Bilateral Sacrospinous Colposuspension with Sling for Advanced Pelvic Organ Prolapse: Anatomical and Functional...

Background: Pelvic organ prolapse (POP) is a prevalent condition that often requires surgical correction of apical support. Vaginal approaches that restore anatomy while minimizing synthetic material are of increasing clinical interest. Bilateral sacrospinous colposuspension with sling has been proposed as a minimally invasive technique; however, evidence from large clinical cohorts remains limited. Objectives: This study aimed to evaluate the anatomical, functional, and safety outcomes of this procedure in women with symptomatic advanced POP. Methods: This retrospective single-center cohort study included 235 consecutive women who underwent bilateral sacrospinous colposuspension with sling for symptomatic POP between 2018 and 2024. The primary outcomes were anatomical success (Baden stage ≤ II) and functional success (absence of vaginal bulge symptoms). Secondary outcomes included urinary, bowel, and sexual function, patient satisfaction, and postoperative complications classified according to the Clavien-Dindo system. Results: At a median follow-up of 20 months, anatomical success was achieved in 87.1% of patients and functional success in 93.6%. Significant improvements were observed in POP-Q points Ba and C (p < 0.001). Among symptomatic patients, stress urinary incontinence improved in 66%, urgency in 63%, and constipation in 71%. Overall morbidity was low (5.5%), with most complications classified as Clavien-Dindo grade I-II. Mesh extrusion occurred in 2.1% of cases, and reintervention was required in 2.1%. Functional recurrence was observed in 6.4% of patients, with 26% requiring surgical reintervention. Patient satisfaction was high (median score: 9/10). Conclusions: These findings support bilateral sacrospinous colposuspension with sling as a safe and effective vaginal approach for symptomatic advanced POP; however, the retrospective design and absence of a control group should be considered when interpreting the results.