Dmitry Shkarupa1, Anastasiya Zaytseva1, Nikita Kubin1, Gleb Kovalev1, Ekaterina Shapovalova2
1Saint Petersburg State University Hospital, Department of Urology, Saint-Petersburg, Russian Federation
2Saint Petersburg State University Hospital, Department of Gynecology, Saint-Petersburg, Russian Federation
Citation: Shkarupa D, Zaytseva A, Kubin N, Kovalev G, Shapovalova E. Native tissue repair of cardinal/uterosacral ligaments cures overactive bladder and prolapse,
but only in pre-menopausal women. Cent European J Urol. 2021; 74: 372-378.
repair on overactive bladder (OAB) and pelvic organ prolapse (POP).
Material and methods Inclusion criteria included decrease of urge symptoms following insertion
of a gauze tampon in the posterior fornix of vagina (‘simulated operation’). Exclusion criteria included
SUI, POP grades 3–4. The surgery consisted of plication of cardinal/uterosacral ligaments. Post-operative
assessment was performed at3, 6, 12 and 18 months after surgery and included evaluation by stage
of prolapse, Urinary Distress Inventory Short Form 6 (UDI-6), Overactive Bladder Questionnaire (OAB-q),
Pelvic Floor Impact Questionnaire- Short Form 7 (PFIQ-7), and International Consultation on Incontinence
Questionnaire – Urinary Incontinence Short Form (ICIQ-SF) questionnaires and voiding diary.
Results At 3 months, cure rates for frequency, urgency, nocturia and prolapse were comparable. By the
6-month review, catastrophic failure commenced in the postmenopausal group, parallel for all pa-rameters,
starkly contrasting with premenopausal group. At 18 months, % cure rates for pre-menopausal
(post-menopausal in brackets) were 79.6 (15.4) for POP, 67.3 (20.5) for urgency, 87.7 (20.5) for nocturia
and 59.2 (15.4) for frequency.
Conclusions We hypothesize the stepwise parallel recurrence of POP and symptoms in the menopausal
group was a consequence of collagen deficiency in the plicated ligaments. Nevertheless, plication
of uterosacral-cardinal ligament complex is simple, inexpensive, effective, especially applicable premenopausally
for POP and as an alternative treatment option in that difficult group of pre-menopausal
women who have major OAB/nocturia symptoms but only minimal prolapse.