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Sacrocolpopexy

Sacrocolpopexy restores vaginal apical support by attaching mesh to the vagina and securing it to the anterior longitudinal ligament over the sacrum. It is an established option for symptomatic vaginal vault prolapse, particularly when durable support and preservation of vaginal length are important. Choice among abdominal mesh repair, vaginal native-tissue suspension and other treatments depends on symptoms, anatomy, operative risk and the patient's priorities.[1][2][3]

For the overall decision framework, see Prolapse Repair Principles. Related operations have separate pages: Supracervical Hysterectomy at Sacrocolpopexy, Sacrohysteropexy and Pectopexy. Cervicosacropexy/vaginosacropexy (CESA/VASA) is a less-established bilateral sacral-fixation alternative developed specifically for apical prolapse with coexisting urgency or mixed incontinence. For the first abdominal sacrocolpopexy and its later evolution, see the History of Prolapse Surgery & Urogynecology.

Patient Selection and Planning​

Consider sacrocolpopexy for bothersome apical prolapse when the patient chooses reconstructive surgery after discussion of nonsurgical and surgical options. Recurrent prolapse, substantial anterior or apical descent, prior surgery and vaginal length help shape that discussion.[1][2]

Before surgery, document:

  • Symptoms and support: bulge bother, POP-Q, vaginal length, compartment defects, bowel symptoms and sexual goals.
  • Urinary function: stress and urgency leakage, emptying symptoms and prolapse-reduction stress testing when relevant to continence planning.
  • Previous treatment: operative reports, prior mesh or graft, hysterectomy status and complications.
  • Operative suitability: abdominal access, ability to tolerate the planned positioning and anesthesia, healing risks, and the feasibility of a vaginal alternative.
  • Patient preferences: permanent mesh, uterine or cervical preservation, recovery priorities and willingness to accept possible future treatment.[1][2]

Counsel about recurrent prolapse, mesh exposure, urinary or bowel dysfunction, pain or dyspareunia, organ or vascular injury and possible further surgery. Mesh implanted abdominally for sacrocolpopexy is a different procedure from transvaginal mesh implantation for prolapse.[1][3][8]

Mesh and Fixation​

ComponentPractical interpretation
MeshMacroporous monofilament polypropylene is the usual synthetic material.[1][7][13] Retrospective comparisons of mesh weight give mixed signals. In a separate 2023 comparison of two sequential prospective cohorts followed for a median of about eight years, graft-related complications occurred in 23/101 (22.8%) with heavier polypropylene mesh and 13/178 assessed (7.3%) with lighter polypropylene/poliglecaprone mesh.[36] One robotic cohort found roughly twice the hazard of overall anatomic failure within three years with ultralightweight versus heavier mesh; among women with anatomic failure, ultralightweight mesh was associated with about five times the hazard of anterior-compartment failure. Mesh exposure was lower in the ultralightweight group (1.6% vs. 6.0%), but follow-up was shorter in that arm.[28] Among 220 of 358 eligible women who attended review after sacrocolpopexy, sacrocervicopexy, or sacrohysteropexy (95 with ultralightweight mesh and 125 with lightweight mesh), a second cohort found no significant difference in composite failure (incidence rate ratio 1.47, 95% CI 0.83–2.52) at median follow-up of 36 versus 63 months, respectively. Overall, repeat surgery for recurrent apical prolapse and mesh exposure occurred in 4% and 2%, respectively.[29] A third, 1,272-patient cohort found similar crude composite anatomic recurrence proportions (54/745 [7.2%] with lightweight versus 35/527 [6.6%] with ultralightweight mesh), but ultralightweight mesh was associated with shorter time to recurrence after adjustment (HR 2.38, 95% CI 1.47–3.87). Median follow-up was 344 versus 143 days, respectively; reported mesh complications were 5.8% versus 1.3%.[30] RANZCOG's 2022 guidance recommends lightweight type I synthetic mesh (level II evidence, grade B).[1]
Vaginal attachmentAbsorbable sutures are a reasonable option. Comparative evidence has not shown worse short-term support and suggests less suture exposure than permanent sutures.[5][6]
Sacral attachmentPermanent fixation to the anterior longitudinal ligament is commonly used.[1][2][6]
Graft alternativesBiologic grafts are less well studied and may be less durable.[1][13] A retrospective series of 12 women, 11 with a history of prior sling or vaginal mesh, used autologous fascia lata for robotic sacrocolpopexy; at a median 14.7-month follow-up (range 5.7–39), no recurrent or persistent apical prolapse was observed, though 3 of 12 (25%) reported recurrent anterior-compartment bulge sensation and there were no intraoperative or postoperative complications.[17]
Peritoneal coverageCover the mesh and manage exposed suture/barbed ends to limit bowel contact. Closure must avoid bowel entrapment and tension on adjacent structures.[1][2] Two delayed small-bowel obstructions from bowel adherent to a barbed suture at the sacral promontory have been reported after peritoneal closure;[18] cinching tissue after each throw and cutting barbed-suture ends flush with the peritoneum has been described to reduce exposed barbs, though this has not been tested against other closure methods.[19]

