Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition.

OBJECTIVE: To assess the sacrocolpopexy with mesh interposition in women with pelvic organ prolapse.

DESIGN: A prospective study.

SETTING: Tertiary referral urogynaecology and pelvic floor reconstruction unit.

POPULATION: Twenty-nine consecutive women with symptomatic vault prolapse and rectocele.

MAIN OUTCOME MEASURES: Subjective and objective success rates and complications.

RESULTS: The mean age was 57 years. The mean number of past prolapse operations was 2.6 which included two past sacrospinous ligament fixations and 17 past posterior repairs. The mean follow up was 14 months. There was an increase in constipation from 41% to 50%, a decrease in faecal soiling from 21% to 10%, and an increase in incomplete defecation from 24% to 36% . Dyspareunia decreased from 38% to 17%, and there was some improvement in the stress and urge incontinence. There was a significant reduction of vault prolapse and rectocele (P < 0.001). All women with Stage II and Stage III vault prolapse were corrected, with an increase in Stage I prolapse from 20% to 27%. All women with Stage II and Stage III rectocele were corrected with a decrease in Stage I prolapse from 36% to 7% . The only significant interoperative complication was a cystotomy. One mesh became infected post-operatively which required removal.

CONCLUSIONS: Sacrocolpopexy and mesh interposition is a safe and reliable operation for the correction of vault prolapse and rectocele. A long term follow up is necessary to detect any late complications.