Treatment Outcomes of Pelvic Organ Prolapse Seven Years After the Introduction of Sacrocolpopexy at a Single Institution.

Abstract

Introduction Pelvic organ prolapse (POP) affects up to 30% of women during their lifetime and significantly impairs quality of life. In Japan, laparoscopic sacrocolpopexy was covered by national insurance starting in 2014 and has become an established treatment option. Objective This study evaluates the long-term outcomes of POP surgery, including recurrence and complications, seven years after the introduction of sacrocolpopexy at our institution. Methods Our institution introduced sacrocolpopexy in 2016, while continuing to perform conventional vaginal surgery. Sacrocolpopexy was primarily offered to patients under 80 years of age without diabetes; for other patients, vaginal surgery was generally chosen. Among vaginal surgeries, patients with a favorable general condition underwent native tissue repair (NTR). We retrospectively reviewed the medical records of patients who underwent sacrocolpopexy or NTR between April 2016 and June 2023. Results During the period, 90 patients underwent POP surgery, with 37 undergoing sacrocolpopexy and 38 receiving NTR; these 75 cases were included in the analysis. In the sacrocolpopexy group, the median time from symptom onset to surgery was 24 months, and 22 patients had used a pessary preoperatively. The median operative time for sacrocolpopexy was 196 minutes, with minimal bleeding and no intraoperative complications. Postoperative adverse events after sacrocolpopexy included one case each of delirium and acute cholecystitis. Recurrence of stage II or higher POP was observed in three patients in the sacrocolpopexy group; two of these had preoperative stage IV disease and had waited 60 months from symptom onset to surgery. In the NTR group, the median time to surgery was 42 months, and 32 patients had used a pessary preoperatively. The median operative time for NTR was 89 minutes, with minimal bleeding and no intraoperative complications. One postoperative complication (vaginal cuff hematoma) was observed after NTR. Recurrence of POP stage II or higher occurred in three NTR patients, all of whom were stage III or higher preoperatively. Conclusion Sacrocolpopexy and NTR are effective surgical options for POP, particularly in patients who do not respond to conservative management. Although sacrocolpopexy and NTR had a low complication and recurrence rate, it is important to bear in mind that recurrence is possible.