The objective of this retrospective review is to evaluate the efficacy and safety of laparoscopic colposacropexy using a Y-shaped, customizable polypropylene macroporous mesh fixed to the sacrum with a titanium Tacker device for the treatment of pelvic organ prolapse (POP).
The surgical technique involves fixing the polypropylene mesh to the levator ani muscles, uterosacral ligaments, anterior-posterior vaginal wall, and the promontory.
Laparotomic colposacropexy is considered the gold standard for vaginal prolapse correction.

This retrospective study includes patients who underwent laparoscopic colposacropexy using two Y-shaped meshes (30x15 cm) fixed to the sacrum with the ProTack™ device between 2010 and 2023, with a follow-up period of 2-15 years.

Data collected included parity, previous urogynecological surgeries, prior urinary incontinence, anatomical POP and its degree, pre-and post-surgical sexual function, intraoperative and early/late postoperative complications, objective and subjective cure rates, and postoperative urinary incontinence.

Since 2010, 94 laparoscopic colposacropexies were performed on patients with a mean age of 60.5 years (range 20-80). A total of 38.29% had previous urogynecological surgery (POP: 16, hysterectomy: 16, SUI: 5).
The mean number of vaginal deliveries was 2.3 (SD: 0.7).
Among the patients, 82.97% were sexually active, with 28.2% reporting preoperative dyspareunia.
The mean total FSFI score was 16.91 (SD: 2.5).
Preoperative SUI was present in 30.85%.
POP-Q ≥2 grade: 100% (POP-Q 3: 69 patients, POP-Q 4: 11 patients).
	Anterior POP: 89.36% (POP-Q>2 in 63.8%).
	Middle POP: 90.40% (POP-Q>2 in 59.57%).
	Posterior POP: 46.80% (POP-Q>2 in 11.7%).
Before surgery, 54 patients (57.44%) used a pessary (median size 70).
The mean duration of the surgery was 179.04 minutes (SD 39.2) with a mean hospital stay of 3 days (range 1-12).
	Intraoperative complications occurred in 9.57% of cases:
•	Vaginal perforation: 5 cases (5.31%)
•	Bladder perforation: 1 case (1.06%)
•	Rectal perforation: 1 case (1.06%)
•	Right common iliac injury: 1 case (1.06%)
All were repaired intraoperatively.
	Early postoperative complications occurred in 12.76%.
The median follow-up period was 94 months (range 24-180).

	Late postoperative complications occurred in 36.17%:
•	De novo SUI: 8.51% (8/94)
•	Persistent SUI: 10.63% (10/94)
•	Postoperative SUI surgery: 66.6% (12/18)
•	De novo UUI: 15.95% (15/94)
•	Symptomatic vaginal mesh erosion requiring mesh resection: 2.12% (2/94) according to ICS/IUGA classification 3BdT4S2
•	Constipation was reported in 12.76%.
•	Post-surgery, 71.27% remained sexually active with a mean FSFI score of 19.25 (SD: 3.5).
The mean objective POP cure rate at 2, 5, 10, and 15 years with POP-Q ≤1 was 90.42%.
Only 3 patients experienced anatomical (POP-Q>2) and symptomatic POP recurrence requiring additional surgical treatment (hysterectomy) after 5, 8, and 9 years of follow-up.
The mean Patient Global Impression of Improvement (PGI-I) score at 2, 5, 10, and 15 years was I or II in 94% of cases.
Percentages were adjusted for losses during follow-up.

Studies show that 80 to 90% of women having sacrocolpopexy are cured of their prolapse and prolapse symptoms. Following surgery, there is a small risk of prolapse developing in another part  of the vagina, such as the front wall that supports the bladder. If this does develop, it may require further surgery.

In our retrospective study only 3 patients experienced anatomical (POP-Q>2) and symptomatic POP recurrence requiring additional surgical treatment (hysterectomy) after 5, 8, and 9 years of follow-up.

Laparoscopic colposacropexy with polypropylene mesh is a safe, effective, and reproducible technique with excellent long-term anatomical and functional outcomes.