Risk factors for the failure of iliococcygeus suspension for apical vaginal prolapse
IUGA Academy. Kim S. Jun 30, 2018; 212782; 481 Topic: Pelvic Organ Prolapse
Sejin Kim
Sejin Kim

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Risk factors for the failure of iliococcygeus suspension for apical vaginal prolapse

Kim, S1; Jeon, MJ1

1: Seoul National University College of Medicine

Introduction: Apical suspension is thought as a key procedure for prolapse surgery to avoid recurrence [1]. Iliococcygeus suspension (ICG) is one of vaginal options [2], however, not popularly used and data on its long-term efficacy are still lacking.

Objective: To evaluate risk factors for the failure of ICG for apical vaginal prolapse using a clinically relevant criterion and estimate long-term success rates according to the presence of risk factors

Methods: This retrospective cohort study included 158 women who underwent transvaginal reconstructive surgery including ICG for symptomatic pelvic organ prolapse. Surgical failure was defined as anatomic recurrence (descent of the vaginal apex beyond the half way point of vagina, or anterior or posterior vaginal wall descent beyond the hymen), symptomatic recurrence (the presence of vaginal bulge symptoms) or re-treatment for prolapse by either surgery or pessary. Univariate and multivariate analyses using the Cox proportional hazard model were conducted to identify risk factors for the failure of ICG. Variables of which p value were <0.1 in the univariate analysis entered the multivariate analysis. The success rates were estimated with the use of the Kaplan-Meier method and compared with the use of the log-rank test. A probability value of <0.05 was considered statistically significant.

Results: During the median 4-year follow-up period, surgical failure was observed in 22 women (13.9%). Multivariate analysis with the Cox proportional hazard model showed that advanced prolapse (preoperative pelvic organ prolapse quantification [POP-Q] stage >2 and point C >0, Hazard ratio [HR] 4.1, 95% confidence interval [CI] 1.5-11.0, p<0.01) and uterus-saving (HR 6.6, 95% CI 2.6-16.8, p<0.01) were independent risk factors for the failure. The estimated 4-year success rates were 100% for mild prolapse (POP-Q stage 2 or point C ≤0) and 87% for advanced prolapse when the ICG was performed as a vault suspension procedure. On the other hand, the corresponding success rates decreased to 78% and 48%, respectively, when done as a hysteropexy (Figure).

Conclusions: This study indicates that the severity of prolapse and uterus-saving affect the prognosis after ICG. The ICG provides a durable vaginal vault support, especially for mild prolapse. In addition, it appears to be an acceptable hysteropexy option for mild uterine prolapse.


[1] Obstet Gynecol 2013;122:981-7.

[2] South Med J 1963;56:577-82.


Work supported by industry: no.

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