Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence

Schachar, Jeffrey S.; Devakumar, Hemikaa; Martin, Laura; Farag, Sara; Hurtado, Eric A.; Davila, G. Willy

doi:10.1007/s00192-018-3626-2

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…The findings of this review suggest that there is no impact—improvement or deterioration—on PFM function as a result of POP/UI surgery. Given this, and the current lack of evidence to support perioperative PFM training, we may need to be guided by findings from studies that have shown a strong association between poorer preoperative PFM status and poorer postoperative PFM function . Therefore, focusing intervention on women with poor PFM function preoperatively, who are most likely to respond may be the best approach to achieve more effective outcomes from perioperative PFM interventions.…”

Section: Discussionmentioning

confidence: 99%

“…Given this, and the current lack of evidence to support perioperative PFM training, 22,50 we may need to be guided by findings from studies that have shown a strong association between poorer preoperative PFM status and poorer postoperative PFM function. 18,19,[51][52][53] Therefore, focusing intervention on women with poor PFM function preoperatively, who are most likely to respond 19,51,53 may be the best approach to achieve more effective outcomes from perioperative PFM interventions. This would need to be confirmed with high quality randomized controlled trials.…”

Section: Discussionmentioning

confidence: 99%

“…The most recent reviews of perioperative PFM training for women undergoing prolapse surgery 22,50 found no significant improvement in prolapse symptoms, degree of prolapse or quality of life with the addition of PFM training. A possible reason for the lack of clear effect in both of these reviews and this one could be that women with poorer preoperative PFM function 18,19,[51][52][53] (at risk group), were not specifically targeted. A clear understanding of the relationship between changes in PFM measures postoperatively and symptom recurrence is challenging without accurate PFM measurement.…”

Section: Discussionmentioning

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: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…The patients were divided into "absent," "weak," and "good" preoperative pelvic muscle strength based on the modified Oxford Grading Scale. The study showed that the recurrence rate of anterior vaginal wall prolapse was significantly higher in women with absent PFM strength (nondetectable PFM contractions) compared to those with weak or good muscle strength (13.89% vs. 3.48% and 4.05%, respectively (p = 0.033)) [22].…”

Section: Preoperative Muscle Function and Surgical Outcomesmentioning

confidence: 91%

Is PREHAB in Pelvic Floor Surgery Needed? A Topical Review

et al. 2020

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Pelvic organ prolapse and urinary incontinence affect approximately 6–11% and 6–40% of women, respectively. These pathologies could result from a weakness of pelvic floor muscles (PFM) caused by previous deliveries, aging or surgery. It seems reasonable that improving PFM efficacy should positively impact both pelvic floor therapy and surgical outcomes. Nonetheless, the existing data are inconclusive and do not clearly support the positive impact of preoperative pelvic floor muscle training on the improvement of surgical results. The restoration of deteriorated PFM function still constitutes a challenge. Thus, further well-designed prospective studies are warranted to answer the question of whether preoperative PFM training could optimize surgical outcomes and if therapeutic actions should focus on building muscle strength or rather on enhancing muscle performance.

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“…Over 300 000 surgical procedures are carried out annually in the USA for POP 1,2 . The etiology is probably multifactorial; common risk factors include vaginal childbirth, elderly age, and a higher body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) 3 . POP, with regards to apical prolapse, can be treated with various approaches.…”

Section: Introductionmentioning

confidence: 99%

Effect of age in women undergoing laparoscopic sacrocolpopexy: A retrospective study

Malekzadeh,

Ramirez‐Caban,

Garcia‐Ruiz

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo determine whether elderly women (≥65 years) have an increased risk of complications and lower success when undergoing laparoscopic sacrocolpopexy (LSC) compared with younger women (<65 years).MethodsThis was a retrospective study of all LSC procedures performed from August 2014 to February 2021 by a single urogynecologic surgeon in an academic affiliated hospital system. Charts were identified through procedure codes. Patient demographics, clinical, surgical, and postoperative data were collected. The primary outcome of this study was to compare complications associated with LSC, including intraoperative and postoperative complications. Secondary outcomes included subjective, objective, and composite success.ResultsIn total, 312 participants met the criteria. The mean age of the group who were younger than 65 years was 55.7 years (±6.5) and of the group aged 65 years or older was 69.3 years (±3.5). Racial demographics revealed no differences between the two groups. Patients aged 65 years or older had a statistically significant lower body mass index (calculated as weight in kilograms divided by the square of height in meters), a higher rate of hypertension, smaller genital hiatus, and a larger anterior vaginal wall prolapse compared with the younger cohort. They also less often underwent a posterior repair. No statistically significant differences were found with regards to intraoperative and postoperative complications, including 30‐day re‐admission, between the two age groups. Both groups had high anatomic success rates, with no significant difference (<65 = 96.3%; ≥65 = 98.4%; P = 0.326). Those aged younger than 65 years compared with those aged 65 years or older had lower subjective success that was not significantly different (<65 = 62.8%; ≥65 = 71.0; P = 0.134). Composite success was noted to reach the threshold of a statistically significant difference in the group aged younger than 65 years compared with those aged 65 years or older (60.1% vs 71.0%; P = 0.0499).ConclusionIn this study, elderly patients did not have increased intraoperative and postoperative complications after undergoing LSC. Similar rates of anatomic and subjective success were also found with younger patients having a lower composite success. Proper candidates for LSC should not be excluded based upon age.

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Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence

Abstract: Patients with preoperative absent pelvic floor muscle strength (nonfunctioning PFM) had a significantly higher anterior vaginal wall recurrence rate than those with weak or good pelvic floor muscle strength.

Cited by 7 publications

References 28 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

Is PREHAB in Pelvic Floor Surgery Needed? A Topical Review

Effect of age in women undergoing laparoscopic sacrocolpopexy: A retrospective study

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