Fixation of mesh at the sacrospinous ligament will provide support for about 80% of the total vaginal length; fixation at a level 1 finger breadth below that will provide support for only 58% of the total vaginal length, Dr. Lotze said.
Therefore, using prespinous fixation means that about a third of the apex will not be supported, and in patients with both cystocele and apical prolapse, this approach is more likely to fail.
Testing this in a cadaver lab to see how high they could get with the mesh kits in total vaginal length, Dr. Lotze and his colleagues found that with sacrospinous kits they were able to get to 100% of the total vaginal length, compared with only 60% of total vaginal length using prespinous kits, in most cases.
“So again, this emphasizes that the prespinous kits may not cut it if you have apical prolapse,” he said.