Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve.
BACKGROUND
Limited prospective data on the anatomic and functional outcome after laparoscopic sacrocolpopexy (LSC) are available in the literature.


OBJECTIVE
To describe the medium-term anatomic and functional outcome of LSC.


METHODS
Prospective consecutive series of 132 women with vaginal vault prolapse undergoing LSC between 2001 and 2006, which was after our learning curve. Patients with urodynamically proven stress incontinence (SI) underwent a concomitant tension-free vaginal tape (TVT) procedure.


METHODS
Patients underwent LSC with a polypropylene implant.


METHODS
Principal outcome measures were anatomic cure (stage 1 or lower) assessed by the Pelvic Organ Prolapse Quantification (POPQ) system and subjective cure and impact on quality of life measured by a standardised interview and, since its introduction in 2004, by a prolapse-specific quality-of-life questionnaire (P-QOL).


CONCLUSIONS
At a mean follow-up of 12.5 mo, the anatomic cure rate for the apex was 98%. Anatomic failures elsewhere were mainly at the posterior compartment (18%). Subjective prolapse cure rate was 91.7%, and no patients required reoperation for recurrent prolapse. Symptoms of preoperative SI, urge incontinence, or constipation were cured in 43%, 46%, and 42% of patients, respectively. The rate of de novo SI was 7.3%. De novo constipation developed in 5% and de novo dyspareunia developed in 19%. Patients' quality of life improved significantly. Erosions occurred in 4.5%, all within 1 yr. A limitation of the study is that the quality-of-life assessment score became available halfway through the study, limiting the number of preoperative observations (n=36).


CONCLUSIONS
We demonstrated that LSC results in good anatomic outcome and subjective cure of prolapse symptoms at medium term. The posterior compartment was most vulnerable for recurrence.
Claerhout
Filip
F
Pelvic Floor Unit, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.
De Ridder
Dirk
D
Roovers
Jan Paul
JP
Rommens
Heidi
H
Spelzini
Federico
F
Vandenbroucke
Vanessa
V
Coremans
Georges
G
Deprest
Jan
J
D000368:Aged; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011126:Polypropylenes; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D019736:Prostheses and Implants; D011475:Prosthesis Failure; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D014563:Urodynamics; D014596:Uterine Prolapse / Q000150:complications / Q000175:diagnosis / Q000601:surgery*
D011126:Polypropylenes