Purpose: For pelvic organ prolapse (POP) patients, voiding dysfunction is associated with the increasing severity of cystocele. After surgical correction of the prolapse, 89% patients had normalization of voiding dysfunction (Fitzgerald MP, 2000). Prolapse repair surgery plays an important role to resolve female lower urinary symptoms. Particularly, laparoscopic sacrocolpopexy (LSC) provides the outcomes of the gold standard abdominal approach while offering the benefits of minimally invasive surgery (Gabriel B, 2011). Since 2014, LSC became a new option for POP patients covered by public health insurance in Japan. The aim of this study is to clarify the postoperative anatomical change after LSC in Kameda Medical Center.
Materials and Methods: We did a retrospective medical chart review between April and December 2014 for patients who underwent LSC and being followed up for one year in our center. The anatomical change was assessed by using POP-Q. Recurrence rate and specific site were also investigated.
Results: A total of 146 patients, aged 65.1±7.8, with average BMI 23.4±2.8, were retrospectively enrolled. Average blood loss was 22.8±25.7ml with 238.5±45.3 minutes in operation time. For anatomical change assessed by POP-Q, Aa changed from 1.1±1.4 to −2.9±0.3; Ba changed from 2.5±2. to −2.9±0.4; C changed from 1.4±3 to −7.4±1.4;gh changed from 4.4±1.1 to 3.7±0.8; pb changed from 3.5±0.7 to 3.7±0.5; tvl changed from 8.1±1.1 to 8.6±1.2; Ap changed from 0±1.6 to −2.8±0.6; Bp changed from 0.6±2.4 to −2.7±0.7; D changed from −3.2±2.5 to −8.3±1.4. Aa, Ba, C, gh, tvl, Ap, Bp, and D of POP-Q showed significant differences between pre- and post-operation. 8 patients (5.5%) showed recurrence during first year after LSC. 2 patents were found to have recurrent anterior vaginal wall prolapse while 7 patients had recurrent posterior wall prolapse. However, using PFDI-20 to assess the feeling of a bulge for recurrent patients, no one felt a bulge in the vaginal area.
Conclusion: POP patients receiving LSC showed significant improvement in anatomical outcome. Rate of recurrence in first year after LSC was about 5%.