Sacrocolpopexy in women over age 75 years old : is it possible?

Illiano E1, Natale F2, Trama F1, Marchesi A1, Costantini E1

Research Type


Abstract Category

Pelvic Organ Prolapse

Abstract 593
Infection and Pot Pourri
Scientific Podium Short Oral Session 38
Prolapse Symptoms Pelvic Organ Prolapse Surgery
1. Andrology and Urogyneoclogical Clinic,Santa Maria Terni Hospital,University of Perugia, 2. Urogyneoclogical Unit,San Carlo Nancy,Rome

Ester Illiano



Hypothesis / aims of study
Pelvic floor disorders are common among and disproportionately affect older women. There are limited data regarding functional and anatomic outcomes in older women undergoing laparoscopic sacrocolpopexy (LSC) 
The primary aim of this study was to evaluate the functional and anatomic outcomes after laparoscopic sacrocolpopexy in women over age 75 years old with symptomatic, advanced pelvic organ prolapse.The secondary aim was to evaluate the postoperative complication.
Study design, materials and methods
This was a prospective single centre study, on patients over age 75 years old with symptomatic POP stage >II in according to POP-Q system underwent LSC. Preoperative evaluation included: history, clinical examination, urodynamic testing, trans labial ultrasound. They completed Patients preoperatively completed self-administered Urinary Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire–Short Form (IIQ-7), for urinary symptoms, and Female Sexual Function Index Questionnaire (FSFI) for sexual dysfunction. All surgical procedures were performed by two senior surgeons. 
Anti incontinence surgery was not performed simultaneously. They were followed up at 1,3,6,12 months after surgery and then annually with the same preoperative protocol. Urodynamic testing was performed 6 months after surgery, and annually they performed uroflowmetry. At last visit they completed also PGI-I questionnaire Anatomic success was defined as prolapse stage<II for all compartments, point C≤5 and at least 7 cm for total vaginal length. Failure to correct normal support (stage 0 or I) was considered as persistence of prolapse and return to a higher stage following initial correction was considered a prolapse recurrence. The postoperative complications were classified in according to Clavien–Dindo classification.Statistic test: Nc Nemar and Chi test, p<0.05.
From January 2016 to January 2017, 20 consecutive women underwent LSC for symptomatic advanced pelvic organ prolapse sacrocolpopexy in our tertiary urogynaecological center. Age mean was 76.7±1.9,follow up median was 42.3 (36-48 months). Preoperatively, no patient was sexually active (table 1) and the FSFI was not completed, all underwent previous hysterectomy (12 abdominal hysterectomy and 8 vaginal hysterectomy).At last visit the cure rate of anterior compartment was 95.6%, 100% for central compartment and 94.3% for posterior compartment. No patients had recurrence in any compartments. One and two out of 20 patients (5% and 10%) had asymptomatic anterior and posterior persistence (stage II) respectively. None of these patients underwent reoperation. Six months after after surgery there was an improvement of all urodynamic parameters (Table 2); at last visit there was an improvement of maximum flow at uroflowmetry (p<0.0001).Detrusor underactivity persisted in 7 women after surgery, while the bladder outlet obstruction disappeared in all patients. The stress urinary incontinence persisted after LSC  in all patients (8 pts) and there were 2 de novo cases. The urgency urinary incontinence resolved in  8 women (40%), and there were 2 de novo cases. The voiding symptoms resolved in all patients, without de novo cases; storage symptoms disappeared in 10 women (55%) with 2 de novo cases OAB symptoms were treated with beta 3 agonist. Constipation persisted in all patients with 2 de novo cases. There was one case of vaginal mesh exposure, and it was treated conservatively.PGI-I score was high in all women, 95% of patients reporting that they are “very much better” or “much better” with the surgery. According to the Clavien Dindo Classification, in there were four cases of grade I complications (nausea, vomiting, fever).
Interpretation of results
Colposacropexy as well as in young women also in elderly women has good anatomical outcomes. The stress urinary incontinence persisted in all patients after surgery probably because the intrinsic sphincter deficiency was a condition quite severe in the elderly. The storage symptoms and urgency incontinence are influenced by aging and this could explain the de novo cases. The vaginal mesh exposure rate was low probably because they were all previously hysterectomized patients. The constipation did not improve in any patient, probably because they were severe cases, and in literature there is no evidence of an improvement of the outcomes after LSC
Concluding message
These results showed that the LSC remains the gold standard even in elderly patients with good anatomic and functional results and few complications, if performed by expert hands
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Funding None Clinical Trial No Subjects Human Ethics Committee CEAS UMBRIA Helsinki Yes Informed Consent Yes
06/07/2024 22:50:36