MP33-09 ROBOT-ASSISTED SACRAL COLPOPEXY WITH AUTOLOGOUS FASCIA LATA: TECHNIQUE AND INITIAL OUTCOMES

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2018MP33-09 ROBOT-ASSISTED SACRAL COLPOPEXY WITH AUTOLOGOUS FASCIA LATA: TECHNIQUE AND INITIAL OUTCOMES Victoria Scott, Janine Oliver, Shlomo Raz, and Ja-Hong Kim Victoria ScottVictoria Scott More articles by this author , Janine OliverJanine Oliver More articles by this author , Shlomo RazShlomo Raz More articles by this author , and Ja-Hong KimJa-Hong Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1080AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To avoid the complications of synthetic mesh, sacral colpopexy (SC) is increasingly being performed with an autologous graft. To our knowledge, at present, minimally-invasive SC with autologous fascia has not been described. We present our technique and initial experience with performing robotic-assisted laparoscopic sacral colpopexy (RSC) with autologous fascia lata (AFL) as a salvage procedure to address recurrent apical prolapse after mesh removal. METHODS A retrospective review was conducted examining the records of all patients who underwent RSC with AFL between January 2015 and November 2017. Of the eleven patients identified, all but one had prior mesh placed for prolapse repair or for stress urinary incontinence. Of the ten patients who underwent salvage RSC, three had concomitant mesh removal and seven underwent staged procedures. Three patients had prior midurethal slings (MUS), three had transvaginal mesh (TVM), two had TVM and MUS, and two had RSC with mesh and MUS. Prolapse severity was assessed by Baden-Walker grading system. After harvesting a 1 x 12 cm segment of fascia lata, RSC was performed using the previously described method for use of AFL in open SC. Records were reviewed for clinical and perioperative data. Outcomes evaluated include recurrence of prolapse symptoms, urinary incontinence (UI), and patient satisfaction, which was measured by the Patient Global Impression of Improvement (PGI-I) questionnaire for urogenital prolapse, administered to patients following surgery by telephone interview. RESULTS Median patient age was 68 years (46-77) and all patients had grade 3 apical prolapse. Median operative time was 225 min (177-302min). Median estimated blood loss was 150 cc (100-150). There were no intraoperative complications. Median length of hospital stay was 2 days (1-11). One patient had a prolonged hospital stay of 11 days due to ileus. After a median follow-up of 9.65 months (0.8-33.7months), the median PGI-I response was 2 (range of 1-3, very much to a little better). Two patients (18%) did report recurrence of sensation of a vaginal bulge. Nine (82%) patients reported UI preoperatively, and 6 patients (55%) reported UI at postoperative follow-up. CONCLUSIONS RSC can be performed with AFL and should be considered in patients with a history of mesh complications. Overall patient satisfaction was high. While these short-term outcomes are encouraging, further studies will be needed to assess long-term durability of anatomic results. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e431 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Victoria Scott More articles by this author Janine Oliver More articles by this author Shlomo Raz More articles by this author Ja-Hong Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...