Redo sacrocolpopexy for recurrent pelvic organ prolapse: an international cohort study.
TL;DR
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 and anchoring to a previously implanted mesh represents a feasible technical alternative when access to the sacral promontory is limited.
Abstract
Objective
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.
Materials And Methods
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).
Results
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.
Conclusions
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.