2078 SURGICAL MANAGEMENT OF PELVIC ORGAN PROLAPSE IN FEMALES: ANATOMICAL AND FUNCTIONAL OUTCOMES OF SACROSPINOUS COLPOPEXY AND CYSTOCELE REPAIR AS A COMBINED PROCEDURE

Abstract

INTRODUCTION AND OBJECTIVES: High stage cystocele usually occurs concomitantly with apical prolapse, and is likely to recur when only the cystocele is surgically corrected. We investigated the anatomical and functional outcome of patients who underwent sacrospinous colpopexy and cystocele repair simultaneously. METHODS: We retrospectively reviewed 71 consecutive women who underwent sacrospinous colpopexy and cystocele repair as a combined procedure and were followed up more than 12 months after surgery. Anti-incontinence surgery was performed when indicated. Severity of prolapse was assessed by the POP-Q staging system. Prolapse-related and lower urinary tact symptoms were assessed. Cystocele was corrected using designed mesh or mesh kits of Perigee or Prolift. For apical correction, sacrospinous ligament fixation was performed. Postoperatively, an anatomical assessment and standardized interview was performed at predetermined intervals. The primary outcome measure was anatomical cure rate. Anatomical cure was defined as stage I or less. Secondary outcomes included subjective cure, symptom status, subjective or objective stress urinary incontinence and uroflowmetric parameters. Women reporting they were never or rarely bothered by prolapse-related symptoms were classified as subjectively cured. RESULTS: All cystoceles were stage III or more and all apical prolapses were stage II or more preoperatively. The success rates of cystocele repair and apical wall repair were 76.1% and 97.2% at postoperative 1 year, respectively. Among the 17 patients in which cystocele recurrence occurred, 15 cases were in stage 2 and none of them showed apical prolapse recurrence or prolapse-related symptoms. There were only 2 cases in which cystocele recurrence occurred higher than stage 3, and all of them had simultaneous apical wall prolapse. In both of these cases, abdominal sacrocolpopexy was performed. Postoperatively, prolapse-related symptoms were completely improved and lower urinary tract symptoms were much improved. Maximal flow rates and postvoid residual urine volumes were significantly improved. De novo incontinence occurred in 23.3% of the patients who did not undergo anti-incontinence surgery simultaneously. All complications were managed conservatively. No mesh erosion was identified. CONCLUSIONS: When apical prolapse was corrected successfully, cystocele recurrence did not exceed stage 2 and no symptoms were identified. When apical correction was not successful, high stage cystocele recurrence occurred.