Causes of Failure of Abdominal Colposacropexy for the Treatment of Genital and Vaginal Vault Prolapse

The goal of this study was to assess factors associated with the failure of abdominal colposacropexy. Between 1986 and 1997, 217 colposacropexies were performed (mean patient age 49.9 years ± 11.2; average follow-up 5.5 years, range 1-136 months). Synthetic mesh placement consisted of 182 anterior and posterior attachments, 9 anterior only and 26 posterior only. One hundred ninety-six procedures were performed using Mersilene as the graft material, 18 with Gore-Tex, and 3 with absorbable material. A total of 179 posterior colporraphies and 208 culdoplasties (Moschowitz's procedure) were performed. The anatomical and functional results for prolapse showed a treatment success rate of 97.7% (212/217). Fifty-eight percent (125/217) of the patients were totally continent in the long term (no postoperative incontinence). Eight-two percent (178/217) of patients were classified as having been successfully treated and/or having improved condition following the surgical procedure (postoperative incontinence was less important than preoperative incontinence). The incidence of recurrent prolapse was 1.1% (2/179) and 7.9% (3/38) for colposacropexy with or without posterior colporraphy, respectively (p = 0.009, odds ratio [OR] = 0.14, confidence interval [CI] = 0.02-0.86). The incidence of recurrent prolapse for colposacropexy with or without culdoplasty was 1.9% (4/208) and 11.1% (1/9), respectively (p = 0.04, OR = 0.17, CI = 0.02-1.58). The recurrence of urinary stress incontinence was 44.4% (4/9) in cases where the anterior mesh alone was attached and 15.4% (28/182) for cases of both anterior and posterior mesh attachment (p = 0.03, OR = 0.34, CI = 0.12-0.97). Rejected grafts were 16.7% (3/18) in Gore-Tex mesh and 1.1% in Mersilene mesh (p = 0.004). These results confirm that performing the full surgical procedure significantly reduces the risk of recurrence of vaginal vault prolapse and urinary stress incontinence.