posthysterectomy vaginal vault prolapse concerns 0.51.8% of all patients who have undergone hysterectomy [ 1 , 2 ] and 11.6% of the patients with prior hysterectomy for uterine prolapse . the patients are usually elderly , with age - related diseases that decrease their operability . . unilateral sacrospinous ligament fixation ( sslf ) is a widely accepted vaginal procedure for vaginal vault prolapse treatment . it has a short - term efficacy of up to 9698% with or without uterine preservation [ 3 , 4 ] , and it provides good long - term objective and subjective outcomes with good cost effectiveness . traditional operative procedures for the treatment of vaginal vault prolapse are demanding and have rather a long learning curve ; that which is why there has been a need to develop optional surgical techniques . the advantage of this operation is the easier operative technique with a shorter surgeon 's learning curve compared to traditional operative techniques . the efficacy of this technique is acceptable , with success rates varying from 75% to 98% in a short follow - up [ 79 ] . mean blood loss and patients ' experience of pain have been reported to be minimal . the aim of our retrospective nonrandomized single institutional study was to compare posterior intravaginal slingplasty and unilateral sacrospinous ligament fixation procedures in terms of efficacy , complication rate , and patient satisfaction . between february 2001 and march 2005 , a total of 33 patients with operatively managed vaginal vault prolapse were enrolled in our retrospective study in oulu university hospital in finland . there were no statistically significant differences in age , body mass index , or parity between the study groups ( table 1 ) . all patients in the pivs group had undergone a prior hysterectomy , while two patients in the sslf group had a concomitant vaginal hysterectomy , and 15 had previously undergone hysterectomy . uterine prolapse was indication for prior hysterectomy in 63% and 59% of the cases in the pivs group and the sslf group , respectively . in the pivs group there were two patients who had undergone a prior sslf operation because of a vaginal vault prolapse . we used the pelvic organ prolapse quantification ( pop - q ) system to evaluate the objective anatomical outcome . the stage of the preoperative prolapse was iii or iv in 76% of the cases in the sslf group and in 50% of the cases in the pivs group . in posterior intravaginal slingplasty technique a polypropylene multifilament tape ( ivs tunneler , tyco us surgical , norwalk , ct , usa ; covidien , mansfield , ma , usa ) is inserted through perineal incisions along the ischiorectal fossae bilaterally towards the incision made in the beginning of the operation at the vaginal apex and pararectal space . the goal of this procedure is to create an artificial uterosacral neoligament for the vaginal vault . a sacrospinous ligament fixation procedure was performed by unilateral dissection of the pararectal space on the right side of the patient to expose the sacrospinous ligament , attaching the left and right corners of the vaginal apex with two absorbable sutures to the ligament , using size 0  pds suture . intravenous cefuroxime 1.5  g antibiotic prophylaxis was used in all cases . at the follow - up visit we gathered information about urinary , bowel , and sexual dysfunctions and difficulties using a standardized questionnaire . a gynecological examination was performed in horizontal gynecological position , and the maximal size of the prolapse was provoked using the valsalva maneuver or cough test . anatomical failure was defined as recurrent prolapse of stage ii ( any pop - q point 1 ) or worse . because of the skewed distribution of most variables , we used the mann - whitney u test . median intraoperative blood loss was 50  ml ( 0350  ml ) in both groups . comparison of the most relevant anatomical postoperative outcomes using the pop - q scale is found in table 3 . we found no significant p values between the two study groups concerning these measurements . at the postoperative visit recurrent apical prolapse ( point c  1 ) was observed in five ( 31% ) patients in the pivs group and in two ( 12% ) patients in the sslf group . anterior vaginal wall prolapse was identified in six patients in the pivs group ; one of these was isolated , and the rest were combined with apical prolapse . in the sslf group posterior vaginal wall prolapse was identified in eight patients in the pivs group and in four patients in the sslf group ; two of these were isolated in the pivs group and all four in the sslf group . altogether postoperative anatomical stage ii or worse prolapse was observed in eight ( 50% ) patients in the pivs group and in nine ( 53% ) patients in the sslf group at the follow - up visit . four ( 33% ) anterior wall and five ( 62% ) posterior wall postoperative prolapses were recurrent in the pivs group . in the sslf group the figures were four ( 44% ) and three ( 75% ) , respectively . one of these patients had a recurrent anterior vaginal wall prolapse which was repaired at the same time with the mesh removal . four other pivs patients ' prolapse symptoms required reoperation . all of these patients suffered from recurrent apical prolapse ; three of them were treated with sacrospinous fixation and one with colpocleisis . altogether 50% of the pivs patients required recurrent operative treatment . in the sslf group two ( 12% ) eight patients ( 50% ) in the pivs group and eight patients ( 47% ) in the sslf group suffered from postoperative urinary symptoms . symptoms eased off in five ( 31% ) patients in the pivs group and in ten ( 59% ) patients in the sslf group ( p = ns ) . six ( 38% ) patients in the pivs group and eight ( 47% ) patients in the sslf group suffered from postoperative bowel symptoms . at the postoperative follow - up visit , 38% of the patients in the pivs group and 41% in the sslf group were sexually active . the operation worsened the sexual life of one ( 6% ) patient in the pivs and of two ( 12% ) patients in the sslf group ( p = ns ) , while improvement was seen in two ( 13% ) and four ( 24% ) patients , respectively . ten ( 62% ) patients were satisfied with the operation in the pivs group and thirteen ( 76% ) in the sslf group . half of the unsatisfied patients ( 4/8 ) in the pivs group and all unsatisfied patients ( 3 ) in the sslf group suffered from anatomical failure . our results demonstrate a nonsignificant difference in the success rate between sslf and pivs procedures concerning apical prolapse , 88% versus 69% . our results are not comparable with other studies where success rates vary from 96% to 100% in sslf patients and from 82% to 98% in pivs patients [ 4 , 5 , 1114 ] . in jordaan et al . 