SACROCOLPOPEXY - A RETROSPECTIVE STUDY OF A CLINICIAN EXPERIENCE

Objective To assess the factors that may predispose patients to the development of vaginal vault prolapse and enterocele, and to determine the success of sacrocolpopexy in correcting prolapse. Design A retrospective study of women with vault prolapse undergoing sacrocolpopexy over a 10 year period between 1983 and 1993, with analysis of postoperative complications and success. Setting St. George's Hospital in London, a university teaching hospital, and private practice. Subjects Forty-one women, presenting with symptomatic vault prolapse, who desired preservation of sexual function. Interventions Forty-one patients underwent 43 sacrocolpopexies. Of these, 39 were performed by the senior author. All but four were reviewed in the clinic within the last year. Main outcome measures Pre- and post-operative data and any interim prolapse or incontinence surgery were recorded. Success was assessed subjectively and by clinical examination for recurrence of prolapse, associated post-operative complications, subsequent voiding difficulties, and incidence of incontinence. Results Failure was defined as a symptomatic enterocele or evidence of a third degree enterocele on examination. The 41 patients were followed for a mean time of 21.2 months. The cure rate of vault prolapse was 88 %. The most common complications were stress incontinence, urinary tract infection, and persistent vaginal discharge. Using the unpaired t-test and chi(2) analysis, there was no significant difference between failures or successes in terms of weight, parity, age, previous surgery, pulmonary history, or difficulties with defaecation, although the number of patients studied was small. Conclusions Sacrocolpopexy is a successful operation for the correction of prolapse. Complications include the development of genuine stress incontinence, detrusor instability, voiding difficulty, and mesh infection.