Laparoscopic Lateral Suspension Versus Sacrocolpopexy: A Retrospective Cohort Study with Median 50-Month Patient-Reported and 14-Month Anatomical Outcomes.

INTRODUCTION AND HYPOTHESIS: Laparoscopic lateral suspension (LLS) has emerged as an alternative to laparoscopic sacrocolpopexy (SCP) for apical pelvic organ prolapse (POP). Comparative patient-reported data remain limited, particularly at long-term follow-up. We compared the mid-to-long-term patient-reported and anatomical outcomes of the two procedures. METHODS: Women who underwent LLS or SCP for symptomatic apical POP (2017-2024) were retrospectively reviewed; no baseline subjective scores were available. The primary outcome was subjective improvement on the Patient Global Impression of Improvement (PGI-I). Secondary outcomes were composite anatomical success (Ba < 0, Bp < 0, C ≤ -½ total vaginal length), PFDI-20, FSFI-6, de novo urinary incontinence, and perioperative parameters. Between-group comparisons and multivariable logistic regression analyses were performed. RESULTS: Of 115 patients (LLS 57; SCP 58), 84 completed subjective assessment at a median of 50 months. PGI-I-defined improvement was more frequent after LLS than SCP, though the difference was not statistically significant (84.8% vs. 68.4%; p = 0.074). After multivariable adjustment, SCP showed lower odds of improvement (OR 0.222, 95% CI 0.060-0.828; p = 0.025). Anatomical success was similar (66.7% vs. 69.0%; p = 0.792), as were PFDI-20, FSFI-6, and de novo incontinence rates. Concomitant anterior colporrhaphy and hysterectomy were less frequent with LLS (both p < 0.001). Complications were rare; mesh exposure requiring surgery occurred only after SCP. CONCLUSIONS: LLS is a viable alternative to SCP for apical prolapse, offering comparable anatomical outcomes and favorable patient-reported results. Adequately powered prospective studies are needed to confirm these findings.