Post-operative outcomes associated with anterior mesh location after laparoscopic sacrocolpopexy.

Post-operative outcomes associated with anterior mesh location after laparoscopic sacrocolpopexy. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Post-operative outcomes associated with anterior mesh location after laparoscopic sacrocolpopexy. Nassir Habib, Matteo Giorgi, Tania Tahtouh, Amel Hamdi, Gabriele Centini, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4572463/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Sep, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 5 You are reading this latest preprint version Abstract Objective To investigate the relationship between the position of the anterior mesh, measured by ultrasound through the Bladder neck - Mesh Distance technique and the surgical outcomes after laparoscopic sacrocolpopexy (SCP) for apical prolapse. Study design: Retrospective analysis of prospectively collected data in a tertiary care hospital. Between January 2019 and September 2019, 63 women who underwent laparoscopic SCP due to apical prolapse were included. Bladder neck - Mesh Distance was measured immediately after surgery. The pelvic floor was evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System before, one month, and 2.7 years (mid-term) after the surgery. Postoperative stress urinary incontinence (SUI) and Patient Global Impression of Improvement (PGI-I) scores were also assessed. The correlation between Bladder neck - Mesh Distance and the postoperative outcomes was investigated using the Spearman rank correlation coefficient. Results At mid-term follow-up visit, Bladder neck - Mesh Distance was inversely correlated with the correction of apical prolapse and postoperative SUI. No correlation was detected with the anterior compartment prolapse correction. PGI-I scores were high in all patients at mid-term follow-up, irrespective of Bladder neck - Mesh Distance values. Conclusion The shorter the Bladder neck - Mesh Distance, the better the outcome for apical compartment repair. Bladder neck - Mesh Distance had no correlation with the anterior anatomical correction. Shorter Bladder neck - Mesh Distance values were positively correlated to better PGI-I scores and a higher risk of SUI. Bladder neck-Mesh Distance Genital prolapse Mesh Prolapse repair Ultrasound Summary This retrospective study investigates the surgical outcomes of laparoscopic sacrocolpopexy, evaluating the position of the anterior mesh by measuring bladder neck-mesh distance with introital ultrasound. 1. INTRODUCTION Sacrocolpopexy (SCP) is currently considered the reference option for vaginal vault prolapse [1]. According to the recent literature, the laparoscopic approach is preferrable because it is associated to lower operative morbidity than the laparotomic approach and, indeed, guarantees similar anatomical and functional results [1–3] with comparable recurrence and re-operation rates (1.7 to 11.5%) [4–7]. Nevertheless, the surgical technique of SCP remains poorly standardized [8]. Currently, there is no universal consensus on the height of mesh fixation to the anterior vaginal wall and the historic principle “ as low as possible ” is still applied by surgeons, making this surgical step somewhat controversial and largely based on surgeon’s experience and individual clinical judgment [9]. Such a variability may affect the outcomes and the recurrence rate associated to SCP procedure. Therefore, research aiming to a more uniform and homogeneous mesh fixation along with a more precise graft location could represent a step towards the standardization of SCP surgery [10]. Ultrasonography allows a dynamic evaluation of pelvic organ mobility and pelvic floor function, and either transvaginal or transperineal approach has been proposed [11,12]. The transperineal approach (translabial or introital) seems more suitable than the transvaginal approach because it does not modify the anatomical relationships between pelvic organs. Therefore, 2D- and 3D-transperineal ultrasonography has been recently used to evaluate the position of the mesh on the vagina, as well as its folding and contraction after laparoscopic SCP [13–15]. Wong et al investigated the anterior mesh position after SCP using transperineal ultrasound [16]. Mesh location was evaluated according to the distance between the distal extremity of the anterior mesh and a line passing through the inferior margin of the pubic symphysis. By using this ultrasound technique, the mesh was identified in 62% of the cases. Among these, the risk of anterior compartment prolapse recurrence increased by 7% for every mm the mesh was positioned further from the bladder neck. Recently, we introduced a new introital ultrasound measure to localize the mesh in relation to the bladder neck [10]. The Bladder neck-Mesh Distance seems a feasible technique with a reported mesh detection rate of 100%. The aim of the present study was to assess the relationship between the anterior vaginal mesh position - evaluated through Bladder neck - Mesh Distance measure - on mid-term postoperative outcomes including anatomical results, postoperative SUI and patients’ satisfaction after laparoscopic SCP for apical prolapse. 2. METHODS 2.1 Study protocol This observational single center study followed an a priori protocol based on STROBE guidelines and checklist [17]. It is a retrospective analysis of prospectively collected data which includes all consecutive women who underwent laparoscopic SCP for stage 2 or higher apical vaginal compartment prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) Systemin a tertiary care hospital (Medico-Surgical Center of Ambroise Paré - Pierre Cherest – Hartmann, France) between January 2019 and September 2019 [18]. Patients with a history of prolapse surgery, subtotal hysterectomy, and/or sub-urethral sling surgery were excluded because of potential modifications of the pelvic landmarks and the associated artifacts on ultrasound examination. We excluded patients who had sub-urethral sling placement and/or any type of vaginal repair concomitant to SCP procedure for better comparison. We also excluded patients who previously experienced SUI. We included patients who had a previous total hysterectomy and these who underwent total hysterectomy at the time of SCP. Medical records were retrieved from institutional electronic databases and clinical reports. The main aim of the study was to investigate the relationship between Bladder neck - Mesh Distance measures after SCP and surgical anatomical outcomes, especially these of the apical and anterior compartment (i.e.: Ba, C, and their pre- and post-operative variations). Secondary aims of the study were to evaluate the feasibility of Bladder neck - Mesh Distance measuring and assess the relationship between Bladder neck - Mesh Distance measures, postoperative SUI, and PGI-I scores. 2.2 Preoperative assessment According to the hospital routine practice, preoperative clinical assessment of women affected by genital prolapse included collection of previous medical history, urogynecological examination and transvaginal ultrasonography. For each patient, clinical data were acquired as follows: age, body mass index (kg/m 2 ), parity, number of vaginal deliveries, menopausal status, use of hormonal replacement therapy, and previous surgeries. Preoperative prolapse staging was assessed according to the POP-Q classification [18] and urodynamic testing was performed only when deemed necessary. Presence of stress urinary incontinence (SUI) was also investigated. Ultrasonographic evaluation using Voluson E8 ultrasound machine (GE Healthcare, Zipf, Austria) with a 4–9 MHz volumetric vaginal probe was employed to exclude gynecological diseases (i.e.: fibroids, ovarian cysts). One to three-months after preoperative assessment, laparoscopic SCPs were all performed by an experienced endoscopic surgeon (G.B.). 2.3 Surgical procedure The procedure started with the incision of the anterior pelvic peritoneum, if not previously performed for total hysterectomy (whose surgical steps will not be described as out of the purpose of this study). The depth of the vesicovaginal dissection was limited to the point just above the catheter balloon, as a landmark for the bladder trigone. The anterior, monofilament, polypropylene mesh (Gynecare Gynemesh PS, Ethicon ® ) was fixed on the anterior vaginal wall using three nonabsorbable sutures (Ethibond 2/0, Ethicon ® ) and was secured to the vaginal vault with two nonabsorbable stiches (Ethibond 0/0, Ethicon ® ). Posterior mesh fixation was not routinely performed; in fact, according to the literature, posterior mesh fixation is known to have minor effect on anterior and apical compartment rather than the opposite [1,2,19–22]. When deemed necessary by the surgeon, on the basis of the preoperative assessment, and after careful placement, the posterior mesh was attached laterally to levator ani muscles, the posterior vaginal wall, and the uterosacral ligaments using multiple 2/0 multifilament absorbable sutures (Vicryl 2/0, Ethicon ® ). Following the posterior peritoneum dissection starting from the promontory with a caudocranial direction, the mesh was then fixed to the anterior longitudinal ligament (Ethibond 0/0, Ethicon ® ). Peritonealization of the mesh was completed using an absorbable continuous suture (Monocryl 2/0, Ethicon ® ). Sub-urethral sling placement was not carried out at the time of SCP surgery as recommended by the French surgical society’s guidelines [23]. Intraoperative complications were assessed according to Clavien-Dindo classification [24]. 2.4 Bladder neck - Mesh Distance measurement An introital ultrasound, with the patient in a lithotomy position, was performed by the surgeon immediately at the end of the surgical procedure using Voluson E8 ultrasound machine (GE Healthcare, Zipf, Austria) with a 4–9 MHz volumetric vaginal probe [13,15,16]. The balloon of the foley catheter was used as a landmark to locate the bladder neck and Bladder neck - Mesh Distance was measured between the mesh and a tangential plane running below the balloon, perpendicularly to the urethra, according to the study by Habib et al. [10], thus preventing measure discrepancies related to balloon insufflation and bladder emptiness. The foley catheter maintained a neutral position and was not tractioned during the ultrasound, allowing to standardize the measurements. Mean Bladder neck - Mesh Distance value for each patient was used for statistical analysis. 