RESULTS
There were a total of 132 patients who underwent sacrocolpopexy using
autologous rectus fascia during the study period. Patient
characteristics are shown on Table 1. Mean age was 59.0 (range 32-83)
years. Mean body mass index was 25.9 kg/m2 (SD 3.8
kg/m2). Preoperatively, 23.7% of patients presented
with stage II prolapse, 71.0% with stage III prolapse and 4.6% with
stage IV prolapse. This was the initial prolapse repair for 75.8% of
the patients. Concomitant surgeries performed included: total
hysterectomy (47.7%), supracervical hysterectomy (11.4%), Burch
colposuspension (61.4%), posterior colporrhaphy (50.8%). Mean
operative time was 258 minutes (SD 104). The mean post-operative
hematocrit was 33.0 g/dL (SD 3.1 g/dL). Two patients (1.5%) received
blood transfusion. Mean length of stay was 2.2 days (SD 1.1 days). The
length of stay was significantly lower for patients who underwent
surgery after the implementation of Enhanced Recovery After Surgery
(ERAS) protocol compared to before ERAS (1.8 ± 0.6 days vs. 2.4 ± 1.3
days, respectively; P=0.008).
Out of all 132 eligible patients, 95 (72%) consented to have additional
follow up for the purposes of this study. For patients who were not able
to have additional follow up during the study period, follow up data
were collected from chart review. A total of 128 (97%) of patients had
postoperative POPQ exams either as part of routine care or follow up
during the study.
Median follow-up time was 2.2 years, ranging from 1 month to 6.2 years.
Survival analyses showed that the probability of composite failure was
0.8% (CI 0.1-5.9%) at 12 months, 3.5% (CI 1.1-10.7%) at 2 years,
13.2% (CI 7.0-24.3%) at 3 years, and 28.3% (CI 17.0-44.8%) at 5
years (Figure 1). The probability of anatomic failure was 0% at 12
months, 1.4% (CI 0.2-9.2%) at 2 years, 3.1% (CI 0.8-12.0%) at 3
years, and 6.8% (CI 2.0-22.0%) at 5 years (Figure 2). The probability
of symptomatic failure was 0% at 12 months, 1.3% (CI 0.2-9.0%) at 2
years, 2.9% (CI 0.7-11.3%) at 3 years, and 13.1% (CI 5.3-30.3%) at 5
years (Figure 3). The probability of retreatment was 0.8% (CI
0.1-5.9%) at 12 months and 2 years, 9.4% (CI 4.2-20.3%) at 3 years,
and 13.0% (CI 6.0-27.2%) at 5 years (Figure 4). A total of 7 patients
underwent surgical retreatment for prolapse, 3 patients had an anterior
and posterior colporrhaphy, 2 patients had only a posterior
colporrhaphy, 1 patient had posterior colporrhaphy with a sacrospinous
ligament fixation, and 1 patient had an anterior and posterior
colporrhaphy with a sacrospinous ligament fixation.
On follow-up, 7.7% of patients had stage 0, 63.1% had stage I, 28.5%
had stage II, and 0.8% had stage III prolapse. None had stage IV
prolapse. All POP-Q measurements except for total vaginal length were
significantly improved from baseline (P<0.001). In terms of
subjective outcomes, PFDI scores were significantly improved from
baseline (99.8, CI 86.7-112.9) to follow-up (52.3, CI 42.0-62.6;
P<0.001).
In terms of post-operative complications, 13.6% of patients were
treated for post-operative infections other than urinary tract
infections. Of these, 6.1% of patients had surgical site infections and
3.8% had pneumonia. Rate of readmission within 30 days of surgery was
9.1%. This included 5.3% of patients readmitted with ileus or small
bowel obstruction (0.8% requiring surgical intervention), and 1.5% of
patients readmitted for pain. There were no patients with post-operative
venous thromboembolism and no other patient requiring reoperation within
30 days.
Postoperative voiding dysfunction was present in 4.5% of patients
beyond the immediate postoperative period. The rate of overactive
bladder symptoms was 35.6% post-operatively and 12.9% received
medications. Although 32.6% of all patients reported stress urinary
incontinence symptoms post-operatively, 10.6% had positive cough stress
test, and 13.6% underwent subsequent treatment for stress urinary
incontinence. The rate of subsequent mid-urethral slings was 5.3%, the
rate of subsequent pubovaginal slings was 3.8%, and the rate of
subsequent urethral bulking was 7.6%, with 3.0% of patients undergoing
both urethral bulking and mid-urethral slings. Overall 19.7% of
patients received physical therapy post-operatively. No patients were
diagnosed or treated for incision site hernia.