Does pelvic floor muscle maximum voluntary contraction improve after vaginal pelvic organ prolapse surgery? A prospective study

Duarte, Thaiana Bezerra; Bonacin, Marília A. P.; Brito, Luiz Gustavo Oliveira; Frawley, Helena; Dwyer, Peter; Thomas, Elizabeth; Ferreira, Carmen V.

doi:10.1002/nau.23503

Cited by 6 publications

(12 citation statements)

References 25 publications

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“…Few of the reported measures within this review have been shown to be valid measures of PFM morphometry or function, or demonstrate sufficient reliability and responsiveness to measure small or clinically significant changes in PFM function that may be evident with surgery. An additional reason that we found no change in PFM function postoperatively may be due to the fact that only one study was powered to detect a change in PFM morphometry or function …”

Section: Discussionmentioning

confidence: 92%

“…A total of 5 randomized controlled trials, 14 prospective cohort studies and 2 retrospective cohort studies were included (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…A wide range of surgical interventions was represented in the studies (Table ). A total of 3 studies investigated procedures for UI and 12 studies reported on vaginal prolapse repair . Combined POP/UI procedures were performed in four studies .…”

Section: Resultsmentioning

confidence: 99%

“…Participants in six studies had not undergone any previous pelvic surgery. 27,37,41,42,46,48 Only three studies reported participants' previous experience with PFM training: in one study participants had no prior PFM training 46 ; in another study 9% had completed PFM training before participation in the study 40 ; and in the third study over 59% had done previous PFM training. 32 A single study reported the presence of levator avulsion preoperatively.…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…A total of 3 studies investigated procedures for UI 27,39,45 and 12 studies reported on vaginal prolapse repair. 28,32,34,37,[40][41][42][43][44][46][47][48] Combined POP/UI procedures were performed in four studies. 31,33,35,49 One study reported perineal levatorplasty and transrectal repair surgery to correct anterior rectocele.…”

Section: Interventionsmentioning

confidence: 99%

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The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

Mastwyk

McClelland

Rosamilia

et al. 2019

Neurourology and Urodynamics

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Aims To systematically review the evidence for the effect of pelvic organ prolapse (POP) and/or continence surgery on pelvic floor muscle (PFM) morphometry and function in women, and to investigate whether a relationship exists between PFM measures and clinician‐reported objective pelvic floor outcomes postoperatively. Methods Six electronic databases were searched until March 2018. Studies were included if they examined the effect of POP and/or continence surgery on the PFM in women, and reported pre‐ and postoperative data. Methodological quality was assessed using a modified Downs and Black checklist. Three meta‐analyses were planned based on postoperative follow‐up time. Results Twenty‐one studies met the inclusion criteria. Varied surgical interventions and 33 different PFM measures were represented. The methodological quality of included studies varied considerably. The 0 to 6 weeks postoperative meta‐analysis showed no statistically significant change in PFM function (SMD = 0.04; 95% confidence interval [CI] = −0.26 to 0.33). This was consistent at 3 and 6 or more months (SMD = 1.13; 0.35 95% CI = −0.34 to 2.60, − 0.42 to 1.12 respectively). None of the included studies investigated the relationship between PFM measures and clinician‐reported objective outcomes postoperatively. Conclusions This review did not show a clear effect of POP and/or continence surgery on PFM morphometry or function in women and was unable to show a relationship with outcomes such as objective prolapse score and urodynamic findings. This could be because surgery does not measurably impact on the PFM or due to the poor quality and heterogeneity of studies. Future well‐designed research is needed to specifically investigate change in the PFM following surgery.

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Section: Discussionmentioning

confidence: 92%

“…A total of 5 randomized controlled trials, 14 prospective cohort studies and 2 retrospective cohort studies were included (Table ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Participant Characteristicsmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

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The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

Mastwyk

McClelland

Rosamilia

et al. 2019

Neurourology and Urodynamics

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Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial

Nyhus

Mathew

Salvesen

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives To evaluate the effect of preoperative pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction, symptoms of pelvic organ prolapse (POP) and anatomical POP, 6 months after prolapse surgery, and to assess the overall changes in PFM contraction, POP symptoms and pelvic organ descent after surgery. Methods This was a randomized controlled trial of 159 women with symptomatic POP, Stage 2 or higher, scheduled for surgery. Participants were randomized to intervention including daily PFMT from inclusion to surgery (n = 81) or no intervention (controls; n = 78). Participants were examined at inclusion, on the day of surgery and 6 months after surgery. PFM contraction was assessed by: vaginal palpation using the Modified Oxford scale (MOS; 0–5); transperineal ultrasound, measuring the percentage change in levator hiatal anteroposterior diameter (APD) from rest to maximum PFM contraction; vaginal manometry; and surface electromyography (EMG). POP distance from the hymen in the compartment with the most dominant prolapse and organ descent in the anterior, central and posterior compartments were measured on maximum Valsalva maneuver. POP symptoms were assessed based on the sensation of vaginal bulge, which was graded using a visual analog scale (VAS; 0–100 mm). Linear mixed models were used to assess the effect of PFMT on outcome variables. Results Of the 159 women randomized, 151 completed the study, comprising 75 in the intervention and 76 in the control group. Mean waiting time for surgery was 22 ± 9.7 weeks and follow‐up was performed on average 28 ± 7.8 weeks after surgery. Postoperatively, no difference was found between the intervention and control groups with respect to PFM contraction assessed by vaginal palpation (MOS, 2.4 vs 2.2; P = 0.101), manometry (19.4 vs 19.7 cmH2O; P = 0.793), surface EMG (33.5 vs 33.1 mV; P = 0.815) and ultrasound (change in hiatal APD, 20.9% vs 19.3%; P = 0.211). Furthermore, no difference between groups was found for sensation of vaginal bulge (VAS, 7.4 vs 6.0 mm; P = 0.598), POP distance from the hymen in the dominant prolapse compartment (−1.8 vs −2.0 cm; P = 0.556) and sonographic descent of the bladder (0.5 vs 0.8 cm; P = 0.058), cervix (−1.3 vs −1.1 cm; P = 0.569) and rectal ampulla (0.3 vs 0.4 cm; P = 0.434). In all patients, compared with findings at initial examination, muscle contraction improved after surgery, as assessed by palpation (MOS, 2.1 vs 2.3; P = 0.007) and ultrasound (change in hiatal APD, 17.5% vs 20.1%; P = 0.001), and sensation of vaginal bulge was reduced (VAS, 57.6 vs 6.7 mm; P < 0.001). In addition, compared with the baseline examination, POP distance from the hymen in the dominant prolapse compartment (1.9 vs −1.9 cm; P < 0.001) and sonographic descent of the bladder (1.3 vs 0.6 cm; P < 0.001), cervix (0.0 vs −1.2 cm; P < 0.001) and rectal ampulla (0.9 vs 0.4 cm; P = 0.001) were reduced. Conclusions We found no effect of preoperative PFMT on PFM contraction, POP symptoms or anatomical prolapse after surgery. In all patie...

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Impact of preoperative pelvic floor muscle function on the success of surgical treatment of pelvic organ prolapse

Szymański,

Starzec-Proserpio,

Bartosińska-Raczkiewicz

et al. 2023

Int Urogynecol J

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Introduction and hypothesis The objective of this study was to identify the potential characteristics of pelvic floor muscles (PFM) in the preoperative assessment that could be associated with post-surgical prolapse severity. We hypothesized that the same variables, if identified, could be addressed in preoperative rehabilitation to improve surgical results. Methods This was a single-center prospective observational study that included women who underwent surgical pelvic organ prolapse repair between 2020–2022. Genital prolapse was evaluated according to the Pelvic Organ Prolapse Quantification (POP-Q) system. All the participants underwent a PFM assessment, including a vaginal digital assessment and manometry (Peritron™ 9300 V) before surgery and at 1-, 3-, and 6-month follow-ups. Several PFM variables were recorded: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), area under the curve during a 10-second MVC, ability to correctly contract the PFMs, and reflexive activation during cough and relaxation. The primary endpoint of the analysis was objective surgical success defined as POP-Q 0 or 1 at the 6-month follow-up. Additionally, a change in pelvic floor muscle function was recorded during postoperative visits. Results A total of 106 females were included in the study. Fifty-one were lost during the 6-month follow-up, which is a major limitation of the study. None of the examined parameters evaluating PFM were associated with surgical success. No statistically significant difference was found in MVC and PFM endurance before and after surgery. Post-surgery, a significant change was observed in the vaginal resting pressure and the ability to correct PFM activation and relaxation. Conclusions Preoperative PFM function is not associated with surgical success 6 months after surgery.

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Does pelvic floor muscle maximum voluntary contraction improve after vaginal pelvic organ prolapse surgery? A prospective study

Abstract: There was no difference in MVC pre and postsurgery, however we found an improvement in PFM average contraction strength postsurgery.

Cited by 6 publications

References 25 publications

The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial

Impact of preoperative pelvic floor muscle function on the success of surgical treatment of pelvic organ prolapse

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