Abdominal sacral colpopexy using a porcine dermal graft and bone anchors in the elderly overweight patient

Objective: The objective of this study was to determine the efficacy of treating uterine/apical vaginal prolapse in the elderly overweight patient with abdominal sacral colpopexy using a porcine dermal graft and bone anchors. Methods: Patients were offered abdominal sacral colpopexy using a porcine dermal graft and bone anchors for the following indications: symptomatic uterine or apical vaginal prolapse beyond the hymeneal ring, or symptomatic uterine or apical vaginal prolapse along with a shortened vaginal vault. Patient demographics as well as prolapseand incontinence-related symptoms were evaluated in all patients. Additionally, a telephone interview for a predetermined protocol was performed within 3 to 25 months. Surgery was considered successful if the patient was free of prolapse-related symptoms and the Pelvic Organ Prolapse Quotient (POPQ) scores at last objective follow up were within 1 cm of normal values. Results: Eighteen patients over 60 years of age with a body mass index over 25 kg/m² underwent surgical repair using bone anchors and a porcine dermal graft. Intraoperative and postoperative complications were limited. All preoperative reports of vaginal pressure, bulge, and discomfort were resolved. Urinary frequency and urgency improved in 50% and 29%, respectively. Stress and urge urinary incontinence were eliminated in 80% and 54%, respectively. Apical descent was cured in 94% at last visit. Fifteen patients were satisfied or extremely satisfied with the surgical outcome. Conclusions: In this pilot study, we demonstrate that abdominal sacral colpopexy can be performed in the elderly overweight patient using bone anchors and porcine dermis with demonstrated efficacy and tolerability. Use of these materials should limit the risks of harvesting fascia and permanent materials in this population.