort study with 3-14 years of follow-up. Data were obtained from a national urogynaecological database, medical records, and questionnaires: International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Floor Impact Questionnaire-7 (PFIQ-7). A total of 1016 women with prior hysterectomy underwent first-time VVS between 2010 and 2020, including sacrocolpopexy (SCP, n = 107), laparoscopic uterosacral ligament suspension (LUSLS, n = 25), ipsilateral uterosacral ligament suspension (IUSLS, n = 284), vaginal extraperitoneal uterosacral ligament suspension (VEULS, n = 56), sacrospinous ligament fixation (SSLF, n = 493), and sacrospinous ligament fixation with graft (SSLF with graft, n = 51). Patients were identified using NOMESCO procedure codes. Multivariable analyses adjusted for age, time since VVS, and prior prolapse surgery. The primary outcome was global impact of vaginal symptoms; secondary outcomes included sexual symptom burden and vaginal, bowel, and urinary symptoms. RESULTS: SCP was associated with lower symptom burden than other procedures. Compared with SCP global impact score was higher following IUSLS (ratio 1.30, 95% CI 1.01-1.69) and SSLF (ratio 1.28, 95% CI 1.00-1.64). Sexual symptom burden was higher after SSLF with graft (ratio 4.07, 95% CI 1.19-13.91), and higher PFIQ-7 scores were observed following IUSLS (ratio 1.56, 95% CI 1.07-2.30). CONCLUSION: SCP was associated with lower long-term symptom burden, whereas SSLF with graft and IUSLS were associated with higher symptom burden in selected domains. Findings should be interpreted with caution due to potential confounding.