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 6–52). 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 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 cannot recommend the usage of either technique in operative treatment of vaginal vault prolapse. 1. Introduction Posthysterectomy vaginal vault prolapse concerns 0.5–1.8% of all patients who have undergone hysterectomy [1, 2] and 11.6% of the patients with prior hysterectomy for uterine prolapse [2]. Management of vaginal vault prolapse is challenging. The patients are usually elderly, with age-related diseases that decrease their operability. Vaginal approach under regional anesthesia is often preferred to the abdominal approach. 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 96–98% with or without uterine preservation [3, 4], and it provides good long-term objective and subjective outcomes with good cost effectiveness [5]. The most common complications of this procedure are hemorrhages and buttock pain [6]. 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 posterior intravaginal slingplasty (PIVS) procedure was presented by Petros in 1997. The advantage of this operation is the easier operative technique with a shorter surgeon’s learning curve
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