How do you decide between sacrocolpopexy and vaginal native tissue repair for apical prolapse in a patient with no prior mesh complications?

Sacrocolpopexy provides better average anatomic durability. In the 2024 ASPIRe randomized trial of posthysterectomy vault prolapse, adjusted 36-month composite failure was 28% after sacrocolpopexy versus 43% after native-tissue repair. Nevertheless, symptom improvement, satisfaction, and decision re...

I have a discussion with the patient regarding risks, benefits, and alternatives. If they decide on surgery rather than conservative management with a pessary, or if they fail a pessary, I describe both options.

Most patients choose the vaginal approach - 45 minutes, outpatient, no risk of mesh comp...

The patient's comorbidities (e.g., ability to withstand Trendelenburg, previous abdominal surgeries, overall health status) are an important contributor, with more comorbid patients likely undergoing vaginal repairs. The other important factor is the desire to preserve coitus. Any vaginal surgery ca...