2.5 Postoperative assessment Postoperative follow-up included a short-term revaluation at one month after surgery and a mid-term clinical examination between 24 and 36 months after surgery. Patients’ assessment was based on the following items: a cough stress test (CST), following the ICS recommendations [25], assessing the presence of postoperative SUI (defined as the complaint of any involuntary loss of urine on effort or physical exertion, or on sneezing or coughing according to the ICS terminology [26] and patients’ satisfaction using the Patient Global Impression of Improvement (PGI-I score) [27] [28]; a urogynecological examination. Anatomical prolapse recurrence was defined as POP-Q stage ≥ 2 at short- or mid-term revaluation; postoperative complications were also assessed using the Clavien-Dindo classification [24]. To estimate the effect of anterior compartment, apical and posterior compartment prolapse repair, the variables ∆-Ba, ∆-C and ∆-Bp were created and represented anterior, apical and posterior compartment differences between pre- and post-operative anatomical points, respectively. 2.6 Ethical statement The study was approved by the local ethic committee (2018/21 EVAPRO) and conducted in accordance with the Declaration of Helsinki. All patients gave their informed consent at the time of inclusion in the study. 2.7 Statistical analysis Numerical variables were expressed as means ± standard deviations (SD) and categorical variables were summarized as frequencies and percentages. Continuous variables were compared with Student’s t test or Mann-Whitney test where appropriate, and qualitative variables with Chi-square test (or Fisher’s exact test when expected numbers < 5). The Spearman rank correlation coefficient was used to examine the relation between Bladder neck - Mesh Distance and outcomes variables (expressed as ϱ, CI 95%). According to Schober et al. [29], statistical correlation between variables was a priori categorized as no correlation for ϱ=0, very weak for 0.00<ϱ≤0.19, weak for 0.20≤ϱ≤0.39, moderate for 0.40≤ϱ≤0.59, strong for 0.60≤ϱ≤0.79, very strong for 0.80≤ϱ<1.00 and monotonic correlation for ϱ=1.00. A p value < 0.05 was considered statistically significant. The analyzes were conducted using STATA version 13 software (Stata-Corps). 3. RESULTS Sixty-three patients were included for study analysis. Mean age of study population was 63.8±8.5 years and most of them were postmenopausal (94.8%). Preoperative assessment showed 73.0% of patients suffered from stage III prolapse (Table 1). Apical vaginal prolapse was detected in all participants, whereas 85.7% had anterior compartment prolapse and 46.6% had posterior compartment prolapse. Mean±SD preoperative Ba, C and Bp points were +24.5±14.0 mm, +9.3±26.3 mm, and -10±14.6 mm, respectively. SCP was performed with fixation of anterior and posterior mesh arms in 69.8% of the cases, whereas in 30.2% the graft was sutured only to the anterior vaginal wall . The mean follow-up time was 32.7±3.1 months, i.e. 2.7 years. At one month follow-up, mean Ba, C and Bp points were -15.8±6.9 mm, -58.7±9.9 mm and -19.8±4.3 mm (Table 2). All POP-Q points were significantly improved (p<0.001). Mid-term follow-up POP-Q measurements were significantly different from preoperative values (p<0.001). However, when these values were compared to those of 1-month follow-up, significant worsening was detected (p<0.05). Overall prolapse recurrence rate at mid-term follow-up was 48.2%. All patients had POP-Q stage ≤2; among them, 5 women (8.6%) suffered from stage 2 posterior compartment recurrence and 25 women (43.1%) showed stage 2 anterior compartment recurrence. Measurement of Bladder neck - Mesh Distance was feasible for all women ( n =63/63, 100%) (Table 3). Mean Bladder neck - Mesh Distance measured 5.3±3.1 mm. Preoperative C and Bp points were inversely correlated to Bladder neck - Mesh Distance with low strength of association (ϱ=-0.30 and ϱ=-0.25, respectively; p<0.05). No statistical significance was detected for correlation with Ba point (Table 3). Bladder neck - Mesh Distance showed inverse significant correlation with ∆-C and ∆-Bp at one-month follow-up revaluation; hence, the shorter the Bladder neck - Mesh Distance , the higher the reduction of C and Bp compartment prolapse (ϱ=-0.32 and ϱ=-0.28, respectively; p<0.05). Correction of C point (∆-C) was positively correlated with correction of Ba point (∆-Ba) at one month (ϱ=0.36, p<0.05) and at 2.7 years (ϱ=0.30, p<0.05) follow-up. As additional data, no significant association was detected between Bladder neck - Mesh Distance and anterior compartment (4.9±2.9 mm for recurrence group vs 5.6±3.3 for patients with no recurrence , p≥0.05) or posterior compartment prolapse recurrence. At midterm follow-up, no apical compartment prolapse recurrence occurred. Nineteen women suffered from postoperative SUI at the second follow-up revaluation after POP repair (Supplemental Table 1). Mean Bladder neck - Mesh Distance was significantly longer in women without SUI (5.9±3.1 mm vs 4.0±2.9 mm, p<0.05), and showed a tendency to decrease along with SUI occurrence (ϱ=-0.28, p<0.001) (Supplemental Table 2). According to the PGI-I score, the postoperative satisfaction rate was high: 98.4% of women declared to feel very much or much better (PGI-I=1 or 2) one month after surgery (Supplemental Table 1). At mid-term follow-up, 44 women (69.8%) felt very much better and 19 (30.2%) were much better. Correlation analysis was significant at mid-term follow-up, with the PGI-I scores improved when Bladder neck - Mesh Distance measures were higher (Table 4). 4. DISCUSSION Two years after laparoscopic SCP, mean Bladder neck - Mesh Distance was inversely correlated with the correction of apical prolapse and the occurrence of postoperative SUI. So, the shorter the Bladder neck - Mesh Distance , the better the correction of apical prolapse and the higher the chance of postoperative SUI. Bladder neck - Mesh Distance measures were not significantly associated to anterior compartment prolapse evaluated through the Ba point, whereas correction of anterior compartment (∆-Ba) was positively correlated with correction of apical prolapse (∆-C). The overall results and recurrence rates of SCP are well known. However, the technical aspects of surgery, such as the degree of anterior and posterior dissection, mesh positioning and traction on the promontory are mainly based on clinical judgment[8]. Moreover, their effect on the outcomes and recurrence rates are limited to common wisdom and experience [9]. The widely accepted “rules” for the SCP technique are limited to “avoid the trigone to prevent postoperative bladder irritation and incontinence” and “fix the meshes with a moderate traction on the promontory” [10]. Some authors have already reported results in favor of a limited anterior dissection [10]; through our study we attempted an objective investigation on the relationship between the depth of anterior dissection and the postoperative anatomical results. Two-dimensional ultrasound Bladder neck - Mesh Distance measurement can be considered an objective technique. It was feasible in all included patients, which means it could be a reproducible and valid technique to investigate optimal mesh positioning. The echogenicity of polypropylene meshes facilitates visualization by ultrasound whereas interpretation can be more difficult with other imaging methods as conventional radiology, CT scanner and MRI [30,19]. However, further larger studies are needed to investigate the intra- and inter-operator reproducibility of this technique. Our correlation analysis showed that anterior compartment anatomical correction measured through Ba point was related to apical correction, and no association was detected with the deepness of mesh fixation. This finding supports the hypothesis that correction of the apex defect may lead to an indirect correction of other compartments’ defect, even partially, with the reconstruction of the “Canadian tent” [20]. Nevertheless, overall prolapse recurrence rate at mid-term follow-up was 48,2%, and the risk of recurrence affecting the anterior compartment at mid-term follow-up is worth attention, bothering over 43% of the patients. This data may seem high; however, they are referred to the objective measurement of vaginal compartments through POP-Q system, thus enhancing the detection of “anatomical” prolapse rather than that of “clinical” prolapse. The latter may be better expressed by the PGI-I score which, indeed, reflects good-to-great overall patients’ satisfaction. Our series seems to confirm our clinical impression that dissection of the bladder should not be “ as low as possible ”. Indeed, postoperative SUI was more frequent with deeper dissections. This may be explained by the correction of cystocele and removal of the “ ball effect ”, in addition to an opening of the urethrovesical angle due to the traction that increases in lower dissection [21, 31]. On the contrary, Cosma et al. published in 2018 a series of 121 patients treated with a "simplified" laparoscopic sacropexy. Meshes were anchored exclusively to the vaginal apex even in presence of advanced multi-compartmental vaginal prolapse. This surgical technique provided good anatomical results, low complication rate and satisfactory correction of the other compartments[32]. Indeed, there is increasing awareness that overall outcomes of multicompartmental prolapse are better when multicompartmental repair is performed [1,33–35]. Simultaneous correction of compartment other than the affected one could prevent de novo prolapse development [35]. Furthermore, Wong et al. concluded that risk of anterior compartment prolapse recurrence increased of 6 to 7% for every mm that the anterior mesh is inserted far from the bladder neck [16]. However, the relationship between low vesico-vaginal space dissection and risk of complications was not investigated. Therefore, considering the limits of Cosma’s and Wong’s