Department of Gynecology and Obstetrics, VieCuri Medical Centre, P.O. Box 1926, 5900 BX, Venlo, The Netherlands.
Department of Gynecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
Int Urogynecol J. 2023 Nov;34(11):2705-2712. doi: 10.1007/s00192-023-05587-1. Epub 2023 Jul 1.
Vaginal sacrospinous fixation (VSF) without mesh and sacrocolpopexy (SCP) with mesh are the most frequently performed surgical procedures for apical prolapse in the Netherlands. There is no long-term evidence suggesting the optimal technique, however. The aim was to identify which factors play a role in the choice between these surgical treatment options.
A qualitative study using semi-structured interviews amongst Dutch gynecologists was carried out. An inductive content analysis was performed with Atlas.ti.
Ten interviews were analyzed. All gynecologists performed vaginal surgeries for apical prolapse, six gynecologists perform SCP themselves. Six gynecologists would perform VSF for a primary vaginal vault prolapse (VVP); three gynecologists preferred a SCP. All participants prefer a SCP for recurrent VVP. All participants have stated that multiple comorbidities could be a reason for choosing VSF, as this procedure is considered less invasive. Most participants choose a VSF in the case of older age (6 out of 10) or higher body mass index (7 out of 10). All treat primary uterine prolapse with vaginal, uterine-preserving surgery.
Recurrent apical prolapse is the most important factor in advising patients which treatment they should undergo for VVP or uterine descent. Also, the patient's health status and the patient's own preference are important factors. Gynecologists who do not perform the SCP in their own clinic are more likely to perform a VSF and find more reasons not to advise a SCP. All participants prefer a vaginal surgery for a primary uterine prolapse.
阴道骶骨固定术（VSF）不使用网片和骶骨阴道固定术（SCP）联合网片是荷兰治疗子宫顶端脱垂最常施行的手术。然而，目前尚无长期证据表明哪种技术是最佳的。本研究旨在确定在这些手术治疗方案之间选择的因素。
对荷兰妇科医生进行了一项使用半结构式访谈的定性研究。采用 Atlas.ti 进行了归纳内容分析。
分析了 10 次访谈。所有妇科医生都施行阴道手术治疗子宫顶端脱垂，其中 6 位医生亲自施行 SCP。6 位妇科医生会对原发性阴道穹窿脱垂（VVP）施行 VSF；3 位妇科医生更倾向 SCP。所有参与者均更倾向对复发性 VVP 施行 SCP。所有参与者都表示，多种合并症可能是选择 VSF 的原因，因为该手术被认为侵入性更小。大多数参与者选择 VSF 的情况为年龄较大（10 人中的 6 人）或体重指数较高（10 人中的 7 人）。所有医生都采用阴道、保留子宫的手术治疗原发性子宫脱垂。
复发性子宫顶端脱垂是向患者建议应施行哪种手术治疗 VVP 或子宫下降的最重要因素。此外，患者的健康状况和患者自身的偏好也是重要因素。不在自己的诊所施行 SCP 的妇科医生更可能施行 VSF，并且找到更多不建议施行 SCP 的理由。所有参与者都更倾向对原发性子宫脱垂施行阴道手术。
