Native tissue repair vs sacrocolpopexy for prolapse
When you decide on surgery for pelvic organ prolapse, two main repairs come up. One uses your own tissue and is done through the vagina. The other, called sacrocolpopexy, uses soft mesh and is usually done with a robot through a few small belly incisions.
Both have good track records. Here is the honest trade-off I talk through with patients. In the first year or so, the two repairs work about equally well. Over the longer term, the mesh repair tends to hold up a bit better. The cost of that durability is a small chance the mesh wears through the vaginal wall. Using your own tissue avoids mesh entirely and works well for many women, though the prolapse is somewhat more likely to come back over time.
Native tissue repair
This repair uses your own ligaments and tissue to rebuild the support inside your pelvis. The two most common ways to lift the top of the vagina are uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF). A large trial found these two about equal at 5 years.
The whole repair is done through the vagina. There are no belly incisions.
What to expect:
- Done through the vagina, with no outside incisions
- Uses your own tissue, no mesh
- Often shorter operating time, around 1 to 2 hours
- Can fix more than one area of prolapse in the same surgery
- You usually go home the same day or after one night
Sacrocolpopexy
Sacrocolpopexy connects the top of the vagina to a strong ligament over your tailbone using a soft strip of mesh. The mesh acts like a sturdy bridge that holds the vagina in place. It is usually done with a robot through a few small belly incisions.
What to expect:
- Done through the belly, with a robot or laparoscope
- Uses soft, lightweight mesh for support
- Often longer operating time, around 2 to 3 hours
- Tends to be the most durable repair over the long term
- You usually go home the same day or after one night
Side-by-side comparison
| Factor | Native tissue repair | Sacrocolpopexy |
|---|---|---|
| Approach | Through the vagina, no belly incisions | Robotic or laparoscopic, small belly incisions |
| Material | Your own tissue | Soft mesh |
| First-year results | Works well; very few women need another surgery | Works well; very few women need another surgery |
| Long-term durability | Good; prolapse is somewhat more likely to come back over the years | A bit more durable over the long term |
| Operating time | About 1 to 2 hours | About 2 to 3 hours |
| Recovery | A few weeks | A few weeks; the small belly incisions heal quickly |
| Mesh | No mesh, so no mesh-related risk | Soft mesh through the belly (not the transvaginal mesh that was withdrawn); small chance it wears through the vaginal wall |
| Often a good fit for | Women who want to avoid mesh, women having several areas repaired at once | Women wanting the most durable repair, women whose main problem is the top of the vagina dropping |
What the research shows
A few findings help put the choice in plain terms.
In the first year, the two repairs land in the same place. A large real-world registry followed women after both surgeries. At 12 months, the prolapse came back at about the same rate with your own tissue (14%) and with sacrocolpopexy (14%). Across all of these repairs, fewer than 2% of women needed another operation in the first year, and more than 9 in 10 said they felt much better.
Over the long term, the mesh repair tends to hold up a bit better. That is why sacrocolpopexy is often called the more durable option.
The trade-off is mesh. With sacrocolpopexy, the main risk is the mesh slowly wearing through the vaginal wall over the years. You may see older numbers as high as 1 in 10, but those studies used heavier mesh and open belly surgery. With the lightweight polypropylene mesh I use today, placed through small incisions, the risk is much lower, in the low single digits. It often shows up as discharge or spotting, and it can usually be fixed with a minor procedure. Repairs using your own tissue carry no mesh risk at all.
One more point on safety. Sacrocolpopexy is not the transvaginal mesh that made the news. Those vaginal mesh kits were taken off the market in 2019. Sacrocolpopexy places soft mesh through the belly onto a strong ligament, and it remains a standard, well-studied repair.
My take
This is one of the closer calls in my field, and there is no single right answer. Both operations are good, and recovery from each is similar. The mesh repair tends to be a little more durable over time. The repair using your own tissue avoids mesh entirely.
I weigh your anatomy, your age and health, any surgery you have had before, and what matters most to you. Then we decide together. Some women want the most durable fix and are fine with the small mesh risk. Others would rather avoid mesh, even if that means a slightly higher chance the prolapse comes back. Both are reasonable.
Who each repair tends to suit
A repair using your own tissue may fit you if you:
- Want to avoid mesh
- Are having several areas of prolapse fixed at once
- Have a health reason to keep the surgery shorter
Sacrocolpopexy may fit you if you:
- Want the most durable repair over the long term
- Have mainly the top of the vagina dropping
- Are comfortable with the small mesh risk in exchange for durability
Making your decision
The best repair is the one that fits your symptoms, your health, and what you value. We will go through both options together, answer your questions, and pick the path you feel good about.
References
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Ferrando CA, Bradley CS, Meyn LA, et al. Twelve-month outcomes of pelvic organ prolapse surgery in patients with uterovaginal or posthysterectomy vaginal prolapse enrolled in the multicenter Pelvic Floor Disorders Registry. Urogynecology. 2023. doi:10.1097/SPV.0000000000001410
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Andy UU, Meyn L, Brown HW, et al. Outcomes at 12, 24, and 36 months in women treated for pelvic organ prolapse with pessary or surgery: results from the multicenter Pelvic Floor Disorders Registry. Urogynecology. 2025. doi:10.1097/SPV.0000000000001669
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Barber MD, Brubaker L, Burgio KL, et al. Comparison of two transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023-1034. doi:10.1001/jama.2014.1719
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Jelovsek JE, Barber MD, Brubaker L, et al. Effect of uterosacral ligament suspension vs sacrospinous ligament fixation on surgical outcomes and prolapse symptoms at 5 years in the OPTIMAL randomized clinical trial. JAMA. 2018;319(15):1554-1565. doi:10.1001/jama.2018.2827
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Nygaard I, Brubaker L, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016-2024. doi:10.1001/jama.2013.4919
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Committee on Practice Bulletins—Gynecology and the American Urogynecologic Society. Pelvic organ prolapse. ACOG Practice Bulletin No. 214. Obstet Gynecol. 2019;134(5):e126-e142. doi:10.1097/AOG.0000000000003519
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Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853. doi:10.1136/bmj.i3853