(Poster 114) Effect of Hysteropexy Method on Postoperative Urinary Incontinence

Objectives: To determine if there is a difference in developing urinary incontinence (UI) following uterosacral hysteropexy (US-H) compared to sacrospinous hysteropexy (SS-H)

Methods: A retrospective review was conducted of patients who underwent either a transvaginal US-H or a SS-H between June 2018-December 2024. Patient characteristics including age, parity, body mass index (BMI) kg/m2 and menopausal status were collected. Preoperative lower urinary tract symptoms (LUTS), pelvic organ prolapse quantification (POPQ) stage, urodynamics studies (UDS), operative procedures and postoperative LUTS were recorded. UI types included urinary stress incontinence (USI), urgency urinary incontinence (UUI) and mixed urinary incontinence (MUI). These diagnoses were based on patient reported symptoms and UDS reports, and all definitions are in accordance with standards by the International Continence Society. Independent t test, paired t test, chi-square test, and Fisher’s exact test were used to analyze the data. P< 0.05 was considered significant.

Results: A total of 72 patients were included in this study, 25 (35%) patients in the US-H group and 47 (65%) patients in the SS-H group. Patients in the US-H group were notably older (51.1 years vs 63.9 years, p< 0.001 and proportionally more postmenopausal (44.4% vs 95.8%, p< 0.001) compared to the those in the SS-H group. The BMI was greater in the SS-H group compared to the US-H group (27.3±4.0 vs. 25.2±4.3 kg/m2 respectively p=0.04). Preoperatively there was no difference in stage of prolapse (median stage 3) between the groups. The incidence of UI was similar (p=0.94) between the two groups, with 52% of those in the US-H group having a UI (12.0% USI, 16.0% UUI and 24.0% MUI) compared to 51% in the SS-H group (10.6% SUI, 14.0% UUI and 25.6% MUI). Most surgeries had a concomitant anterior colporrhaphy, 92% US-H and 95% SS-H (p=0.61). Midurethral slings procedures did not differ significantly between US-H and SS-H (32% vs 18%, respectively p=0.16). Post operatively, UI was greater in the SS-H group 23.4% compared to the US-H group 4%, p=0.04 (Figure 1). At 6 months post operative, all the patients in the US-H group had resolution of preoperative UI, while in the SS-H group 72.7% (8/11) had resolution of UI. De novo UI was more common in the SS-H group compared to US-H group, however, not significantly (17.0% vs 4.0%, p=0.11)

Conclusions: These results suggest that there is more UI seen in patients following sacrospinous hysteropexy compared to uterosacral hysteropexy. Most of the difference is attributed to de novo urinary incontinence while the resolution of preoperative urinary incontinence was similar in both groups. Results must be interpreted with caution as patients in the SS-H group were older, more were menopausal and had a higher BMI.

Figure 1: Incidence of Urinary Incontinence