The 2023 Pollack systematic review found no detected difference in sacrocolpopexy success in its direct comparisons of permanent and absorbable vaginal sutures (RR 1.00, 95% CI 0.98–1.03).[5] Most included evidence was observational and follow-up was relatively short. A separate randomized cohort reported ten-year data for 104/195 women (53.3%) after nerve-preserving sacrocolpopexy: no vaginal-suture-group difference in apical support was detected, but two women in the resorbable arm had undergone recurrence surgery and were excluded from the examination cohort, and attrition precludes an equivalence claim.[37]

In the 150-patient Tagliaferri trial, polyglactin 910 was compared with braided polyester during laparoscopic sacrocervicopexy with supracervical hysterectomy. Both arms used permanent sacral fasteners. At one year, mesh exposures were 0/75 versus 3/75; the difference was not statistically significant and the trial was not powered to establish rare-complication safety.[6]

In a randomized trial of 59 women with post-hysterectomy vaginal prolapse undergoing laparoscopic or robotic sacrocolpopexy, Y-shaped mesh (Restorelle Y, n = 30) and flat mesh (n = 29) did not differ in case time or mesh-placement time, and PFDI-20 improvement at 6 months did not differ by mesh type.[33] At six months, no recurrent prolapse on examination, retreatment or mesh exposure was reported.[33] In the randomized cohort's 24-month report, 44/59 women (74.5%) had data; objective recurrence was defined as apical descent beyond one-third of the vaginal canal, anterior or posterior descent beyond the hymen, or retreatment.[38] Nine of 44 women (20.5%) met that definition (seven examination findings alone and two reoperations), four reported bulge, and none had apical recurrence or mesh exposure.[38] No between-configuration difference was detected.[38]

Open, Laparoscopic and Robotic Approaches​

Minimally invasive access can reduce the burden of an abdominal incision and shorten recovery. Open surgery remains an option when clinical circumstances favor it. The operative route should reflect the patient's needs and the surgeon's and team's experience.[1][2]

Robotic assistance has not been shown to confer universally better clinical outcomes than conventional laparoscopy. The 2026 Ferrari review found no clear difference in several reported outcomes, but the evidence combines randomized and observational reports, heterogeneous techniques and follow-up. Its reported lower conversion rate with robotics comes from observational cohorts.[4]

For open versus conventional laparoscopic access, the three-center UK LAS equivalence trial randomized women with symptomatic post-hysterectomy vault prolapse to abdominal or laparoscopic sacrocolpopexy. At one year, apical support was equivalent (mean POP-Q point C −6.63 cm open versus −6.67 cm laparoscopic), 90% of the open and 80% of the laparoscopic group rated themselves much better, and the laparoscopic group had less blood loss and a shorter hospital stay.[34]

