Surgery for women with apical vaginal prolapse

Abstract

Sacral colpopexy is associated with lower risk of awareness of prolapse, recurrent prolapse on examination, repeat surgery for prolapse, postoperative SUI and dyspareunia than a variety of vaginal interventions.The limited evidence does not support use of transvaginal mesh compared to native tissue repair for apical vaginal prolapse. Most of the evaluated transvaginal meshes are no longer available and new lighter meshes currently lack evidence of safetyThe evidence was inconclusive when comparing access routes for sacral colpopexy.No clear conclusion can be reached from the available data comparing uterine preserving surgery versus vaginal hysterectomy for uterine prolapse.

Comment on “Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis”

“…First, we congratulate the authors on a well-conducted systematic review on this very pertinent topic. Broadly, the results are in agreement with those of other systematic reviews comparing uterus-preserving prolapse repair procedures with vaginal hysterectomy [2].…”

“…First, we congratulate the authors on a well-conducted systematic review on this very pertinent topic. Broadly, the results are in agreement with those of other systematic reviews comparing uterus-preserving prolapse repair procedures with vaginal hysterectomy [2].We wonder why the authors did not include the large randomized controlled trial by Detollenaere et al of vaginal sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension [3]. This randomized controlled trial with over 100 women in each arm would meet the inclusion criteria of the current review and add strength to the evidence.…”

Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse — analysis of short-term results, pelvic floor ultrasound evaluation

“…Nowadays apical prolapse is an important clinical and scientific issue, because it is the probable reason for many failures after POP repair operations [2]. Various surgical treatments are available to treat this condition and there are no strict recommendation when to use them [3]. There are data suggesting that sacral colpopexy is operation of choice for apical vaginal prolapse, especially in younger, sexually active women.…”

“…This is one of the reasons why specialists often choose vaginal route [4,5]. There is limited evidence of transvaginal meshes and most of those evaluated so far are no longer available [3]. There are data suggesting that new lighter meshes with 6 arms are effective to treat both anterior and apical prolapse, also in sexually active women, but still more data are needed [5].…”

Robotic Surgery for the Treatment of Apical Pelvic Organ Prolapse at a Single Institution

“…The gold standard procedure for the treatment of apical POP is sacrocolpopexy, which corrects the anatomical pathology in 78-100% of cases (3). Sacrocolpopexy is associated with lower risk of recurrent POP, postoperative stress urinary incontinence and dyspareunia than vaginal procedures (4). Although there are growing evidences indicating that high satisfaction and low recurrence rates can be accomplished using a variety of sacral hysteropexy techniques, the role of preservation of uterus at the time of prolapse surgery remains controversial (5).…”