Uterus-preserving laparoscopic lateral suspension provides durable anatomical and functional success in apical pelvic organ prolapse: long-term results from a single-center study

OBJECTIVES: To evaluate the long-term anatomical, functional, and patient-reported outcomes of uterus-preserving laparoscopic lateral suspension (LLS) in women with apical pelvic organ prolapse (POP). MATERIAL AND METHODS: This retrospective cohort study included 98 women with symptomatic apical POP who underwent uterus-preserving LLS between January 2018 and December 2021 at a single tertiary center. All patients had at least 24 months of follow-up (mean: 40.6 ± 10.8 months). Anatomical outcomes were assessed using the POP-Q system, functional outcomes with POP-SS, P-QOL, M-ISI, and FSFI, and patient satisfaction with the PGI-I scale. The primary endpoint was composite clinical success, defined as anatomical success (POP-Q stage 0-1 in all compartments), absence of reoperation, and a positive PGI-I response. RESULTS: The mean age was 48.1 ± 10.5 years, mean BMI was 27.0 ± 3.5 kg/m², and 42.9% were postmenopausal. Concomitant procedures were performed in 44.9% of cases. At long-term follow-up, significant improvements were observed in all POP-Q points (Ba from 0.6 to -3.4 cm, C from 0.3 to -2.5 cm, and Bp from -1.7 to -3.6 cm; all p < 0.001). POP-SS, P-QOL, and M-ISI scores improved markedly (all p < 0.001). FSFI showed significant improvement in the pain domain. Composite clinical success was achieved in 93.9% of patients, with anatomical success rates of 98.0% (apical), 98.0% (anterior), and 96.9% (posterior). Patient satisfaction was high, with 96.9% reporting "very much better" or "much better" on PGI-I. Reoperation was required in 3.1% of cases. Intraoperative complications included bladder injury (2.0%) and bleeding requiring transfusion (1.0%). Late complications were rare, with mesh exposure in 2.0% and dyspareunia in 3.1%. CONCLUSIONS: Uterus-preserving LLS provides durable long-term anatomical and functional success, high patient satisfaction, and low complication rates, representing a safe and effective alternative to sacrocolpopexy in the surgical management of apical POP.