Port layout, robotic platform, retraction and instruments vary. Training and observed competence include dissection, fixation, recognition of injury and management of complications.[1][2]

Operative Sequence​

The following describes core laparoscopic and robotic steps. Sequence, mesh configuration and the extent of dissection vary with vault versus cervical attachment, compartment defects, scars and tissue quality.[2][13]

  1. Position and expose. Use protected lithotomy and the Trendelenburg needed for access, within anesthetic tolerance. Establish abdominal access and retract bowel under direct vision. A vaginal sizer or other retractor can define the vault. For open access, an assistant-held malleable vaginal retractor to reduce and distend the prolapsed vagina into the pelvis has been described as stabilizing the wall and facilitating anterior and posterior dissection.[22]
  2. Identify sacral landmarks. Identify the right ureter, iliac vessels and middle sacral vessels. Expose the anterior longitudinal ligament sufficiently for controlled fixation while limiting presacral dissection. Avoid the L5–S1 disc and deep bites into underlying structures. Identifying the aortic bifurcation, inferior vena cava and middle sacral vessels, with meticulous hemostasis around the presacral venous plexus, has been described as part of this exposure; because the robotic surgeon lacks direct haptic feedback, a bedside assistant can help confirm the promontory. If adequate exposure would require mobilizing major vessels, strong consideration should be given to abandoning sacrocolpopexy for an alternative prolapse repair.[21]
  3. Develop the vaginal planes. Separate bladder anteriorly and rectum posteriorly from the vagina. Tailor distal dissection to the defect and planned attachment; protect the vaginal wall and adjacent organs. An EEA sizer or vaginal stent, elevated anteriorly or posteriorly by an assistant, has been described to help delineate the vesicovaginal and rectovaginal planes; one retrospective post-hysterectomy robotic sacrocolpopexy cohort reported vaginotomy in 10/101 cases (9.9%)[42], and dissection at a thin post-hysterectomy cuff closure warrants particular care. If vaginotomy occurs, reinforcing it with a second imbricating layer and avoiding mesh placement directly over the defect has been described.[19]
  4. Attach the mesh. Spread the vaginal portions smoothly and secure them to supportive tissue without excessive tightening. The number and distribution of sutures depend on the mesh and anatomy. Inspect for vaginal epithelial penetration and correct misplaced sutures.[27] A digital vaginal and rectal examination at the end of the case, alongside cystoscopy, has been described to identify a suture perforating either organ; the clinical significance of vaginal penetration by a delayed-absorbable or barbed suture is reported as unknown in one series with no observed increase in mesh exposure.[27]
  5. Set sacral attachment and support. Secure the mesh stem to the identified ligament with controlled fixation. Assess vaginal length, axis and support while avoiding excessive traction, constriction or distortion. No single ischial-spine target substitutes for assessment of the reconstruction. Leaving approximately two fingerbreadths of space between the mesh and rectum has been described for open surgery to avoid rectal compression; for laparoscopic or robotic surgery, where that spacing cannot be reproduced directly, observing the mesh attachment while the vagina is elevated cephalad with an EEA sizer to its maximum length, without actively stretching it, has been described instead.[20]
  6. Cover and inspect. Close the peritoneal opening over the mesh when feasible, account for exposed suture ends, and inspect hemostasis and bowel relationships. Reassess any recognized organ injury and its implications for the planned reconstruction. For open access in thin patients, a blunt subperitoneal tunnel (rather than extending the peritoneal incision to the vaginal apex) has been described to simplify retroperitonealization and mesh curvature while avoiding ureteral kinking, though without head-to-head evidence that it is safer.[22] For a recognized bladder injury, two-layer absorbable repair with catheter drainage has been described; whether to continue vaginal mesh attachment is left to the surgeon, but placing mesh adjacent to or near the cystotomy is discouraged because of concern for later bladder-mesh erosion or fistula.[24] For a recognized bowel injury, a Delphi-process, limited-evidence recommendation supports proceeding with sacrocolpopexy after an uncomplicated, intraoperative bladder or small-bowel injury;[23] separately, enterotomy with fecal or enteric soilage, or a large-bowel injury, has been described as precluding mesh placement, favoring repair of the injury and either concluding the case or converting to a non-mesh vaginal or laparoscopic suspension; native-tissue support such as rectus fascia has been suggested as an alternative to consider in that setting.[23][24] The 2023 French HAS guideline permits abdominal-route mesh after a satisfactory bladder repair and recommends checking the repair for leakage (expert consensus); after rectal injury, it advises against pre-rectal mesh (expert consensus), while after rectal suturing it permits anterior vesicovaginal mesh and recommends abdominal-route macroporous monofilament polypropylene (grade C).[45] Injury site, repair quality, contamination, and reconstructive goals guide the mesh decision.
  7. Check urinary integrity. Perform cystoscopic assessment of the bladder and ureteral efflux, and investigate an abnormal finding before completion. Document the implant, fixation and any concomitant procedures.[1][2][13]

