Redo sacrocolpopexy for recurrent pelvic organ prolapse: an international cohort study

To describe the safety and efficacy of redo sacrocolpopexy (SCP) in patients with recurrent pelvic organ prolapse (POP) following primary SCP, with a focus on an alternative anchoring technique involving fixation of the mesh to the previously implanted prosthesis.

A retrospective, observational, multicenter study was conducted at three urogynecological referral centers (Lille, Rome, Liège). Fifty-two patients with recurrent POP (POP-Q stage ≥ 2) who underwent redo laparoscopic or robotic SCP between January 2020 and January 2025 were included. The cohort was stratified into two groups according to the site of apical suspension: fixation to the prevertebral ligament (n = 23) versus anchoring to the previously implanted mesh (n = 29). Median follow-up was 6 months (IQR 6-12.5 months). Primary outcomes included anatomical and functional results, perioperative complications, and subjective satisfaction assessed with the Patient Global Impression of Improvement (PGI-I).

No significant differences were observed between the two groups in anatomical outcomes or functional symptoms (urinary, bowel, or prolapse-related). No mesh-related complications were identified. A single minor postoperative complication was recorded (transient thigh hypoesthesia). Approximately 90% of patients (47/52) reported meaningful improvement on the PGI-I (defined as PGI-I categories 1 or 2). No Clavien-Dindo grade ≥3 events occurred. In univariate analysis, younger age was inversely associated with anatomical recurrence (OR 0.91; 95% CI: 0.84-0.99; p = 0.03); this finding should be interpreted cautiously given the small number of recurrence events.

In this selected multicenter cohort, redo SCP was feasible and associated with acceptable short-term anatomical, functional, and safety outcomes in the surgical management of recurrent POP. Anchoring to a previously implanted mesh represents a feasible technical alternative when access to the sacral promontory is limited. Prospective studies with extended follow-up are warranted to confirm these findings.