BERKELEY, CA (UroToday Inc.) - Minimally invasive approaches for pelvic floor reconstruction have increased in recent years. Dr. Francois Rozet and colleagues from Paris and Le Mans, France performed a retrospective review of their patients who underwent laparoscopic sacral colpopexy for pelvic prolapse. Their technique uses two pieces of polyester mesh coated with silicone on one side and used to suspend anteriorly the vaginal wall and posteriorly the levator ani muscle to the sacral promontory. Their results were published in the February 2005 edition of European Urology.

They retrospectively studied 363 patients with symptomatic vaginal prolapse with or without stress urinary incontinence who underwent a laparoscopic sacral colpopexy from June 1996 to March of 2003. Follow-up was performed at 6 months, 1, 3, and 5 years. A physical examination and questionnaire were completed on the first two visits. Subsequent follow-up consisted of patient completed non-validated questionnaires that included the following parameters: continence, constipation, intercourse, complications, and overall satisfaction.

A total of 363 women underwent the procedure, but only 325 had complete baseline data. The average patient age was 63 years (range 35-78). 12% (38/325) had a previous colposuspension while 25% (82/325) had a previous hysterectomy. By the Baden-Walker grading system for vaginal prolapse, 25% were stage II, 67% were stage III, and 8% were stage IV. 54% of the women had urodynamically proven incontinence associated with their prolapse.

Eight patients were not included in the final analysis because they were converted to an open procedure. The reasons for conversion were: bleeding (3), extensive adhesions (3), and hypercapnia (2). For the remainder, mean operative time was 97 minutes (range 45-156 minutes). Blood loss was minimal except in the 3 patients. A tension free vaginal tape (TVT) was performed also in 49% and hysterectomy in 4%. The mean hospital stay was 3.7 days (range 2-7 days).

Overall the postoperative complication rate was 15.5%. The following postoperative complications occurred: de novo urge incontinence (19); prolapse relapse (13); vaginal mesh erosion (3); mesh infection (2); urinary retention with TVT (2); port site hernia (1); intestinal obstruction (1); and spondylitis (1).

Mean follow-up was 14.6 months (range 6 months - 5 years). The cure rate at last physical exam was 96% with a 96% satisfaction rate. 6% complained of constipation, but this resolved within 6 months after surgery. There were no complaints of dyspareunia.

The authors conclude that their technique of laparoscopic sacral colpopexy using synthetic mesh is a highly effective and durable procedure to treat vaginal prolapse. They had excellent patient satisfaction. The procedure is safe with an acceptable complication rate similar to open prolapse repair procedures.

Eur Urol 2005;47: 230-236