Abstract / Summary
Abstract Background : Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) often yield suboptimal results with traditional point-based repairs. This study evaluates the long-term safety, anatomical efficacy, and functional outcomes of adding perineoplasty (locking-type muscular reinforcement) to anterior pelvic reconstruction with mid-urethral sling. Methods: Retrospective analysis of 1,155 patients with stage III–IV anterior POP and SUI (2018-2025). After exclusions, 526 underwent standard anterior repair + TOT sling (Group A), and 629 received the same plus perineoplasty (Group B). Outcomes included POP-Q staging, PFDI-20/PFIQ-7, modified Oxford scale, levator hiatal area (3D ultrasound), PISQ-12, and complications, with follow-up to 5 years. Resutls: Baseline characteristics were comparable. Group B had longer operative time (93.7 vs. 73.3 min) and slightly higher blood loss (41.3 vs. 33.3 mL). At 5 years, all Group B achieved POP-Q ≤ I, with greater improvements at posterior points versus Group A. Levator hiatal area decreased 49% in Group B (vs. 31% in Group A) at 1 month, sustained at 5 years. Pelvic floor muscle strength and patient-reported outcomes (PFDI-20/PFIQ-7) improved significantly more in Group B (P < 0.05). PISQ-12 scores and partner satisfaction were higher in Group B. Long-term complications were low: mesh erosion (0.79% vs. 0.95%), anatomical recurrence (0.95% vs. 3.23%), and dyspareunia (0.64% vs. 1.71% at 3 months) favored Group B. Conclusion: The locking-type perineoplasty technique provides durable anatomical restoration, lowers recurrence, preserves sexual function, and maintains safety over 5 years, supporting its use as an advanced strategy for selected POP/SUI patients. Trial registration: The study protocol was registered at ClinicalTrials.gov (ChiCTR2500115839) on Dec 31, 2025.