Positive effects of laparoscopic sacrocolpopexy on anterior lateral defects and stress urinary incontinence

Laparoscopic sacrocolpopexy (SCP) is considered the gold standard for the correction of middle compartment (apical) prolapse. The extent to which simultaneous correction of the anterior compartment is necessary remains unclear. The aim of this study was to examine the anatomical and functional outcomes of the SCP on the anterior compartment with respect to the correction of central and lateral defects as well as stress urinary incontinence (SUI).

This was a retrospective clinical follow-up with records of recurrences and complications as well as effects on SUI after laparoscopic SCP with and without simultaneous vaginal correction at Elisabeth Hospital, Essen, Germany, from 2014-2020 in 65 of 86 patients, with an average follow-up of 3.3 years.

Without simultaneous vaginal correction of the anterior compartment, recurrence was more common in women with central defect POP-Q Ba > - 2.0 [4 of 8 patients without correction (50% recurrence) vs. 1 of 23 patients with correction (4% recurrence)]. The OR for recurrence with surgery was 0.05 (95% CI 0.01; 0.52, p < 0,001). In women with lateral defects of the anterior compartment with a POP-Q Ba > - 2.0, simultaneous vaginal correction was not necessary, with a low recurrence rate (1 of 18 recurrences, 6%). Preexisting SUI grade ≥ 1 could be corrected in 27 of 36 patients. (75%, p < 0,001) according to the SCP. Mesh erosion with reoperation (Clavien-Dindo IIIb) occurred in three patients (4.6%).

Overall, this study suggests that patients with a central defect of the anterior vaginal wall can benefit from additional vaginal correction as part of the SCP. Furthermore, existing incontinence improves with the correction of prolapse.