study, the current literature evidence, and our data, we would not recommend limiting the dissection to the vaginal cuff, nor delving deep. An optimal cut-off value is yet to determined, but our study dived into the relationship of the depth of anterior dissection and anatomical outcomes, and Bladder neck - Mesh Distance values associated to SUI may give us some indications [10]. Indeed, a significant though small mean Bladder neck - Mesh Distance difference was observed between women with and without postoperative SUI, and an inverse relationship between Bladder neck - Mesh Distance and SUI was also detected. We might assume that mesh should be fixed at least 6 mm far from the bladder neck, and that Bladder neck - Mesh Distance measurement may be helpful if performed during the surgical procedure to correctly place the mesh [10]. However, other studies are needed to confirm our hypothesis and safely introduce Bladder neck - Mesh Distance measurement as a helpful tool during SCP procedure. Our study has some limitations. The small sample size and the retrospective design prevent us from drawing straight conclusions. Larger studies with longer follow-up are required to confirm our findings and validate Bladder neck - Mesh Distance as a predictive index for surgical efficacy. The heterogeneous application of the posterior mesh, which was not performed routinely in all patients, but limited to those cases in which it was deemed necessary by the surgeon, according to the preoperative assessment, might be considered a limit, but postoperative assessment of the posterior compartment repair was not the main aim of the study, and posterior mesh fixation is associated with minor effect on anterior and apical compartment rather than the opposite [1,2,19–22]. The use of nonabsorbable sutures for mesh fixation, as implemented in the present study, has been previously associated with an increased rate of mesh exposure [36], while it seems, according to the recent literature, to be associated only with vaginal exposure of the suture itself, with similar anatomical results when compared with delayed absorbable sutures [37]. In addition, the well-known fibrotic process which follows the placement of the mesh during sacrocolpopexy, could potentially interfere in the measurement of Bladder neck - Mesh Distance, especially during mid-term follow-up. Despite optimal feasibility of Bladder neck - Mesh Distance measurement in this series, the distance was evaluated by the same operator in all the patients. Therefore, intra- and inter-operator reproducibility of Bladder neck - Mesh Distance measurement has yet to be established. Also, because prolapse is a dynamic process, repeating the ultrasound measurements in a longer follow-up, could lead to a better understanding of the relationship between Bladder neck - Mesh Distance and surgical outcomes. 5. CONCLUSIONS Shorter Bladder neck - Mesh Distance measures are correlated with a better apical correction and the occurrence of postoperative SUI. Deeper anterior dissection had no correlation with anterior anatomical correction, while it was positively correlated with better PGI-I scores. Larger studies with longer follow-up are needed to investigate the optimal Bladder neck - Mesh Distance measure linked to the best ratio between the correction of apical prolapse and the occurrence of postoperative complications. Declarations Statements: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. AUTHOR CONTRIBUTIONS: N. H: Protocol/project development, Data collection or management, Data analysis. M. G.: Data analysis, Manuscript writing/editing. T. T.: Data analysis, Manuscript writing/editing. A. H.: Data analysis. Manuscript writing/editing. G. C.: Protocol/project development, Data collection or management, Data analysis. A. C.: Data analysis, Manuscript writing/editing. G. B.: Data analysis. Manuscript writing/editing. Acknowledgment(s): None Data Availability: The data underlying this article cannot be shared publicly due to the need for privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author. Sources of funding: None. Author agreement statement: All authors meet the ICMJE requirements for authorship and each author read and agreed to the published version of the manuscript. 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Female Pelvic Med Reconstr Surg 16:229–233 Reisenauer C, Andress J, Schoenfisch B, Huebner M, Brucker SY, Lippkowski A, Beilecke K, Marschke J, Tunn R (2022) Absorbable versus non-absorbable sutures for vaginal mesh attachment during sacrocolpopexy: a randomized controlled trial. Int Urogynecol J 33:411–419 Tables Table 1 . Descriptive analysis of patients’ characteristics. Variable Mean ± SD or N(%) Age, years 63.5±8.5 BMI, kg/m 2 24.8±3.5 Parity 2.8±1.3 Vaginal deliveries 1 11 (17.5) 2 17 (27.0) ≥3 35 (55.5) Menopausal status No 6 (9.5) Yes, no HRT 54 (85.7) Yes, with HRT 3 (4.8) Previous surgery None 28 (44.4) Abdominal surgery 16 (25.4) Laparoscopic surgery 12 (19.1) Vaginal surgery 5 (7.9) Other surgeries 2 (3.2) Symptoms Dysuria 29 (46.0) Voiding dysfunction 12 (19.0) Constipation 15 (23.8) Pelvic pain 13 (20.6) Bulging 58 (92.1) Preoperative SUI 17 (27.0) Preoperative prolapse staging (POP-Q classification) 2 8 (14.3) 3 46 (73.0) 4 8 (12.7) Type of vaginal prolapse Anterior compartment 54 (85.7) Apical 63 (100.0) Posterior compartment 29 (46.0) SCP procedure Anterior mesh fixation 19 (30.2) Anterior plus posterior mesh fixation 44 (69.8) Follow up, months 32.7±3.1 Continuous variables are expressed as mean±standard deviation and categorical variables are expressed as counts (percentages, %), Abbreviations: BMI: body mass index; SD: standard deviation; HRT: hormonal replacement therapy; N: count; POP-Q: Pelvic Organ Prolapse Quantification; SCP: sacrocolpopexy; SUI: stress urinary incontinence. Table 2 . Pelvic organ prolapse points assessed preoperatively, one month after surgery and at mid-term follow-up visit. POP-Q Preoperative One-month follow-up Mid-term follow-up Ba point (mm) +24.5±14.0 -15.8±6.9* -14.7±5.7* C point (mm) +9.3±26.3 -58.7±9.9* -57.0±9.5* Bp point (mm) -9.7±14.6 -19.8±4.3* -17.9±3.9* Continuous variables are expressed as mean±SD. Abbreviations: POP-Q: Pelvic Organ Prolapse Quantification. *P-value <0.05. Table 3. Correlation of prolapse surgical variables with Bladder neck - Mesh Distance measures. Variable Spearman correlation coefficient with Bladder neck - Mesh Distance (ϱ) Preoperative prolapse staging -0.09 (-0.52; -0.062) BMI, kg/m² +0.13 (-0.11; +0.39) Preoperative Ba point -0.02 (-0.29; +0.22) C point -0.30 (-0.50; -0.03)* Bp point -0.25 (-0.47; +0.01)* One-month follow-up Ba point -0.05 (-0.30; +0.20) C point -0.07 (-0.32; +0.18) Bp point +0.06 (-0.20; +0.31) ∆-Ba point -0.03 (-0.28; +0.23) ∆-C point -0.30 (-0.49; -0.02)* ∆-Bp point -0.28 (-0.51; -0.04)* Mid-term follow-up Ba point -0.07 (-0.32; +0.19) C point -0.08 (-0.33; +0.18) Bp point -0.01 (-0.26; +0.25) ∆-Ba point -0.01 (-0.27; +0.24) ∆-C point -0.28 (-0.48; -0.00)* ∆-Bp point -0.22 (-0.46; +0.03) Values are expressed as Spearman correlation coefficient, ϱ (CI 95%). BMI: body mass index; ∆: difference between preoperative point and postoperative point at one-month or 2.7 years after surgery. *P-value <0.05. Table 4: Assessment of PGI correlation to prolapse staging points and Bladder neck - Mesh Distance measures. Variable Spearman correlation coefficient with PGI-I (ϱ) One-month follow-up Ba point -0.06 (-0.31; +0.20) C point +0.02 (-0.23; +0.28) Bp point -0.21 (-0.44; +0.05) BMD +0.05 (-0.20; +0.30) Mid-term follow-up Ba point +0.09 (-0.17; +0.34) C point +0.06 (-0.20; +0.31) Bp point -0.11 (-0.35; +0.15) BMD -0.25 (-0.48; -0.01)* Values are expressed as Spearman correlation coefficient, ϱ (CI 95%). Abbreviations: BMD: Bladder neck-Mesh Distance; PGI-I: Patient Global Impression of Improvement. *P-value <0.05. Supplementary Files SupplementalTable12.docx Cite Share Download PDF Status: Published Journal Publication published 25 Sep, 2024 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Reviewers agreed at journal 25 Jun, 2024 Reviewers invited by journal 23 Jun, 2024 Editor invited by journal 19 Jun, 2024 Editor assigned by journal 13 Jun, 2024 First submitted to journal 12 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4572463","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317840171,"identity":"1f4cf03d-371e-4cf4-84dd-77d08297ffbc","order_by":0,"name":"Nassir Habib","email":"","orcid":"","institution":"CH Francois Quesnay: Centre Hospitalier Francois Quesnay","correspondingAuthor":false,"prefix":"","firstName":"Nassir","middleName":"","lastName":"Habib","suffix":""},{"id":317840172,"identity":"1e940120-bb1f-45b3-ad54-3a2c618d92f0","order_by":1,"name":"Matteo Giorgi","email":"","orcid":"","institution":"Siena University Hospital: Azienda Ospedaliera Universitaria Senese","correspondingAuthor":false,"prefix":"","firstName":"Matteo","middleName":"","lastName":"Giorgi","suffix":""},{"id":317840173,"identity":"4e29f2a7-adc6-45de-9282-6afd96093884","order_by":2,"name":"Tania Tahtouh","email":"","orcid":"","institution":"Abu Dhabi University","correspondingAuthor":false,"prefix":"","firstName":"Tania","middleName":"","lastName":"Tahtouh","suffix":""},{"id":317840174,"identity":"ab90f51b-3975-45b9-ac90-7048f3698261","order_by":3,"name":"Amel Hamdi","email":"","orcid":"","institution":"Abu Dhabi University","correspondingAuthor":false,"prefix":"","firstName":"Amel","middleName":"","lastName":"Hamdi","suffix":""},{"id":317840175,"identity":"5e7e1a20-48f0-4fab-bd7c-fc241ff0ab40","order_by":4,"name":"Gabriele Centini","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIie2RMUvEMBTH3+2RbPIO4fIVEgrSwd2vkXBrFccbRDPdTUfXHn4EF6FQHAvCuaS6Vlzqfsq51UVMWhWHtq6C+Q0vj/B++ScEwOP5q0hAW4lrQqDNzsmgMNI/FISxdgr/RWlX4goCz906oNDF8rZ6ug6BHRbrbTXDSXB/qbYVB0Z3804FzZ3SyiAIczxNpMFgv3xO0V5MrC5kp8IxElrNraKjAGyjsrK4corkjz0K23wq8cYq73ieJkVaDypIWoWhS9H2fLrMBlPQRCKxCuH4MgW5RpGUO1koOfa+hS4Mf32bn01YfHQzqk8PGI2L9KGe2WavW/mCtN/RBDeTODjewPR3cN4/5fF4PP+SD+XLXInlt8WiAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-6113-7401","institution":"Università degli Studi di Siena: Universita degli Studi di