Effects of Sacrocolpopexy Route on Anterior and Posterior Compartment Outcomes

Importance Comparative studies of prolapse outcomes among various routes of sacrocolpopexy (SCP) are limited. Objectives The objective was to examine the relationship between surgical route of SCP and anterior or posterior compartment anatomic failure. The secondary objective was to determine the relationship between concomitant colporrhaphy and retreatment. Study Design This was a retrospective cohort of patients with robotic (RSCP), laparoscopic (LSCP) or abdominal SCP (ASCP). Primary outcomes were anterior or posterior compartment failure defined as a postoperative Pelvic Organ Prolapse Quantification point Aa, Ba, or Ap, Bp ≥0, noted at least 90 days after SCP. Performance of concomitant vaginal colporrhaphy (or perineorrhaphy) at the time of SCP was analyzed for effect on this outcome. Retreatment rates were compared across all surgical routes. Results A total of 487 cases were included with 270 LSCP, 162 RSCP, and 55 ASCP. Among these patients, 26 (5.4%) had anterior failure, 27 (5.5%) had posterior failure, and 5 (1%) had both. Anterior compartment failure was identified among 17 (6.3%) LSCP, 12 (7.4%) RSCP, and 2 (3.5%) ASCP patients ( P = 0.71). Posterior compartment failure was seen in 14 (5.2%) LSCP, 15 (9.3%) RSCP, and 3 (5.5%) ASCP patients ( P = 0.24). Later, 79 patients (16.2%) underwent retreatment for prolapse, with 33 (41.8%) undergoing reoperation, and 46 (58.2%) were conservatively managed with pessaries or physical therapy. Concomitant colporrhaphy at SCP surgery did not predict retreatment ( P = 0.57). Conclusions Route of SCP was not associated with anatomic anterior or posterior compartment failure. Concomitant colporrhaphy or perineorrhaphy at the time of index SCP was not associated with need for surgical or nonsurgical retreatment.