Medium-Term Outcomes of Total Autologous Fascia Lata Anterior and Apical Pelvic Organ Prolapse Repair.

Abstract

Purpose: The recognition of synthetic vaginal mesh as a high-risk device in pelvic organ prolapse (POP) repair has led to a resurgence in the utilization of autologous graft and emphasizes the need for long-term studies into the use of autologous materials. In a 33-patient cohort, we highlighted our earliest results of a transvaginal repair for apical and anterior prolapse using a graft harvest of autologous fascia lata. In an updated cohort of 63 patients with up to 5 years of follow-up, we report our current findings.

Methods: The Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair begins with a solitary, lateral 7-10 cm thigh incision, through which, a 4 × 14 cm segment of fascia lata is harvested. Transvaginal reconfiguration of the graft results in apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia. Concurrent procedures, including autologous pubovaginal sling, were performed as indicated. Several patient parameters were monitored including medical history, Visual Analog Pain (VAP) Score, SEAPI scores, POP-Q scores, and Baden-Walker grading. We defined a successful repair as absent symptomatic apical or anterior POP.

Results: A total of 63 patients with an average age of 64 years underwent AAA-POP repair. Mean follow-up was 17 months (range 1-65); 18 patients had 24 months or more of follow-up. Complete POP symptom resolution was reported in 49 (78%) patients. In total, 11 patients (17%) experienced treatment failure; 5 of this subgroup (45%) underwent a uterine sparing procedure. Urinary retention postoperatively occurred in 20 patients and pubovaginal sling was concurrently performed in 18 of the patients in this subgroup (90%). Minor harvest site issues occurred and were managed expectantly. Nonbothersome thigh bulges occurred in 15 patients. Nine patients experienced a seroma at the harvest site, and five underwent aspiration. Mild paresthesia was reported by 37 patients. Mean VAP score of the fascia lata harvest site was 0.37.

Conclusion: The AAA-POP repair medium-term follow-up results reaffirm the procedure's efficacy as a transvaginal and nonmesh repair of POP. Patients should be advised of several precautions including the higher frequency of treatment failure with the uterine sparing approach, potential for urinary retention if pubovaginal sling placement is performed concurrently, and morbidities associated with the harvest site. Our results continue to uphold the AAA-POP repair and its role as a treatment option for patients desiring a nonmesh approach to POP repair.