Skip to main content

Severe pelvic organ prolapse. Is there a long-term cure?

International Urogynecology Journal volume 30, pages 1697–1703 (2019)Cite this article

Abstract

Introduction and hypothesis

Vaginally assisted laparoscopic sacrocolpopexy (VALS) is a combined vaginal and laparoscopic surgical approach that has been described for the treatment of women with a uterus who suffer from severe multicompartmental pelvic organ prolapse (POP). The aim of this study is to evaluate the long-term anatomical and functional outcomes and report the long-term mesh-related complications.

Methods

This was a single-center prospective study of women with advanced POP who underwent VALS with at least 3 years of follow-up. The primary outcome was “composite surgical success” defined as: (1) no descent of the vaginal apex (point C) more than one-third into the vaginal canal and no anterior or posterior vaginal wall beyond the hymen (Ba and Bp < 0) (anatomical success), (2) no vaginal bulge symptoms and (3) no re-treatment for prolapse recurrence.

Results

The median follow-up was 7 years (range 3–10 years) with a composite surgical success rate of 95.7% (90/94). Failures (4.3%) included one (1.1%) case of anatomical recurrence (Bp: +1), one woman (1.1%) reporting vaginal bulge symptoms and two women (2.1%) who underwent a posterior colporrhaphy 6 and 12 months after primary surgery (reoperation rate: 2.1%). Two of 94 patients (2.1%) had been treated for mesh extrusion of the vaginal cuff prior to the follow-up visit.

Conclusions

The combined VALS technique can be considered a safe and effective procedure for the treatment of severe POP allowing a long-term anatomical restoration of all compartments with excellent functional outcomes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abbreviations

POP:

Pelvic organ prolapse

SCP:

Sacrocolpopexy

VALS:

Vaginally assisted laparoscopic sacrocolpopexy

POP-Q:

Pelvic Organ Prolapse quantification system

ICS:

International Continence Society

UDS:

Multichannel urodynamics

PFDI-20:

Pelvic Floor Distress Inventory

PFIQ-7:

Pelvic Floor Impact Questionnaire

ICIQ-FLUTS:

International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms

PGI-I:

Patient Global Impression of Improvement questionnaire

MUS:

Midurethral sling

UIQ-7:

Urinary Impact Questionnaire-7

POPIQ-7:

Pelvic Organ Prolapse Impact Questionnaire-7

CRAIQ-7:

Colorectal-Anal Impact Questionnaire-7

SUI:

Stress urinary incontinence

UUI:

Urge urinary incontinence

References

  1. Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J. 2015;26:1559–73. https://doi.org/10.1007/s00192-015-2695-.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Aslam MF, Osmundsen B, Edwards SR, Matthews C, Gregory WT. Preoperative prolapse stage as predictor of failure of Sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22:156–60. https://doi.org/10.1097/SPV.0000000000000233.

    Article  PubMed  Google Scholar 

  3. Delancey JO, Kane Low L, Miller JM, Patel DA, Tumbarello JA. Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol. 2008;199:610 e611–5. https://doi.org/10.1016/j.ajog.2008.04.001.

    Article  Google Scholar 

  4. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;30(4):CD004014. https://doi.org/10.1002/14651858.

    CAS  Article  Google Scholar 

  5. Wong V, Guzman Rojas R, Shek KL, Chou D, Moore KH, Dietz HP. Laparoscopic sacrocolpopexy: how low does the mesh go? Ultrasound Obstet Gynecol. 2017;49:404–8. https://doi.org/10.1002/uog.15882.

    CAS  Article  PubMed  Google Scholar 

  6. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309:2016–24. https://doi.org/10.1001/jama.2013.4919.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Grigoriadis T, Protopapas A, Chatzipapas I, Athanasiou S. Vaginally assisted laparoscopic sacrocolpopexy for the treatment of complete uterovaginal prolapse. Int Urogynecol J. 2015;26:449–50. https://doi.org/10.1007/s00192-014-2541-4.

    Article  PubMed  Google Scholar 

  8. Athanasiou S, Grigoriadis T, Chatzipapas I, Protopapas A, Antsaklis A. The vaginally assisted laparoscopic sacrocolpopexy: a pilot study. Int Urogynecol J. 2013;24:839–45. https://doi.org/10.1007/s00192-012-1947-0.

    Article  PubMed  Google Scholar 

  9. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26. https://doi.org/10.1007/s00192-009-0976-9.

    Article  PubMed  Google Scholar 

  10. Weber AM, Abrams P, Brubaker L, Cundiff G, Davis G, et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:178–86.

    CAS  Article  Google Scholar 

  11. Grigoriadis T, Athanasiou S, Giannoulis G, Mylona SC, Lourantou D, Antsaklis A. Translation and psychometric evaluation of the Greek short forms of two condition-specific quality of life questionnaires for women with pelvic floor disorders: PFDI-20 and PFIQ-7. Int Urogynecol J. 2013;24:2131–44. https://doi.org/10.1007/s00192-013-2144-5.

