Abstract
Purpose
This study aimed to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥ stage II). It sought to determine if additional posterior repair was necessary for successful support of the posterior compartment and to evaluate the impact on bowel function in women undergoing surgery.
Methods
Data from all women who underwent laparoscopic sacrocolpopexy with or without posterior repair between 01/2017 and 07/2022 for symptomatic multicompartment prolapse, including apical and posterior compartment descent ≥ stage II, were retrospectively evaluated. All women underwent a urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system and completed the validated German Female Pelvic Floor questionnaire pre- and postoperatively (6-12 weeks). Preoperative anatomic support and bowel symptoms were compared to postoperative values.
Results
In total 112 women met the criteria for surgical correction. The majority (87%) had stage II posterior descent, with only 10% undergoing concurrent posterior repair during laparoscopic sacrocolpopexy. Significant (p<0.001) objective improvement was seen for all compartments post- compared to preoperatively (Ba: 0(-1/2) vs -3(-3/-2), C: -1(-2/0) vs -8(-12/-7), Bp:0(-1/0) vs -3(-2/-2); (Median 25%/75% quartiles)). Subsequent surgery for persistent rectocele and/or stool outlet symptoms was required in 4% of cases. Most bowel specific questions in the German Female Pelvic Floor Questionnaire showed significant improvement (p<0.001).
Conclusion
Nerve-sparing sacrocolopopexy alone seems to be a suitable surgical approach correcting multicompartment prolapse, including a rectocele ≥ stage II and results in a reduction of objective signs and symptoms of pelvic organ prolapse.