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.