Mesh Exposure and Long-Term Outcomes in Robotic Sacrocolpopexy with Concomitant Radical Hysterectomy

To evaluate prolapse recurrence, mesh exposure, and de novo incontinence following robotic sacrocolpopexy (rSCP) with radical hysterectomy (rRH) for cancer and non-cancer indications.

We conducted a retrospective cohort study of patients undergoing concurrent rSCP and rRH at a tertiary referral center, July 2006-August 2023. Outcomes included prolapse recurrence (≥ stage 2 by POP-Q or symptomatic recurrence), mesh exposure, and de novo urinary incontinence within 12 months. Kaplan-Meier analyses estimated time to prolapse recurrence and mesh exposure stratified by indication (cancer vs non-cancer).

In total, 109 patients underwent rSCP with rRH (36 for cancer, 73 for non-cancer indications). Median follow-up among patients without recurrence or mesh exposure was 15 months (IQR 7.5-43). Prolapse recurrence occurred in 12 patients: 1/36 and 11/73 in the cancer and non-cancer cohorts, respectively. One patient in each group required postoperative revision surgery after ≥10 years). Mesh exposure occurred in 8 patients: 1/36 and 7/73 in the cancer and non-cancer cohorts, respectively; 5 patients underwent surgical revision. Among 54 patients with ≥12 months follow-up and available continence data, de novo incontinence developed in 4 (7.4%) patients (3 cancer, 1 non-cancer).

Concomitant rSCP-rRH demonstrates acceptable rates of prolapse recurrence, mesh exposure, and de novo incontinence. Although underpowered to detect small differences, outcomes were comparable in cancer vs non-cancer cases. rSCP can safely be integrated in rRH when clinically indicated.