Sacrocolpopexy Prolapse Treatment

Risk Factors

Risk factors for apical prolapse requiring sacrocolpopexy:

• Prior hysterectomy
• Vaginal delivery with prolonged pushing
• Connective tissue disorders
• Chronic raised intra-abdominal pressure
• Menopause and estrogen deficiency
• Failed prior vaginal repair surgery

Who is at Risk

Women with vault prolapse after hysterectomy, those with recurrent or complex prolapse, and women for whom vaginal repair has failed are ideal candidates for sacrocolpopexy. Women wishing to preserve fertility may benefit from sacrohysteropexy.

Diagnosis

Pre-operative evaluation includes:

• Pelvic examination with POP-Q staging
• Pelvic floor ultrasound and MRI
• Urodynamic studies for bladder function
• Cystoscopy if bladder involvement is suspected
• Defecography for posterior compartment assessment

Treatment Options

Laparoscopic or robotic sacrocolpopexy using synthetic polypropylene mesh or biological graft is the preferred approach. The procedure can be combined with colporrhaphy, mid-urethral sling, or hysterectomy as required for comprehensive repair.

The Procedure

Sacrocolpopexy involves:

• Laparoscopic or robotic access under general anesthesia
• Dissection of the anterior and posterior vaginal walls
• Mesh attachment to the vaginal apex anteriorly and posteriorly
• Fixation of mesh to the anterior longitudinal ligament at the sacral promontory
• Peritoneal closure over the mesh
• Combined procedures such as colporrhaphy or sling as needed
• Post-operative catheterization and monitoring

After the Surgery

Post-operative care includes:

• Hospital stay of 1 to 2 days
• Urinary catheter for 24 to 48 hours
• Gradual return to activity over 4 to 6 weeks
• Pelvic floor physiotherapy beginning at 6 weeks
• Avoidance of heavy lifting for 8 weeks
• Follow-up at 6 weeks and 1 year post-surgery

Possible Complications of Sacrocolpopexy

Potential complications include:

• Mesh erosion or exposure in the vagina or bowel
• Sacral osteomyelitis from mesh fixation site
• De novo urinary urgency or stress incontinence
• Constipation or bowel dysfunction
• Recurrence of prolapse in a small percentage of cases
• Pelvic pain or dyspareunia