6. Results 6.1. Patient Characteristics Forty-one patients with stage III/IV prolapse underwent RASCP between December 2008 and March 2010. The first 20 patients were performed exclusively by the attending surgeon (Group I) and the following 21 patients’ surgeries were performed by urology NSC639966 or gynecology residents (group 2). Overall, the mean age was 61.5 (15) years and mean BMI was 28.6 (12.7) kg/m2. Both groups were comparable regarding their age, ethnicity, and BMI. Stage and history of prior prolapse and incontinence surgery were similar between groups. Eighty-three percent of patients’ surgeries were menopausal. Selected comorbidities were present in 12 patients (9 in group 1 and 3 in group 2; P = 0.033). Patients’ characteristics were summarized in (Table 1).

Table 1 Patient/clinical demographics overall and by group, P value is comparison between groups. 6.2. Intraoperative Outcomes Concomitant procedures were performed in 36 (88%) patients. When comparing operative outcome measures, there was no significant difference in OR time, procedure time, estimated blood loss, and PACU time between the two groups (Table 2). In addition, bladder perforation was encountered in 1 (2%) of patients of group 1. It was recognized and adequately repaired intraoperatively without adverse sequelae. Vaginal wall was accidentally opened in one patient of group 2 due to extremely thin vagina and was sutured with adequate reapproximation. Table 2 Surgical outcomes overall and by group. 6.3. Postoperative Outcomes Postoperative complications are described in Table 2.

One patient in group 2 developed postoperative cuff dehiscence and was diagnosed 6 weeks postoperatively during routine postoperative follow-up visit. The vaginal cuff was revisited and adequately sutured under general anesthesia. One patient in group 1 required blood transfusion due to anemia secondary to chronic hemorrhoids in the postoperative period. Two patients in group 1 and one patient in group 2 were readmitted to the hospital for surgical repair of a vaginal mesh extrusion. Mesh extrusion is defined as any vaginal mesh exposure during the follow up period. All erosions were managed by freshening the edges and closing the vaginal defect. One patient required excision of a portion of the exposed mesh. Vaginal estrogen cream was offered to all patients after surgery.

Three patients in group 1 developed postoperative urinary tract infection and were properly treated with antibiotics. Prolapse recurrence was reported in one patient of group 1 where the anterior vaginal wall was prolapsed to the level Brefeldin_A of the hymen. This patient underwent vaginal McCall culdoplasty. One patient in group 2 was complicated by postoperative ileus diagnosed with a CT scan. The patient was managed conservatively and showed a significant improvement on day 6 where she was discharged.