Infracoccygeal sacropexy using mesh to repair uterine prolapse

In a systematic review of surgery using mesh for uterine or vaginal vault prolapse in 7,054 patients (which included 976 patients who had infracoccygeal sacropexy), the results after a median follow‑up of 13 months were as follows: prolapse recurrence rate 5% (range 0 to 25%, n=402), rate of patient-reported persistent symptoms 9% (range 2 to 21%, n=262), and reoperation rate 8% (range 0 to 30%, n=288). For uterine prolapse only, prolapse recurrence rates were 1% (1/79 of patients, 1 non-randomised comparative study) and 10% (1/10 of patients, 1 case series). In a systematic review of 3,093 patients with uterine prolapse (which included 143 patients who had infracoccygeal sacropexy), the reoperation rate for prolapse recurrence was 3% within 6 to 30 months after the procedure.

In a randomised controlled trial (RCT) of 49 patients with uterine or vaginal vault prolapse who had infracoccygeal sacropexy or sacrospinous suspension, postoperative rates of stress urinary incontinence or urgency and quality-of-life scores were not statistically significantly different between the treatment groups after a mean follow‑up of 17 months. The only statistically significant difference was for the Pelvic Organ Prolapse Distress Inventory score, which improved by 50% or more in 75% of patients who had infracoccygeal sacropexy compared with 65% for sacrospinous suspension (p=0.02).

In the systematic review of 3,093 patients, the anatomical cure rates for apical support ranged from 90% to 97%.

In the RCT of 49 patients who had infracoccygeal sacropexy or sacrospinous suspension, 86% and 79% of patients respectively were satisfied or very satisfied after the procedure.

The specialist advisers listed the key efficacy outcomes as: patient satisfaction and comfort, quality of life, change in urinary, bowel and sexual function, objective prolapse assessment and long-term prolapse recurrence risk.