Doctor Rich:
Welcome back to the Doctor Rich channel. It’s been a while since we’ve talked about sacrocolpopexy, and subscriber Franca Difalco had a question. So today, we’re going to review her question, talk about what a sacrocolpopexy is, what the success rate is, and how or when it might recur. And stick around to the end to find out what you need to know before deciding to have the sacrocolpopexy procedure.
Don’t have time to read this post? Watch the video here instead!
Here’s a great question from subscriber Franca: “What is the success rate and does it ever have to be done again?” Can prolapse recur?
First off, if you haven’t seen our prior video on sacrocolpopexy, please check that out now. It’s where we discuss, in depth, the procedure.
As a brief refresher, women can have what’s called pelvic organ prolapse — where they might feel pressure or a bulge coming out of the vagina. Sacrocolpopexy is a surgery that repairs that and lifts or suspends the bladder and the top of the vagina. The surgery involves the use of a surgical robot, and we placed an abdominal mesh to suspend the top of the vagina. Now, this is the good mesh, and if you haven’t seen our video on mesh, make sure you check that one out here.
So how successful is this surgery?
It’s very successful.
It’s considered to be the gold standard with success rates as high as 95%.
So when would you need to have surgery again? Well, for a very busy surgeon like myself, if you do a hundred surgeries in a year, after four or five years… you would expect to see four or five recurrences per year.
So let’s talk about when, and why, and how this happens. So in my experience, here are the three most common reasons that prolapse can recur (although rarely) with the sacral colpopexy procedure:
- The mesh that’s actually suspending can break.
- The suspension involves lifting the bladder, the top of the vagina and the rectum — but those organs can actually slide behind the area that’s being suspended.
- The mesh itself can pull free of the vagina, resulting in the prolapse coming down again.
So what do we do when the sacrocolpopexy fails? Well, in most circumstances, we can do a revision which will involve placing a new mesh on top of the old one or fixing the gap in the area of weakness that occurred (that allowed for the prolapse to come back down).
In some circumstances, a prolapse can recur at a different site that wasn’t initially covered by the sacrocolpopexy repair. For example, something called a rectocele that is lower than the level of the suspension from the original repair — and then a different approach entirely can be done with a vaginal sacrospinous fixation. So what in the world is a sacrospinous fixation? Stay tuned for our next video to find out!
As promised, what do you need to consider if you’re thinking about sacrocolpopexy as the answer to your prolapse problem?
Well, here are three things that you need to ask your provider:
- How many do they do? It doesn’t have to be a hundred a year, but it should be a major part of their practice!
- Are they a board certified subspecialist in urogynecology?
- What is their recurrence rate, and where do they get their referrals? If all the other doctors in town are sending to them — there’s a good chance that they’re an expert in that field!
They don’t have to have all of those things, but a combination of those is going to give you the best ability to advocate for yourself to find an expert that’s going to be right for you.
Thank you, Franca DiFalco, for sparking this meaningful and important conversation. And for the rest of you… be like Franca DiFalco and hit the subscribe button now!
