Laxity of the anterior vaginal wall leads to the funnelling of the bladder neck and triggering inappropriate micturition reflexes and thus might lead to urinary incontinence. In the upright body position the anatomical support of the anterior vaginal wall (on which urethra and bladder base rest) is mainly ensured by the cervix / uterus, thus an intact apical suspension is mandatory. 
Sacrocolpopexy (SCP) is the gold-standard for apical reconstruction. The technical performance of each SCP varies according to the surgeon´s discretion, and comparison of clinical outcomes may be hampered. Therefore, a comprehensible surgical technique for bilateral apical fixation with a minimum amount of synthetic material was developed. Therefore, a comprehensible surgical technique for bilateral apical fixation with a minimum amount of synthetic material was developed.

Evaluation of the clinical 1-year results after cervicosacropexy (either abdominal or laparoscopic) and its effect on prolapse and urinary incontinence.

Retrospective analysis in a tertiary center of women with POP-Q stages I-IV and urinary incontinence. All patients received a standardized bilateral uterosacral ligament (USL) replacement using polyvinylidene-fluoride tapes (PVDF) either open abdominal (cervicosacropexy, CESA) or laparoscopic (laCESA). These PVDF tapes were identical in shape, that is 0.4cm width and 8.8cm length. Clinical outcome was assessed at 12 months.

145 patients were evaluable, 75 patients were operated with the abdominal, 70 patients with the laparoscopic approach. No major complications occurred intraoperatively and no mesh erosions were detected within 1-year postoperatively. There was no significant difference in clinical outcome one year after surgeries. Apical support (POP-Q stage 0) was restored in 100% of patients and urinary continence restored in 59% of patients (59% after laparotomy vs 62% after laparoscopy, respectively). After laCESA, patients stayed 3 days in mean compared to 5 days after CESA. Regarding the operating time, a CESA lasted in mean 120 minutes (89 - 168 minutes), whereas a laCESA lasted in mean 89 minutes (58 - 128 minutes).

In contrast to many other apical fixations, both USL were replaced using a clearly defined surgical technique (in term of type of material, size, shape of mesh, and positioning). This standardization ensured comparable and reproducible clinical outcomes, despite different surgical access paths.

The bilateral uterosacral ligament replacement with the CESA surgical procedure shows a very good anatomical result even one year after surgery, without any mesh complications. Thus, the CESA procedure is an alternative  option for apical fixation, especially since only a minimum of synthetic material is used.

Laparoscopic bilateral cervicosacropexy: introduction to a new tunneling technique. Int Urogynecoll J, 2019 Jul;30(7):1215-1217. Ludwig S., Morgenstern B., Mallmann P.
Laparoscopic Bilateral Cervicosacropexy and Vaginosacropexy: New Surgical Treatment Option in Women with Pelvic Organ Prolapse and Urinary Incontinence. Journal of Endourology, 2018 Nov;32(11):1058-1064. Rexhepi S, Rexhepi E, Stumm M, Mallmann P, Ludwig S