Spondylodiscitis is a recognized, uncommon complication. Persistent or new severe low-back or radiating leg pain after sacrocolpopexy warrants assessment for spondylodiscitis, whether or not fever or other systemic symptoms are present; MRI is preferred when it is suspected.[1][2][13][39] For acute or worsening low-back pain after sacrocolpopexy, the 2026 U-POP consensus recommends ESR and CRP first, followed by contrast-enhanced MRI if elevated to evaluate for post-sacrocolpopexy lumbosacral discitis (moderate-quality evidence).[43] A 2024 case-series review found that most reported patients required mesh excision and prolonged intravenous antibiotics; the consensus also permits consideration of antibiotics alone in selected patients without systemic symptoms, mesh exposure, abscess, or leukocytosis (low-evidence expert consensus).[47][43]

Uncontrolled presacral bleeding is a distinct intraoperative emergency. Cautious packing has been described first, with the caveats that bleeding may recur when packing is removed and excess pressure can tear the venous network; sutures, clips, cautery and bone wax are described hemostatic options, and stainless-steel or titanium thumbtacks at a retracted basivertebral vein are described as a rare, life-threatening bailout.[25] Thumbtacks cannot be applied to bleeding from a sacral neural foramen or near vital structures.[41] Direct pressure with a blunt instrument and a gauze or cottonoid sponge for at least 5 minutes has also been described, escalating to a topical hemostatic matrix (such as a gelatin-thrombin matrix or an absorbable hemostat) at the bleeding site with continued gauze pressure if bleeding persists.[26] For laparoscopic or robotic cases, whether to convert to open surgery is described as depending on the vessel injured, bleeding control and visualization.[25][26]

Efficacy: Read the Endpoint Before the Percentage​

ASPIRe: post-hysterectomy vault prolapse​

The ASPIRe trial randomized 376 women with symptomatic prolapse after total hysterectomy to sacrocolpopexy, vaginal native-tissue repair or transvaginal mesh repair; 360 underwent surgery. Its primary endpoint was the first occurrence of retreatment, prolapse beyond the hymen or bothersome vaginal bulge.[3]

Three-year modelled composite failureSacrocolpopexyNative-tissue repairTransvaginal mesh
Adjusted estimate28%43%29%

Sacrocolpopexy had lower failure than native-tissue repair (adjusted HR 0.57; 99% CI 0.33–0.98; P=.008). The transvaginal-mesh arm met its prespecified noninferiority comparison with sacrocolpopexy, but did not demonstrate superiority over native-tissue repair at the trial's adjusted significance threshold.[3] The Uphold LITE transvaginal device is no longer marketed in the United States.[3]

