Surgical management of pelvic organ prolapse in women

Abstract

Abdominal sacral colpopexy was associated with a lower rate of recurrent vault prolapse and dyspareunia than with vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of mesh or graft inlays at the time of anterior vaginal wall repair reduces the risk of recurrent anterior wall prolapse, on examination. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. The value of the addition of a continence procedure to a prolapse repair operation in women who are dry before operation remains to be assessed. Adequately powered randomised controlled clinical trials are urgently needed on a wide variety of issues and particularly need to include women's perceptions of prolapse symptoms.

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

“…In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10). Moreover, short-term outcome rates including subjective satisfaction, apical prolapse recurrence, de novo urgency, and de novo dyspareunia were not statistically significantly different among the four groups and these data are in concordance with previous published data (8)(9)(10)18).…”

“…This may be explained by the fact that the patient group with the highest BMI consisted of the oldest patients and that the vaginal surgical route was preferred in this patient group. De novo SUI ranging from 17%-37% and 4%-50% is the most frequently reported complication associated with sacrocolpopexy and SSLF (8)(9)(10)18). In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10).…”

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

“…In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10). Moreover, short-term outcome rates including subjective satisfaction, apical prolapse recurrence, de novo urgency, and de novo dyspareunia were not statistically significantly different among the four groups and these data are in concordance with previous published data (8)(9)(10)18).…”

“…This may be explained by the fact that the patient group with the highest BMI consisted of the oldest patients and that the vaginal surgical route was preferred in this patient group. De novo SUI ranging from 17%-37% and 4%-50% is the most frequently reported complication associated with sacrocolpopexy and SSLF (8)(9)(10)18). In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10).…”

Vaginal Repair with Polypropylene Mesh Compared to Traditional Colporrhaphy for Pelvic Organ Prolapse: Medium-Term Follow-Up

“…This fits with the randomized trial of Carey 5 but not with other trials where mesh was significantly more efficacious, 3 as with the finding of a recent Cochrane Review for anterior prolapse. 8 Our results with mesh are similar to studies where success rates for polypropylene mesh range from 71%, 29 87%, 6 93%, 30 to 95%. 31 In the NICE (National Institute of Clinical Excellence) systematic review comprising 10 RCTs on anterior compartment mesh, the objective failure rate was 30% for procedures without mesh, and 14% for polypropylene mesh.…”

Perioperative Complications and Cost of Vaginal, Open Abdominal, and Robotic Surgery for Apical Vaginal Vault Prolapse

“…However, RSC was associated with shorter hospitalization. These findings were similar to those of a systematic review in which another transvaginal approach, sacrospinous ligament fixation, was associated with shorter operative time, shorter recovery, and lower inpatient cost compared with ASC (19). …”

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

“…In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10). Moreover, short-term outcome rates including subjective satisfaction, apical prolapse recurrence, de novo urgency, and de novo dyspareunia were not statistically significantly different among the four groups and these data are in concordance with previous published data (8)(9)(10)18).…”

“…This may be explained by the fact that the patient group with the highest BMI consisted of the oldest patients and that the vaginal surgical route was preferred in this patient group. De novo SUI ranging from 17%-37% and 4%-50% is the most frequently reported complication associated with sacrocolpopexy and SSLF (8)(9)(10)18). In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10).…”

Vaginal Repair with Polypropylene Mesh Compared to Traditional Colporrhaphy for Pelvic Organ Prolapse: Medium-Term Follow-Up

“…This fits with the randomized trial of Carey 5 but not with other trials where mesh was significantly more efficacious, 3 as with the finding of a recent Cochrane Review for anterior prolapse. 8 Our results with mesh are similar to studies where success rates for polypropylene mesh range from 71%, 29 87%, 6 93%, 30 to 95%. 31 In the NICE (National Institute of Clinical Excellence) systematic review comprising 10 RCTs on anterior compartment mesh, the objective failure rate was 30% for procedures without mesh, and 14% for polypropylene mesh.…”

Perioperative Complications and Cost of Vaginal, Open Abdominal, and Robotic Surgery for Apical Vaginal Vault Prolapse

“…However, RSC was associated with shorter hospitalization. These findings were similar to those of a systematic review in which another transvaginal approach, sacrospinous ligament fixation, was associated with shorter operative time, shorter recovery, and lower inpatient cost compared with ASC (19). …”

Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, sacrospinous ligament fixation, and iliococcygeus fixation procedures

“…In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10). Moreover, short-term outcome rates including subjective satisfaction, apical prolapse recurrence, de novo urgency, and de novo dyspareunia were not statistically significantly different among the four groups and these data are in concordance with previous published data (8)(9)(10)18).…”

“…This may be explained by the fact that the patient group with the highest BMI consisted of the oldest patients and that the vaginal surgical route was preferred in this patient group. De novo SUI ranging from 17%-37% and 4%-50% is the most frequently reported complication associated with sacrocolpopexy and SSLF (8)(9)(10)18). In our cohort, we observed de novo SUI rates of 3.7% in the sacrocolpopexy group (n = 81) and 6.2% in vaginal suspension procedures (n = 64), which is in accordance with previously published data (10).…”

Vaginal Repair with Polypropylene Mesh Compared to Traditional Colporrhaphy for Pelvic Organ Prolapse: Medium-Term Follow-Up

“…This fits with the randomized trial of Carey 5 but not with other trials where mesh was significantly more efficacious, 3 as with the finding of a recent Cochrane Review for anterior prolapse. 8 Our results with mesh are similar to studies where success rates for polypropylene mesh range from 71%, 29 87%, 6 93%, 30 to 95%. 31 In the NICE (National Institute of Clinical Excellence) systematic review comprising 10 RCTs on anterior compartment mesh, the objective failure rate was 30% for procedures without mesh, and 14% for polypropylene mesh.…”

Perioperative Complications and Cost of Vaginal, Open Abdominal, and Robotic Surgery for Apical Vaginal Vault Prolapse

“…However, RSC was associated with shorter hospitalization. These findings were similar to those of a systematic review in which another transvaginal approach, sacrospinous ligament fixation, was associated with shorter operative time, shorter recovery, and lower inpatient cost compared with ASC (19). …”