International Journal of Women's Health (Jul 2023)
The Outcome of Sacrocolpopexy/Sacrohysteropexy for Patients with Pelvic Organ Prolapse and Predictors of Anatomical Failure
Abstract
Jawaher A Alsahabi,1,2 Saeed Alsary,1,2 Mostafa A Abolfotouh2 1Department Urogynecology & Reconstructive Female Pelvic Surgery, King Abdul-Aziz Medical City, King Saud Ben Abdu Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh, 22490, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), King Saud Ben Abdul Aziz University for Health Sciences (KSAU-HS), Ministry of National Guard-Health Affairs, Riyadh, 11481, Saudi ArabiaCorrespondence: Mostafa A Abolfotouh, King Abdullah International Medical Research Center/ King Saud bin Abdulaziz University for Health Sciences, Riyadh/Ministry of National Guard Health Affairs, POB 22490, Riyadh, 11426, Saudi Arabia, Email [email protected]: 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.Keywords: pelvic organ prolapse, Sacrocolpopexy, Sacrohysteropexy, laparoscopy, mesh complications, prolapse recurrence, surgical failure, success rate