Siena","correspondingAuthor":true,"prefix":"","firstName":"Gabriele","middleName":"","lastName":"Centini","suffix":""},{"id":317840176,"identity":"1dea29b4-6421-471a-92a5-d3906d8f9dfd","order_by":5,"name":"Alberto Cannoni","email":"","orcid":"","institution":"Siena University Hospital: Azienda Ospedaliera Universitaria Senese","correspondingAuthor":false,"prefix":"","firstName":"Alberto","middleName":"","lastName":"Cannoni","suffix":""},{"id":317840177,"identity":"67220cb7-d8ef-455a-a904-e706813ad81f","order_by":6,"name":"Georges Bader","email":"","orcid":"","institution":"Ambroise Paré University Hospital: Centre Hospitalier Universitaire Ambroise Pare","correspondingAuthor":false,"prefix":"","firstName":"Georges","middleName":"","lastName":"Bader","suffix":""}],"badges":[],"createdAt":"2024-06-12 21:11:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4572463/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4572463/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00404-024-07719-4","type":"published","date":"2024-09-25T15:56:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":65628373,"identity":"530013eb-f9f3-4c39-8c61-fc17e611760d","added_by":"auto","created_at":"2024-09-30 16:18:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":613396,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4572463/v1/546cacff-c7e4-4575-b3f9-a05323820576.pdf"},{"id":60189860,"identity":"4ea7aa1f-e907-415d-aded-1c4dd88183cb","added_by":"auto","created_at":"2024-07-12 19:47:20","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":16222,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalTable12.docx","url":"https://assets-eu.researchsquare.com/files/rs-4572463/v1/383076c7997f5b7b354fce91.docx"}],"financialInterests":"","formattedTitle":"Post-operative outcomes associated with anterior mesh location after laparoscopic sacrocolpopexy.","fulltext":[{"header":"Summary","content":"\u003cp\u003eThis retrospective study investigates the surgical outcomes of laparoscopic sacrocolpopexy, evaluating the position of the anterior mesh by measuring bladder neck-mesh distance with introital ultrasound.\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"1. INTRODUCTION","content":"\u003cp\u003eSacrocolpopexy (SCP) is currently considered the reference option for vaginal vault prolapse [1]. According to the recent literature, the laparoscopic approach is preferrable because it is associated to lower operative morbidity than the laparotomic approach and, indeed, guarantees similar anatomical and functional results [1\u0026ndash;3] with comparable recurrence and re-operation rates (1.7 to 11.5%) [4\u0026ndash;7]. Nevertheless, the surgical technique of SCP remains poorly standardized [8]. Currently, there is no universal consensus on the height of mesh fixation to the anterior vaginal wall and the historic principle \u0026ldquo;\u003cem\u003eas low as possible\u003c/em\u003e\u0026rdquo; is still applied by surgeons, making this surgical step somewhat controversial and largely based on surgeon\u0026rsquo;s experience and individual clinical judgment [9]. Such a variability may affect the outcomes and the recurrence rate associated to SCP procedure. Therefore, research aiming to a more uniform and homogeneous mesh fixation along with a more precise graft location could represent a step towards the standardization of SCP surgery [10].\u003c/p\u003e\n\u003cp\u003eUltrasonography allows a dynamic evaluation of pelvic organ mobility and pelvic floor function, and either transvaginal or transperineal approach has been proposed [11,12]. The transperineal approach (translabial or introital) seems more suitable than the transvaginal approach because it does not modify the anatomical relationships between pelvic organs. Therefore, 2D- and 3D-transperineal ultrasonography has been recently used to evaluate the position of the mesh on the vagina, as well as its folding and contraction after laparoscopic SCP [13\u0026ndash;15].\u003c/p\u003e\n\u003cp\u003eWong et al investigated the anterior mesh position after SCP using transperineal ultrasound [16]. Mesh location was evaluated according to the distance between the distal extremity of the anterior mesh and a line passing through the inferior margin of the pubic symphysis. By using this ultrasound technique, the mesh was identified in 62% of the cases. Among these, the risk of anterior compartment prolapse recurrence increased by 7% for every mm the mesh was positioned further from the bladder neck.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecently, we introduced a new introital ultrasound measure to localize the mesh in relation to the bladder neck\u0026nbsp;[10]. The Bladder neck-Mesh Distance \u0026nbsp;seems a feasible technique with a reported mesh detection rate of 100%.\u003c/p\u003e\n\u003cp\u003eThe aim of the present study was to assess the relationship between the anterior vaginal mesh position - evaluated through Bladder neck - Mesh Distance measure - on mid-term postoperative outcomes including anatomical results, postoperative SUI and patients\u0026rsquo; satisfaction after laparoscopic SCP for apical prolapse.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003ch2\u003e2.1 Study protocol\u003c/h2\u003e\n\u003cp\u003eThis observational single center study followed an a priori protocol based on STROBE guidelines and checklist [17]. It is a retrospective analysis of prospectively collected data which includes all consecutive women who underwent laparoscopic SCP for stage 2 or higher apical vaginal compartment prolapse according to the\u0026nbsp;Pelvic Organ Prolapse Quantification (POP-Q) Systemin a tertiary care hospital (Medico-Surgical Center of Ambroise Par\u0026eacute; - Pierre Cherest \u0026ndash; Hartmann, France) between January 2019 and September 2019 [18]. Patients with a history of prolapse surgery, subtotal hysterectomy, and/or sub-urethral sling surgery were excluded because of potential modifications of the pelvic landmarks and the associated artifacts on ultrasound examination. We excluded patients who had sub-urethral sling placement and/or any type of vaginal repair concomitant to SCP procedure for better comparison. We also excluded patients who previously experienced SUI. We included patients who had a previous total hysterectomy and these who underwent total hysterectomy at the time of SCP.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMedical records were retrieved from institutional electronic databases and clinical reports.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe main aim of the study was to investigate the relationship between\u0026nbsp;Bladder neck - Mesh Distance\u0026nbsp; measures after SCP and surgical anatomical outcomes, especially these of the apical and anterior compartment (i.e.: Ba, C, and their pre- and post-operative variations). Secondary aims of the study were to evaluate the feasibility of\u0026nbsp;Bladder neck - Mesh Distance\u0026nbsp; measuring and assess the relationship between\u0026nbsp;Bladder neck - Mesh Distance\u0026nbsp; measures, postoperative SUI, and PGI-I scores.\u003c/p\u003e\n\u003ch2\u003e2.2 Preoperative assessment\u003c/h2\u003e\n\u003cp\u003eAccording to the hospital routine practice, preoperative clinical assessment of women affected by genital prolapse included collection of previous medical history, urogynecological examination and transvaginal ultrasonography. For each patient, clinical data were acquired as follows: age, body mass index (kg/m\u003csup\u003e2\u003c/sup\u003e), parity, number of vaginal deliveries, menopausal status, use of hormonal replacement therapy, and previous surgeries. Preoperative prolapse staging was assessed according to the POP-Q classification [18] and urodynamic testing was performed only when deemed necessary. Presence of stress urinary incontinence (SUI) was also investigated. Ultrasonographic evaluation using Voluson E8 ultrasound machine (GE Healthcare, Zipf, Austria) with a 4\u0026ndash;9 MHz volumetric vaginal probe was employed to exclude gynecological diseases (i.e.: fibroids, ovarian cysts). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne to three-months after preoperative assessment, laparoscopic SCPs were all performed by an experienced endoscopic surgeon (G.B.).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e2.3 Surgical procedure\u003c/h2\u003e\n\u003cp\u003eThe procedure started with the incision of the anterior pelvic peritoneum, if not previously performed for total hysterectomy (whose surgical steps will not be described as out of the purpose of this study). The depth of the vesicovaginal dissection was limited to the point just above the catheter balloon, as a landmark for the bladder trigone. The anterior, monofilament, polypropylene mesh (Gynecare Gynemesh PS, Ethicon\u003csup\u003e\u0026reg;\u003c/sup\u003e) was fixed on the anterior vaginal wall using three nonabsorbable sutures (Ethibond 2/0, Ethicon\u003csup\u003e\u0026reg;\u003c/sup\u003e) and was secured to the vaginal vault with two nonabsorbable stiches (Ethibond 0/0, Ethicon\u003csup\u003e\u0026reg;\u003c/sup\u003e). Posterior mesh fixation was not routinely performed; in fact, according to the literature, posterior mesh fixation is known to have minor effect on anterior and apical compartment rather than the opposite\u0026nbsp;[1,2,19\u0026ndash;22].\u0026nbsp;When deemed necessary by the surgeon, on the basis of the preoperative assessment, and after careful placement, the posterior mesh was attached laterally to levator ani muscles, the posterior vaginal wall, and the uterosacral ligaments using multiple 2/0 multifilament absorbable sutures (Vicryl 2/0, Ethicon\u003csup\u003e\u0026reg;\u003c/sup\u003e). Following the posterior peritoneum dissection starting from the promontory with a caudocranial direction, the mesh was then fixed to the anterior longitudinal ligament (Ethibond 0/0, Ethicon\u003csup\u003e\u0026reg;\u003c/sup\u003e). Peritonealization of the mesh was completed using an absorbable continuous suture (Monocryl 2/0, Ethicon\u003csup\u003e\u0026reg;\u003c/sup\u003e).\u003c/p\u003e\n\u003cp\u003eSub-urethral sling placement was not carried out at the time of SCP surgery as recommended by the French surgical society\u0026rsquo;s guidelines [23].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIntraoperative complications were assessed according to Clavien-Dindo classification [24].