Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse

Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse Wael Hosni, Carl-Michael Schmidt, Sebastian Ludwig, Peter Mallmann This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2165710/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 29 Mar, 2023 Read the published version in BMC Urology → Version 1 posted 10 You are reading this latest preprint version Abstract Background Pelvic organ prolapse is a bothersome condition affecting many women at advanced age, but also frequently observed in young women with certain risk factors. Various surgical techniques have been developed with the aim of providing effective surgical treatment for apical prolapse. The vaginal bilateral sacrospinous colposuspension surgery with BSC-mesh and utilization of the i- stich is a relatively new minimal invasive technique with very promising outcomes. The technique offers apical suspension, in the presence or absence of the uterus. The objective of this study is to evaluate the anatomical and functional outcomes of bilateral sacrospinous colposuspension (BSC) in 30 Patients treated with the vaginal single incision standardized technique. Methods In this retrospective study, 30 patients were treated by BSC for significant vaginal, uterovaginal or cervical prolapse. A simultaneous anterior colporrhaphy, posterior colporrhaphy or both were performed when indicated. Anatomical and functional outcomes were assessed 1 year postoperatively using the pelvic organ prolapse quantification system (POP-Q) and the standardised Perceived Quality of Life (P-QOL) questionnair. Results The POP-Q parameters were significantly improved at twelve months after surgery compared to baseline. The total score and all four subdomains of the P-QOL-questionnaire showed positive trends and improvement at twelve months after surgery when compared to preoperative values. All patients were asymptomatic and expressed high satisfaction one year after surgery. No intraoperative adverse events were recorded for all patients. Only minimal postoperative complicatations were recorded and they all resolved completely with conservative management. Conclusion This study highlights the functional and anatomical outcomes of the minimally invasive bilateral sacrospinal colposuspension for the management of apical prolapse. The BSC procedure can produce excellent outcomes with minimal complications. The data published here are very promising and warrant further investigations and more studies to evaluate the long-term outcomes of BSC in the surgical management of apical defects. Trial registration: The study protocol was approved by the Ethics Committee at the University Hospital of Cologne, Germany (Date of registration: 08.02.2022) (Registration number: 21-1494-retro) (retrospectively registered). Background Pelvic organ prolapse (POP) is a bothersome condition affecting many women at advanced age (1), but also frequently observed in young women with certain risk factors. High parity is the strongest risk factor for POP (2), however, other factors like obesity (3), neurologic injury to the pelvic floor (4), connective tissue disorders (5) and previous hysterectomy (6) have also been implicated. Decreased vaginal or uterine support is seen in more than 30% of women presenting for routine gynecological examination. A women’s lifetime risk of surgery for symptomatic POP is 12–19% (7). Conservative treatment with vaginal pessaries, pelvic floor physical therapy and local estrogen application in postmenopausal women is considered the first line therapy. Surgery is generally reserved for patients with symptomatic POP who have at least stage 2 prolapse on examination when conservative treatment methods have failed or rejected by the patient. Apical prolapse refers to the downward displacement of the vaginal apex, uterus or cervix. Symptoms of apical prolapse include palpable or visible tissue protrusion, foriegn body sensation, pelvic pain and heaviness, dyspareunia and obstructed intercourse. Patients with apical prolapse often also complain of altered bladder und bowel functions that include obstructed voiding, urinary retention or incontinence, obstructed defecation and fecal urgency or incontinence (8). Apical support is of paramount importance for the stability of the pelvic floor. It is now clear that a good apical support at the time of surgical treatment of POP is benificial for reducing the long term risk of prolapse recurrence (9). Various surgical techniques have been developed with the aim of providing effective surgical treatment for apical prolapse. Historically, abdominal techniques such as abdominal sacrocolpopexy and vaginal approaches such as the unilateral Amreich-Richter operation were implicated (10–11). Drawbacks to the abdominal approach were the significant intraoperative blood loss, long hospital stay and the increased risk of postoperative ilieus (12). The main disadvantage of the vaginal unilateral sacrospinous attachment was the high recurrence of prolapse in the anterior wall, presumably due to posterior deflection of the vaginal apex (13). To minimize the above mentioned drawbacks, laparoscopic approaches were developed. This includes the laparoscopic sacrocolpopexy, laparoscopic pectopexy and the laparoscopic lateral suspension (14–16). While these techniques are minimal invasive and associated with excellent outcomes, vaginal apical repair may still be preferable in terms of the shorter operative time, quicker recovery and avoidance of any abdominal incisions (17). This is even more appealing when treating patients with a history of multiple abdominal surgeries, obese patients and patients with significant concomitant comorbid conditions. Farnsworth proposed the intravaginal slingoplasty surgery for the management of vaginal vault prolapse (18). The surgical technique was promising in a small series of cases, however, rectal injuries led to abandonment of the technique. Kieback proposed a bilateral sacrospinous colposuspension technique (BSC) as a novel, minimal invasive, reproducible method for the treatment of apical prolapse (19). The procedure utilizes an ultralight polypropylene mesh with very high porosity leading to rapid anatomical integration and minimal tissues reaction. The mesh is fixed vaginally to the sacrospinous ligaments bilaterally with the help of an i-stitch anchoring instrument. The vaginal bilateral sacrospinous colposuspension surgery with BSC-mesh and utilization of the i- stich is a relatively new minimal invasive technique with very promising outcomes. The technique offers apical suspension, in the presence or absence of the uterus. The aim of this study is to evaluate the anatomical and functional outcomes of the bilateral sacrospinous colposuspension (BSC) in 30 Patients treated with the single incision standardized technique. Methods Design and data collection This retrospective, single center study involved 30 patients who underwent vaginal bilateral sacrospinous colposuspension surgery at Marienhospital Brühl, a teaching hospital of the University of Cologne, Germany. All surgeries were performed between January 2018 and July 2020. The study protocol was approved by the Ethics Committee at the University Hospital of Cologne (Registration number: 21-1494-retro). All patients included in the study had significant vaginal, uterovaginal or cervical prolapse and were treated with BSC according to the published single incision standardized technique. All patients receiving the surgery were presenting with symptomatic stage II prolapse or higher. We have only included patients that were able to show up for postoperative evaluation 12 months after the surgery. Most patients had additionally either a cystocele, rectocele or combined cystorectocele. A simultaneous anterior colporrhaphy, post colporrhaphy or both were performed when indicated. A simultaneous hysterectomy was only performed in patients with an associated uterine pathology, for example symptomatic fibroids. There was no simultaneous TVT or TOT placement at the time of surgery in patients complaining of stress urinary incontinence (SUI). Preoperative assessment and postoperative follow-up included a vaginal examination and a pelvic ultrasound. Patients were asked to answer the female pelvic floor questionnaire before, as well as 12 months after the surgery. All patients were examined according to the pelvic organ prolapse quantification system (POP-Q) during the preoperative assessment and 12 months after surgery. The primary outcome measure was the improvement of the pelvic floor symptoms and the secondary outcome measure was the anatomical correction of prolapse. The following data were retrospectively collected, statistically analyzed and used to assess the functional and anatomical outcomes of the BSC technique: Patients characteristics: Age, BMI, parity, menopausal status and surgical history of hysterectomy. Perioperative and postoperative complications. POP-Q quantification: preoperative assessment and at least one year postoperative. Standardized quality of life questionnaire: preoperative assessment and at least one year postoperative. The premanufactured BSC-Kit (A.M.I. Inc.) includes an ultralight polypropelene U-shaped mesh with two loading units of the i-stitch instrument was used for the surgery. At a material weight of 21 g per square meter; the entire BSC-implant weighs around 0.085 g. The implant has a very high porosity of 93% and is isoelastic. These properties allow an elastic form of suspension for the uterus or vagina with a minimum of foriegn body. Surgical intervention All surgeries were conducted in general anesthesia and performed by two experienced designated urogynecological surgeons. A perioperative single dose i.v. antibiotic prophylaxis with a