Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction.

OBJECTIVES: The objectives of this study were to identify factors that predict long-term success, defined as the absence of anatomic defects, in women undergoing pelvic reconstruction and to identify which defects most frequently persist or recur. STUDY
DESIGN: Eighty-one women treated by sacrospinous ligament suspension and pelvic reconstruction between 1984 and 1990 had site-specific analysis performed preoperatively and at consecutive postoperative visits. The findings at the 6-week postoperative visit and subsequent visits were compared for each of five sites: urethra, bladder, cuff, cul-de-sac, and rectum.
RESULTS: The Fisher exact test showed that patients with no support defects at the 6-week visit were less likely to require subsequent repair than patients who had any defect at that visit (p = 0.003). Thirteen patients with subsequent or persistent cystoceles had no bladder repair performed at the time of the study procedure. However, even with repair the bladder was the most likely site for persistence or recurrence.
CONCLUSION: Absence of any pelvic support defect at the 6-week postoperative visit is associated with a 3% likelihood that the patient will require subsequent reconstructive surgery within 2 to 5 years. The anterior segment provides the greatest challenge to restoration of normal anatomy.