\u003c/p\u003e\n\u003ch2\u003e2.4 Bladder neck - Mesh Distance \u0026nbsp;measurement\u003c/h2\u003e\n\u003cp\u003eAn introital ultrasound, with the patient in a lithotomy position, was performed by the surgeon immediately at the end of the surgical procedure using Voluson E8 ultrasound machine (GE Healthcare, Zipf, Austria) with a 4\u0026ndash;9 MHz volumetric vaginal probe [13,15,16]. The balloon of the foley catheter was used as a landmark to locate the bladder neck and Bladder neck - Mesh Distance \u0026nbsp;was measured between the mesh and a tangential plane running below the balloon, perpendicularly to the urethra, according to the study by Habib et al.\u0026nbsp;[10], thus preventing measure discrepancies related to balloon insufflation and bladder emptiness. The foley catheter maintained a neutral position and was not tractioned during the ultrasound, allowing to standardize the measurements. Mean Bladder neck - Mesh Distance value for each patient was used for statistical analysis.\u003c/p\u003e\n\u003ch2\u003e2.5 Postoperative assessment\u003c/h2\u003e\n\u003cp\u003ePostoperative follow-up included a short-term revaluation at one month after surgery and a mid-term clinical examination between 24 and 36 months after surgery. Patients\u0026rsquo; assessment was based on the following items:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;a cough stress test (CST), following the ICS recommendations [25], assessing the presence of postoperative SUI (defined as the complaint of any involuntary loss of urine on effort or physical exertion, or on sneezing or coughing according to the ICS terminology\u0026nbsp;[26] and patients\u0026rsquo; satisfaction using the Patient Global Impression of Improvement (PGI-I score)\u0026nbsp;[27] [28];\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ea urogynecological examination. Anatomical prolapse recurrence was defined as POP-Q stage \u0026ge; 2 at short- or mid-term revaluation; postoperative complications were also assessed using the Clavien-Dindo classification [24].\u003c/p\u003e\n\u003cp\u003eTo estimate the effect of anterior compartment, apical and posterior compartment prolapse repair, the variables ∆-Ba, ∆-C and ∆-Bp were created and represented anterior, apical and posterior compartment differences between pre- and post-operative anatomical points, respectively.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e2.6 Ethical statement\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the local ethic committee (2018/21 EVAPRO) and conducted in accordance with the Declaration of Helsinki. All patients gave their informed consent at the time of inclusion in the study.\u003c/p\u003e\n\u003ch2\u003e2.7 Statistical analysis\u003c/h2\u003e\n\u003cp\u003eNumerical variables were expressed as means \u0026plusmn; standard deviations (SD) and categorical variables were summarized as frequencies and percentages. Continuous variables were compared with Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e test or Mann-Whitney test where appropriate, and qualitative variables with Chi-square test (or Fisher\u0026rsquo;s exact test when expected numbers \u0026lt; 5).\u003c/p\u003e\n\u003cp\u003eThe Spearman rank correlation coefficient was used to examine the relation between Bladder neck - Mesh Distance \u0026nbsp;and outcomes variables (expressed as ϱ, CI 95%). According to Schober et al. [29], statistical correlation between variables was \u003cem\u003ea priori\u003c/em\u003e categorized as no correlation for ϱ=0, very weak for 0.00\u0026lt;ϱ\u0026le;0.19, weak for 0.20\u0026le;ϱ\u0026le;0.39, moderate for 0.40\u0026le;ϱ\u0026le;0.59, strong for 0.60\u0026le;ϱ\u0026le;0.79, very strong for 0.80\u0026le;ϱ\u0026lt;1.00 and monotonic correlation for ϱ=1.00.\u003c/p\u003e\n\u003cp\u003eA p value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003eThe analyzes were conducted using STATA version 13 software (Stata-Corps).\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eSixty-three patients were included for study analysis. Mean age of study population was 63.8\u0026plusmn;8.5 years\u0026nbsp;and most of them were postmenopausal (94.8%).\u0026nbsp;Preoperative assessment showed 73.0% of patients suffered from stage III prolapse (Table 1). Apical vaginal prolapse was detected in all participants, whereas 85.7% had anterior compartment prolapse and 46.6% had posterior compartment prolapse.\u003c/p\u003e\n\u003cp\u003eMean\u0026plusmn;SD preoperative Ba, C and Bp points were +24.5\u0026plusmn;14.0 mm, +9.3\u0026plusmn;26.3 mm, and -10\u0026plusmn;14.6 mm, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSCP was performed with fixation of anterior and posterior mesh arms in 69.8% of the cases, whereas in 30.2% the graft was sutured only to the anterior vaginal wall .\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe mean follow-up time was 32.7\u0026plusmn;3.1 months, i.e. 2.7 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt one month follow-up, mean Ba, C and Bp points were -15.8\u0026plusmn;6.9 mm, -58.7\u0026plusmn;9.9 mm and -19.8\u0026plusmn;4.3 mm (Table 2). All POP-Q points were significantly improved (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eMid-term follow-up POP-Q measurements were significantly different from preoperative values (p\u0026lt;0.001). However, when these values were compared to those of 1-month follow-up, significant worsening was detected (p\u0026lt;0.05). Overall prolapse recurrence rate at mid-term follow-up was 48.2%. All patients had POP-Q stage \u0026le;2; among them, 5 women (8.6%) suffered from stage 2 posterior compartment recurrence and 25 women (43.1%) showed stage 2 anterior compartment recurrence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMeasurement of Bladder neck - Mesh Distance \u0026nbsp;was feasible for all women (\u003cem\u003en\u003c/em\u003e=63/63, 100%) (Table 3). Mean Bladder neck - Mesh Distance \u0026nbsp;measured\u0026nbsp;5.3\u0026plusmn;3.1 mm. Preoperative C and Bp points were inversely correlated to Bladder neck - Mesh Distance \u0026nbsp;with low strength of association (ϱ=-0.30 and ϱ=-0.25, respectively; p\u0026lt;0.05). No statistical significance was detected for correlation with Ba point (Table 3).\u003c/p\u003e\n\u003cp\u003eBladder neck - Mesh Distance \u0026nbsp;showed inverse significant correlation with ∆-C and ∆-Bp at one-month follow-up revaluation; hence, the shorter the\u0026nbsp;Bladder neck - Mesh Distance\u0026nbsp;, the higher the reduction of C and Bp compartment prolapse (ϱ=-0.32 and ϱ=-0.28, respectively; p\u0026lt;0.05). Correction of C point (∆-C) was positively correlated with correction of Ba point (∆-Ba) at one month (ϱ=0.36, p\u0026lt;0.05) and at 2.7 years (ϱ=0.30, p\u0026lt;0.05) follow-up.\u003c/p\u003e\n\u003cp\u003eAs additional data, no significant association was\u0026nbsp;detected\u0026nbsp;between\u0026nbsp;Bladder neck - Mesh Distance\u0026nbsp; and anterior compartment (4.9\u0026plusmn;2.9 mm for recurrence group vs 5.6\u0026plusmn;3.3 for patients with no recurrence , p\u0026ge;0.05) or posterior compartment prolapse recurrence. At midterm follow-up, no apical compartment prolapse recurrence occurred.\u003c/p\u003e\n\u003cp\u003eNineteen women suffered from postoperative SUI at the second follow-up revaluation after POP repair (Supplemental Table 1). Mean\u0026nbsp;Bladder neck - Mesh Distance\u0026nbsp; was significantly longer in women without SUI (5.9\u0026plusmn;3.1 mm vs 4.0\u0026plusmn;2.9 mm, p\u0026lt;0.05), and showed a tendency to decrease along with SUI occurrence (ϱ=-0.28, p\u0026lt;0.001) (Supplemental Table 2).\u003c/p\u003e\n\u003cp\u003eAccording to the PGI-I score, the postoperative satisfaction rate was high: 98.4% of women declared to feel very much or much better (PGI-I=1 or 2) one month after surgery (Supplemental Table 1). At mid-term follow-up, 44 women (69.8%) felt very much better and 19 (30.2%) were much better. Correlation analysis was significant at mid-term follow-up, with the PGI-I scores improved when Bladder neck - Mesh Distance \u0026nbsp;measures were higher (Table 4).\u0026nbsp;\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eTwo years after laparoscopic SCP, mean Bladder neck - Mesh Distance \u0026nbsp;was inversely correlated with the correction of apical prolapse and the occurrence of postoperative SUI. So, the shorter the Bladder neck - Mesh Distance , the better the correction of apical prolapse and the higher the chance of postoperative SUI. Bladder neck - Mesh Distance \u0026nbsp;measures were not significantly associated to anterior compartment prolapse evaluated through the Ba point, whereas correction of anterior compartment (∆-Ba) was positively correlated with correction of apical prolapse (∆-C).\u003c/p\u003e\n\u003cp\u003eThe overall results and recurrence rates of SCP are well known. However, the technical aspects of surgery, such as the degree of anterior and posterior dissection, mesh positioning and traction on the promontory are mainly based on clinical judgment[8]. Moreover, their effect on the outcomes and recurrence rates are limited to common wisdom and experience [9]. The widely accepted \u0026ldquo;rules\u0026rdquo; for the SCP technique are limited to \u0026ldquo;avoid the trigone to prevent postoperative bladder irritation and incontinence\u0026rdquo; and \u0026ldquo;fix the meshes with a moderate traction on the promontory\u0026rdquo; [10].\u003c/p\u003e\n\u003cp\u003eSome authors have already reported results in favor of a limited anterior dissection [10]; through our study we attempted an objective investigation on the relationship between the depth of anterior dissection and the postoperative anatomical results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTwo-dimensional ultrasound Bladder neck - Mesh Distance \u0026nbsp;measurement can be considered an objective technique. It was feasible in all included patients, which means it could be a reproducible and valid technique to investigate optimal mesh positioning. The echogenicity of polypropylene meshes facilitates visualization by ultrasound whereas interpretation can be more difficult with other imaging methods as conventional radiology, CT scanner and MRI [30,19]. However, further larger studies are needed to investigate the intra- and inter-operator reproducibility of this technique.