The Outcome of Sacrocolpopexy/Sacrohysteropexy for Patients with Pelvic Organ Prolapse and Predictors of Anatomical Failure

Abstract

Background Pelvic organ prolapse (POP) is a medical condition that profoundly impacts women’s quality of life. Unfortunately, the literature lacks long–term predictors and risk factors for its recurrence. This study aims to assess the efficacy and safety of Sacrocolpopexy/Sacrohysteropexy and to identify the predictors of recurrence in a Saudi setting. Methods In a retrospective cohort study, all patients who underwent Sacrocolpopexy (n=144) and Sacrohysteropexy (n=56) between 2009–2021 were followed up. Electronic medical records were examined to collect data on the following: Patient characteristics [age, parity, BMI, and past medical and surgical history], prolapse-related characteristics/symptoms, Surgery-related characteristics [type and approach of surgery, mesh type, and concomitant surgery], and Outcome characteristics. Postoperative anatomical success and failure rates were determined according to the Baden-Walker classification. Logistic regression analysis was applied to identify the predictors of overall anatomical failure of Sacrocolpopexy. Significance was considered at p<0.05. Results Success rates of 96.8%, 99.4%, and 85.2% were detected in the anterior, apical, and posterior vaginal prolapse, respectively, with an overall success rate of 83.1%. The overall failure rate was 15.9%, with an incidence density of 5.98 per 100 women-years. The onset of failure in 27 failure cases ranged from 40 days to 11.5 years postoperative. After adjustment for the possible potential confounders, older age (OR=1.06, 95% CI:1.01‒1.13, p=0.03) and the presence of diabetes (OR=4.93, 95% CI:1.33‒18.33, p=0.02) were the only significant predictors of operation failure. As for complications, six cases (3.6%) required reoperation, two cases (1.2%) had a bowel obstruction two and seven years after surgery, and one patient (0.6%) had vaginal mesh exposure. Conclusion The outcomes of Sacrocolpopexy/Sacrohysteropexy in our study are comparable to those in previous studies. Diabetes and elder age at the time of the surgery played a role in predicting recurrence. Sacrocolpopexy has a long–term profile of safety and efficacy. These findings could be key to stratifying surgical plans for pelvic organ prolapse cases.

Transvaginal mesh implant for pelvic organ prolapse: Huaxi protocol

“…Otherwise, the reconstructive procedure preserves the patient's sex, but increases the possibility of POP recurrence [6] . Apical compartment prolapse can be divided into vaginal approaches, which include sacrospinous ligament fixation and uterosacral ligament suspension [8] , and abdominal approaches, which include sacrocolpopexy (open, laparoscopic, and robotic) and laparoscopic lateral suspension (or robotically assisted) [9,10] . The surgical method for treating anterior and posterior vaginal prolapse is colporrhaphy, which can be performed with plication or augmentation [6] .…”