Composite failure was much more common than retreatment: 5/120 sacrocolpopexy participants received additional prolapse treatment, and vaginal mesh exposure occurred in 4/120 (3%) (versus 6/115 [5%] with transvaginal mesh). Some failures were examination findings alone. Prior prolapse mesh or grafts and several higher-risk conditions were excluded, limiting generalization. Of 360 treated participants, 296 (82%) completed the study. Pandemic-related virtual visits left physical examination unavailable for 294/670 (44%) visits in 2020 and 181/622 (29%) in 2021; time-to-failure assessment was incomplete in more than 30% of visits during months 30–54, although 301/360 (84%) completed a final-visit examination.[3]

Primary uterovaginal prolapse​

When hysterectomy is chosen for primary uterovaginal prolapse, the September 2026 U-POP review adds evidence favoring sacrocolpopexy durability.

Longer-term outcomes​

In E-CARE, the extension of an older open abdominal sacrocolpopexy trial, estimated seven-year anatomic failure was 27% with Burch and 22% without Burch; composite failure was 48% and 34%, respectively. These estimates use different definitions from ASPIRe and have substantial uncertainty and attrition: 215 entered the extension and 126 completed seven-year follow-up.[8]

Against a vaginal alternative, a randomized trial allocated 95 women with vault prolapse to abdominal sacral colpopexy (n = 47) or vaginal sacrospinous colpopexy (n = 48). At a mean of two years (range 6–60 months), subjective success among assessed women was 43/46 (94%) with abdominal versus 39/43 (91%) with vaginal sacrospinous colpopexy (P = .19), and objective success was 35/46 (76%) versus 29/42 (69%) (P = .48); the abdominal route had longer operating time, slower return to daily activities and greater cost.[35]

A 2023 Cochrane review of seven randomized comparisons (613 women; follow-up six months to four years) found less prolapse awareness (RR for vaginal procedures versus sacral colpopexy 2.31; four RCTs, n = 346), repeat prolapse surgery (RR 2.33; six RCTs, n = 497), and prolapse on examination (RR 1.87; five RCTs, n = 422) after sacral colpopexy for vault prolapse; certainty was moderate for these outcomes.[46]

Counsel with separate outcomes: relief of bulge, anatomic support, urinary and bowel and sexual function, retreatment, and mesh-related harm. Follow-up duration and ascertainment materially change the percentages.[3][7][8]

Complications and Follow-up​

Early concerns include hemorrhage, bladder, ureter or bowel injury, ileus or bowel obstruction, infection, thromboembolism and voiding dysfunction. Later concerns include recurrent prolapse, new urinary or bowel symptoms, pain or dyspareunia, suture exposure and mesh complications.[1][2][8]

Mesh exposure can present years after repair. In the 2024 e-PACT II follow-up of minimally invasive total hysterectomy and sacrocolpopexy, cumulative mesh exposure was 18/182 (9.9%) at mean 5.3 years, incorporating earlier exposure events. Only 82 of the original 200 participated at this follow-up, and 56 underwent examination.[7] The reported 95% success applies to these participants.[7]

E-CARE estimated mesh erosion at 10.5% by seven years (95% CI 6.8–16.1), using older and varied operative materials.[8]

Review healing and bladder emptying, then assess symptoms and support over time. For sacrocolpopexy with synthetic polypropylene mesh, NICE NG123 calls for collection of procedure details and short- and long-term outcomes in a national registry and says to give patients written implant information naming the device, manufacturer, insertion date, and implanting surgeon with contact details.[40] Offer a six-month review after prolapse surgery with vaginal examination and a mesh-exposure check, as NICE NG123 recommends; RANZCOG recommends at least six months of follow-up with patient outcomes recorded (level III, grade C).[1][40] New bleeding, persistent discharge, pain, dyspareunia or recurrent urinary symptoms should prompt examination and appropriate evaluation. Mesh exposure, organ erosion, infection and pain without visible exposure are different problems and may require different management.[1][7][8]

Recurrence and Revision​

When apical prolapse recurs after sacrocolpopexy, the failure mechanism directs the reoperation. A 2026 review of 15 studies (116 patients) found a median time to recurrence of 24 months and a median recurrent stage of 3; mesh had detached from the vagina in 51.7% and from the sacrum in 9.5%.[48] Stage every compartment before planning, because a new anterior or posterior defect may be the failure rather than the apex, and exclude mesh exposure, infection or mesh-attributed pain, which turn the operation into excision (Mesh Complications).

