Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition

Authors

  • Sarah D. Fox,

    Fellow
    1. Urogynaecology Unit, Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, London
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  • Stuart L. Stanton

    Professor, Corresponding author
    1. Urogynaecology Unit, Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, London
      Correspondence: Professor S. L. Stanton, St. George's Hospital, Urogynaecology Unit, Cranmer Terrace, London SW17 ORE, UK.
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Correspondence: Professor S. L. Stanton, St. George's Hospital, Urogynaecology Unit, Cranmer Terrace, London SW17 ORE, UK.

Abstract

Objective To assess the sacrocolpopexy with mesh interposition in women with pelvic organ prolapse.

Design A prospective study.

Setting Tertiary referral urogynaecology and pelvic floor reconstruction unit.

Population Twenty-nine consecutive women with symptomatic vault prolapse and rectocele.

Main outcome measures Subjective and objective success rates and complications.

Results The mean age was 57 years. The mean number of past prolapse operations was 2.6 which included two past sacrospinous ligament fixations and 17 past posterior repairs. The mean follow up was 14 months. There was an increase in constipation from 41% to 50%, a decrease in faecal soiling from 21% to 10%, and an increase in incomplete defecation from 24% to 36%. Dyspareunia decreased from 38% to 17%, and there was some improvement in the stress and urge incontinence. There was a significant reduction of vault prolapse and rectocele (P < 0.001). All women with Stage II and Stage III vault prolapse were corrected, with an increase in Stage I prolapse from 20% to 27%. All women with Stage II and Stage III rectocele were corrected with a decrease in Stage I prolapse from 36% to 7%. The only significant interoperative complication was a cystotomy. One mesh became infected post-operatively which required removal.

Conclusions Sacrocolpopexy and mesh interposition is a safe and reliable operation for the correction of vault prolapse and rectocele. A long term follow up is necessary to detect any late complications.

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