Strengths and Limitations
The strengths of our study include the prospective collection of primary outcomes, the size of our population, and the duration of follow-up. We included both subjective and objective outcome measures as either type of outcome measure alone may not capture the patient’s true experience and quality of life after pelvic reconstructive surgery. PFDI-20 is a validated measure of patient’s pelvic floor symptoms, which we were able to compare across time for each patient. We present the largest cohort of patients who underwent sacrocolpopexy using autologous rectus fascia in the literature and our results provide valuable information for providers and patients seeking alternatives to mesh sacrocolpopexy. We were able to recruit patients for follow-up assessment up to over 6 years from the time of surgery, which allowed us to analyze the outcomes for patients who had at least 3 years of follow-up.
Our results are limited by the fact that some data are collected retrospectively, the range of follow-up time, and single institution data. Certain demographic and medical history data were collected retrospectively and may be limited by the accuracy of medical records. Patients chose their surgical treatment after extensive counseling and there is likely to be selection bias. However, our study is targeted at this group of patients, who did not desire mesh material in their prolapse surgery, in order to provide long-term outcomes data for a non-mesh alternative to sacrocolpopexy. Due to the wide range of years during which this procedure was performed and in order to collect a large cohort of patients, some patients did not have long-term follow-up available. We were able to analyze the subgroup of patients who had long-term follow-up, which demonstrated similar outcomes and supported our main results. Because this study was conducted at a single institution, our patient population may not be generalizable to other regions or countries.
Although our results showed that sacrocolpopexy using autologous rectus fascia resulted in significant prolapse improvements and low rates of retreatment, our cohort was subject to selection bias as described. Our findings support future research utilizing randomized controlled trials to provide more robust evidence for sacrocolpopexy using autologous rectus fascia for patients who desire a non-mesh alternative.