Repeat sacrocolpopexy. Laparoscopic repeat sacrocolpopexy was the most common retreatment (80.2%), and only 23.3% of reported cases excised the prior mesh.[48] Mean subjective success was 89.7%, objective success 85.2% (definitions varied) and reoperation 6.6%, at a median follow-up of 6 months.[48] In a three-center cohort of 52 redo laparoscopic or robotic sacrocolpopexies, anchoring the new mesh to the previously implanted mesh (n = 29) gave anatomical and functional outcomes similar to fixation to the prevertebral ligament (n = 23); 47/52 reported meaningful improvement (PGI-I 1–2) and no Clavien-Dindo grade 3 or higher events occurred at a median of 6 months.[49] In 170 age-matched patients, second-line sacrocolpopexy after previous vaginal prolapse surgery had recurrence (10.6% vs 9.4%) and complication rates similar to first-line sacrocolpopexy at a mean of 3 years.[50]

Complete mesh excision. In 19 women having complete sacrocolpopexy mesh excision with concomitant autologous fascia sacrocolpopexy, mostly for refractory pain or exposure, median operative time was 228 minutes, blood loss 200 mL and stay 5 days; minor and major complications within 60 days were 36.8% and 5.3%, and none needed retreatment for apical prolapse at a median of 9.9 months.[51]

Hostile promontory. Peritoneocolpopexy suspends the vault without promontory fixation, securing the mesh with barbed delayed-absorbable sutures. In 14 women, 3 of them after excision of infected mesh, apical support was maintained to a median of 9.7 years, with one secondary anterior repair.[52]

Women who do not want vaginal intercourse can be offered colpocleisis; a pessary or native-tissue vaginal suspension avoids abdominal re-entry.

Concomitant Hysterectomy and Other Repairs​

Choose among total hysterectomy, supracervical hysterectomy and uterine preservation according to uterine or cervical pathology, screening needs, anatomy and patient preference. Older series and the 2024 Shahid review associate concomitant total hysterectomy with higher mesh exposure, and many surgeons therefore favor supracervical hysterectomy or a staged approach. For women with primary uterovaginal prolapse undergoing minimally invasive sacrocolpopexy, the 2026 U-POP consensus recommends total vaginal or total laparoscopic hysterectomy over supracervical hysterectomy when lower composite failure is the priority; it recommends supracervical over total laparoscopic hysterectomy when lower vaginal mesh exposure is the priority.[43] Both statements are based on moderate-quality evidence.[43] A 2024 Premier database cohort of 17,111 minimally invasive cases found similar two-year exposure with supracervical and total hysterectomy (0.7% versus 0.62%), although it relied on administrative coding.[14] Discuss the tradeoffs for the actual mesh and operation being planned.[2][7][13][14]

See Supracervical Hysterectomy at Sacrocolpopexy and Sacrohysteropexy.[2] Additional vaginal repair or a combined colorectal procedure should address a demonstrated defect or symptom and be planned with the relevant specialist.[2]

Concomitant Anti-Incontinence Procedures​

Discuss existing symptomatic SUI separately from occult leakage on prolapse reduction and prophylaxis in a woman without preoperative SUI symptoms. Combined and staged procedures have different tradeoffs.[9][11]

