Preventive posterior mesh placement during laparoscopic double sacrocolpopexy for anterior urogenital prolapse: anatomical and functional outcomes from a 20-year single center experience.

Fiche publication

Date publication

juillet 2026

Journal

The French journal of urology

Auteurs

Membres identifiés du Cancéropôle Est :
Pr LANG Hervé , Dr TRICARD Thibault

Tous les auteurs :
Maillard C, Tricard T, Lang H, Saussine C

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/42471124

Résumé

Introduction - Genital prolapse is a common and disabling functional condition in women, affecting nearly one-third of women over 70 years of age in France. This descriptive study reviews the systematic use of laparoscopic double sacrocolpopexy (LDS) in our center, assessing its anatomical and functional benefits in the management of anterior or apical prolapse to prevent secondary rectocele. Materials and Methods - This retrospective, descriptive, single-center French study included 41 patients who underwent LDS between 2000 and 2019, with at least 5 years of follow-up. Patients were reassessed using a structured interview, self-administered questionnaires (MHU, PFIQ-7, I-QOL, UDI-6, USP) and a gynecological examination. The primary objective was the anatomical outcome of the posterior compartment after LDS with preventive pre-rectal mesh placement. Secondary objectives were the functional impact on overall and specific (urinary and digestive) quality of life, the anatomical outcomes of the anterior and middle compartments, and peri- and postoperative complications (Clavien-Dindo classification). Results - With an average follow-up of 11.2 years, the anatomical success rate (absence of rectocele stage > 2 according to Baden-Walker) reached 98% (40/41). At reassessment, 71% of the cohort (29/41) had no rectocele. Among the 12 patients with postoperative rectocele (29% with follow-up > 5 years), the vast majority had BW stage 1 rectocele (11/12). Furthermore, none of these patients required reintervention for rectocele following LDS (12/12), and no posterior colporrhaphy was performed. Functionally, urinary and digestive disorders were uncommon, as reflected by promising quality-of-life scores: MHU (2.75/28), I-QOL (104/110), PFIQ-7 (11/300), UDI-6 (2.6/18) and USP (1.2/9 ; 1.8/21 ; 0.7/9). In the long-term (follow-up > 5 years), 9% (4/41) had persistent anorectal discomfort, compared with 39% (16/41) in the early postoperative period (< 3 months), suggesting that persistent ano-rectal discomfort improves over time after surgery. Finally, no severe complications (Clavien-Dindo ≥ 3) were observed during follow-up. Regarding the anterior compartment, 65% (27/41) had grade 1 cystocele and 25% (10/41) had grade 2 according to Baden-Walker (BW). Overall, 85% reported satisfaction with the procedure, particularly regarding the correction of their initial urogenital prolapse and the resolution of pelvic heaviness. Conclusion - Our study shows that laparoscopic double sacrocolpopexy (LDS) achieves high anatomical success rates following preventive posterior mesh placement in patients with anterior urogenital prolapse. In our study population, this technique is associated with a very low incidence of rectocele and resulted in minimal long-term functional sequelae, with limited impact on both overall quality of life and urinary and digestive function. Nevertheless, the lack of a control group limits the interpretation of these findings and does not allow any conclusion to be drawn regarding the preventive effect of posterior mesh placement on rectocele development. Category : Urology.