In recent years minimally invasive transperitoneal procedures of pelvic organ prolapse (POP) surgery are rising compared to traditional transvaginal techniques.  Although sacrocolpopexy (SC) is the most common approach, different techniques have showed similarly success. In this regard, lateral colposuspension (LCS) could be compared as alternative to SC for the treatment of anterior and apical vaginal POP.
Purpose of this study was to compare anatomical and functional outcomes of the two techniques.

A retrospective analysis involving two Italian centres was performed. Anatomical and functional outcomes of LCS (group A) versus SC (group B) were compared. Before the surgery, all patients underwent a medical interview, urogenital examination, urine analysis/ urine culture and invasive urodynamics.
Laparoscopic approach was used in group A, while laparoscopic or robot-assisted surgery was performed in group B.
After the surgery, patients were visited at 1, 3 and 6 months, then yearly. Outcomes included clinical staging of POP and stress urinary incontinence (SUI) classified by POP-Q system and Valsalva stress test, respectively. Recurrent (persistent and/or de novo) POP was defined significant if greater than stage I. Persistent or de novo constipation and overactive bladder (OAB) were defined as bowel symptoms and urinary urgency/frequency/nocturia/dysuria after surgery.

One-hundred and thirty eight women have been included in the study: 42 patients in group A, and 96 in group B. No preoperative differences in terms of anterior POP (p=0.88) in both groups, on the contrary apical and posterior POP were different (p=0.0008 and p<0.0001, respectively). SC showed overall better results in terms of recurrent (de novo/persistence) POP (overall p<0.0001, persistence p<0.0001, de novo p=0.022) although a higher rate of constipation was recorded (p=0.001). POP recurrence is more frequent in LCS for all types of POP, particularly at the apical level (p=0.0003). Nevertheless, the persistence/de novo rate of significant POP (POP-Q>1) was not different between the groups (p=0.07, p=0.46). No post-operative change in term of de novo/recurrence symptoms OAB or SUI was documented (p=0.5, p=0.9). Mean follow-ups of 10.47±4.52 months (1-24) of group A versus 33.6±28 months (range 3-113) of group B were statistically different (p>0.0001). Uni- and multi-variable cox-regression analysis and Kaplan-Meier survival curves revealed that SC had a more durable outcome over time than LCS, regardless of age, BMI, POP-Q, previous pelvic surgery, previous hysterectomy, and different follow-up numbers.

Even if LCS has the known advantage to treat successfully apical compartment with low rate of complications, this study shows that POP recurrence is more frequent in LCS for all types of POP, particularly at the apical level (p=0.0003). Although patients were different at the baseline, the integrated analysis pointed out that SC has a longer POP recurrence-free time than LCS.

SC has better long-term anatomical results compared to LCS which presents a higher POP recurrence rate for all types of POP, particularly at the apical level. However, LCS is a suitable option in case of difficult access to the retroperitoneum/sacrum bone and represents a fast and safe procedure with low risk of organ injury.

Continence 2S2 (2022) 100238
DOI: 10.1016/j.cont.2022.100238