Long-Term Success of Synthetic Mesh in Pelvic Reconstructive Surgery
Drs. M. Murphy, M. Heit, G, Hammons, P. Culligan

University of Louisville Health Sciences Center

Louisville, Kentucky

Objective:   While there is a large body of literature regarding the durability of sacral colpopexy, never before has a validated prolapse measurement tool been utilized in the analyses.  Therefore, our aim was to determine the point in time at which an abdominal sacral colpopexy using synthetic mesh can be considered a long-term success using such a tool. 
Materials and Methods :  A retrospective chart review of all the patients who underwent sacral colpopexy with synthetic mesh at our institution was performed.  Data was collected longitudinally using the Pelvic Organ Prolapse Quantification (POP-Q) system both preoperatively and postoperatively at 6 weeks, 3 months, 12 months, 18 months, and yearly thereafter.  Preoperative and postoperative measurements were analyzed as a function of time using the Freidman test.  Objective failure was defined as stage 2 or greater by the POP-Q system.  Subjective failure was defined as the time at which patients noticed a recurrence of their vaginal bulge.  Long-term follow-up was considered to be greater than or equal to 18 months after surgery.  The data were analyzed to determine the time point at which symptomatic pelvic organ prolapse recurred in patients with surgical failure.
Results:   252 patients underwent sacral colpopexy using synthetic mesh.  To date, 62 (24.6%) of the patients have had long-term follow-up.  There were no statistically significant differences between the patients with and without long-term follow-up in terms of age, race, BMI, tobacco use, pre-operative stage, and prior prolapse or incontinence surgeries.  All POP-Q data points showed significant improvement from pre- to post-op examinations when graphed as a function of time (p<0.05).  There were 36 (14.3%) objective failures, 14 (5.5%) of which were also subjective failures.  Only 5 (14%) of our objective failures were identified after 12-month follow-up.  None of these patients had subjective failures. All subjective failures were identified by 12-month follow-up. 
Conclusions:   Based on our preliminary data, in the vast majority of cases, failure after sacral colpopexy using synthetic mesh occurs within 12 months.  Therefore, future randomized clinical trials of abdominal sacral colpopexy may be designed to detect differences in failure rates within a 12-month period.  Key Words:  sacral colpopexy, pelvic organ prolapse