Abdominal Mesh Colpopexy Without Promontory Fixation: 10-Year Follow-up Results of the Peritoneocolpopexy Technique

• Published in: Urology (Ridgewood, N.J.) N.J.), 2024-11, Vol.193, p.73-76
• Main Authors: Papp, Sara B., Christie, Alana L., Lee, Dominic, Zimmern, Philippe E.
• Format: Article
• Language: English
• Subjects: Aged; Female; Follow-Up Studies; Gynecologic Surgical Procedures - methods; Humans; Middle Aged; Pelvic Organ Prolapse - surgery; Prospective Studies; Surgical Mesh - adverse effects; Surveys and Questionnaires; Time Factors; Treatment Outcome; Vagina - surgery
• ISSN: 0090-4295; 1527-9995; 1527-9995
• DOI: 10.1016/j.urology.2024.08.065

To restore apical vaginal prolapse support when the access to the promontory is challenging, a modified method of colpopexy may be needed. We present our 10-year results on the peritoneocolpopexy (PCP) technique without promontory fixation relying on unidirectional barbed delayed absorbable sutures (V-Loc). Fourteen women who underwent PCP for vaginal vault prolapse between 2011 and 2014 participated in an IRB-approved prospective study (11 noninfected; 3 with infected mesh needing excision). Ten-year follow-up data including validated questionnaires (Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), QoL), pelvic organ prolapse quantifications (POP-Q), complications, reoperations, and secondary prolapses were collected. Paired statistical analyses compared various timepoints and mixed model analysis assessed questionnaire and POP-Q trends over time. Median follow-up was 9.7years (interquartile range (IQR): 6.0-0.7) to last POP-Q and 10.4years (IQR: 9.6-11.5) to last contact. No patients were lost to follow-up. Mean baseline C point for all patients was −4.3 and −2.9; 1-year C point was −9.1 and −9.2 and −8.6 and −8.5, respectively at last visit. POP-Q findings improved between pre-PCP and 1-year post surgery and did not significantly change until the last visit. Trends in UDI-6, IIQ-7, QoL, and POP-Q findings showed no significant change in any category per year (95% confidence interval (CI), P=.2-.9). Secondary anterior compartment prolapse was noted in 3 patients with 1 requiring a repair. PCP provides durable vaginal apical support when access to the promontory is compromised. PCP can also be used to prevent secondary prolapse after an infected mesh removal.