In Japan, laparoscopic sacrocolpopexy (LSC) became covered by insurance in 2014. Many reports suggested its potential superiority in incidence of perioperative complications, disease recurrence and patient satisfaction compared with tension-free vaginal mesh (TVM) surgery. Therefore, the trend of treatment selection for pelvic organ prolapse (POP) has shifted from TVM surgery to LSC. However, there are few reports on lower urinary tract symptoms (LUTS) directly compared between TVM surgery and LSC. In this study, we compared TVM surgery and LSC concerning the LUTS before and after surgery in non-randomized prospective study.

From April 2014 to March 2017, we experienced a total of 40 surgical cases of POP (20 cases with TVM surgery and 20 cases with LSC) that were enrolled in this study, each with a postoperative observation period more than 1 year. The evaluated parameters included perioperative variables (age, degree of POP, Charlson comorbidity index, time of surgery and blood loss), before and postsurgical time course of international prostate symptom score (IPSS), IPSS- quality of life (QOL), maximum flow rate (Qmax) and postvoid residual urine volume (PVR). We obtained a written informed consent from all enrolled patient before surgery.

The age was significantly older in the TVM group (p < 0.05). When assessed with POP-Q system, the degree of POP showed no significant difference. When compared using Charlson comorbidity index, high risk significantly associated with patients in TVM group (p < 0.05). The operation time was significantly shorter in the TVM group (p < 0.05). The amount of bleeding was significantly larger in the TVM group (p < 0.05). With respect to lower urinary tract symptoms, both IPSS total score and QOL score were significantly improved in both groups at 6 months and 12 months after surgery (p < 0.05). At 12 months after surgery, we observed a significant improvement in the change of IPSS total score from the baseline in the LSC group compared to the TVM group (p < 0.05) (Fig. 1). A tendency of more improvement in change of the QOL score was observed in the LSC group compared to the TVM group at 6 months and 12 months after surgery (Fig. 2). Concerning IPSS sub score, improvement was observed in all items except for nocturia (p < 0.05) in both groups. In the TVM group, there was no significant Qmax improvement at 6 months and 12 months after surgery, however, the PVR was significantly improved (p < 0.05). On the other hand, in the LSC group, both Qmax and PVR were significantly improved (p < 0.05) in both 6 months and 12 months after surgery. Compared with the TVM group, change in the Qmax from the baseline was larger in the LSC group with significance (p < 0.05). There was no difference in the amount of change from PVR baseline in both groups. In both groups, no recurrence was observed at 1 year after surgery.

LSC had longer operation time than TVM surgery, suggesting the presence of a learning curve. LSC showed superior Improvements of LUTS than TVM surgery. One possible reason for this is that LSC requires no peeling of lateral vesical cavity compared to TVM surgery, resulting in low possibility of nerve damage.

The present study indicated superior improvements of LUTS of LSC compared to TVM surgery. Of course, the appropriate selection of both operations is important in surgical treatment for POP.