Urinary Functional Outcomes and Prolapse Recurrence After Laparoscopic Sacrocolpopexy: A 400-Patient Single-Centre Study.

INTRODUCTION AND HYPOTHESIS: Laparoscopic sacrocolpopexy (LSC) is the reference surgical treatment for pelvic organ prolapse (POP), providing durable anatomical correction with a favourable safety profile. However, postoperative urinary symptom evolution remains incompletely characterized. We aimed to evaluate the surgical and functional outcomes of LSC and identify factors associated with postoperative urinary symptoms. METHODS: This retrospective observational study included 400 consecutive women who underwent LSC for POP between 2011 and 2025. In accordance with our institutional staged continence-management strategy, no concomitant anti-incontinence procedures were performed. Surgical complications, prolapse recurrence, and urinary outcomes were evaluated. Persistent, resolved, and de novo stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) were assessed. Univariable logistic regression identified factors associated with postoperative urinary symptoms and prolapse recurrence. RESULTS: Median follow-up was 30 months (interquartile range [IQR] 15-48). Intraoperative complications occurred in 7.8% of patients, mainly bladder (3.5%) and vaginal (2.0%) injuries. Overall prolapse recurrence was 7.8%. Preoperative SUI and UUI were present in 38% and 41% of patients, respectively. UUI prevalence decreased to approximately 15% postoperatively, whereas SUI remained close to 29%. Persistent SUI and UUI occurred in 38% and 23% of symptomatic patients, while de novo SUI and UUI developed in 23% and 9%, respectively. Preoperative urinary symptoms were the only significant predictors of postoperative urinary symptoms. CONCLUSIONS: LSC performed without concomitant anti-incontinence surgery was associated with favourable urinary outcomes, particularly for urgency symptoms. Preoperative urinary symptoms were the strongest predictors of postoperative urinary outcomes, emphasizing the importance of comprehensive preoperative assessment and individualized patient counselling.