Combined Transvaginal Hysterectomy, Mesh Placement, and Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse with Voiding Dysfunction: A Case Series

Abstract

Objective: To evaluate the feasibility, safety, and clinical outcomes of a hybrid surgical technique combining transvaginal hysterectomy, transvaginal polypropylene mesh placement, and laparoscopic sacrocolpopexy in women with pelvic organ prolapse (POP) and voiding dysfunction. Materials and Methods: The present study was a retrospective cohort study conducted at the Division of Urology, Siriraj Hospital, Thailand. Women aged 18 years and older with stage II or higher POP and concurrent lower urinary tract symptoms (LUTS) who underwent the hybrid procedure between September 2022 and September 2024 were included. Patients with neurological disorders, prior pelvic radiation, or incomplete clinical data were excluded. Preoperative assessment included medical history, POP-Q staging, and video-urodynamic studies. All procedures were performed by a single reconstructive urologist. Data on baseline characteristics, operative outcomes, and postoperative findings were analyzed. Results: Ten women met the inclusion criteria. Median age was 70 years (range of 66 to 80), and a mean BMI of 24.7 kg/m^2. All patients presented with obstructive voiding symptoms. A mixed urinary incontinence was observed in seven patients. Median operative time was 130 minutes (range of 80 to 225), and median estimated blood loss was 50 mL (range of 10 to 300). No major intraoperative complications occurred. Catheters were removed within two days postoperatively in all cases. At a median follow-up of 116.5 days (range of 64 to 389), all patients reported significant improvement in both LUTS and prolapse symptoms. Four patient experienced urgency urinary incontinence, which was well-controlled with medication. No mesh extrusion or recurrent prolapse was observed. Conclusion: This hybrid technique offers a safe, effective, and efficient approach for managing POP with voiding dysfunction. It achieves excellent anatomical restoration, symptom relief, and rapid recovery.