Anatomical and Functional Outcome After Vaginal Hysterectomy and Sacrospinous Ligament Fixation for Stage III and IV Pelvic Organ Prolapse

Abstract

Background: Advanced pelvic organ prolapse (Stage III and IV) significantly impairs quality of life, yet surgical management remains a clinical challenge, particularly in low-resource settings with high parity. While sacrospinous ligament fixation (SSLF) is an established technique for apical support, there is a scarcity of prospective data focusing on both anatomical success and functional recovery in patients with advanced disease. This study seeks to address this gap by evaluating the efficacy of SSLF in restoring pelvic integrity and symptomatic relief. Objective: To evaluate the anatomical restoration and functional outcomes of vaginal hysterectomy combined with sacrospinous ligament fixation (SSLF) in women presenting with advanced pelvic organ prolapse (POP). Methods:This quasi-experimental study was conducted at Bangladesh Medical University, Dhaka, from March 2023 to February 2024. Twenty-seven multiparous, postmenopausal women with Stage III or IV POP underwent vaginal hysterectomy with right-sided SSLF and concomitant colporrhaphy. Anatomical success was measured using the Pelvic Organ Prolapse Quantification (POP-Q) system, and functional outcomes were assessed via a validated pelvic floor questionnaire at a six-month postoperative follow-up. Data were analyzed using paired t-tests and McNemar’s Chi-square (χ2) tests with level of significance being set at 5%. Results:  The median age of participants was 60 years. Preoperatively, 92.6% of patients had Stage III and 7.4% had Stage IV prolapse. At six months, almost 89% achieved full anatomical restoration (Stage 0). Significant improvements were recorded across all POP-Q points (p < 0.001), notably at Point C, the genital hiatus, and the perineal body. The mean Total Pelvic Floor Dysfunction Score decreased significantly from 26.5 ± 7.7 to 1.7 ± 3.7 (p < 0.001), with marked symptomatic relief in bladder, bowel, and sexual function domains. Conclusion: Vaginal hysterectomy with SSLF is a highly effective, mesh-free surgical approach for advanced POP. It provides durable anatomical correction and significant quality-of-life improvements, making it a reliable treatment option for severe pelvic floor dysfunction in resource-limited settings.