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur correlation analysis showed that anterior compartment anatomical correction measured through Ba point was related to apical correction, and no association was detected with the deepness of mesh fixation. This finding supports the hypothesis that correction of the apex defect may lead to an indirect correction of other compartments\u0026rsquo; defect, even partially, with the reconstruction of the \u0026ldquo;Canadian tent\u0026rdquo; [20]. Nevertheless, overall prolapse recurrence rate at mid-term follow-up was 48,2%, and the risk of recurrence affecting the anterior compartment at mid-term follow-up is worth attention, bothering over 43% of the patients. This data may seem high; however, they are referred to the objective measurement of vaginal compartments through POP-Q system, thus enhancing the detection of \u0026ldquo;anatomical\u0026rdquo; prolapse rather than that of \u0026ldquo;clinical\u0026rdquo; prolapse. The latter may be better expressed by the PGI-I score which, indeed, reflects good-to-great overall patients\u0026rsquo; satisfaction.\u003c/p\u003e\n\u003cp\u003eOur series seems to confirm our clinical impression that dissection of the bladder should not be \u0026ldquo;\u003cem\u003eas low as possible\u003c/em\u003e\u0026rdquo;. Indeed, postoperative SUI was more frequent with deeper dissections. This may be explained by the correction of cystocele and removal of the \u0026ldquo;\u003cem\u003eball effect\u003c/em\u003e\u0026rdquo;, in addition to an opening of the urethrovesical angle due to the traction that increases in lower dissection [21, 31].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the contrary, Cosma et al. published in 2018 a series of 121 patients treated with a \u0026quot;simplified\u0026quot; laparoscopic sacropexy. Meshes were anchored exclusively to the vaginal apex even in presence of advanced multi-compartmental vaginal prolapse. This surgical technique provided good anatomical results, low complication rate and satisfactory correction of the other compartments[32]. Indeed, there is increasing awareness that overall outcomes of multicompartmental prolapse are better when multicompartmental repair is performed [1,33\u0026ndash;35]. Simultaneous correction of compartment other than the affected one could prevent \u003cem\u003ede novo\u0026nbsp;\u003c/em\u003eprolapse development [35]. Furthermore, Wong et al. concluded that risk of anterior compartment prolapse recurrence increased of 6 to 7% for every mm that the anterior mesh is inserted far from the bladder neck [16]. However, the relationship between low vesico-vaginal space dissection and risk of complications was not investigated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, considering the limits of Cosma\u0026rsquo;s and Wong\u0026rsquo;s study, the current literature evidence, and our data, we would not recommend limiting the dissection to the vaginal cuff, nor delving deep. An optimal cut-off value is yet to determined, but our study dived into the relationship of the depth of anterior dissection and anatomical outcomes, and Bladder neck - Mesh Distance \u0026nbsp;values associated to SUI may give us some indications [10]. Indeed, a significant though small mean Bladder neck - Mesh Distance \u0026nbsp;difference was observed between women with and without postoperative SUI, and an inverse relationship between Bladder neck - Mesh Distance \u0026nbsp;and SUI was also detected. We might assume that mesh should be fixed at least 6 mm far from the bladder neck, and that Bladder neck - Mesh Distance \u0026nbsp;measurement may be helpful if performed during the surgical procedure to correctly place the mesh [10]. However, other studies are needed to confirm our hypothesis and safely introduce Bladder neck - Mesh Distance \u0026nbsp;measurement as a helpful tool during SCP procedure.\u003c/p\u003e\n\u003cp\u003eOur study has some limitations. The small sample size and the retrospective design prevent us from drawing straight conclusions. Larger studies with longer follow-up are required to confirm our findings and validate Bladder neck - Mesh Distance \u0026nbsp;as a predictive index for surgical efficacy. The heterogeneous application of the posterior mesh, which was not performed routinely in all patients, but limited to those cases in which it was deemed necessary by the surgeon, according to the preoperative assessment, might be considered a limit, but postoperative assessment of the posterior compartment repair was not the main aim of the study, and posterior mesh fixation is associated with minor effect on anterior and apical compartment rather than the opposite [1,2,19\u0026ndash;22]. The use of nonabsorbable sutures for mesh fixation, as implemented in the present study, has been previously associated with an increased rate of mesh exposure [36], while it seems, according to the recent literature, to be associated only with vaginal exposure of the suture itself, with similar anatomical results when compared with delayed absorbable sutures [37]. In addition, the well-known fibrotic process which follows the placement of the mesh during sacrocolpopexy, could potentially interfere in the measurement of Bladder neck - Mesh Distance, especially during mid-term follow-up. Despite optimal feasibility of Bladder neck - Mesh Distance \u0026nbsp;measurement in this series, the distance was evaluated by the same operator in all the patients. Therefore, intra- and inter-operator reproducibility of Bladder neck - Mesh Distance \u0026nbsp; measurement has yet to be established. Also, because prolapse is a dynamic process, repeating the ultrasound measurements in a longer follow-up, could lead to a better understanding of the relationship between Bladder neck - Mesh Distance and surgical outcomes.\u003c/p\u003e"},{"header":"5. CONCLUSIONS","content":"\u003cp\u003eShorter Bladder neck - Mesh Distance \u0026nbsp;measures are correlated with a better apical correction and the occurrence of postoperative SUI. Deeper anterior dissection had no correlation with anterior anatomical correction, while it was positively correlated with better PGI-I scores.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLarger studies with longer follow-up are needed to investigate the optimal Bladder neck - Mesh Distance measure linked to the best ratio between the correction of apical prolapse and the occurrence of postoperative complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eStatements:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS:\u0026nbsp;\u003c/strong\u003eN. H: Protocol/project development, Data collection or management, Data analysis. M. G.: Data analysis, Manuscript writing/editing. T. T.: Data analysis, Manuscript writing/editing. A. H.: Data analysis. Manuscript writing/editing. G. C.: Protocol/project development, Data collection or management, Data analysis. A. C.: Data analysis, Manuscript writing/editing. G. B.: Data analysis. Manuscript writing/editing.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgment(s):\u003c/strong\u003e None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The data underlying this article cannot be shared publicly due to the need for privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of funding:\u0026nbsp;\u003c/strong\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor agreement statement:\u003c/strong\u003e All authors meet the ICMJE requirements for authorship and each author read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB\u003c/strong\u003e 2018/21, obtained 19/1/2019,\u0026nbsp;local committee of Ethics of the Medico-Surgical Center of Ambroise Pare - Pierre Cherest \u0026ndash; Hartmann, Neilly sur Seine, France.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026ldquo;What does this study adds to the clinical work\u0026rdquo;:\u0026nbsp;\u003c/strong\u003ethe placement of the anterior mesh in laparoscopic sacrocolpopexy can influence surgical outcomes and patients\u0026rsquo; satisfaction.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMaher C, Feiner B, Baessler K et al Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev 2017:3011\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaher C, Feiner B, Baessler K et al (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 30:CD004014\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBartoletti R (2007) Pelvic Organ Prolapse: A Challenge for the Urologist. Eur Urol 51:884\u0026ndash;886\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMandron E, Bryckaert P-E (2005) Prolapsus et colpoc\u0026egrave;le ant\u0026eacute;rieure. Double promontofixation cœlioscopique. Technique. Ann Urol 39:247\u0026ndash;256\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBacle J, Papatsoris AG, Bigot P et al (2011) Laparoscopic promontofixation for pelvic organ prolapse: A 10-year single center experience in a series of 501 patients. Int J Urol 18:821\u0026ndash;826\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeprest J, Ridder D, De, Roovers J-P et al (2009) Medium Term Outcome of Laparoscopic Sacrocolpopexy With Xenografts Compared to Synthetic Grafts. J Urol 182:2362\u0026ndash;2368\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStepanian AA, Miklos JR, Moore RD et al (2008) Risk of Mesh Extrusion and Other Mesh-Related Complications After Laparoscopic Sacral Colpopexy with or without Concurrent Laparoscopic-Assisted Vaginal Hysterectomy: Experience of 402 Patients. J Minim Invasive Gynecol 15:188\u0026ndash;196\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCassis C, Mukhopadhyay S, Morris E (2019) Standardizing abdominal sacrocolpopexy for the treatment of apical prolapse: One year on. Int J Gynaecol Obstet 147:49\u0026ndash;53\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWagner L, Boileau L, Delmas V et al (2009) Traitement chirurgical du prolapsus par promontofixation cœlioscopique. Techniques et r\u0026eacute;sultats. Progr Urol 19:994\u0026ndash;1005\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabib N, Centini G, Pizzoferrato A-C et al (2019) Laparoscopic