In CARE, 322 women without preoperative SUI symptoms were randomized during open abdominal sacrocolpopexy. After the journal's 2016 coding correction, the three-month composite SUI endpoint was 33.6% with Burch versus 57.4% without Burch.[10] CARE’s composite included symptoms, stress testing or treatment.[9][10]

The 2026 Cochrane review describes uncertainty and inconsistency in prophylactic Burch evidence for stress-continent women. Its more favorable concomitant-sling findings concern different populations and procedures. In the single-center MICRO randomized trial of 50 stress-continent women with negative preoperative supine cough tests, the three-month composite of SUI symptoms, a positive retrofill cough test, or SUI treatment occurred in 13/26 (50.0%) with prophylactic Burch and 10/24 (41.7%) without (P = .555); longer-term effects remain uncertain.[44] NICE NG123 recommends against surgery to prevent incontinence during prolapse repair in women who do not have incontinence.[40] See Burch's evidence discussion.[11]

Postoperative Recovery​

Encourage early mobilization and give a recovery plan based on the operation, complications and the patient's function. Routine prolonged home rest is not supported by the available recovery evidence.[1][12]

Same-day discharge is feasible in selected patients. In a retrospective cohort of 272 women after robotic sacrocolpopexy, 80 (29.4%) went home the same day; there was no difference in unplanned provider visits, emergency-department visits or readmission between the same-day and later-discharge groups.[31] In a separate prospective same-day-discharge protocol after minimally invasive sacrocolpopexy, 37 of 47 eligible women (78.7%) achieved same-day discharge, with no increase in adverse events or postoperative health-care utilization and high patient satisfaction compared with routine overnight care.[32] Patient selection (age, comorbidity, case start time, a caretaker at home) shaped eligibility in both series and should guide any same-day-discharge plan.

The 2023 O'Shea randomized trial assigned 123 women to standard restrictions or expedited activity after minimally invasive apical prolapse surgery; 107 completed the primary analysis, including 48 who underwent robotic sacrocolpopexy. Expedited instructions produced noninferior anatomic and symptom outcomes at three months. Both groups avoided sexual activity until the six-week visit.[12]

The earlier double-masked ReCOUP trial randomized women having prolapse surgery (58/95 [61%] of those allocated to the intervention and completing the three-month primary outcome underwent minimally invasive sacrocolpopexy) to liberal activity or to 3 months of restricted activity, with no heavy lifting or high-impact activity.[12][15][53] In its planned 1-year secondary analysis (77 of 95 women with both functional and anatomic assessment), anatomic failure was 8.8% with liberal and 7.0% with restricted instructions, and anatomic and functional outcomes did not differ significantly.[15] The sample was small.[15][16]

The 2025 AUGS consensus statement recommends that surgeons allow patients to resume activity liberally after urogynecologic surgery. It found no evidence to justify different activity advice after mesh versus native-tissue prolapse repair, while noting that the trials were not powered to compare them.[16]

This supports a more flexible return to ordinary physical activity after uncomplicated surgery. The study selected women with reasonable baseline mobility, and measured postoperative activity was similar despite different instructions.[12]

Podcasts​

Season 2, Episode 3: Laparoscopic Sacral Colpopexy
IUGA Podcast, Season 2 Episode 3 (2023)
open.spotify.com

Videos​

Laparoscopic Management of Presacral Haematoma After Sacrocolpopexy
Panico G, et al. Facts Views Vis ObGyn 2025
Read the article

References​

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3. Menefee SA, Richter HE, Myers D, et al. Apical suspension repair for vaginal vault prolapse: a randomized clinical trial. JAMA Surg. 2024;159:845-855. doi:10.1001/jamasurg.2024.1206. Figure-label correction.

4. Ferrari A, Borrelli M, Moretti G, et al. Laparoscopic versus robot-assisted sacrocolpopexy: a systematic review and meta-analysis. BJOG. 2026. doi:10.1111/1471-0528.70218.

