The Posterior Intravaginal Slingplasty treatment for apical prolapse: 3 years experience in a single centre setting

Aim: To assess the anatomic effectiveness and complications of the Posterior IVS technique for the treatment of pelvic organ prolapse over a period of 3 years. Methods: A retrospective, single-arm, non-comparative study involving routine, standardised, pre-operative assessment, surgery and follow-up care using the Pelvic Organ Prolapse Quantifications score at 1, 2 and 3 years was performed. The Posterior IVS technique was performed in patients with a symptomatic grade 2 or greater prolapse of the apical compartment (i.e. point C and/or D ≥ -1). Concomitant prolapse procedures were allowed. Results: Twenty-nine consecutive patients underwent a Posterior IVS suspension over a period of 2 years. Ninety percent (26/29) of patients required a concomitant prolapse procedure (79% an anterior and 55% a posterior vaginal wall repair). No serious peroperative complications, bladder injuries or rectal perforations were encountered. Overall anatomical success rates (<Stage 2, International Continence Society criteria) declined from 86% to 58% and 50% after 1, 2 and 3 years, respectively. In 14% (4/29) of patients the site of anatomic recurrence was located in the apical compartment, in 31% (9/29) at the level of the anterior compartment and 14% (4/29) at the level of the posterior vaginal wall. Erosion of the Posterior IVS tape was encountered in 14% (4/29) of patients; 2 of which presented as gluteo-vaginal fistula’s. Conclusion: Three years follow-up of the Posterior IVS yields a high anatomical failure and substantial surgical reintervention rate.