promontofixation: Where to stop the anterior dissection? Med Hypotheses 124:60\u0026ndash;63\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDietz HP (2006) Why pelvic floor surgeons should utilize ultrasound imaging. Ultrasound Obstet Gynecol 28:629\u0026ndash;634\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDietz HP, Kamisan Atan I, Salita A (2016) Association between ICS POP -Q coordinates and translabial ultrasound findings: implications for definition of \u0026lsquo;normal pelvic organ support\u0026rsquo;. Ultrasound Obstet Gynecol 47:363\u0026ndash;368\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEisenberg VH, Callewaert G, Sindhwani N et al (2019) Ultrasound visualization of sacrocolpopexy polyvinylidene fluoride meshes containing paramagnetic Fe particles compared with polypropylene mesh. Int Urogynecol J 30:795\u0026ndash;804\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEisenberg VH, Steinberg M, Weiner Z et al (2014) Three-dimensional transperineal ultrasound for imaging mesh implants following sacrocolpopexy. Ultrasound Obstet Gynecol 43:459\u0026ndash;465\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSvab\u0026iacute;k K, Martan A, Masata J et al (2011) Ultrasound appearances after mesh implantation\u0026ndash;evidence of mesh contraction or folding? Int Urogynecol J 22:529\u0026ndash;533\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong V, Guzman Rojas R, Shek KL et al (2017) Laparoscopic sacrocolpopexy: how low does the mesh go? Ultrasound Obstet Gynecol 49:404\u0026ndash;408\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evon Elm E, Altman DG, Egger M et al (2007) Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335:806\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBump RC, Mattiasson A, B\u0026oslash; K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10\u0026ndash;17\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaitakari KE, M\u0026auml;kel\u0026auml;-Kaikkonen JK, P\u0026auml;\u0026auml;kk\u0026ouml; E et al (2019) A prospective pilot study on MRI visibility of iron oxide-impregnated polyvinylidene fluoride mesh after ventral rectopexy. Tech Coloproctol 23:633\u0026ndash;637\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaden WF, Walker T (1992) Surgical repair of vaginal defects. Lippincott, New York\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtherton MJ, Stanton SL (2000) A comparison of bladder neck movement and elevation after tension-free vaginal tape and colposuspension. BJOG 107:1366\u0026ndash;1370\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWall LL, Versi E, Norton P et al (1998) Evaluating the outcome of surgery for pelvic organ prolapse. Am J Obstet Gynecol 178:877\u0026ndash;879\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe Normand L, Cosson M, Cour F et al (2016) Recommandations pour la pratique clinique: synth\u0026egrave;se des recommandations pour le traitement chirurgical du prolapsus g\u0026eacute;nital non r\u0026eacute;cidiv\u0026eacute; de la femme par l\u0026rsquo;AFU, le CNGOF, la SIFUD-PP, la SNFCP, et la SCGP. J Gynecol Obstet Biol Reprod 45:1606\u0026ndash;1613\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDindo D, Demartines N, Clavien P-A (2004) Classification of Surgical Complications. Ann Surg 240:205\u0026ndash;213\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PFWM. ICS Educational Module: Cough Stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn. ;37:1849\u0026ndash;1855. [26] Haylen, De Ridder BT, Freeman D (2018) RM, An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn 2010;29:4\u0026ndash;20\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYalcin I, Bump RC (2003) Validation of two global impression questionnaires for incontinence. Am J Obstet Gynecol 189:98\u0026ndash;101\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSrikrishna S, Robinson D, Cardozo L (2010) Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 21:523\u0026ndash;528\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchober P, Schwarte LA (2018) Correlation Coefficients: Appropriate Use and Interpretation. Anesth Analg 126:1763\u0026ndash;1768\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrocker KA, Lippus F, Alt CD et al (2015) Magnetic Resonance-Visible Polypropylene Mesh for Pelvic Organ Prolapse Repair. Gynecol Obstet Invest 79:101\u0026ndash;106\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePregazzi R, Sartore A, Bortoli P et al (2002) Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. BJOG 109:821\u0026ndash;827\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosma S, Petruzzelli P, Chiad\u0026ograve; Fiorio Tin M et al (2018) Simplified laparoscopic sacropexy avoiding deep vaginal dissection. Int J Gynecol Obstet 143:239\u0026ndash;245\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Lancey JOL (2016) What\u0026rsquo;s new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol 28:420\u0026ndash;429\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo J, Chen L, Fenner DE et al (2015) A Multi-Compartment 3-D Finite Element Model of Rectocele and Its Interaction with Cystocele HHS Public Access. J Biomech 48:1580\u0026ndash;1586\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWithagen MI, Milani AL, De Leeuw JW et al (2012) Development of de novo prolapse in untreated vaginal compartments after prolapse repair with and without mesh: a secondary analysis of a randomised controlled trial. BJOG 119:354\u0026ndash;360\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShepherd JP, Higdon HL 3rd, Stanford EJ, Mattox TF (2010) Effect of suture selection on the rate of suture or mesh erosion and surgery failure in abdominal sacrocolpopexy. Female Pelvic Med Reconstr Surg 16:229\u0026ndash;233\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReisenauer C, Andress J, Schoenfisch B, Huebner M, Brucker SY, Lippkowski A, Beilecke K, Marschke J, Tunn R (2022) Absorbable versus non-absorbable sutures for vaginal mesh attachment during sacrocolpopexy: a randomized controlled trial. Int Urogynecol J 33:411\u0026ndash;419\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Descriptive analysis of patients\u0026rsquo; characteristics.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD or N(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, \u003cem\u003eyears\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e63.5\u0026plusmn;8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, \u003cem\u003ekg/m\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e24.8\u0026plusmn;3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e2.8\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVaginal deliveries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e11 (17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e17 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e35 (55.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMenopausal status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e6 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eYes, no HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e54 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eYes, with HRT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e3 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e28 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eAbdominal surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e16 (25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eLaparoscopic surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e12 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eVaginal surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e5 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eOther surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e2 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eDysuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e29 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eVoiding dysfunction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e12 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eConstipation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e15 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003ePelvic pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e13 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eBulging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e58 (92.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003ePreoperative SUI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e17 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative prolapse staging\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(POP-Q classification)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e8 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e46 (73.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e8 (12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of vaginal prolapse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eAnterior compartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e54 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eApical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e63 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003ePosterior compartment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e29 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSCP procedure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eAnterior mesh fixation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e19 (30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003eAnterior plus posterior mesh fixation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e44 (69.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"67.56756756756756%\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow up,\u003cem\u003e\u0026nbsp;months\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.432432432432435%\"\u003e\n \u003cp\u003e32.7\u0026plusmn;3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eContinuous variables are expressed as mean\u0026plusmn;standard deviation and categorical variables are expressed as counts (percentages, %), Abbreviations: BMI: body mass index; SD: standard deviation; HRT: hormonal replacement therapy; N: count; POP-Q: Pelvic Organ Prolapse Quantification; SCP: sacrocolpopexy; SUI: stress urinary incontinence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Pelvic organ prolapse points assessed preoperatively, one month after surgery and at mid-term follow-up visit.