's study the success rate ( 75% ) for pivs was close to our results . half of the patients in both study groups suffered from postoperative prolapse of any compartment . in addition to apical reprolapses also recurrence of anterior and posterior wall prolapses was frequent , from 33% to 75% . a minority of postoperative anterior and posterior vaginal wall prolapses consisted of de novo formation . one of them is our patient material with severe ( stages iii - iv ) preoperative prolapses in 50% in the pivs group and in 76% in the sslf group . preoperative stage iv has been proven to be a risk factor for prolapse recurrence [ 15 , 16 ] . we defined recurrent prolapse in our study as any pop - q point 1 , which is the cut point of pop - q stage ii . the strength in our measurements is that the operative surgeon and the investigator at the postoperative visit were different persons , which rules out surgeon 's influence on the pop - q outcome .   in our study the rate of reoperation in the pivs group was 50% during the follow - up compared to 12% in the sslf group . previous studies show less need for reoperations in the pivs patients , 5% to 25% [ 1114 , 17 , 18 ] . the need for reoperation in sslf patients has been reported to be 8% which is close to our result . vaginal erosion rate in the pivs patients seems to have a direct effect on the need for reoperation . in our study vaginal erosion was found in 25% of the pivs patients , and all of these erosions were treated operatively . in other studies erosion rate has varied from 0 to 18% [ 1114 , 17 , 18 ] . postoperative voiding difficulties were common , as nearly half of the patients in both study groups suffered from voiding problems . in de tayrac et al . 's study   only 14% of the pivs patients and 33% of the sslf patients had voiding difficulties . the high percentage of overall postoperative problems is probably a reflection of our study 's poor anatomical results . the two most commonly reported reasons for ending of sexual activity were lack of partner or partner 's illness . in the pivs group , two of the three patients with unsatisfying sexual life had dyspareunia . however , the effect of concomitant anterior or posterior vaginal wall surgery on dyspareunia can not be ruled out . other studies do not show dyspareunia after pivs [ 10 , 11 ] , but it has been reported after sslf . in our study in previous studies , the overall satisfaction measured for pivs has been 86%   and that for sslf 80% . this difference is actually easy to understand , because our study revealed a high rate of vaginal erosion and need for reoperation in pivs patients . on the other hand , two thirds of the patients with recurrence in the sslf group and half of the patients in the pivs group were satisfied with the result of the operation . this confirms that anatomical result does not directly correlate with patients ' symptoms and satisfaction . the strength of our study is that all operations were performed by one experienced surgeon with good experience on both operative methods . the limitations of our study are the retrospective approach and the small number of the patients in our study . the main reason for small number of recruited patients is that we abandoned the use of the ivs tape after a short period , because we paid attention to vaginal erosions among pivs as well as ivs patients . as an idea , the intraoperative complication rate is low , which is important when treating elderly patients who are poor candidates for major operations . the amount of mesh material is minimal compared to other meshes intended for the treatment of vaginal vault prolapse . according to the literature , the anatomical result is better than after sslf , and the recovery time is shorter than after abdominal approach . the high incidence of vaginal erosions after usage of ivs tape has given rise to discussion on the reasons for erosion . the microporous and nonelastic nature of the tape has been suggested to be the reason for the vaginal erosion . one recent report demonstrates a significant difference in erosion rate after using two different surgical techniques for the placement of the midurethra ivs tape , and the authors suggest that the high erosion rate of the ivs tape is due to surgical technique . however , the use of this multifilament polypropylene tape has diminished over the last few years . attempts have recently been made to solve the problem of erosion with the use of monofilament polypropylene tape for infracoccygeal sacropexy technique , and the results look promising . the efficacy of sslf and pivs techniques is equally poor in the treatment of vaginal vault prolapse . in addition , the need for secondary operation is higher and overall satisfaction is poorer in pivs patients compared to sslf patients , mainly due to high incidence of vaginal erosions . the risk for vaginal erosion is significant when using polyfilament tape material , and we have therefore abandoned the use of this material . based on our study we can not recommend the use of either technique in treatment of vaginal vault prolapse , and we do not recommend the use of polyfilament tape material with infracoccygeal sacropexy technique .
objective . to investigate the differences in efficacy , postoperative complications , and patient satisfaction between posterior intravaginal slingplasty ( pivs ) and unilateral sacrospinous ligament fixation ( sslf ) procedures 
 . study design . 
 a retrospective study of thirty - three women who underwent pivs or sslf treatment for vaginal vault prolapse in oulu university hospital . 
 the patients were invited to a follow - up visit to evaluate the objective and subjective outcomes . 
 median follow - up time was 16 months ( range 652 ) . 
 the anatomical outcome was detected by the pelvic organ prolapse quantification ( pop - q ) system . 
 information on urinary , bowel , and sexual dysfunctions and overall satisfaction was gathered with specific questionnaire . 
 the data were analyzed using mann - whitney u test and fisher 's exact test . 
 results . 
 mesh erosion was found in 4 ( 25% ) patients in the pivs group . 
 anatomical stage ii prolapse or worse ( any pop - q point 1 ) was detected in 8 ( 50% ) patients in the pivs group and 9 ( 53% ) patients in the sslf group . 
 overall satisfaction rates were 62% and 76% , respectively . conclusion . 
 the efficacy of pivs and sslf is equally poor , and the rate of vaginal erosion is intolerably high with the pivs method . 
 based on our study , we can not recommend the usage of either technique in operative treatment of vaginal vault prolapse .