Burns Ramzy T, Black Morgan, Jeng Ginnie, Powell Charles R
Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Neurourol Urodyn. 2025 Aug;44(6):1339-1343. doi: 10.1002/nau.70094. Epub 2025 Jun 27.
To evaluate the medium-term outcomes of robotic sacral colpopexy (RSC) using autologous fascia lata for the treatment of apical pelvic organ prolapse.
An IRB-approved retrospective review was conducted on patients who underwent RSC with autologous fascia lata at a single institution between November 2017 and August 2022. Only patients with a minimum of 24 months of follow-up were included as short-term results have already been published. Data collected included patient demographics, operative details, surgical complications, Pelvic Organ Prolapse Quantification (POP-Q) measurements, and patient-reported outcomes using the Urogenital Distress Inventory-6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7). The primary outcome was the medium-term durability of autologous fascia lata RSC, with recurrence defined as > 0 cm from the hymen in any compartment on postoperative POP-Q examination or recurrence at the apex of ≥ 2 cm.
Nineteen patients met the inclusion criteria, with a mean follow-up of 42.8 ± 11.9 months. All POP-Q values showed significant improvement postoperatively, with only one (6.3%) patient experiencing posterior compartment recurrence and one (6.3%) with exactly 2 cm of apical descent. One patient (5.2%) required surgical retreatment with posterior colporrhaphy and a pubovaginal sling. Patient-reported outcomes demonstrated significant improvement in UDI-6 and IIQ-7 scores (p < 0.05). Minor complications related to fascia lata harvest were observed, including seroma (10.5%), transient paresthesia (21%), hematoma (5.2%), and deep vein thrombosis (5.2%), with most resolving spontaneously.
RSC with autologous fascia lata provides durable medium-term anatomic and symptomatic improvement for apical POP, with low recurrence and retreatment rates. While minor harvest-related complications were observed, most were self-limiting. These findings support the use of autologous fascia lata as a viable alternative to synthetic mesh in RSC. Larger, multicenter studies with extended follow-up are needed to further validate these results.
评估使用自体阔筋膜进行机器人骶骨阴道固定术（RSC）治疗盆腔器官顶端脱垂的中期疗效。
对2017年11月至2022年8月期间在单一机构接受自体阔筋膜RSC手术的患者进行了一项经机构审查委员会批准的回顾性研究。由于短期结果已经发表，仅纳入随访至少24个月的患者。收集的数据包括患者人口统计学资料、手术细节、手术并发症、盆腔器官脱垂定量（POP-Q）测量结果，以及使用泌尿生殖系统困扰量表-6（UDI-6）和尿失禁影响问卷-7（IIQ-7）的患者报告结局。主要结局是自体阔筋膜RSC的中期耐久性，复发定义为术后POP-Q检查时任何区域距处女膜>0 cm或顶端复发≥2 cm。
19例患者符合纳入标准，平均随访42.8±11.9个月。所有POP-Q值术后均有显著改善，仅1例（6.3%）患者出现后盆腔复发，1例（6.3%）顶端下降恰好2 cm。1例患者（5.2%）需要行后阴道壁修补术和耻骨后阴道吊带术进行手术再治疗。患者报告结局显示UDI-6和IIQ-7评分有显著改善（p<0.05）。观察到与阔筋膜采集相关的轻微并发症，包括血清肿（10.5%）、短暂性感觉异常（21%）、血肿（5.2%）和深静脉血栓形成（5.2%），大多数并发症可自发缓解。
自体阔筋膜RSC可为盆腔器官顶端脱垂提供持久的中期解剖学和症状改善，复发率和再治疗率较低。虽然观察到与采集相关的轻微并发症，但大多数为自限性。这些发现支持在RSC中使用自体阔筋膜作为合成网片的可行替代方案。需要开展更大规模、多中心且随访时间更长的研究来进一步验证这些结果。
