Is Midline Uterosacral Plication Anterior Colporrhaphy Combo (MUSPACC) Procedure a Good Option in Management of Vaginal Vault Prolapse and Cystocele?

Objective: Following the publication from Haylen BT et al¹ describing the MUSPACC (midline uterosacral plication anterior colporrhaphy combo) procedure, we changed our clinical practice and started performing MUSPACC in patients with cystocele and vaginal vault prolapse (VVS). The aims of this study were to evaluate peri- and postoperative complications, vaginal and urinary symptoms including patient satisfaction 3 months postoperatively. Materials and Methods: A retrospective study of 58 women, who underwent MUSPACC during a 5-year period. Patients completed three prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Con-sultation on Incontinence Questionnaire- Urinary Incontinence Short Form preoperatively and 3 months postoperatively. Records were reviewed for demography, peri- and postop-erative complications. Results: At follow-up, patients had a significant improvement in vaginal symptoms with a preoperative mean ICIQ-VS score of 15.2 declining to 1.16. A total of 42,1% of patients with preoperative urinary incontinence (UI) became completely dry after MUSPACC pro-cedures alone. Three patients (15%) experienced de novo UI. Perioperative complications occurred in one patient. Postoperative complication rate was 20,7% (12/58) including one patient, who experienced a postoperative fistula between right ureter and vagina. No patients required further operation. Totally 96,4% of patients were satisfied postoperatively. Conclusion: MUSPACC procedure is a good surgical option for treatment of VVP and cys-tocele with a positive impact on vaginal and urinary symptoms, high patient satisfaction and with a low rate of serious complications. Cystoscopy should be performed periopera-tively for immediate detection and management of possible lesions of the urinary tract.