There were 698 participants that had POPQ stage 3-4 prolapse pre-operatively (401 uterovaginal prolapse, 297 vaginal vault prolapse). In those with POPQ stage 3-4 prolapse, 3 statistically distinct prolapse clusters (subsequently referred to as prolapse phenotype) were identified by POPQ points in those who had uterovaginal prolapse and 3 distinct clusters in those who had vaginal vault prolapse (Figure 1). In women with uterovaginal prolapse (UVP), there was a statistically significant difference only in ethnicity, pre-operative POPQ stage and OR time by anatomic phenotype (Table 1). In women with vaginal vault prolapse there were no statistically significant differences in bio demographical variables except for pre-operative POPQ stage.
For women with UVP, pre-operative prolapse phenotype was predictive of surgical outcome by minimally invasive sacrocolpopexy. Phenotype 1 is anterior vaginal wall-predominant with the apex near the introitus, Phenotype 2 is anterior wall-predominant with some preserved apical and posterior vaginal wall support, and Phenotype 3 is apical-predominant with loss of both anterior and posterior vaginal wall support (Figure 1). Post-operatively, participants with prolapse phenotype 1 (cluster 1) were more likely to have POPQ stage ≤1 support (95.7%, aOR=1) compared with phenotype 2 (86.7%, aOR=0.29, 0.09-0.89, p=0.02) and phenotype 3 (83.9%, aOR=0.23, 0.06-0.78, p=0.02). By “ideal” surgical outcome, participants with POPQ stage 0-1 support post operatively had, on average, ~1cm better support at points Aa and Ba (-2.50 vs -1.53, and -2.49 vs -1.50, respectively, p<0.001), >0.5cm better support at points Ap and Bp (-2.65 vs -2.15, and -2.65 vs -1.97, respectively, p<0.001), a GH ~1cm smaller (2.86 vs 3.70, p<0.001), and were 7.0-fold more likely to have had a midurethral sling (RR=6.97, p=0.01) compared to those with stage ≥2 support (worse support). There was not a statistically significant difference between postoperative point C or TVL between phenotypes but there was a statistically significant difference between the delta of the POPQ point pre-C to post-C for phenotypes 1 vs 2 vs 3 (-8.17 vs -6.84 vs -13.55cm, respectively, p<0.001). Perineorrhaphy rates were very low and were not significant between outcome groups. For women with prior hysterectomy, anatomic phenotype was not predictive of outcome after minimally invasive sacrocolpopexy.