Hypothesis / aims of study
Robotic sacral colpopexy (RSC) is rapidly emerging as a safe and effective approach for the treatment of advanced stage pelvic organ prolapse. The operation can be performed with either mesh or autologous fascia lata. The use of autologous fascia lata during RSC has previously been described as a safe option with rare apical prolapse recurrences and complications mainly related to fascia harvest including seroma, DVT [1,2]. Mesh is considered to be the gold standard option with low prolapse recurrence rates and complications mainly related to mesh erosion[3]. The hypothesis is that fascia lata will provide non-inferior prolapse outcomes with no risk of mesh erosion.
Study design, materials and methods
We performed a single-institution, institutional review board approved analysis of patients enrolled in a prospective non-randomized trial to undergo RSC from November 2017- December 2019. Patients were offered mesh or autologous fascia lata. No patients were excluded from the study. Patient data were extracted from medical records and patient surveys. Data analyzed included preoperative factors, operative timing, postoperative hospital stay, and complications, Pelvic Organ Prolapse Quantification (POP-Q) exam, and patient reported outcomes including Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). Failure was defined as POP-Q stage 2 or greater in any compartment.
Interpretation of results
There were significant improvements in patient-reported outcomes and POP-Q exams for both groups with a failure rate in the fascia lata group that was not significant as seen in Figure 1. The average operative time including harvest was longer for fascia lata. The complication rates associated with both methods were low, but differed in nature.