(Poster 44) Single Site Comparison of Mesh Sacrocolpopexy Use in Urologists & Gynecologists

Objectives: Mesh sacrocolpopexy (M-SCP) has been traditionally avoided in the elderly. However, demonstrated safety and success in this population has made it a reasonable treatment option. Differences in pelvic organ prolapse (POP) treatment patterns between Urology-trained Urogynecologists (UTU) and Gynecology-trained Urogynecologists (GTU) have been demonstrated, though a comparison of apical POP repairs in the elderly has not been explored. We aim to evaluate differences in type of apical POP repairs at our single institution in patients 70 and older between UTU and GTU.

Methods: A retrospective chart review of all apical POP repairs performed by UTU (2 surgeons) and GTU (3 surgeons) at our tertiary referral center in patients aged 70 and older between 2020 to 2025. M-SCP versus suture-based suspension (SBS) was collected. A sub-analysis of demographic and clinical data in these patients between 1/2023-8/2024 was performed using chart review. Our institutional Urogynecology faculty were then surveyed to assess surgeon preferences for POP repair in patient case scenarios using the following criteria: stage of POP, comorbidities, prior POP repair, and prior abdominal surgeries.

Results: From 2020-2025, a significant rise in the use of M-SCP compared to SBS was demonstrated in UTU surgeons, while no GTU surgeons performed M-SCP in the elderly population. All SBS were performed transvaginally. A comparison of 114 patients from 1/2023-8/2024 demonstrated GTU patients had a higher stage of prolapse, higher prevalence of stroke and a lower likelihood of prior POP repair and pessary use. A Chi-Square test was then performed using survey data to evaluate the highest ranked procedures among UTU and GTU. In all scenarios, when M-SCP was chosen, 91.7% was by UTU, 8.3% was by GTU, and when SBS was chosen, 35.1% was by Uro, 64.9% was by Gyn (p < .003).

Conclusions: At our institution, UTU are increasingly performing M-SCP in elderly patients (70 and older), while GTU are not. Elderly patients seen by UTU are more likely to be healthier (lower stroke rates), have less severe POP, prior POP repair and prior pessary use. Overall, M-SCP is more favored by UTU, and SBS by GTU at our institution. Examination of surgeon and patient preferences on a larger scale are needed to better understand these trends.