combination of cephalosporin and metronidazole was administered. The patients were placed in lithotomy position. The vagina was thoroughly disinfected, bladder emptied with intermittent catheterisation and draping was achieved. All surgeries followed the standardized previously published 10 surgical steps. Preoperative treatment: At least two weeks of vaginal estriol pretreatment for postmenopausal women was mandatory. Vaginal wall incision: The incision site is infiltrated with a vasoconstringent medication. The site of the vaginal incision depended on whether a simultaneous anterior colporrhaphy or posterior colporrhaphy were performed. A 3–4 cm longitudinal incision is made in the midline, either on the anterior or posterior vaginal wall. Bilateral access to the sacrospinous ligament: The access canals to the sacrospinous ligaments on both sides are prepared using minimal sharp dissection with fine scissors and blunt dissection with the index finger. There is no need for extensive tissue dissection or visualization of the sacrospinous ligaments. Preparation of the vaginal apex or cervix: The dissection and mobilization of the cystocele or rectocele from the vaginal wall is performed at this point. The horizontal space under the vaginal apex is dissected and prepared for the subsequent attachment of the BSC-tape. In cases with intact uterus; the anterior or posterior walls of the cervix are prepared for the attachment of the tape. Suture placement for fixation on the sacrospinous ligaments: The I-Stitch instrument guided with the surgeon’s index finger is introduced into the previously prepared canal. The index finger now pushes the tip of the I-Stitch into the tissue of the sacrospinous ligament at the desired point of fixation. The suture is advanced into the ligament and the instrument is retracted and removed. Traction is then applied to the suture to test its stability. Knotting is not made at this point. The suture is fixed on the thigh with adhesive tape. The same procedure is repeated on the other side. Suture placement for central fixation of BSC-mesh: Two sutures are placed in the midline, either on the cervical wall or the vaginal apex. We utilize nonabsorbable sutures for this step (prolene 3 − 0). The sutures are held in place with Kocher clamps. As a result, a total of four sutures have been placed for the bilateral sacrospinous colposuspension. Threading the sutures through the mesh: All 4 sutures are threaded through the mesh. The median sutures are threaded through the central part of the mesh. The I-Stitch sutures are then threaded through the arms of the mesh. The sutures are now held again with clamps or adhesive tape. Mesh fixation and tying of sutures: The two midline sutures are first tied to fix the central part of the mesh. The I-Stitch sutures are now tied and the knot is guided with the index finger to the fixing point on the sacrospinous ligament. The elevation of the cervix or vaginal apex becomes obvious at this point. Additional colporrhaphy and closure of the vaginal incision: additional sutures for the simultaneous anterior or posterior repair could be placed during this step if needed. Finally, the vaginal wall incision is closed with absorbable running suture. Urinary catheterization and vaginal packing: We routinely insert a Foley catheter and a vaginal gauze coated with estriol creme. The catheter and the gauze are removed on the second postoperative day. This was followed by routine measurement of postvoidal residual volume. Statistical Analysis The statistical analysis was carried out using R Software version 3.5.2 (2018-12-20) "Eggshell Igloo" . Data were expressed as mean with standard deviation or frequency and percentage. Pre- and 12 months postoperative POP-Q results were compared using paired samples Wilcoxon test (Wilcoxon signed-rank test). The results of preoperative & 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire were compared using Fisher's exact test. The value of p < 0.05 was considered to be statistically significant. Results A total of 30 Patients were included in this single center retrospective study. We have only included patients that were able to show up for postoperative evaluation 12 months after the surgery. The demographic data of these women are summerized in Table 1 . Table 1 Demographic data of patients (n = 30) at time of BSC operation Age, y, mean ± SD 64.73 ± 12.65 BMI, kg/㎡, mean ± SD 27.26 ± 4.38 Menopausal status, n (%) Pre-menopausal Post-menopausal 3 (10) 27 (90) Parity, median (range) 2 (0–9) ASA, mean (range) 2 (2–3) Previous hysterectomy, n (%) Total hysterectomy Supracervical hysterectomy 9 (30) 2 (7) The average age of the patients was 64.73 (SD ± 12.65) and the average BMI was 27.26 (SD ± 4.38). 90% of the patients were postmenopausal. The average parity of the patients was 2 (range 0–9) and most patients had an ASA classification 2 (range 2–3). 9 patients (30%) had a history of total hysterectomy and were presenting with vaginal vault prolapse. 2 patients (7%) had a history of supracervical hysterectomy and the rest of patients had an intact uterus at the time of BSC surgery. Table 2 shows the concomitant procedures that were performed at the time of BSC surgeries. 26 patients (87%) had an anterior colporrhaphy due to an associated cystocele. 4 patients (13%) had a posterior colporrhaphy due to an associated rectocele. Only 2 patients (7%) had a vaginal hysterectomy before the colposuspension due to symptomatic fibroids. Table 2 Concomitant procedures performed at time of BSC operation Anterior colporrhaphy 26 (87) Posterior colporrhaphy 4 (13) Vaginal hysterectomy 2 (7) Data are given as number (%). No intraoperative adverse events were recorded for all patients. Table 3 summerizes the postoperative complications. There was no record for visceral injury or need for reoperation due to hematoma formation or pain. Urinary tract infections did not occur in any of the patients in the immidiate follow-up period. 2 patients (6.7%) developed postoperative urinary retention. Spontaneous remission occured in both patients after an additional two days of catheterization and medical treatment with Tamsulosin. 3 Patients (10%) complained of postoperative lower back pain and 1 patient (3%) complained of groin pain. The pain was managed conservatively with pain medications and physiotherapy and disappeared after a couple of weeks in all 4 patients. 1 patient (3%) developed a small hematoma that was detected with an ultrasound examination and resolved spontaneously without a surgical intervention. There was no recorded surgery site infection or mesh induced vaginal erosion or visceral injury. Table 3 Postoperative complications Lower back pain 3 (10) Groin tendonitis / groin pain 1 (3) Postoperative hematoma 1 (3) Data are expressed as number (%). The POP-Q parameters were significantly improved at twelve months after surgery compared to baseline. All women were asymptomatic one year after surgery and had either a stage 0 or stage 1 POP. Total vaginal length was shorter at the one year follow up examination when compared to baseline. (Table 4 & Fig. 1 ) Table 4 Comparative analysis between pre- & 12-months postoperative assessment for pelvic organ prolapse quantification (POP-Q): POP-Q parameters Preoperative 12-months postoperative P value Aa Mean ± SD 0.81 ± 1.21 -2.10 ± 1.08 < 0.001*** Ba Mean ± SD 1.37 ± 1.53 -2.27 ± 1.17 < 0.001*** C Mean ± SD 0.70 ± 2.25 -5.33 ± 2.59 < 0.001*** TVL Mean ± SD 9.98 ± 1.24 8.33 ± 0.90 < 0.001*** Ap Mean ± SD -1.13 ± 1.43 -2.25 ± 1.09 < 0.001*** Bp Mean ± SD -0.83 ± 1.52 -2.27 ± 1.01 < 0.001*** Data are expressed as mean ± standard deviation (SD); Aa: anterior vaginal wall, 3cm proximal to the hymen; Ba: most distal position of the remaining upper anterior vaginal wall; C: cervix or cuff; TVL: total vaginal length; Ap: posterior vaginal wall, 3cm proximal to the hymen; Bp: most distal position of the remaining upper posterior vaginal wall. P-QOL-questionnaire is a generic tool for assessing perceived QOL and the level of satisfaction with life. The questionnaire has been divided into four domains covering: General health perception, relationships and limitations. Urinary symptoms associated with prolapse Bowel symptoms associated with prolapse Other symptoms associated with prolapse The answers for each question have been assigned a numeric scoring system. Lower points reflect better quality of life and lower symptoms. Higher points reflect worse quality of life and more severe symptoms. The total score and all four subdomains of the P-QOL-questionnaire showed positive trends and improvement at twelve months after surgery when compared to preoperative values. All patients were satisfied with the surgery outcomes at the follow-up time of 12 months. (Tables 5– 8 and Figs. 2 – 5 ) Table 5 Comparative analysis between pre- & 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire domains: (General health) Data are represented as frequency & (percentage). Table 6 Comparative analysis between preoperative & 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire domains: (Urinary symptoms) Preoperative 12-months postoperative P value General Health None 9 (30.0%) 24 (80.0%) < 0.001 Little 9 (30.0%) 5 (16.7%) Moderate 10 (33.3%) 1 (3.3%) Severe 2 (6.7%) 0 (0.0%) Prolapse impact on life None 1 (3.3%) 26 (86.7%) < 0.001 Little 1 (3.3%) 3 (10.0%) Moderate 12 (40.0%) 1 (3.3%) Severe 16 (53.3%) 0 (0.0%) Role Limitation None 7 (23.3%) 28 (93.3%) < 0.001 Little 6 (20.0%) 2 (6.7%) Moderate 11 (36.7%) 0 (0.0%) Severe 6 (20.0%) 0 (0.0%) Physical Limitation None 10 (33.3%) 28 (93.3%) < 0.001 Little 14 (46.7%) 2 (6.7%) Moderate 5 (16.7%) 0 (0.0%) Severe 1 (3.3%) 0 (0.0%) Social Limitation None 20 (66.7%) 30 (100.0%) 0.001 Little 7 (23.3%) 0 (0.0%) Moderate 2 (6.7%) 0 (0.0%) Severe 