Long-term pelvic organ prolapse recurrence and mesh exposure following sacrocolpopexy

• Published in: International Urogynecology Journal Vol. 31; no. 9; pp. 1763 - 1770
• Main Authors: Thomas, Tonya N., Davidson, Emily R. W., Lampert, Erika J., Paraiso, Marie F. R., Ferrando, Cecile A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2020; Springer Nature B.V
• Subjects: Gynecology; Laparoscopy; Medicine; Medicine & Public Health; Original Article; Pelvic organ prolapse; Robotics; Urology; Mesh exposure; Sacrocolpopexy; Pelvic organ prolapse; Mesh complication; Minimally invasive sacrocolpopexy; Pelvic organ prolapse recurrence
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-020-04291-8

Introduction and hypothesis Large, long-term studies are needed to compare pelvic organ prolapse (POP) recurrence and mesh exposure following all modes of sacrocolpopexy (open, robotic, and laparoscopic). We hypothesized that the prevalence of recurrent POP and mesh exposure does not differ between modes of sacrocolpopexy. Methods This is a retrospective cohort study with a cross-sectional, prospective survey. Participants were surveyed regarding complications, retreatments, and symptoms following sacrocolpopexy. Baseline characteristics, POP recurrence, mesh exposure, and survey responses were compared. Results A total of 709 participants met the criteria. Median time from sacrocolpopexy to last follow-up for all participants was 0.5 years (2 days to 13.4 years). 15.0% experienced recurrent stage 2 or greater POP or underwent retreatment (open 11.7% [95% CI 7.8–17.2%]; robotic 21.1% [95% CI 15.6–27.9%]; laparoscopic 13.8% [95% CI 10.6–17.9%]; p  = 0.03). After adjusting for baseline differences there was no significant difference among groups ( p  = 0.30). 5.3% experienced mesh and/or suture exposure (mesh n  = 19, suture n  = 10, mesh and suture n  = 8) with no significant difference among groups (open 7.7% [95% CI 4.6–12.5%]; robotic 3.6% [95% CI 1.7–7.6%]; laparoscopic 4.9% [95% CI 3.1–7.7%]; p  = 0.20). Median time from sacrocolpopexy to survey completion was 6.5 (1.6–13.4) years. 9.2% reported evaluation or treatment for recurrent POP (open 6.3% [95% CI 2.1–16.8%]; robotic 12.5% [95% CI 6.9–21.5%]; laparoscopic 8.5% [5.1–13.8%]; p  = 0.44). 6.9% reported evaluation or treatment for mesh exposure (open 6.0% [95% CI 2.1–16.2%]; robotic 3.9% [95% CI 1.3–10.7%]; laparoscopic 8.6% [5.2–13.9%]; p  = 0.38). Conclusions Objective and patient-reported long-term prevalence of POP recurrence and mesh exposure are low following all modes of sacrocolpopexy.