To compare different sacrocolpo(hystero)pexy (SC) methods in terms of success, complications, and perioperative outcomes.

This retrospective study was conducted in accordance with the ethical standards of the 1964 Declaration of Helsinki and its subsequent amendments and was approved by the local ethics committee (No: I02-190-25). Data from 303 patients with Baden–Walker grade 3 or 4 apical prolapse treated at five tertiary hospitals were assessed. Of these, 228 patients who underwent ASC, RSC, or LSC and had sufficient follow-up data were included in the study. Failure criteria following surgical repair encompassed the presence of Baden-Walker grade 2 or higher prolapse, the necessity for reoperation or pessary placement, and persistant bulge symptoms. Postoperative comlications were assessed using the Clavien-Dindo Classification system.

The normality of continuous variables was assessed using the Shapiro-Wilk test. Normally distributed variables were expressed as mean ± SD and compared using one-way ANOVA; non-normally distributed variables were presented as median (IQR) and analyzed with the Kruskal–Wallis test. Significant results were followed by appropriate post hoc tests (Tukey or Dunn with Bonferroni). Welch ANOVA and Games–Howell were used when variance homogeneity was violated. Categorical variables were reported as number (%) and compared using chi-square or Fisher’s exact test. A p-value <0.05 was considered significant.

A total of 228 patients who underwent abdominal sacrocolpo(hystero)pexy (ASC, n=96), robotic sacrocolpo(hystero)pexy (RSC, n=81), or laparoscopic sacrocolpo(hystero)pexy (LSC, n=51) were included. A statistically significant difference was found among the groups regarding age and BMI(p<0.05). The preoperative variables of ASA-score, comorbidities, smoking status, parity, symptom duration did not differ significantly between the groups (p>0.05).

Concurrent stress urinary incontinence was more frequent in the ASC group (49%) compared to RSC (28.7%) and LSC (33.3%) (p=0.016). Concurrent mid-urethral sling procedures were performed more often in minimally invasive groups (p=0.04). Concurrent hysterectomy rates differed significantly, being highest in the LSC group (62.7%) (p<0.001).

Median operative time differed significantly among groups, being longest in ASC (150 min), followed by RSC (120 min) and LSC (90 min) (p<0.001). Similarly, hospital stay was significantly longer in the ASC group (4 days) compared to RSC (3 days) and LSC (2 days) (p=0.003). Median follow-up duration was comparable across groups (approximately 12 months). Overall success rates were high and similar among groups (91.7% ASC, 92.6% RSC, 88.2% LSC; p=0.676). Regarding complications, de-novo incontinence rates were low and did not differ significantly. Rates of Clavien–Dindo grade 1–3 complications were low and comparable between groups. Grade 4-5 complications were not seen. However, estimated blood loss was significantly lower in the LSC group (50 ml) compared to ASC (130 ml) and RSC(120 ml)(p<0.001).

This study shows the real-world data regarding apical prolapse treatment. The success rates of ASC, RSC and LSC for the surgical management of POP are comperable. The selection of procedure must take into account complication rates, duration of the operation and hospital stay, blood loss, de-novo incontinence, and the surgeon's expertise. Minimally invasive treatments, such as RSC and LSC, provide benefits for surgical duration, length of hospital stay, and estimated blood loss.

ASC is considered the gold standard method for apical prolapse repair, and, its high success rate and long-term durability have been demonstrated in various studies. Nevertheless, due to the extended duration of operation and hospitalization, and higher complication rates, RSC and LSC techniques have emerged to overcome this issues. Currently, ASC is an efficient method for apical prolapse; however, if RSC and LSC are accessible, these procedures should be prioritized.