1 (3.3%) 0 (0.0%) Sexual & Personal Relationship None 20 (66.7%) 30 (100.0%) 0.001 Little 8 (26.7%) 0 (0.0%) Moderate 2 (6.7%) 0 (0.0%) Severe 0 (0.0%) 0 (0.0%) Mood swings, anxiety & depression None 14 (46.7%) 30 (100.0%) < 0.001 Little 9 (30.0%) 0 (0.0%) Moderate 4 (13.3%) 0 (0.0%) Severe 3 (10.0%) 0 (0.0%) Lack of sleep and energy None 16 (53.3%) 27 (90.0%) 0.011 Little 7 (23.3%) 2 (6.7%) Moderate 5 (16.7%) 1 (3.3%) Severe 2 (6.7%) 0 (0.0%) Severity of POP Symptoms None 0 (0.0%) 28 (93.3%) < 0.001 Little 1 (3.3%) 2 (6.7%) Moderate 11 (36.7%) 0 (0.0%) Severe 18 (60.0%) 0 (0.0%) Urinary symptoms Preoperative 12-months postoperative P value Urinary frequency None 6 (20.0%) 16 (53.3%) 0.002 Little 7 (23.3%) 8 (26.7%) Moderate 8 (26.7%) 6 (20.0%) Severe 9 (30.0%) 0 (0.0%) Urinary urgency None 10 (33.3%) 23 (76.7%) 0.001 Little 3 (10.0%) 3 (10.0%) Moderate 9 (30.0%) 4 (13.3%) Severe 8 (26.7%) 0 (0.0%) Urge incontinence None 15 (50.0%) 24 (80.0%) 0.013 Little 3 (10.0%) 4 (13.3%) Moderate 6 (20.0%) 2 (6.7%) Severe 6 (20.0%) 0 (0.0%) Stress incontinence None 12 (40.0%) 20 (66.7%) 0.177 Little 8 (26.7%) 6 (20.0%) Moderate 4 (13.3%) 2 (6.7%) Severe 6 (20.0%) 2 (6.7%) Weak urine flow None 7 (23.3%) 22 (73.3%) 0.001 Little 8 (26.7%) 5 (16.7%) Moderate 7 (23.3%) 1 (3.3%) Severe 8 (26.7%) 2 (6.7%) Strain to empty the bladder None 15 (50.0%) 26 (86.7%) 0.02 Little 6 (20.0%) 2 (6.7%) Moderate 3 (10.0%) 1 (3.3%) Severe 6 (20.0%) 1 (3.3%) Post-void dribbling None 13 (43.3%) 24 (80.0%) 0.005 Little 6 (20.0%) 5 (16.7%) Moderate 6 (20.0%) 1 (3.3%) Severe 5 (16.7%) 0 (0.0%) Data are represented as frequency & (percentage). Table 7 Comparative analysis between preoperative & 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire domains: (Bowel symptoms) Bowel symptoms Preoperative 12-months postoperative P value Feeling of incomplete bowel emptying after defecation None 19 (63.3%) 26 (86.7%) 0.147 Little 8 (26.7%) 3 (10.0%) Moderate 0 (0.0%) 0 (0.0%) Severe 3 (10.0%) 1 (3.3%) Constipation None 19 (63.3%) 25 (83.3%) 0.344 Little 5 (16.7%) 2 (6.7%) Moderate 3 (10.0%) 1 (3.3%) Severe 3 (10.0%) 2 (6.7%) Straining to defecate None 19 (63.3%) 25 (83.3%) 0.178 Little 6 (20.0%) 1 (3.3%) Moderate 3 (10.0%) 3 (10.0%) Severe 2 (6.7%) 1 (3.3%) Use of fingers to defecate None 25 (83.3%) 30 (100.0%) 0.052 Little 4 (13.3%) 0 (0.0%) Moderate 0 (0.0%) 0 (0.0%) Severe 1 (3.3%) 0 (0.0%) Data are represented as frequency & (percentage). Table 8 Comparative analysis between pre- and 12 months postoperative assessment of Perceived Quality of Life (P-QOL) questionnaire domains: (other symptoms) Other symptoms Preoperative 12-months postoperative P value Bulging in the vagina None 2 (6.7%) 24 (80.0%) < 0.001 Little 0 (0.0%) 6 (20.0%) Moderate 2 (6.7%) 0 (0.0%) Severe 26 (86.7%) 0 (0.0%) Vaginal discomfort None 3 (10.0%) 25 (83.3%) < 0.001 Little 0 (0.0%) 5 (16.7%) Moderate 4 (13.3%) 0 (0.0%) Severe 23 (76.7%) 0 (0.0%) Heaviness in the vagina or pelvic area None 3 (10.0%) 27 (90.0%) < 0.001 Little 1 (3.3%) 3 (10.0%) Moderate 3 (10.0%) 0 (0.0%) Severe 23 (76.7%) 0 (0.0%) Vaginal bulge disturbing in sexual intercourse None 14 (46.7%) 29 (96.7%) < 0.001 Little 3 (10.0%) 1 (3.3%) Moderate 8 (26.7%) 0 (0.0%) Severe 5 (16.7%) 0 (0.0%) Lower back pain None 12 (40.0%) 21 (70.0%) 0.074 Little 7 (23.3%) 6 (20.0%) Moderate 7 (23.3%) 2 (6.7%) Severe 4 (13.3%) 1 (3.3%) Data are represented as frequency & (percentage). Discussion The aim of this retrospective study was to assess the anatomical and functional outcomes of the bilateral sacrospinous colposuspension (BSC) in 30 Patients treated with the single incision standardized technique. The utilization of the i-stitch instrument allows minimal invasive access to the fixation points i.e. the medio-cranial aspect of the sacrospinous ligament. (Fig. 6) Figure 6 Fixation of the BSC mesh on the medio-cranial aspect of the sacrospinous ligament Obtained with permission from A.M.I. Austria The technique offers apical suspension, in the presence or absence of the uterus. The BSC mesh acts like pelvic neo-ligaments and establishes symmetrical, bilateral suspension of the vaginal vault or cervix to the sacrospinous ligaments. This recreates the support previously provided by the natural ligaments which are no longer functioning. (Fig. 7) Figure 7 BSC suspending the uterus Obtained with permission from A.M.I. Austria Large mesh implants for the management of pelvic organ prolapse are facing scepticism due to possible complaictions. However, the weight of the BSC-mesh is equivalent to a 0–0 suture and the anchoring technique is minimally invasive. Till date, very few studies were published evaluating the results of this surgical technique in terms of its functional and anatomical outcomes. The surgical steps were first described by Kieback in 2019 to allow for the standardization and reproducibility of the technique (19). In a prospective study of 132 patients with vaginal prolapse; surgical and functional outcomes of BSC have been evaluated with 6 months follow-up. The authors concluded that BSC is an effecient minimal inavasive technique for the treatment of female apical prolapse with a very favourable risk / benifit ratio (20). Another study evaluated the quality of life after surgical treatment of isolated apical defects with BSC. The study involved 60 patients and was more focused on the assessment of patients` satisfaction after the surgery. The authors concluded that in most patients, surgical treatment of isolated apical defects using BSC-mesh resulted in the elimination of bothersome symptoms and improvement of quality of life (21). A thorough literature research revealed no other published studies assessing the outcomes of BSC as a minimally invasive vaginal surgery for the treatment of apical prolapse. The results of our study show that bilateral sacrospinous colposuspension is reproducible, minimal invasive, and results in high patient´s satisfaction. The POP-Q data demonstrate that BSC establisches adequate pelvic support for genital organ prolapse. The comparison of our preoperative and postoperative POP-Q results revealed strong significant differences for points Aa, Ba, C, Ap, and Bp (P < 0.001). The bilateral fixation of the mesh on the sacrospinous ligaments ensures that the vaginal axis is close to the original anatomic position. Unilateral sacrospinous fixation may be satisfactory, however, it is associated with deviation of the vaginal axis and may lead to dysparunia and altered bowel functions (22). The study revealed that in addition to significantly improving patients‘ quality of life, urogenital symptoms and also bowel symptoms have improved postoperatively. A good argument here is that this improvement is a result of the concomitant anterior or posterior colporrhaphy. However, patients with pelvic organ prolapse experience symptoms that do not necessarily correlate with compartment-related defects (23). Due to this poor correlation between the prolapsed compartments and symptomatology; it is difficult in combination prolapse surgery to attribute the entire improvement of symptoms to a certain procedure. As described earlier; most complications were self limiting. There were no intra- or postoperative complications that required a surgical intervention or removal of mesh. Other complications that have been associated with vaginal mesh are mesh exposure and dysparunia. None of the 30 patients had complained of dysparunia or had a mesh exposure in the 12 months postoperative period. This outcome maybe linked to several factors including routine pre- and postoperative local vaginal treatment with estrogen, avoidance of extensive tissue dissection or manipulation, avoidance of concomitant sling procedures for SUI, the type of mesh used, and fixation of the mesh in a tension-free manner. Obviously, there are limitations to our study. The follow-up time of 12 months is considered short and long-term results of the procedure should be evaluated. All procedures were performed by the same two experienced surgeons, hence a multicenter study would be of great value in validating the excellent outcomes of this study. Conclusion This study highlights the functional and anatomical outcomes of the minimally invasive vaginal bilateral sacrospinal colposuspension for the management of apical prolapse. The BSC procedure can produce excellent functional and anatomical outcomes with minimal complications. The data published here are very promising and warrant further investigations and more studies to evaluate the long-term outcomes of BSC in the surgical management of apical defects. References Wilkins MF, Wu JM. Lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse. Minerva Ginecol. 2017 Apr;69(2):171–177. doi: 10.23736/S0026- 4784.16.04011-9. Epub 2016 Dec 21. PMID: 28001022. Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997 May;104(5):579 – 85. doi: 10.1111/j.1471-0528.1997.tb11536.x . PMID: 9166201. Whitcomb EL, Lukacz ES, Lawrence JM, Nager CW, Luber KM. Prevalence and degree of bother from pelvic floor disorders in obese women. Int Urogynecol J Pelvic Floor Dysfunct. 2009 Mar;20(3):289 – 94. doi: 10.1007/s00192-008-0765-x. Epub 2008 Nov 11. PMID: 19002365; PMCID: PMC4943873. Jones PN, Lubowski DZ, Swash M, Henry MM. Relation between perineal descent and pudendal nerve damage in idiopathic faecal incontinence. Int J Colorectal Dis. 1987 Jun;2(2):93 – 5. doi: 10.1007/BF01647699 . PMID: 3625013. Jackson SR, Avery NC, Tarlton JF, Eckford SD, Abrams P, Bailey AJ. Changes in metabolism of collagen in genitourinary prolapse. Lancet. 1996 Jun 15;347(9016):1658-61. doi: 10.1016/s0140-6736(96)91489-0 . PMID: 8642960. Weintraub AY, Glinter H, Marcus-Braun N. Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol. 2020 Jan- Feb;46(1):5–14. doi: 10.1590/S1677-5538.IBJU.2018.0581. PMID: 31851453; PMCID: PMC6968909. Barber MD. Pelvic organ prolapse. BMJ. 2016 Jul 20;354:i3853. doi: 10.1136/bmj.i3853 . PMID: 27439423. Beer M, Kuhn A. Surgical techniques for vault prolapse: a review of the literature. Eur J Obstet Gynecol Reprod Biol. 2005 Apr 1;119(2):144 – 55. doi: 10.1016/j.ejogrb.2004.06.042 . PMID: 15808370. Eilber KS, Alperin M, Khan A, Wu N, Pashos CL, Clemens JQ, Anger JT. Outcomes of vaginal prolapse surgery among female Medicare beneficiaries: the role of apical support. Obstet Gynecol. 2013 Nov;122(5):981–7. doi: 10.1097/AOG.0b013e3182a8a5e4 . PMID: 24104778; PMCID: PMC3857933. Takacs EB, Kreder KJ. Sacrocolpopexy: Surgical Technique, Outcomes, and Complications. Curr Urol Rep. 2016 Dec;17(12):90. doi: 10.1007/s11934-016-0643-x . PMID: 27796653. Lantzsch T, Goepel C, Wolters M, Koelbl H, Methfessel HD. Sacrospinous ligament fixation for vaginal vault prolapse. Arch Gynecol Obstet. 2001 Mar;265(1):21 – 5. doi: 10.1007/s004040000116 . PMID: 11327088. Campbell P, Cloney L, Jha S. Abdominal Versus Laparoscopic Sacrocolpopexy: A Systematic Review and Meta-analysis. Obstet Gynecol Surv. 2016 Aug;71(7):435 – 42. doi: 10.1097/OGX.0000000000000335 . PMID: 27436178. Rane A, Lim YN, Withey G, Muller R. Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: a randomised study. Aust N Z J Obstet Gynaecol. 2004 Apr;44(2):135-9. doi: 10.1111/j.1479-828X.2004.00186.x . PMID: 15089837. Gabriel B, Nassif J, Barata S, Wattiez A. Twenty years of laparoscopic sacrocolpopexy: where are we now? Int Urogynecol J. 2011 Sep;22(9):1165–9. doi: 10.1007/s00192-011-1361-z . Epub 2011 Mar 18. PMID: 21416376. Noé KG, Schiermeier S, Alkatout I, Anapolski M. Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study. J Endourol. 2015 Feb;29(2):210–5. doi: 10.1089/end.2014.0413 . Epub 2014 Nov 20. PMID: 25350228; PMCID: PMC4313410. Dubuisson JB, Veit-Rubin N, Wenger JM, Dubuisson J. La suspension latérale cœlioscopique, une autre façon de traiter les prolapsus génitaux [Laparoscopic lateral suspension, another way to treat genital prolapse]. Gynecol Obstet Fertil Senol. 2017 Jan;45(1):32–36. French. doi: 10.1016/j.gofs.2016.12.009 . Epub 2017 Jan 17. PMID: 28238313. Maher CM, Feiner B, Baessler K, Glazener CM. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J. 2011 Nov;22(11):1445–57. doi: 10.1007/s00192-011-1542-9 . Epub 2011 Sep 17. PMID: 21927941. Farnsworth BN. Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapse–a preliminary report on efficacy and safety. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):4–8. doi: 10.1007/s001920200001. PMID: 11999204. Kieback DG "Bilateral Sacrospineous Colposuspension (BSC) for the treatment of vaginal vault prolapse–description of a novel method." Pelviperineology , vol. 38, no. 2, 2019, p. 46+. Hemptenmacher FC, et al "Bilateral Sacrospineous Colposupension in the treatment of female genital prolapse: Risk-Benefit Considerations and Six Months Follow-up." Pelviperineology 39.3 (2020): 85. Zalewski M, Kołodyńska G, Mucha A, et al. The assessment of quality of life and satisfaction with life of patients before and after surgery of an isolated apical defect using synthetic materials. BMC Urol. 2020;20: 104. David-Montefiore E, Garbin O, Hummel M, Nisand I. Sacro-spinous ligament fixation peri-operative complications in 195 cases: visual approach versus digital approach of the sacro-spinous ligament. Eur J Obstet Gynecol Reprod Biol. 2004 Sep 10;116(1):71 – 8. doi: 10.1016/j.ejogrb.2003.12.020 . PMID: 15294372. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001 Dec;185(6):1332-7; discussion 1337-8. doi: 10.1067/mob.2001.119078 . PMID: 11744905. Declarations. Ethics approval and consent to participate. The study. have been performed in accordance with the declaration of Helsinki. Informed consents were obtained from all participants. The study protocol was approved by the Ethics Committee. at the University Hospital of Cologne, Germany (Date of registration: 08.02.2022) (Registration number: 21-1494-retro) (retrospectively registered). Consent. for publication. Informed consents were obtained from all participants. Unsectioned Paragraphs Title : Authors : Availability of data and materials. Funding. Authors‘ contributions. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 29 Mar, 2023 Read the published version in BMC Urology → Version 1 posted Editorial decision: Major revision 23 Dec, 2022 Reviews received at journal 11 Dec, 2022 Reviewers agreed at journal 03 Dec, 2022 Reviews received at journal 30 Nov, 2022 Reviewers agreed at journal 15 Nov, 2022 Reviewers invited by journal 03 Nov, 2022 Editor assigned by journal 03 Nov, 2022 Editor invited by journal 03 Nov, 2022 Submission checks completed at journal 03 Nov, 2022 First submitted to journal 14 Oct, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2165710","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":149099369,"identity":"9fe62944-ddef-459a-9716-38449b7873b8","order_by":0,"name":"Wael Hosni","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYDACCRBhACKSD4C4MqRoSUsAcXmI1AIGOWCNhLUY3G4+/LmggCGanz3n86sbNRY8DOyHj27Aq+XOsTTpGQYMuTN73m6zzjkGdBhPWtoNfFrMbuSYMfMAtWy4kbvNOIcNqEWCx4yQFuPPIC37b+Q8M875R5wWA2mwLRI5zI9z24jQYn8jLQ2oRSJ3xplnZsy5fRI8bIT8Ijkj+fBnnj82uf3tyY8/53yrk+NnP3wMrxYoAMcOG4QkQjkcMH8gRfUoGAWjYBSMHAAAB6REVUjhgsIAAAAASUVORK5CYII=","orcid":"","institution":"Marienhospital Brühl (Teaching Hospital, University of Cologne)","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Wael","middleName":"","lastName":"Hosni","suffix":""},{"id":149099370,"identity":"aa4ab109-24b4-43a7-bfce-f0af808b39ed","order_by":1,"name":"Carl-Michael Schmidt","email":"","orcid":"","institution":"Marienhospital Brühl (Teaching Hospital, University of Cologne)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Carl-Michael","middleName":"","lastName":"Schmidt","suffix":""},{"id":149099371,"identity":"64cea430-efe4-49f7-8515-85077a1052fa","order_by":2,"name":"Sebastian Ludwig","email":"","orcid":"","institution":"University of Cologne","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Ludwig","suffix":""},{"id":149099372,"identity":"2e386515-7803-49fa-b16a-7c8e416a8f3a","order_by":3,"name":"Peter Mallmann","email":"","orcid":"","institution":"University of Cologne","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Peter","middleName":"","lastName":"Mallmann","suffix":""}],"badges":[],"createdAt":"2022-10-14 10:14:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2165710/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2165710/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12894-023-01213-w","type":"published","date":"2023-03-29T20:16:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44724037,"identity":"9411fd85-2c20-4a56-bc26-98b8013768e5","added_by":"auto","created_at":"2023-10-16 20:23:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":488989,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2165710/v1/faccd2bb-b3a6-4749-8c24-955d428d03e7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse","fulltext":[{"header":"Background","content":"\u003cp\u003ePelvic organ prolapse (POP) is a bothersome condition affecting many women at advanced age (1), but also frequently observed in young women with certain risk factors. High parity is the strongest risk factor for POP (2), however, other factors like obesity (3), neurologic injury to the pelvic floor (4), connective tissue disorders (5) and previous hysterectomy (6) have also been implicated.\u003c/p\u003e \u003cp\u003eDecreased vaginal or uterine support is seen in more than 30% of women presenting for routine gynecological examination. A women\u0026rsquo;s lifetime risk of surgery for symptomatic POP is 12\u0026ndash;19% (7).\u003c/p\u003e \u003cp\u003eConservative treatment with vaginal pessaries, pelvic floor physical therapy and local estrogen application in postmenopausal women is considered the first line therapy. Surgery is generally reserved for patients with symptomatic POP who have at least stage 2 prolapse on examination when conservative treatment methods have failed or rejected by the patient.\u003c/p\u003e \u003cp\u003eApical prolapse refers to the downward displacement of the vaginal apex, uterus or cervix. Symptoms of apical prolapse include palpable or visible tissue protrusion, foriegn body sensation, pelvic pain and heaviness, dyspareunia and obstructed intercourse. Patients with apical prolapse often also complain of altered bladder und bowel functions that include obstructed voiding, urinary retention or incontinence, obstructed defecation and fecal urgency or incontinence (8).\u003c/p\u003e \u003cp\u003eApical support is of paramount importance for the stability of the pelvic floor. It is now clear that a good apical support at the time of surgical treatment of POP is benificial for reducing the long term risk of prolapse recurrence (9).\u003c/p\u003e \u003cp\u003eVarious surgical techniques have been developed with the aim of providing effective surgical treatment for apical prolapse. Historically, abdominal techniques such as abdominal sacrocolpopexy and vaginal approaches such as the unilateral Amreich-Richter operation were implicated (10\u0026ndash;11).\u003c/p\u003e \u003cp\u003eDrawbacks to the abdominal approach were the significant intraoperative blood loss, long hospital stay and the increased risk of postoperative ilieus (12).\u003c/p\u003e \u003cp\u003eThe main disadvantage of the vaginal unilateral sacrospinous attachment was the high recurrence of prolapse in the anterior wall, presumably due to posterior deflection of the vaginal apex (13).