title: Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations.
abstract: Sacrocolpopexy is considered a reference operation for pelvic organ prolapse repair but its indications and technical aspects are not standardized. A faculty of urogynecology surgeons critically evaluated the peer-reviewed literature published until September 2015 aiming to produce evidence-based recommendations. PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English language. The modified Oxford data grading system was used to access quality of evidence and grade recommendations. The Delphi process was implemented when no data was available. Thirteen randomized, controlled trials were identified, that provided levels 1 to 3 of evidence on various aspects of sacrocolpopexy. Sacrocolpopexy is the preferred procedure for vaginal apical prolapse (Grade A), monofilament polypropylene mesh is the graft of choice and the laparoscopic approach is the preferred technique (Grade B). Grade B recommendation supports the performance of concomitant procedures at the time of sacrocolpopexy. Grade C recommendation suggests either permanent or delayed sutures for securing the mesh to the vagina, permanent tackers or sutures for securing the mesh to the sacral promontory and closing the peritoneum over the mesh. A Delphi process Grade C recommendation supports proceeding with sacrocolpopexy after uncomplicated, intraoperative bladder or small bowel injuries. There is insufficient or conflicting data on hysterectomy (total or subtotal) or uterus preservation during sacrocolpopexy (Grade D). Sacrocolpopexy remains an excellent option for vaginal apical prolapse repair. The issue of uterine preservation or excision during the procedure requires further clarification. Variations exist in the performance of most technical aspects of the procedure.
authors: Urological and Andrological Clinic, Department of Surgical Science and Biomedical Sciences, University of Perugia, Perugia, Italy. Electronic address: elisabetta.costantini@unipg.it.
authors: Elisabetta
authors: E
authors: Costantini
authors: Dean Stritch School of Medicine, Maywood, IL, USA.
authors: Linda
authors: L
authors: Brubaker
authors: Catholic University, Rome, Italy.
authors: Mauro
authors: M
authors: Cervigni
authors: Department Obstetrics and Gynecology, UNC Hospital, NC, USA.
authors: Catherine A
authors: CA
authors: Matthews
authors: Cork University Maternity Hospital, Cork, Ireland.
authors: Barry A
authors: BA
authors: O'Reilly
authors: College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.
authors: Diaa
authors: D
authors: Rizk
authors: Department of Urology, Patras University Hospital, Patras University, Patras, Greece.
authors: Konstantinos
authors: K
authors: Giannitsas
authors: Royal Brisbane and Women's Hospital, Wesley Hospital and University of Queensland, Australia.
authors: Christopher F
authors: CF
authors: Maher
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Efficacy; Pelvic organ prolapse; Recommendations; Sacrocolpopexy; Technical aspects