Outcomes beyond 10 years after laparoscopic uterosacral ligament suspension combined with cervical amputation in young women with pelvic organ prolapse and cervical elongation: a prospective observational cohort study

Abstract

Abstract Background Pelvic organ prolapse (POP) in young women who desire uterine preservation remains clinically challenging, particularly when apical prolapse is accompanied by cervical elongation. Evidence regarding the long-term durability of laparoscopic uterosacral ligament suspension (LUSLS) combined with cervical amputation remains limited. This study aimed to evaluate long-term anatomical, symptomatic, and functional outcomes after LUSLS combined with cervical amputation in young women with POP and cervical elongation. Methods This single-center prospective observational cohort study included young women with symptomatic apical POP and cervical elongation who underwent LUSLS combined with cervical amputation. The primary outcome was composite failure, defined as the occurrence of anatomical failure, subjective failure, or POP-related reoperation. Secondary outcomes included anatomical failure, subjective failure, POP-related reoperation, postoperative quality of life, sexual function, and patient satisfaction. Kaplan-Meier analysis was used to estimate cumulative failure rates. Results Among 33 enrolled patients, 26 (78.79%) completed the final follow-up. The median follow-up duration was 146.15 months (interquartile range, 129.10-179.70). The estimated 10-year cumulative rates of composite failure, anatomical failure, and subjective failure were 26.36% (95% CI, 6.01%–53.14%), 7.43% (95% CI, 0.45%–46.94%), and 26.47% (95% CI, 6.07%–53.23%), respectively. The reoperation rate for recurrent POP was 11.54%. Pelvic floor distress symptoms, quality of life, and sexual function remained significantly improved more than 10 years after surgery, and 88.46% of patients reported satisfaction with the procedure. No cervical canal stenosis, cervical canal adhesion, hematometra, or menstrual outflow obstruction was documented during follow-up, and one patient achieved childbirth after surgery. Conclusion LUSLS combined with cervical amputation may provide durable apical support, sustained symptom relief, and favorable functional outcomes in young women with POP and cervical elongation who desire uterine preservation. This native tissue procedure may represent an effective uterus-sparing surgical option for appropriately selected patients.