\u003c/p\u003e \u003cp\u003eTo minimize the above mentioned drawbacks, laparoscopic approaches were developed. This includes the laparoscopic sacrocolpopexy, laparoscopic pectopexy and the laparoscopic lateral suspension (14\u0026ndash;16). While these techniques are minimal invasive and associated with excellent outcomes, vaginal apical repair may still be preferable in terms of the shorter operative time, quicker recovery and avoidance of any abdominal incisions (17). This is even more appealing when treating patients with a history of multiple abdominal surgeries, obese patients and patients with significant concomitant comorbid conditions.\u003c/p\u003e \u003cp\u003eFarnsworth proposed the intravaginal slingoplasty surgery for the management of vaginal vault prolapse (18). The surgical technique was promising in a small series of cases, however, rectal injuries led to abandonment of the technique.\u003c/p\u003e \u003cp\u003eKieback proposed a bilateral sacrospinous colposuspension technique (BSC) as a novel, minimal invasive, reproducible method for the treatment of apical prolapse (19). The procedure utilizes an ultralight polypropylene mesh with very high porosity leading to rapid anatomical integration and minimal tissues reaction. The mesh is fixed vaginally to the sacrospinous ligaments bilaterally with the help of an i-stitch anchoring instrument.\u003c/p\u003e \u003cp\u003eThe vaginal bilateral sacrospinous colposuspension surgery with BSC-mesh and utilization of the i- stich is a relatively new minimal invasive technique with very promising outcomes. The technique offers apical suspension, in the presence or absence of the uterus.\u003c/p\u003e \u003cp\u003eThe aim of this study is to evaluate the anatomical and functional outcomes of the bilateral sacrospinous colposuspension (BSC) in 30 Patients treated with the single incision standardized technique.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and data collection\u003c/h2\u003e \u003cp\u003eThis retrospective, single center study involved 30 patients who underwent vaginal bilateral sacrospinous colposuspension surgery at Marienhospital Br\u0026uuml;hl, a teaching hospital of the University of Cologne, Germany. All surgeries were performed between January 2018 and July 2020. The study protocol was approved by the Ethics Committee at the University Hospital of Cologne (Registration number: 21-1494-retro).\u003c/p\u003e \u003cp\u003eAll patients included in the study had significant vaginal, uterovaginal or cervical prolapse and were treated with BSC according to the published single incision standardized technique. All patients receiving the surgery were presenting with symptomatic stage II prolapse or higher. We have only included patients that were able to show up for postoperative evaluation 12 months after the surgery.\u003c/p\u003e \u003cp\u003eMost patients had additionally either a cystocele, rectocele or combined cystorectocele. A simultaneous anterior colporrhaphy, post colporrhaphy or both were performed when indicated. A simultaneous hysterectomy was only performed in patients with an associated uterine pathology, for example symptomatic fibroids.\u003c/p\u003e \u003cp\u003eThere was no simultaneous TVT or TOT placement at the time of surgery in patients complaining of stress urinary incontinence (SUI).\u003c/p\u003e \u003cp\u003ePreoperative assessment and postoperative follow-up included a vaginal examination and a pelvic ultrasound. Patients were asked to answer the female pelvic floor questionnaire before, as well as 12 months after the surgery. All patients were examined according to the pelvic organ prolapse quantification system (POP-Q) during the preoperative assessment and 12 months after surgery.\u003c/p\u003e \u003cp\u003eThe primary outcome measure was the improvement of the pelvic floor symptoms and the secondary outcome measure was the anatomical correction of prolapse. The following data were retrospectively collected, statistically analyzed and used to assess the functional and anatomical outcomes of the BSC technique:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePatients characteristics: Age, BMI, parity, menopausal status and surgical history of hysterectomy.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePerioperative and postoperative complications.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePOP-Q quantification: preoperative assessment and at least one year postoperative.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStandardized quality of life questionnaire: preoperative assessment and at least one year postoperative.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe premanufactured BSC-Kit (A.M.I. Inc.) includes an ultralight polypropelene U-shaped mesh with two loading units of the i-stitch instrument was used for the surgery.\u003c/p\u003e \u003cp\u003eAt a material weight of 21 g per square meter; the entire BSC-implant weighs around 0.085 g. The implant has a very high porosity of 93% and is isoelastic. These properties allow an elastic form of suspension for the uterus or vagina with a minimum of foriegn body.\u003c/p\u003e \u003c/div\u003e"},{"header":"Surgical intervention","content":"\u003cp\u003eAll surgeries were conducted in general anesthesia and performed by two experienced designated urogynecological surgeons. A perioperative single dose i.v. antibiotic prophylaxis with a combination of cephalosporin and metronidazole was administered. The patients were placed in lithotomy position. The vagina was thoroughly disinfected, bladder emptied with intermittent catheterisation and draping was achieved. All surgeries followed the standardized previously published 10 surgical steps.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePreoperative treatment: At least two weeks of vaginal estriol pretreatment for postmenopausal women was mandatory.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eVaginal wall incision: The incision site is infiltrated with a vasoconstringent medication. The site of the vaginal incision depended on whether a simultaneous anterior colporrhaphy or posterior colporrhaphy were performed. A 3\u0026ndash;4 cm longitudinal incision is made in the midline, either on the anterior or posterior vaginal wall.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBilateral access to the sacrospinous ligament: The access canals to the sacrospinous ligaments on both sides are prepared using minimal sharp dissection with fine scissors and blunt dissection with the index finger. There is no need for extensive tissue dissection or visualization of the sacrospinous ligaments.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePreparation of the vaginal apex or cervix: The dissection and mobilization of the cystocele or rectocele from the vaginal wall is performed at this point. The horizontal space under the vaginal apex is dissected and prepared for the subsequent attachment of the BSC-tape. In cases with intact uterus; the anterior or posterior walls of the cervix are prepared for the attachment of the tape.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSuture placement for fixation on the sacrospinous ligaments: The I-Stitch instrument guided with the surgeon\u0026rsquo;s index finger is introduced into the previously prepared canal. The index finger now pushes the tip of the I-Stitch into the tissue of the sacrospinous ligament at the desired point of fixation. The suture is advanced into the ligament and the instrument is retracted and removed. Traction is then applied to the suture to test its stability. Knotting is not made at this point. The suture is fixed on the thigh with adhesive tape. The same procedure is repeated on the other side.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSuture placement for central fixation of BSC-mesh: Two sutures are placed in the midline, either on the cervical wall or the vaginal apex. We utilize nonabsorbable sutures for this step (prolene 3\u0026thinsp;\u0026minus;\u0026thinsp;0). The sutures are held in place with Kocher clamps. As a result, a total of four sutures have been placed for the bilateral sacrospinous colposuspension.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThreading the sutures through the mesh: All 4 sutures are threaded through the mesh. The median sutures are threaded through the central part of the mesh. The I-Stitch sutures are then threaded through the arms of the mesh. The sutures are now held again with clamps or adhesive tape.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eMesh fixation and tying of sutures: The two midline sutures are first tied to fix the central part of the mesh. The I-Stitch sutures are now tied and the knot is guided with the index finger to the fixing point on the sacrospinous ligament. The elevation of the cervix or vaginal apex becomes obvious at this point.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAdditional colporrhaphy and closure of the vaginal incision: additional sutures for the simultaneous anterior or posterior repair could be placed during this step if needed. Finally, the vaginal wall incision is closed with absorbable running suture.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUrinary catheterization and vaginal packing: We routinely insert a Foley catheter and a vaginal gauze coated with estriol creme. The catheter and the gauze are removed on the second postoperative day. This was followed by routine measurement of postvoidal residual volume.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis was carried out using \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eR Software version 3.5.2 (2018-12-20) \"Eggshell Igloo\"\u003c/span\u003e. Data were expressed as mean with standard deviation or frequency and percentage.\u003c/p\u003e \u003cp\u003ePre- and 12 months postoperative POP-Q results were compared using paired samples Wilcoxon test (Wilcoxon signed-rank test).