Sacrocolpopexy (SCP) is the gold standard for apical pelvic organ prolapse (POP), yet recurrence remains a clinical challenge requiring reoperation. When redo SCP is performed, direct access to the sacral promontory may be limited by dense adhesions from prior surgery. This study aimed to evaluate the safety and efficacy of redo SCP for recurrent POP following failed primary SCP, and to assess whether anchoring the new mesh to a previously implanted, well-integrated SCP prosthesis represents a feasible and effective alternative to standard fixation

This retrospective, observational, multicenter cohort study was conducted at two high-volume European urogynecological referral centers: the University Hospital Centre of Lille (France) and the Isola Tiberina-Gemelli Isola Hospital in Rome (Italy). Women aged >=18 years with symptomatic recurrent apical and/or anterior and/or posterior POP (POP-Q stage >=2) who had previously undergone abdominal, laparoscopic, or robotic SCP and subsequently underwent redo SCP between January 2020 and January 2025 were included. Patients were stratified into two groups based on the site of mesh suspension during redo surgery: fixation to the prevertebral ligament (Group 1) versus anchoring to the previously implanted mesh firmly adherent to the sacral promontory (Group 2). The redo SCP was performed laparoscopically or robotically following standardized anatomical principles. Primary outcomes included anatomical cure (POP-Q stage <2 in all compartments), intraoperative and postoperative complications (Clavien-Dindo classification), and subjective outcomes

A total of 43 women were included: 18 in Group 1 (prevertebral fixation) and 25 in Group 2 (previous mesh fixation). Baseline characteristics were comparable between groups, except for a higher rate of prior posterior mesh placement in Group 1 (88.9% vs 60.0%; p=0.04) and more advanced preoperative anterior and apical POP stages (p<0.05). Significant intraoperative differences included a higher rate of subtotal hysterectomy (64.0% vs 22.2%; p=0.007) and robotic approach (60.0% vs 11.1%; p=0.002) in Group 2. Conversion to laparotomy occurred in one case per group due to inaccessible promontory. No significant differences in anatomical outcomes, bulge symptoms, urinary symptoms, or constipation were observed between groups, although a non-significant trend toward higher anatomical recurrence was noted in Group 2. Only one minor postoperative complication was recorded (transient anterior thigh hypoesthesia; Clavien-Dindo grade I). No mesh-related complications were identified. Approximately 90% of patients (38/43) reported being much improved or very much improved on PGI-I. Two women in Group 2 required reoperation via vaginal sacrospinous ligament fixation. On univariate logistic regression, younger age was the only variable significantly associated with anatomical recurrence (OR 0.91, 95% CI 0.84-0.99; p=0.03)

Redo SCP demonstrated an excellent safety profile and high patient satisfaction regardless of the anchoring technique employed. Both fixation to the prevertebral ligament and to a previously integrated SCP mesh yielded comparable anatomical and functional outcomes, with no statistically significant differences. The non-significant trend toward higher recurrence with prior mesh fixation warrants validation in larger prospective cohorts. The identification of younger age as the sole independent risk factor for anatomical recurrence is consistent with existing literature, likely reflecting greater physical activity, higher tissue demands, and longer exposure to recurrence risk over time. The early mean recurrence time of 4.7 months suggests that technical factors and individual patient risk profiles may play a primary role in early failures.

Redo SCP is a safe and effective surgical option for recurrent POP after primary SCP failure, with high patient satisfaction and a low complication rate. When direct access to the sacral promontory is technically challenging or unsafe, anchoring to a previously implanted, well-integrated mesh represents a viable and comparable alternative to prevertebral ligament fixation. These findings support the broader adoption of redo SCP. Larger prospective randomized studies with extended follow-up are needed

Continence 19S (2026) 102795
DOI: 10.1016/j.cont.2026.102795