自体半腱肌腱骶骨固定术治疗顶端脱垂的前瞻性多中心注册研究中期分析

原文

STUDY OBJECTIVE: Pelvic organ prolapse (POP) affects more than 40% of parous women. This registry study evaluates clinical and patient-reported outcomes of minimally invasive sacropexy using the autologous semitendinosus tendon for apical prolapse repair. DESIGN: Prospective multicenter registry interim analysis. SETTING: Six centers for minimally invasive pelvic floor surgery in Germany, Austria, and Switzerland. PARTICIPANTS: Patients with symptomatic apical POP (POP-Q ≥1) undergoing laparoscopic or robotic-assisted sacropexy between March 2023 and September 2025 (n = 514). INTERVENTIONS: Sacropexy was performed using an autologous semitendinosus tendon graft. MEASUREMENTS AND MAIN RESULTS: Outcomes were assessed at discharge, 3 months (FU3), and 12 months (FU12) using POP-Q staging and the validated German Pelvic Floor Questionnaire (GPFQ). Anatomical correction (POP-Q points Ba, Bp, C), complication rates, reoperation for POP, and patient-reported pelvic floor symptoms (GPFQ). Median age was 62 years and median BMI 24.2 kg/m²; 8.9% had previous POP surgery. Mean tendon harvesting time was 7 minutes and mean hospital stay 4 days. Intraoperative complications occurred in 3.5% and postoperative complications in 5.3%. POP-Q points Ba, Bp, and C improved significantly at all follow-ups (all p <.05). Reoperation for POP occurred in 3.9% by FU12 without clinically relevant apical recurrence. All GPFQ domains improved significantly (total score 12.3 preoperatively vs. 4.5 at FU3 and 5.4 at FU12; p <.001). Stress urinary incontinence symptoms decreased significantly. CONCLUSIONS: Autologous semitendinosus sacropexy is a safe minimally invasive alternative to mesh-based repair, providing excellent anatomical outcomes and significant quality-of-life improvement at mid-term follow-up.