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePOP-Q\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.89156626506024%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne-month follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.650602409638555%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMid-term follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBa point\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e+24.5\u0026plusmn;14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.89156626506024%\"\u003e\n \u003cp\u003e-15.8\u0026plusmn;6.9*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.650602409638555%\"\u003e\n \u003cp\u003e-14.7\u0026plusmn;5.7*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e\u003cstrong\u003eC point\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e+9.3\u0026plusmn;26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.89156626506024%\"\u003e\n \u003cp\u003e-58.7\u0026plusmn;9.9*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.650602409638555%\"\u003e\n \u003cp\u003e-57.0\u0026plusmn;9.5*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBp point\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(mm)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.228915662650603%\"\u003e\n \u003cp\u003e-9.7\u0026plusmn;14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.89156626506024%\"\u003e\n \u003cp\u003e-19.8\u0026plusmn;4.3*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.650602409638555%\"\u003e\n \u003cp\u003e-17.9\u0026plusmn;3.9*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eContinuous variables are expressed as mean\u0026plusmn;SD. Abbreviations: POP-Q: Pelvic Organ Prolapse Quantification. *P-value \u0026lt;0.05.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e Correlation of prolapse surgical variables with Bladder neck - Mesh Distance measures.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"539\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman correlation coefficient with\u0026nbsp;\u003c/strong\u003eBladder neck - Mesh Distance\u003cstrong\u003e\u0026nbsp;(ϱ)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative prolapse staging\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.09 (-0.52; -0.062)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, \u003cem\u003ekg/m\u0026sup2;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e+0.13 (-0.11; +0.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eBa point\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.02 (-0.29; +0.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eC point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.30 (-0.50; -0.03)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eBp point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.25 (-0.47; +0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne-month follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eBa point\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.05 (-0.30; +0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eC point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.07 (-0.32; +0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eBp point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e+0.06 (-0.20; +0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e∆-Ba point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.03 (-0.28; +0.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e∆-C point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.30 (-0.49; -0.02)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e∆-Bp point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.28 (-0.51; -0.04)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMid-term follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eBa point\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.07 (-0.32; +0.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eC point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.08 (-0.33; +0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003eBp point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.01 (-0.26; +0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e∆-Ba point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.01 (-0.27; +0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e∆-C point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.28 (-0.48; -0.00)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.11502782931354%\"\u003e\n \u003cp\u003e∆-Bp point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.88497217068646%\"\u003e\n \u003cp\u003e-0.22 (-0.46; +0.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eValues are expressed as Spearman correlation coefficient, ϱ (CI 95%). \u0026nbsp;BMI: body mass index; ∆: difference between preoperative point and postoperative point at one-month or 2.7 years after surgery. *P-value \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u0026nbsp;\u003c/strong\u003eAssessment of PGI correlation to prolapse staging points and Bladder neck - Mesh Distance measures.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman correlation coefficient with PGI-I (ϱ)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOne-month follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eBa point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e-0.06 (-0.31; +0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eC point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e+0.02 (-0.23; +0.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eBp point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e-0.21 (-0.44; +0.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eBMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e+0.05 (-0.20; +0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003e\u003cstrong\u003eMid-term follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eBa point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e+0.09 (-0.17; +0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eC point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e+0.06 (-0.20; +0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eBp point\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e-0.11 (-0.35; +0.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.18269230769231%\"\u003e\n \u003cp\u003eBMD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60.81730769230769%\"\u003e\n \u003cp\u003e-0.25 (-0.48; -0.01)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eValues are expressed as Spearman correlation coefficient, ϱ (CI 95%). Abbreviations: BMD: Bladder neck-Mesh Distance; PGI-I: Patient Global Impression of Improvement. *P-value \u0026lt;0.05.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Bladder neck-Mesh Distance, Genital prolapse, Mesh, Prolapse repair, Ultrasound","lastPublishedDoi":"10.21203/rs.3.rs-4572463/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4572463/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo investigate the relationship between the position of the anterior mesh, measured by ultrasound through the Bladder neck - Mesh Distance technique and the surgical outcomes after laparoscopic sacrocolpopexy (SCP) for apical prolapse.\u003c/p\u003e\u003ch2\u003eStudy design:\u003c/h2\u003e \u003cp\u003eRetrospective analysis of prospectively collected data in a tertiary care hospital. Between January 2019 and September 2019, 63 women who underwent laparoscopic SCP due to apical prolapse were included. Bladder neck - Mesh Distance was measured immediately after surgery. The pelvic floor was evaluated using the Pelvic Organ Prolapse Quantification (POP-Q) System before, one month, and 2.7 years (mid-term) after the surgery. Postoperative stress urinary incontinence (SUI) and Patient Global Impression of Improvement (PGI-I) scores were also assessed. The correlation between Bladder neck - Mesh Distance and the postoperative outcomes was investigated using the Spearman rank correlation coefficient.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAt mid-term follow-up visit, Bladder neck - Mesh Distance was inversely correlated with the correction of apical prolapse and postoperative SUI. No correlation was detected with the anterior compartment prolapse correction. PGI-I scores were high in all patients at mid-term follow-up, irrespective of Bladder neck - Mesh Distance values.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe shorter the Bladder neck - Mesh Distance, the better the outcome for apical compartment repair. Bladder neck - Mesh Distance had no correlation with the anterior anatomical correction. Shorter Bladder neck - Mesh Distance values were positively correlated to better PGI-I scores and a higher risk of SUI.\u003c/p\u003e","manuscriptTitle":"Post-operative outcomes associated with anterior mesh location after laparoscopic sacrocolpopexy.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 19:47:15","doi":"10.21203/rs.3.rs-4572463/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-06-25T09:59:57+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-23T09:08:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Archives of Gynecology and Obstetrics","date":"2024-06-19T06:26:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-13T10:02:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2024-06-12T17:10:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a51522c9-e8fc-424a-87c0-c0772bb6b00d","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-30T16:13:54+00:00","versionOfRecord":{"articleIdentity":"rs-4572463","link":"https://doi.org/10.1007/s00404-024-07719-4","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2024-09-25 15:56:57","publishedOnDateReadable":"September 25th, 2024"},"versionCreatedAt":"2024-07-12 19:47:15","video":"","vorDoi":"10.1007/s00404-024-07719-4","vorDoiUrl":"https://doi.org/10.1007/s00404-024-07719-4","workflowStages":[]},"version":"v1","identity":"rs-4572463","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4572463","identity":"rs-4572463","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}