Surgical management of pelvic organ prolapse in women

Abstract

Background Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with the prolapse. Objectives To determine the effects of the many different surgeries used in the management of pelvic organ prolapse. Search methods We searched the Cochrane Incontinence Group Specialised Register (9 February 2009) and reference lists of relevant articles. We also contacted researchers in the field. Selection criteria Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. Data collection and analysis Trials were assessed and data extracted independently by two review authors. Six investigators were contacted for additional information with five responding. Main results Forty randomised controlled trials were identified evaluating 3773 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86). However there was no statistically significant difference in re-operation rates for prolapse (RR 0.46, 95% CI 0.19 to 1.11). The vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The three trials contributing to this analysis were clinically heterogeneous. For anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented with a polyglactin mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.72, 95% CI 1.20 to 6.14); but data on morbidity and other clinical outcomes were lacking. Standard anterior repair was associated with more anterior compartment failures 1 Surgical management of pelvic organ prolapse in women (Review)

Does anchoring vaginal mesh increase the potential for correcting stress incontinence?

“…Surprisingly, the double-sling extrusion rate was extremely low (0–10%) [ 12 , 32 ]. The corresponding figures were 1.6% in our mTVM group and 9.7% among our TVM participants, which is in agreement with the mean value of 11.6% (ranging from 3.9 to 16%) reported in the literature [ 4 , 20 , 24 , 27 , 33 , 34 ]. The extrusion rate generally correlates well with the prosthesis breadth; however, we observed a remarkably higher extrusion rate for mesh compared to that for modified mesh.…”

Does anchoring vaginal mesh increase the potential for correcting stress incontinence?

“…Surprisingly, the double-sling extrusion rate was extremely low (0–10%) [ 12 , 32 ]. The corresponding figures were 1.6% in our mTVM group and 9.7% among our TVM participants, which is in agreement with the mean value of 11.6% (ranging from 3.9 to 16%) reported in the literature [ 4 , 20 , 24 , 27 , 33 , 34 ]. The extrusion rate generally correlates well with the prosthesis breadth; however, we observed a remarkably higher extrusion rate for mesh compared to that for modified mesh.…”

Risk factors for stress urinary incontinence after native‐tissue vaginal repair of pelvic organ prolapse

“…In this large retrospective study, POSUI was reported in 20.9% of patients after native‐tissue POP repair by the vaginal route. This rate is consistent with previous findings . The presence of SUI before surgery, a detrusor pressure at maximum flow of less than 30 cm H 2 O, and urodynamically diagnosed SUI were independent risk factors for the development of POSUI.…”

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).…”

Does anchoring vaginal mesh increase the potential for correcting stress incontinence?

“…Surprisingly, the double-sling extrusion rate was extremely low (0–10%) [ 12 , 32 ]. The corresponding figures were 1.6% in our mTVM group and 9.7% among our TVM participants, which is in agreement with the mean value of 11.6% (ranging from 3.9 to 16%) reported in the literature [ 4 , 20 , 24 , 27 , 33 , 34 ]. The extrusion rate generally correlates well with the prosthesis breadth; however, we observed a remarkably higher extrusion rate for mesh compared to that for modified mesh.…”

Risk factors for stress urinary incontinence after native‐tissue vaginal repair of pelvic organ prolapse

“…In this large retrospective study, POSUI was reported in 20.9% of patients after native‐tissue POP repair by the vaginal route. This rate is consistent with previous findings . The presence of SUI before surgery, a detrusor pressure at maximum flow of less than 30 cm H 2 O, and urodynamically diagnosed SUI were independent risk factors for the development of POSUI.…”

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).…”

Does anchoring vaginal mesh increase the potential for correcting stress incontinence?

“…Surprisingly, the double-sling extrusion rate was extremely low (0–10%) [ 12 , 32 ]. The corresponding figures were 1.6% in our mTVM group and 9.7% among our TVM participants, which is in agreement with the mean value of 11.6% (ranging from 3.9 to 16%) reported in the literature [ 4 , 20 , 24 , 27 , 33 , 34 ]. The extrusion rate generally correlates well with the prosthesis breadth; however, we observed a remarkably higher extrusion rate for mesh compared to that for modified mesh.…”

Risk factors for stress urinary incontinence after native‐tissue vaginal repair of pelvic organ prolapse

“…In this large retrospective study, POSUI was reported in 20.9% of patients after native‐tissue POP repair by the vaginal route. This rate is consistent with previous findings . The presence of SUI before surgery, a detrusor pressure at maximum flow of less than 30 cm H 2 O, and urodynamically diagnosed SUI were independent risk factors for the development of POSUI.…”

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).…”