5. Pollack BL, Popiel P, Toaff MC, et al. Permanent compared with absorbable suture in apical prolapse surgery: a systematic review and meta-analysis. Obstet Gynecol. 2023;141:268-283. doi:10.1097/AOG.0000000000005032.

6. Tagliaferri V, Ruggieri S, Taccaliti C, et al. Comparison of absorbable and permanent sutures for laparoscopic sacrocervicopexy: a randomized controlled trial. Acta Obstet Gynecol Scand. 2021;100:347-352. doi:10.1111/aogs.13997.

7. Bretschneider CE, Myers ER, Geller EJ, Kenton KS, Henley BR, Matthews CA. Long-term mesh exposure 5 years following minimally invasive total hysterectomy and sacrocolpopexy. Int Urogynecol J. 2024;35:901-907. doi:10.1007/s00192-024-05769-5.

8. Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309:2016-2024. doi:10.1001/jama.2013.4919. Time-unit correction.

9. Brubaker L, Cundiff GW, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354:1557-1566. doi:10.1056/NEJMoa054208.

10. Brubaker L, Brown MB, Weber AM, NICHD Pelvic Floor Disorders Network Investigators. Corrections to report of a trial of Burch colposuspension. N Engl J Med. 2016;374:2295. doi:10.1056/NEJMc1605817.

11. Baessler K, Christmann-Schmid C, Haya N, et al. Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. Cochrane Database Syst Rev. 2026;2:CD013108. doi:10.1002/14651858.CD013108.pub2.

12. O'Shea M, Siddiqui NY, Truong T, Erkanli A, Barber MD. Standard restrictions vs expedited activity after pelvic organ prolapse surgery: a randomized clinical trial. JAMA Surg. 2023;158:797-805. doi:10.1001/jamasurg.2023.1649.

13. Shahid U, Chen Z, Maher C. Sacrocolpopexy: the way I do it. Int Urogynecol J. 2024;35:2107-2123. doi:10.1007/s00192-024-05922-0.

14. Glass Clark S, Bretschneider CE, Bradley MS, et al. Risk of postoperative mesh exposure following sacrocolpopexy with supracervical versus total concomitant laparoscopic hysterectomy. Int Urogynecol J. 2024;35(1):207-213. doi:10.1007/s00192-023-05658-3

15. Mueller MG, Collins SA, Lewicky-Gaupp C, Tavathia M, Kenton K. Restricted convalescence following urogynecologic procedures: 1-year outcomes from a randomized controlled study. Female Pelvic Med Reconstr Surg. 2021;27(2):e336-e341. doi:10.1097/SPV.0000000000000922.

16. Mueller MG, Das D, Davis-Wilson H, et al. Postoperative activity instructions following urogynecologic surgery. Urogynecology (Phila). 2025;31(10):913-925. doi:10.1097/SPV.0000000000001750. AUGS Clinical Consensus Statement (Q25).

17. Scott VCS, Oliver JL, Raz S, Kim JH. Robot-assisted laparoscopic sacrocolpopexy with autologous fascia lata: technique and initial outcomes. Int Urogynecol J. 2019;30(11):1965-1971. doi:10.1007/s00192-019-03884-2

18. Vahanian SA, Finamore PS, Lazarou G. Delayed small bowel obstruction after robotic-assisted sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2015;21(1):e11-e13. doi:10.1097/SPV.0000000000000101

19. Rosenblum N, Malacarne D. Robotic/Laparoscopic Female Pelvic Reconstructive Surgery. In: Goldman HB, ed. Complications of Female Incontinence and Pelvic Reconstructive Surgery. 2nd ed. Springer (Humana Press); 2017:103-116. doi:10.1007/978-3-319-49855-3_10

20. Krlin R, Hallner B Jr, Rourke E, Winters JC. Vaginal and Abdominal Reconstructive Surgery for Pelvic Organ Prolapse. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 13th ed. Elsevier; 2025:2426-2459.

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