A Prospective Study of Laparoscopic Sacrocolpopexy for the Management of Pelvic Organ Prolapse

Abstract

Several studies have investigated the use of laparoscopic sacrocolpopexy for the management of posthysterectomy vault prolapse, but most were retrospective and small, and not subject to rigorous assessment. Accordingly, the optimal surgical approach is unclear and remains controversial. An earlier study suggested that vaginal surgery may produce less postoperative pain and allow a more rapid return to daily living than abdominal repair. In a randomized study, however, twice as many patients achieved an optimal anatomical outcome with sacrocolpopexy. Questions have been raised in retrospective studies concerning the effect of laparoscopic sacrocolpopexy on bladder, bowel, and sexual function. To address these issues, this prospective longitudinal observational study investigated the effectiveness and safety of laparoscopic sacrocolpopexy after 2 years of treatment in 22 women undergoing the procedure for prolapse. The study was conducted between 2002 and 2005 at a British tertiary referral center. The average age of the patients was 63.5 years at the time of surgery. Outcomes examined included anatomical assessment of pelvic organ support and quality-of-life scores using validated questionnaires. Pelvic organ support was measured by the pelvic organ prolapse quantification (POP-Q) stages score and quality of life scores assessing vaginal, urinary, and bowel symptoms were determined with a Pelvic Floor Distress Inventory (PFDI) and a Pelvic Floor Impact Questionnaire (PFIQ). Preoperative baseline and postoperative scores at 2 years were compared for all measurements. Follow up at an average of 27.5 months showed that all 22 of the study subjects had apical stage zero vault support with symptoms cured in 21. Although improvement in anterior and posterior vault support was found in all POP-Q stages, improvement at apical stage zero occurred in only 10 and 5 women, respectively. Half of the women with preoperative symptoms who had received sacrocolpopexy alone reported improvement of urinary symptoms at the 2-year follow-up, without the need for additional continence surgery. Treatment for stress incontinence during the follow-up period was not required in any patient. Although reports of postoperative bowel symptoms were uncommon, about one-third of those with such complaints had no bowel symptoms before surgery. At the 2-year follow-up, none of the sexually active women had new onset dyspareunia. Intraoperative complications were rare and no patient required return to surgery. The findings in this prospective study are consistent with previous retrospective studies and suggest that laparoscopic sacrocolpopexy is a safe and effective surgical procedure for management of posthysterectomy vault prolapse.