\u003c/p\u003e \u003cp\u003eThe results of preoperative \u0026amp; 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire were compared using Fisher's exact test. The value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 30 Patients were included in this single center retrospective study. We have only included patients that were able to show up for postoperative evaluation 12 months after the surgery. The demographic data of these women are summerized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of patients (n\u0026thinsp;=\u0026thinsp;30) at time of BSC operation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.73\u0026thinsp;\u0026plusmn;\u0026thinsp;12.65\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI, kg/㎡, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.26\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMenopausal status, n (%)\u003c/p\u003e \u003cp\u003ePre-menopausal\u003c/p\u003e \u003cp\u003ePost-menopausal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (10)\u003c/p\u003e \u003cp\u003e27 (90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParity, median (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA, mean (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious hysterectomy, n (%)\u003c/p\u003e \u003cp\u003eTotal hysterectomy\u003c/p\u003e \u003cp\u003eSupracervical hysterectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (30)\u003c/p\u003e \u003cp\u003e2 (7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average age of the patients was 64.73 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;12.65) and the average BMI was 27.26 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38). 90% of the patients were postmenopausal. The average parity of the patients was 2 (range 0\u0026ndash;9) and most patients had an ASA classification 2 (range 2\u0026ndash;3). 9 patients (30%) had a history of total hysterectomy and were presenting with vaginal vault prolapse. 2 patients (7%) had a history of supracervical hysterectomy and the rest of patients had an intact uterus at the time of BSC surgery.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the concomitant procedures that were performed at the time of BSC surgeries. 26 patients (87%) had an anterior colporrhaphy due to an associated cystocele. 4 patients (13%) had a posterior colporrhaphy due to an associated rectocele. Only 2 patients (7%) had a vaginal hysterectomy before the colposuspension due to symptomatic fibroids.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConcomitant procedures performed at time of BSC operation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior colporrhaphy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (87)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior colporrhaphy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal hysterectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eData are given as number (%).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo intraoperative adverse events were recorded for all patients. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summerizes the postoperative complications. There was no record for visceral injury or need for reoperation due to hematoma formation or pain. Urinary tract infections did not occur in any of the patients in the immidiate follow-up period. 2 patients (6.7%) developed postoperative urinary retention. Spontaneous remission occured in both patients after an additional two days of catheterization and medical treatment with Tamsulosin. 3 Patients (10%) complained of postoperative lower back pain and 1 patient (3%) complained of groin pain. The pain was managed conservatively with pain medications and physiotherapy and disappeared after a couple of weeks in all 4 patients. 1 patient (3%) developed a small hematoma that was detected with an ultrasound examination and resolved spontaneously without a surgical intervention. There was no recorded surgery site infection or mesh induced vaginal erosion or visceral injury.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower back pain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (10)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroin tendonitis / groin pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative hematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eData are expressed as number (%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eThe POP-Q parameters were significantly improved at twelve months after surgery compared to baseline. All women were asymptomatic one year after surgery and had either a stage 0 or stage 1 POP. Total vaginal length was shorter at the one year follow up examination when compared to baseline. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative analysis between pre- \u0026amp; 12-months postoperative assessment for pelvic organ prolapse quantification (POP-Q):\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePOP-Q parameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12-months postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e0.70\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTVL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e9.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e8.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBp\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e-0.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e-2.27\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD); Aa: anterior vaginal wall, 3cm proximal to the hymen; Ba: most distal position of the remaining upper anterior vaginal wall; C: cervix or cuff; TVL: total vaginal length; Ap: posterior vaginal wall, 3cm proximal to the hymen; Bp: most distal position of the remaining upper posterior vaginal wall.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eP-QOL-questionnaire is a generic tool for assessing perceived QOL and the level of satisfaction with life. The questionnaire has been divided into four domains covering:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGeneral health perception, relationships and limitations.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUrinary symptoms associated with prolapse\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBowel symptoms associated with prolapse\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOther symptoms associated with prolapse\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe answers for each question have been assigned a numeric scoring system. Lower points reflect better quality of life and lower symptoms. Higher points reflect worse quality of life and more severe symptoms. The total score and all four subdomains of the P-QOL-questionnaire showed positive trends and improvement at twelve months after surgery when compared to preoperative values. All patients were satisfied with the surgery outcomes at the follow-up time of 12 months. (Tables\u0026nbsp;5\u0026ndash;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e8\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;5\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparative analysis between pre- \u0026amp; 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire domains: (General health)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eData are represented as frequency \u0026amp; (percentage).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative analysis between preoperative \u0026amp; 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire domains: (Urinary symptoms)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePreoperative\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e12-months postoperative\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eP value\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eGeneral Health\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e9 (30.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e24 (80.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e9 (30.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e5 (16.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e10 (33.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eProlapse impact on life\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e26 (86.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e3 (10.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e12 (40.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e16 (53.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eRole Limitation\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e7 (23.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e28 (93.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e6 (20.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e11 (36.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e6 (20.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePhysical Limitation\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e10 (33.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e28 (93.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e14 (46.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e5 (16.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSocial Limitation\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e20 (66.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e30 (100.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e7 (23.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSexual \u0026amp; Personal Relationship\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e20 (66.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e30 (100.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e8 (26.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMood swings, anxiety \u0026amp; depression\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e14 (46.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e30 (100.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e9 (30.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e4 (13.