Pelvic Organ Prolapse with Concomitant Short Total Vaginal Length and Outcomes of Laparoscopic Mesh Sacrocolpopexy.

INTRODUCTION AND HYPOTHESIS: Total vaginal length (TVL) is an important parameter in pelvic organ prolapse (POP) assessment and is significantly associated with POP symptoms. Short TVL (STVL) has been associated with pessary failure and dyspareunia. There is no consensus regarding optimal management of patients with STVL and symptomatic POP. This study was aimed at comparing patient-reported and clinical urogynecological outcomes following laparoscopic sacrocolpopexy (LSC) in patients with short versus normal TVL. METHODS: This retrospective cohort study was conducted in a tertiary urogynecology center. Patients with a history of total hysterectomy who underwent LSC for symptomatic POP between January 2015 and January 2023 were included. Patients were grouped according to preoperative TVL into STVL and normal TVL (NTVL) cohorts, using cut-off values of ≤ 6 cm and ≥ 8 cm respectively. Clinical, patient-reported, and imaging outcomes were assessed preoperatively and 12 months postoperatively. RESULTS: A total of 166 patients were included, with 89 (53.6%) in the STVL group and 77 (46.6%) in the NTVL group. Postoperatively, TVL significantly increased in the STVL group compared with the NTVL group (2.3 ± 0.9 vs - 0.2 ± 0.8; p < 0.0001). The proportions of patients reporting the highest satisfaction (Patient Global Impression of Improvement ≤ 2) in the groups were comparable (97.5% vs 94.0%; p = 0.279). No significant differences between groups were observed in postoperative quality-of-life improvement measured by the Pelvic Floor Distress Inventory and the International Consultation on Incontinence Questionnaire-Urinary incontinence Short Form. CONCLUSIONS: Patient-reported and clinical outcomes following LSC were comparable in patients with short and normal TVL, indicating that laparoscopic sacrocolpopexy may be a feasible option for apical patients with symptomatic POP with a short vagina after a previous hysterectomy.