Purpose This study aimed to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥ stage II). It sought to determine if additional posterior repair was necessary for successful support of the posterior compartment and to evaluate 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 urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system and completed the validated German Female Pelvic Floor questionnaire pre- and postoperatively (6-12 weeks). Preoperative anatomic support and bowel symptoms were compared to 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 to 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 Female Pelvic Floor Questionnaire showed significant improvement (p<0.001). Conclusion Nerve-sparing sacrocolopopexy alone seems to be a suitable surgical approach correcting multicompartment prolapse, including a rectocele ≥ stage II and results in a reduction of objective signs and symptoms of pelvic organ prolapse.

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.