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e3 (10.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eLack of sleep and energy\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e16 (53.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e27 (90.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0.011\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e7 (23.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e5 (16.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSeverity of POP Symptoms\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eNone\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e28 (93.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eLittle\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e1 (3.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2 (6.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eModerate\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e11 (36.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eSevere\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e18 (60.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e0 (0.0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eUrinary symptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12-months postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eUrinary frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (53.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eUrinary urgency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23 (76.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eUrge incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eStress incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eWeak urine flow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (73.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eStrain to empty the bladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePost-void dribbling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are represented as frequency \u0026amp; (percentage).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative analysis between preoperative \u0026amp; 12-months postoperative assessment for Perceived Quality of Life (P-QOL) questionnaire domains: (Bowel symptoms)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBowel symptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12-months postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFeeling of incomplete bowel emptying after defecation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eConstipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eStraining to defecate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eUse of fingers to defecate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (100.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eData are represented as frequency \u0026amp; (percentage).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparative analysis between pre- and 12 months postoperative assessment of Perceived Quality of Life (P-QOL) questionnaire domains: (other symptoms)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOther symptoms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12-months postoperative\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBulging in the vagina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24 (80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26 (86.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eVaginal discomfort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (83.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (76.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHeaviness in the vagina or pelvic area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27 (90.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (76.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eVaginal bulge disturbing in sexual intercourse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (46.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (96.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (26.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLower back pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNone\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLittle\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eModerate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSevere\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4 (13.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData are represented as frequency \u0026amp; (percentage).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this retrospective study was to assess the anatomical and functional outcomes of the bilateral sacrospinous colposuspension (BSC) in 30 Patients treated with the single incision standardized technique. The utilization of the i-stitch instrument allows minimal invasive access to the fixation points i.e. the medio-cranial aspect of the sacrospinous ligament. (Fig.\u0026nbsp;6)\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 6\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eFixation of the BSC mesh on the medio-cranial aspect of the sacrospinous ligament\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eObtained with permission from A.M.I. Austria\u003c/p\u003e \u003cp\u003eThe technique offers apical suspension, in the presence or absence of the uterus. The BSC mesh acts like pelvic neo-ligaments and establishes symmetrical, bilateral suspension of the vaginal vault or cervix to the sacrospinous ligaments. This recreates the support previously provided by the natural ligaments which are no longer functioning. (Fig.\u0026nbsp;7)\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 7\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBSC suspending the uterus\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eObtained with permission from A.M.I. Austria\u003c/p\u003e \u003cp\u003eLarge mesh implants for the management of pelvic organ prolapse are facing scepticism due to possible complaictions. However, the weight of the BSC-mesh is equivalent to a 0\u0026ndash;0 suture and the anchoring technique is minimally invasive.\u003c/p\u003e \u003cp\u003eTill date, very few studies were published evaluating the results of this surgical technique in terms of its functional and anatomical outcomes.\u003c/p\u003e \u003cp\u003eThe surgical steps were first described by Kieback in 2019 to allow for the standardization and reproducibility of the technique (19).\u003c/p\u003e \u003cp\u003eIn a prospective study of 132 patients with vaginal prolapse; surgical and functional outcomes of BSC have been evaluated with 6 months follow-up. The authors concluded that BSC is an effecient minimal inavasive technique for the treatment of female apical prolapse with a very favourable risk / benifit ratio (20).\u003c/p\u003e \u003cp\u003eAnother study evaluated the quality of life after surgical treatment of isolated apical defects with BSC. The study involved 60 patients and was more focused on the assessment of patients` satisfaction after the surgery. The authors concluded that in most patients, surgical treatment of isolated apical defects using BSC-mesh resulted in the elimination of bothersome symptoms and improvement of quality of life (21).\u003c/p\u003e \u003cp\u003eA thorough literature research revealed no other published studies assessing the outcomes of BSC as a minimally invasive vaginal surgery for the treatment of apical prolapse.\u003c/p\u003e \u003cp\u003eThe results of our study show that bilateral sacrospinous colposuspension is reproducible, minimal invasive, and results in high patient\u0026acute;s satisfaction. The POP-Q data demonstrate that BSC establisches adequate pelvic support for genital organ prolapse. The comparison of our preoperative and postoperative POP-Q results revealed strong significant differences for points Aa, Ba, C, Ap, and Bp (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The bilateral fixation of the mesh on the sacrospinous ligaments ensures that the vaginal axis is close to the original anatomic position. Unilateral sacrospinous fixation may be satisfactory, however, it is associated with deviation of the vaginal axis and may lead to dysparunia and altered bowel functions (22).\u003c/p\u003e \u003cp\u003eThe study revealed that in addition to significantly improving patients\u0026lsquo; quality of life, urogenital symptoms and also bowel symptoms have improved postoperatively. A good argument here is that this improvement is a result of the concomitant anterior or posterior colporrhaphy. However, patients with pelvic organ prolapse experience symptoms that do not necessarily correlate with compartment-related defects (23). Due to this poor correlation between the prolapsed compartments and symptomatology; it is difficult in combination prolapse surgery to attribute the entire improvement of symptoms to a certain procedure.\u003c/p\u003e \u003cp\u003eAs described earlier; most complications were self limiting. There were no intra- or postoperative complications that required a surgical intervention or removal of mesh. Other complications that have been associated with vaginal mesh are mesh exposure and dysparunia. None of the 30 patients had complained of dysparunia or had a mesh exposure in the 12 months postoperative period. This outcome maybe linked to several factors including routine pre- and postoperative local vaginal treatment with estrogen, avoidance of extensive tissue dissection or manipulation, avoidance of concomitant sling procedures for SUI, the type of mesh used, and fixation of the mesh in a tension-free manner.\u003c/p\u003e \u003cp\u003eObviously, there are limitations to our study. The follow-up time of 12 months is considered short and long-term results of the procedure should be evaluated. All procedures were performed by the same two experienced surgeons, hence a multicenter study would be of great value in validating the excellent outcomes of this study.