Reoperation for prolapse recurrence after sacrospinous mesh hysteropexy: characteristics of women choosing retreatment.

Journal Article (Multicenter Study;Journal Article)

Introduction and hypothesis

Factors that contribute to reoperation and surgical approaches for the management of recurrent uterovaginal prolapse after vaginal mesh hysteropexy (mesh hysteropexy) are unknown. We aimed to describe surgical management of pelvic organ prolapse recurrence after vaginal mesh hysteropexy, and patient characteristics in those who chose reoperation.


This is a descriptive analysis of women who experienced treatment failure within 5 years of mesh hysteropexy in a multi-site randomized trial. The composite definition of treatment failure included retreatment (pessary or reoperation), prolapse beyond the hymen, or bothersome prolapse symptoms. Characteristics of those pursuing and not pursuing repeat prolapse surgery, measures of prolapse, and symptom severity are described.


Over 5-year follow up, 31/91 (34%) of the hysteropexy group met treatment failure criteria. All seven women who pursued reoperation reported bothersome prolapse symptoms; six were anatomic failures. Most seeking reoperation were early treatment failures; six (86%) by the 12-month visit and all by the 18-month visit. Compared to those electing expectant management, those pursuing reoperation had more apical prolapse, POP-Q point C median (IQR) -5.5 (-6.0, -4.0) cm versus +1.0 (-1.0, 3.0) cm respectively. Hysterectomy was performed in 6/7 reoperations (three vaginal, three endoscopic), with apical suspension in 5/6 hysterectomies. One participant with posterior compartment prolapse underwent transvaginal enterocele plication, uterosacral ligament suspension with posterior colpoperineorrhaphy. At a mean surgical follow-up of 34.3 (15.8) months, all women remained without anatomic or symptomatic failure.


When recurrent prolapse after mesh hysteropexy occurred, most women did not choose reoperation. Those who pursued surgery experienced more significant apical prolapse and were universally symptomatic.

Clinical trial identification number


Full Text

Duke Authors

Cited Authors

  • Napoe, GS; Luchristt, D; Sridhar, A; Ellington, D; Ridgeway, B; Mazloomdoost, D; Sung, V; Ninivaggio, C; Harvie, H; Santiago-Lastra, Y; Gantz, MG; Zyczynski, HM

Published Date

  • January 2023

Published In

Volume / Issue

  • 34 / 1

Start / End Page

  • 255 - 261

PubMed ID

  • 36449027

Pubmed Central ID

  • PMC9839581

Electronic International Standard Serial Number (EISSN)

  • 1433-3023

International Standard Serial Number (ISSN)

  • 0937-3462

Digital Object Identifier (DOI)

  • 10.1007/s00192-022-05411-2


  • eng