Int Urogynecol J (2008) 19:1267–1270 DOI 10.1007/s00192-008-0628-5 ORIGINAL ARTICLE Sacrocolpopexy without concomitant posterior repair improves posterior compartment defects Maryam Guiahi & Kimberly Kenton & Linda Brubaker Received: 6 December 2007 / Accepted: 24 March 2008 / Published online: 22 May 2008 # The Author(s) 2008 Abstract The aim of this study is to determine posterior compartment topography 1-year after sacrocolpopexy (SC). Women who had SC without concomitant anterior or posterior repairs for symptomatic pelvic organ prolapse (POP) were included. Vaginal topography was assessed at baseline and 1-year postoperatively using POP quantifica- tion (POPQ). At baseline, 24% had stage IV POP, 68% stage III, and 8% stage II. One year after surgery, 75% had stage 0/I POP, 24% stage II, and 1% stage III. 112 (75%) were objectively cured (stage 0 or I POP). Anterior compartment was the most common site of POP persistence or recurrence (Ba ≥ stage II in 23 women) followed by posterior compartment (Bp ≥ stage II in 12 women) and apex (C ≥ stage II in 2 women). In 1-year follow-up, SC without concomitant posterior repair restores posterior vaginal topography in the majority of women with undergoing SC. Keywords Posterior compartment . Sacrocolpopexy . Pelvic organ prolapse . Rectocele Introduction The optimal approach for surgical correction of pelvic organ prolapse (POP) remains unclear. Reported POP recurrence or persistence rates after reconstructive surgery M. Guiahi : K. Kenton (*) : L. Brubaker Division of Female Pelvic Medicine and Reconstructive Surgery, Departments of Obstetrics and Gynecology and Urology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA e-mail: kkenton@lumc.edu are nearly 60% at 1 year [1] with reoperation rates as high as 30% [2]. Isolated defects in a single vaginal compart- ment are uncommon in women with apical POP [3–5] and 76% of women with multiple compartment defects may have posterior compartment POP [6]. Surgeons disagree whether it is necessary to perform concomitant posterior repair and/or perineorrhaphy in women undergoing surgery for apical POP. Many surgeons perform a concomitant posterior repair at the time of apical repair to restore posterior vaginal wall topography [7–10], while others believe adequate resuspension of the apex will correct many posterior compartment defects [11, 12]. While posterior repair has been shown to improve posterior vaginal topography, it is associated with high rates of dyspareunia and variable improvement in defecatory dys- function. [13–16] As a result, pelvic surgeons have increasingly focused on correcting the vaginal apex, believing that apical correction will improve posterior compartment topography as well. The aim of our study was to determine posterior vaginal topography 1 year after abdominal sacrocolpopexy (SC) without concomitant posterior repair or perineorrhaphy for advanced prolapse (POP). Materials and methods After Institutional Review Board approval, we reviewed consecutive inpatient and outpatient charts of women who underwent abdominal SC for POP and who were not enrolled in other clinical trials between July 2000 and August 2005 at Loyola University Medical Center. We reviewed operative notes to confirm surgical procedures. Study women all underwent abdominal SC in a standard- ized fashion. A “Y” piece of mersilene mesh was attached