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the functional and anatomical outcomes of the minimally invasive vaginal bilateral sacrospinal colposuspension for the management of apical prolapse. The BSC procedure can produce excellent functional and anatomical outcomes with minimal complications. The data published here are very promising and warrant further investigations and more studies to evaluate the long-term outcomes of BSC in the surgical management of apical defects.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWilkins MF, Wu JM. Lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse. Minerva Ginecol. 2017 Apr;69(2):171\u0026ndash;177. doi: 10.23736/S0026- 4784.16.04011-9. Epub 2016 Dec 21. PMID: 28001022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997 May;104(5):579 \u0026ndash; 85. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1471-0528.1997.tb11536.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1471-0528.1997.tb11536.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 9166201.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitcomb EL, Lukacz ES, Lawrence JM, Nager CW, Luber KM. Prevalence and degree of bother from pelvic floor disorders in obese women. 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Int Urogynecol J. 2011 Nov;22(11):1445\u0026ndash;57. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00192-011-1542-9\u003c/span\u003e\u003cspan address=\"10.1007/s00192-011-1542-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2011 Sep 17. PMID: 21927941.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarnsworth BN. Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapse\u0026ndash;a preliminary report on efficacy and safety. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):4\u0026ndash;8. doi: 10.1007/s001920200001. PMID: 11999204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKieback DG \"Bilateral Sacrospineous Colposuspension (BSC) for the treatment of vaginal vault prolapse\u0026ndash;description of a novel method.\" \u003cem\u003ePelviperineology\u003c/em\u003e, vol.\u0026nbsp;38, no. 2, 2019, p.\u0026nbsp;46+.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHemptenmacher FC, et al \"Bilateral Sacrospineous Colposupension in the treatment of female genital prolapse: Risk-Benefit Considerations and Six Months Follow-up.\" \u003cem\u003ePelviperineology\u003c/em\u003e 39.3 (2020): 85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZalewski M, Kołodyńska G, Mucha A, et al. The assessment of quality of life and satisfaction with life of patients before and after surgery of an isolated apical defect using synthetic materials. BMC Urol. 2020;20:\u0026lt;bvertical-align:super;\u0026gt; \u0026lt;/bvertical-align:super;\u0026gt;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavid-Montefiore E, Garbin O, Hummel M, Nisand I. Sacro-spinous ligament fixation peri-operative complications in 195 cases: visual approach versus digital approach of the sacro-spinous ligament. Eur J Obstet Gynecol Reprod Biol. 2004 Sep 10;116(1):71 \u0026ndash; 8. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ejogrb.2003.12.020\u003c/span\u003e\u003cspan address=\"10.1016/j.ejogrb.2003.12.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 15294372.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEllerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001 Dec;185(6):1332-7; discussion 1337-8. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1067/mob.2001.119078\u003c/span\u003e\u003cspan address=\"10.1067/mob.2001.119078\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 11744905.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026lt;background-color:#BCBCBC;bu\u0026gt;Declarations\u0026lt;/background-color:#BCBCBC;bu\u0026amp;gt.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEthics approval and consent to participate.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe study. have been performed in accordance with the declaration of Helsinki.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInformed consents were obtained from all participants.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe study protocol was approved by the Ethics Committee. at the University Hospital of Cologne, Germany (Date of registration: 08.02.2022) (Registration number: 21-1494-retro) (retrospectively registered).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConsent. for publication.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInformed consents were obtained from all participants.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Unsectioned Paragraphs","content":"\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eTitle\u003c/span\u003e:\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eAuthors\u003c/span\u003e:\u003c/p\u003e\u003cp\u003e\u0026lt;bib id=\"bib31\"\u0026gt;Availability of data and materials.\u0026lt;/bib\u0026gt;\u003c/p\u003e\u003cp\u003e\u0026lt;bib id=\"bib35\"\u0026gt;Funding.\u0026lt;/bib\u0026gt;\u003c/p\u003e\u003cp\u003e\u0026lt;bib id=\"bib37\"\u0026gt;Authors\u0026lsquo; contributions.\u0026lt;/bib\u0026gt;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-2165710/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2165710/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePelvic organ prolapse is a bothersome condition affecting many women at advanced age, but also frequently observed in young women with certain risk factors. Various surgical techniques have been developed with the aim of providing effective surgical treatment for apical prolapse. The vaginal bilateral sacrospinous colposuspension surgery with BSC-mesh and utilization of the i- stich is a relatively new minimal invasive technique with very promising outcomes. The technique offers apical suspension, in the presence or absence of the uterus. The objective of this study is to evaluate the anatomical and functional outcomes of bilateral sacrospinous colposuspension (BSC) in 30 Patients treated with the vaginal single incision standardized technique.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this retrospective study, 30 patients were treated by BSC for significant vaginal, uterovaginal or cervical prolapse. A simultaneous anterior colporrhaphy, posterior colporrhaphy or both were performed when indicated. Anatomical and functional outcomes were assessed 1 year postoperatively using the pelvic organ prolapse quantification system (POP-Q) and the standardised Perceived Quality of Life (P-QOL) questionnair.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe POP-Q parameters were significantly improved at twelve months after surgery compared to baseline. The total score and all four subdomains of the P-QOL-questionnaire showed positive trends and improvement at twelve months after surgery when compared to preoperative values. All patients were asymptomatic and expressed high satisfaction one year after surgery. No intraoperative adverse events were recorded for all patients. Only minimal postoperative complicatations were recorded and they all resolved completely with conservative management.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study highlights the functional and anatomical outcomes of the minimally invasive bilateral sacrospinal colposuspension for the management of apical prolapse. The BSC procedure can produce excellent outcomes with minimal complications. The data published here are very promising and warrant further investigations and more studies to evaluate the long-term outcomes of BSC in the surgical management of apical defects.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003e The study protocol was approved by the Ethics Committee at the University Hospital of Cologne, Germany (Date of registration: 08.02.2022) (Registration number: 21-1494-retro) (retrospectively registered).\u003c/p\u003e","manuscriptTitle":"Anatomical and functional outcomes after bilateral sacrospinous colposuspension (BSC) for the treatment of female genital prolapse","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-11-05 18:09:44","doi":"10.21203/rs.3.rs-2165710/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2022-12-23T10:14:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-12-11T05:25:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"380dcb65-e7b1-4ced-a73a-9f0d9879a66f","date":"2022-12-03T05:35:23+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-11-30T17:56:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"652a674c-8ee2-4e9d-99ad-71fb68bc3fc2","date":"2022-11-15T19:10:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-11-03T09:29:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-11-03T09:09:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-11-03T05:48:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-11-03T05:43:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2022-10-14T10:00:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4c1a5a96-eac3-483a-8a89-af5e4953ea33","owner":[],"postedDate":"November 5th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T20:21:45+00:00","versionOfRecord":{"articleIdentity":"rs-2165710","link":"https://doi.org/10.1186/s12894-023-01213-w","journal":{"identity":"bmc-urology","isVorOnly":false,"title":"BMC Urology"},"publishedOn":"2023-03-29 20:16:15","publishedOnDateReadable":"March 29th, 2023"},"versionCreatedAt":"2022-11-05 18:09:44","video":"","vorDoi":"10.1186/s12894-023-01213-w","vorDoiUrl":"https://doi.org/10.1186/s12894-023-01213-w","workflowStages":[]},"version":"v1","identity":"rs-2165710","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2165710","identity":"rs-2165710","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}