Integral Perineal Sacrocolpopexy: Expanding Surgical Options for Complex Pelvic Organ Prolapse

Sacrocolpopexy is the gold standard for multicompartimental pelvic organ prolapse (POP). Patients with associated perineal descent presents higher recurrence rates. To address this, we developed the Integral Perineal Sacrocolpopexy (IPSC), a modification designed to increase anterior reinforcement through extended anterior dissection and mesh fixation to the levator ani muscles.

In addition to describing the Integral Perineal Sacrocolpopexy technique, we prospectively analyzed a case series of 15 patients with POP and magnetic resonance imaging (MRI)-confirmed perineal descent, treated between October 2018 and January 2024.

The cohort had a median age of 71 years and seven patients had a prior hysterectomy with concomitant prolapse repair. Mean operative time was 145 minutes and median hospital stay was 2 days. No postoperative complications or hospital readmissions occurred. At a median follow-up of 48 months, anatomical success was achieved in all patients. Regarding urinary function, urgency incontinence improved substantially, whereas stress incontinence persisted in one patients and occurred de novo in four. One patient developed late intravesical mesh erosion, treated endoscopically without recurrence.

Integral Perineal Sacrocolpopexy appears to be a safe and feasible technique for highly selected patients with compromised pelvic floor support, offering anatomical and functional correction with a complication profile within the range reported for conventional sacrocolpopexy.