    Article  PubMed  Google Scholar 

  12. Brookes ST, Donovan JL, Wright M, Jackson S, Abrams P. A scored form of the Bristol female lower urinary tract symptoms questionnaire: data from a randomized controlled trial of surgery for women with stress incontinence. Am J Obstet Gynecol. 2004;191:73–82.

    Article  Google Scholar 

  13. Athanasiou S, Grigoriadis T, Kyriakidou N, Giannoulis G, Antsaklis A. The validation of international consultation on incontinence questionnaires in the Greek language. Neurourol Urodyn. 2012;31:1141–4. https://doi.org/10.1002/nau.22197.

    Article  PubMed  Google Scholar 

  14. Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8. https://doi.org/10.1007/s00192-009-1069-5.

    Article  PubMed  Google Scholar 

  15. Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114:600–9. https://doi.org/10.1097/AOG.0b013e3181b2b1ae.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sarlos D, Brandner S, Kots L, Gygax N, Schaer G. Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome-a prospective study with 101 cases. Int Urogynecol J Pelvic Floor Dysfunc. 2008;19:1415–22. https://doi.org/10.1007/s00192-008-0657-0.

    Article  Google Scholar 

  17. Liang S, Zhu L, Song X, Xu T, Sun Z, Lang J. Long-term outcomes of modified laparoscopic sacrocolpopexy for advanced pelvic organ prolapse: a 3-year prospective study. Menopause. 2016;23:765–70. https://doi.org/10.1097/GME.0000000000000628.

    Article  PubMed  Google Scholar 

  18. Higgs PJ, Chua HL, Smith AR. Long term review of laparoscopic sacrocolpopexy. BJOG. 2005;112:1134–8.

    CAS  Article  Google Scholar 

  19. Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol. 2004;191:1533–8.

    Article  Google Scholar 

  20. Diez-Itza I, Aizpitarte I, Becerro A. Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1317–24.

    CAS  Article  Google Scholar 

  21. Weidner AC, Cundiff GW, Harris RL, Addison WA. Sacral osteomyelitis: an unusual complication of abdominal sacral colpopexy. Obstet Gynecol. 1997;90:689–91.

    CAS  Article  Google Scholar 

  22. Visco AG, Weidner AC, Barber MD, Myers ER, Cundiff GW, et al. Vaginal mesh erosion after abdominal sacral colpopexy. Am J Obstet Gynecol. 2001;184:297–302.

    CAS  Article  Google Scholar 

  23. Zacharakis D, Grigoriadis T, Bourgioti C, Pitsouni E, Protopapas A, et al. Pre- and postoperative magnetic resonance imaging (MRI) findings in patients treated with laparoscopic sacrocolpopexy. Is it a safe procedure for all patients? Neurourol Urodyn. 2018;37:316–21. https://doi.org/10.1002/nau.23294.

    Article  PubMed  Google Scholar 

  24. Nosti PA, Carter CM, Sokol AI, Tefera E, Iglesia CB, et al. Transvaginal versus transabdominal placement of synthetic mesh at time of sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22:151–5. https://doi.org/10.1097/SPV.0000000000000222.

    Article  PubMed  Google Scholar 

  25. von Pechmann WS, Aungst MJ, Gruber DD, Ghodsi PM, Cruess DF, Griffis KR. A pilot study on vaginally assisted laparoscopic sacrocolpopexy for patients with uterovaginal prolapse. Female Pelvic Med Reconstr Surg. 2011;17:115–9. https://doi.org/10.1097/SPV.0b013e318216379d.

    Article  Google Scholar 

  26. Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J. 2012;23:527–35. https://doi.org/10.1007/s00192-012-1726-y.

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. First Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, “Alexandra” Hospital, 80 Vas.Sofias Avenue, 11528, Athens, Greece

    Stavros Athanasiou, Dimitrios Zacharakis, Athanasios Protopapas, Eleni Pitsouni, Dimitrios Loutradis & Themos Grigoriadis

Authors
  1. Stavros Athanasiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dimitrios Zacharakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Athanasios Protopapas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eleni Pitsouni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dimitrios Loutradis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Themos Grigoriadis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dimitrios Zacharakis.

Ethics declarations

Conflicts of interest

None.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Athanasiou, S., Zacharakis, D., Protopapas, A. et al. Severe pelvic organ prolapse. Is there a long-term cure?. Int Urogynecol J 30, 1697–1703 (2019). https://doi.org/10.1007/s00192-018-3775-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-018-3775-3

Keywords

  • Pelvic organ prolapse
  • Sacrocolpopexy
  • Long-term outcome
  • Prolapse recurrence
  • Mesh