Sakrospinous fixation sec. Miyazaki – complications and long-term results

Authors: D. Gágyor;  R. Pilka;  M. Kudela;  P. Dzvinčuk;  D. Ondrová;  A. Benická
Authors‘ workplace: Porodnicko-gynekologická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D.
Published in: Ceska Gynekol 2019; 84(2): 105-110


Objective: To evaluate preoperative, perioperative and postoperative data, complications and results in long-term follow-up at patients who underwent Miyazaki´s sacrospinous suspension between January 2002 and December 2018.

Design: Retrospective study.

Setting: Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc.

Methods: The evaluation of results of 240 patients who underwent Myiazaki sacrospinous suspension for vaginal prolaps between January 2002 and December 2018.

Results: The mean age of patients operated between 2014–2018 was higher than the mean age of all patients. Perioperative and early postoperative complications were analysed in six tables and two graphs. The most common complications were transient urinary retention (5.24%), urinary tract infection (3.80%) and pelvic hematoma (7.14%). In the long-term follow-up (131 patients over 24 months) the recurrence of apical defect was recorded at 12 (9.16%), cystocele at 26 (19.85%) and rectocele/enterocele at 3 (2.29%) patients. Patients with recurrence of vaginal vault prolapse underwent Miyazaki´s sacrospinous resuspension in four, transvaginal mesh insertion in three and sacropexy in five cases.

Conclusion: Miyazaki‘s sacrospinous suspension is an effective and safe method how to correct vaginal apical prolapse. The introduction of new surgical methods probably explains the shift of the age of the patients to the older ones in the last years. The most frequent early postoperative complications were urinary tract infections and pelvic hematomas. In the long-term follow up they were the recurrences of the prolaps of the anterior compartment. Total recurent apical vaginal prolaps was recorded at 12 patients (9.16%.)


complications – sacrospinous suspension – Miyazaki – pelvic organ prolapse


1. Barksdale, PA., Gasser, RF., Gauthier, CM., et al. Intraligamentous nerves as a potential source of pain after sacrospinous ligament fixation of the vaginal apex. Int Urogynecol J Pelvic Floor Dysfunct, 1997, 8(3), p. 121–125.

2. Campbell, J., Pedroletti, C., Ekhed, L., Nussler, E., Strandell, A. Patient-reported outcomes after sacrospinous fixation of vault prolapse with a suturing device: a retrospective national cohort study. Int Urogynecol J, 2018, 29(6), p. 821–829.

3. Dietz, HP., Chantarasorn, V., Shek, KL. Levator avulsion is a risk factor for cystocele recurrence. Ultrasound Obstet Gynecol, 2010, 36(1), p. 76–80.

4. Dietz, V., Huisman, M., de Jong, JM., et al. Functional outcome after sacrospinous hysteropexy for uterine descensus. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19(6), p. 747–752.

5. Dietz, V., van der Vaart, CH., van der Graaf, Y., et al. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J, 2010, 21(2), p. 209–216.

6. Halaška, M., Maxová, K., Šottner, O., et al. A multicenter, randomized, prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse. Amer J Obstet Gynecol, 2012, 207(4), p. 301 e1–7.

7. Jelovsek, JE., Barber, MD., Brubaker, L., et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation with or without perioperative behavioral therapy for pelvic organ vaginal prolapse on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. Jama, 2018, 319(15), p. 1554–1565.

8. Kasturi, S., Bentley-Taylor, M., Woodman, PJ., et al. High uterosacral ligament vaginal vault suspension: comparison of absorbable vs. permanent suture for apical fixation. Intern Urogynecol J, 2012, 23(7), p. 941–945.

9. Kow, N., Goldman, HB., Ridgeway, B. Management options for women with uterine prolapse interested in uterine preservation. Curr Urol Rep, 2013,14(5), p. 395–402.

10. Kudela, M., Ondrová, D., Pilka, R., Dzvinčuk, P. Sacrospinous fixation of the prolapsed vagina after the Miyazaki hysterectomy procedure. Čes Gynek, 2004;69(6), p. 493–497.

11. Lo, TS., Uy-Patrimonio, MC., Hsieh, WC., et al. Sacrospinous ligament fixation for hysteropexy: does concomitant anterior and posterior fixation improve surgical outcome? Int Urogynecol J, 2018, 29(6), p. 811–819.

12. Miklos, JR., Chinthakanan, O., Moore, RD., et al. The IUGA/ICS classification of synthetic mesh complications in female pelvic floor reconstructive surgery: a multicenter study. Intern Urogynecol J, 2016, 27(6), p. 933–938.

13. Milani, R., Frigerio, M., Cola, A., et al. Outcomes of Transvaginal High Uterosacral Ligaments Suspension: Over 500-Patient Single-Center Study. Female pelvic Med Reconstruct Surg, 2018, 24(3), p. 203–206.

14. Miyazaki, FS. Miya Hook ligature carrier for sacrospinous ligament suspension. Obstet Gynecol, 1987, 70(2), p. 286–288.

15. Mowat, A., Wong, V., Goh, J., et al. A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation. Aust N Z J Obstet Gynaecol, 2018, 58(1), p. 119–124.

16. Pan, K., Zhang, Y., Wang, Y., et al. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Intern J Gynaecol Obstet, 2016, 132(3), p. 284–291.

17. Pilka, R., Kudela, M., Hejtmánek, P., Dzvinčuk, P. Sacrospinous fixation for vaginal vault prolapse after hysterectomy sec. Miyazaki – longterm results. Čes Gynek, 2013, 78(1), p. 27–31.

18. Spelzini, F., Frigerio, M., Manodoro, S., et al. Modified McCall culdoplasty versus Shull suspension in pelvic prolapse primary repair: a retrospective study. Intern Urogynecol J, 2017, 28(1), p. 65–71.

19. Swift, S., Woodman, P., O’Boyle, A., et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Amer J Obstet Gynecol, 2005, 192(3), p. 795–806.

20. Tseng, LH., Chen, I., Chang, SD., Lee, CL. Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery – a systemic review. Taiwanese J Obstet Gynecol, 2013, 52(3), p. 311–317.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

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