Describing Sacrocolpopexy in Medical Literature: A Proposed Surgical Classification System.

Background: Sacrocolpopexy has become a favored treatment of pelvic organ prolapse due to its durability and efficacy. Sacrocolpopexy has not been standardized and there is no categorization scheme to facilitate communication or research efforts for the procedure. A systematic review was conducted to facilitate construction of a classification system for sacrocolpopexy based on extent of vaginal dissection described in the medical literature. Methods: A systematic review of EMBASE and Medline databases was performed with inclusion criteria of randomized control trials published in the English language. Database entries were reviewed for relevance and, after thorough screening, 52 articles met criteria for analysis. Results: Abdominal, laparoscopic, and robotic approaches were represented in 20, 33, and 20 studies, respectively. In 50% of the reviewed articles (n = 26), extent of anterior dissection was not provided. Dissection to the bladder trigone and bladder neck were found in 37% (n = 19) and the proximal vagina in 13% (n = 7) of studies. In the posterior compartment, 48% (n = 25) did not describe extent of dissection, whereas 15% (n = 8) referenced dissection along the full length of the vagina. Only 2% (n = 1) discussed dissection to the dorsal perineal membrane, 12% described dissection to the perineal body (n = 6), 10% to the distal vagina (n = 5), and 13% (n = 7) to the proximal vagina. Conclusion: Lack of standardization in surgical techniques creates inconsistencies in research on sacrocolpopexy. The systematic review presented informs and demonstrates a framework for classifying sacrocolpopexy based on the extent of dissection in the published literature. This categorization scheme is the first step in standardizing the technique which can aid research efforts and physician communication by unifying language about sacrocolpopexy.