Background: Repeat sacrocolpopexy (reSCP) for recurrent pelvic organ prolapse (POP) is a rare and complex condition with little understanding of how to manage. Most authors recommend complete reSCP regardless of the underlying cause of the failure. This retrospective cohort study presents our management workflow and how to systematically approach this challenging situation. Methods: From 2017 to 2021, we analyzed all women undergoing surgery for recurrent POP after sacrocolpopexy at our tertiary referral hospital at the department of urogynecology. Preoperatively, all women underwent a structured work-up consisting of answering the validated German female pelvic floor questionnaires, a clinical examination utilizing the POP-Q staging system according to the International Continence Society (ICS), and a pelvic floor ultrasound. The surgical management was based on the preoperative findings and was adapted individually during surgery if indicated according to the estimated underlying problem for recurrence. Results: In total, 377 women underwent a primary laparoscopic sacrocolpopexy. However, ten women presented with a symptomatic recurrent prolapse requiring further surgical intervention. A reSCP was performed in eight women, including two with additional laparoscopic paravaginal repair to correct the displaced mesh placement at initial surgery. A vaginal correction was indicated in two women with an isolated posterior compartment prolapse. The analysis demonstrates that reSCP has a low intraoperative complication rate and high subjective and objective success rates. Conclusions: We could demonstrate that individualized reSCP after initial SCP is a challenging yet feasible and safe treatment option, but there may be suitable alternatives. If women undergo pre- and intraoperative standardized problem-oriented examinations, we can often identify the cause of the recurrent prolapse. Tailored surgery must be subsequently performed.

Background/Objectives: Laparoscopic sacrocolpopexy is regarded as the gold standard treatment for apical or multicompartment prolapse, predominantly with anterior compartment descent. However, the optimal surgical approach for concurrent rectocele is still debated. The aim of this study was to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥stage II), analyzing the anatomical outcomes, the necessity for concomitant or subsequent posterior repair, and the impact on bowel function in women undergoing surgery. Methods: Data from all women who underwent laparoscopic sacrocolpopexy with or without posterior repair between 01/2017 and 07/2022 for symptomatic multicompartment prolapse, including apical and posterior compartment descent ≥ stage II, were retrospectively evaluated. All women underwent a standardized urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system, and completed the German-validated Australian Pelvic Floor Questionnaire before and after surgery (6–12 weeks). Preoperative anatomic support and bowel symptoms were compared with postoperative values. Results: In total, 112 women met the criteria for surgical correction. The majority (87%) had stage II posterior descent, with only 10% undergoing concurrent posterior repair during laparoscopic sacrocolpopexy. Significant (p < 0.001) objective improvement was seen for all compartments post- compared with preoperatively (Ba: 0 (−1/2) vs. −3 (−3/−2), C: −1 (−2/0) vs. −8 (−12/−7), Bp: 0 (−1/0) vs. −3 (−2/−2); (median (25%/75% quartiles)). Subsequent surgery for persistent rectocele and/or stool outlet symptoms was required in 4% of cases. Most bowel-specific questions in the German-validated Australian Pelvic Floor Questionnaire showed significant improvement (p < 0.001). Conclusions: Nerve-sparing sacrocolpopexy alone appears to be a suitable surgical approach to correct multicompartment prolapse, including a rectocele ≥ stage II, and results in a reduction of objective signs and symptoms of pelvic organ prolapse.

Purpose: Teaching is an important but time- and resource-consuming process. Therefore, it is important to optimize and structure it effectively. The aim of this study was to evaluate if dry-lab suture and knotting training lead to stable theater performance. Consequently, the learning curve is supposed to be ascribed to only on-patient trainable skills like tissue preparation. Patients and Methods: To test this hypothesis, a structured training and stepwise surgical program were implemented to perform laparoscopic sacrocolpopexy (SCP) for urogynecological fellows adapting existing literature. The program was structured and recorded as following: dry-lab training weekly for knotting and suturing skills, assisting 20 SCP, stepwise overtaking defined steps under supervision including preparation of the dissecting planes anteriorly, posteriorly and at the level of the promontory, mesh fixation and retroperitoneal closure. All women opting for sacrocolpopexy as pelvic organ prolapse repair and being treated by one designated fellow were included without any specific selection. The only exclusion criterium was repeat sacrocolpopexy. Results: Within 45 procedures, the fellow reached a plateau of 80 minutes surgical time for SCP (excluding port-entry/-closure or concomitant interventions like hysterectomy or adnexectomy), with a complication rate of 11.1%. A high subjective and objective success rate was reported post-operatively. Differences in overall time were clearly correlated with overall dissection time. Conclusion: We demonstrated that a stepwise, structured, and standardized intraoperative surgical program facilitated safe and efficient laparoscopic SCP performance in the analyzed situation. Off-patient trainable skills like suturing and knotting led to consistent mesh fixation times from the start of the qualification process and variation arose due to in situ learnable factors.

In this prospective follow-up longitudinal study, we investigated the long-term impact of laparoscopic sacrocolpopexy (SCP) on voiding dysfunction present prior to surgery in women with symptomatic pelvic organ prolapse (POP). Women from a previously published study who underwent SCP for symptomatic POP with objective and/or subjective voiding dysfunction between 01/2019 and 08/2021 were contacted and invited to attend an additional long-term follow-up visit for a clinical re-evaluation identical to the preoperative and postoperative visit (6-12 weeks). The postoperative outcome was assessed using uroflowmetry, the POP-Q quantification system and the validated German version of the Australian Pelvic Floor Questionnaire. Forty-nine of the 84 women seen at the mid-term follow-up returned for a long-term visit, with a mean follow-up period of 20.3 ± 6.5 months. A significant (p < 0.001) objective improvement in POP correction was seen (for Ba, C and Bp) at the long-term visit. A significant (p < 0.001) overall decrease in median postvoid residual volume was achieved (preoperative: 90 ml, mid-term: 10 ml, long-term: 15 ml). Furthermore, the maximal flow rate significantly (p = 0.003) increased and there was a decrease in voiding time (p = 0.048), with no significant difference found between mid- and long-term assessments. Similarly, subjective parameters improved significantly, concerning prolonged urine stream, sensation of incomplete bladder emptying and straining to void (all p values < 0.001). In the same way, a significant improvement was observed in subjective reports regarding overactive bladder symptoms and POP complaints (all p values < 0.001), with no change between mid- and long-term analysis, while no change was noted in dyspareunia over time. Laparoscopic SCP performed for symptomatic POP provides durable anatomical correction and is associated with significant mid- and long-term improvements in both objective voiding function and patient-reported symptoms.