Impact of posterior biologic grafts at the time of posterior colporrhaphy: Focus on posterior vaginal recurrence rates
IUGA Academy. Schachar J. Jun 30, 2018; 212852
Topic: Pelvic Organ Prolapse
Jeffrey Schachar
Jeffrey Schachar

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Impact of posterior biologic grafts at the time of posterior colporrhaphy: Focus on posterior vaginal recurrence rates

Schachar, J1; Martin, L1; Ossin, D1; Hurtado, E1; Davila, GW1

1: Cleveland Clinic Florida

Introduction: Posterior vaginal wall prolapse (PVWP) is present in 75% of patients with pelvic organ prolapse. Native tissue repair success rates range from 73-96%. Synthetic mesh was used to augment native tissue repairs, however its use diminished as it was associated with mesh exposures and dyspareunia. Biologic grafts have been used with the hope of improving success rates of native tissue repairs without the adverse effects of synthetic grafts. The results of posterior biologic grafts have varied in large trials and review papers from no difference to increased rates of failures [1-3].

Objective: The objective was to determine the effectiveness of posterior biologic grafts on PVWP recurrence by focusing on the posterior compartment in those with good apical support.

Methods: This is a retrospective review of patients who underwent reconstructive surgery for posterior compartment vaginal prolapse at a single institution with long-term follow up. Patients were divided into those who had a traditional posterior colporrhaphy (PC) and those who had a traditional colporrhaphy with a biologic graft (BG). Posterior failures were isolated by excluding patients with apical failures on follow up; defined as >1 using the Baden-Walker Halfway system or point “C” greater than half of the vaginal length using the POP-Q system. Failure rates were determined by a composite of subjective and objective outcomes. Objective failure was defined as a greater than grade 1 posterior vaginal wall prolapse using the Baden-Walker Halfway system or a point “Bp” of -1 or greater using the POP-Q system. Subjective failures were defined as “worsened” or “not improved” on a validated 5 point patient improvement satisfaction scale. Subjects that had re-operations or procedures due to prolapse of the posterior compartment were considered failures. A p-value of less than 0.05 was considered statistically significant.

Results: In our comprehensive database, 353 patients met inclusion criteria and were included in the final analysis. Patients in the PC group (n=263) and in the BG group (n=90) had similar descriptive statistics, including comorbidities, pre-operative POP-Q scores, and modified Oxford scores. However, subjects in the BG group were older (62.3 vs 57.7, p=0.001), more likely to be postmenopausal (84.4% vs 67.3%, p=0.002), and were more likely to have had a prior hysterectomy (33.3% vs 11.0%, p <0.001). In the BG group, two non-cross-linked grafts were used; bovine pericardium (44.4%) and porcine dermis (55.6%). Average length of follow up of 146.2 weeks (40 to 982) was similar between the two groups (p=0.2775). 8 patients returned to the operating room, however only 2 of which were for prolapse, and of those only 1 (PC group) was for posterior recurrence and was considered a failure. Outcomes did not differ by type of graft used. For the primary outcome of composite failures the PC and BG had similar rates of failures, 0.76% and 1.11% respectively (p=1.000).

Conclusions: When focusing on the posterior compartment, biologic grafts did not decrease rates of recurrence in the posterior vaginal compartment when compared with traditional posterior colporrhapy. Both techniques had high success rates.


(1) Int Urogynecol J 2012 May;23(5):597-604.

(2) Am J Obstet Gynecol 2006 Dec;195(6):1762-1771.

(3) Obstet Gynecol 2016 Jul;128(1):81-91.

Table 1: Surgical failures by posterior repair

Traditional Colporrhaphy

Biologic Graft

p Value





Subjective Only






Objective Only






Composite Score







Work supported by industry: no. A consultant, employee (part time or full time) or shareholder is among the authors (Acell, Alma Laser, Coloplast, Cook, Pfizer).

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