Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines

Meriwether, Kate V.; Balk, Ethan M; Antosh, Danielle D.; Olivera, Cedric K.; Kim-Fine, Shunaha; Murphy, Miles; Grimes, Cara L.; Sleemi, Ambereen; Singh, Rashmi B. Halker; Dieter, Alexis A.; Crisp, Catrina C.; Rahn, David D.

doi:10.1007/s00192-019-03876-2

Cited by 40 publications

(31 citation statements)

References 71 publications

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“…Patients with ≥ stage 3 POP have a wide POP-Q measurement range reflecting a diverse variety of pelvic floor injuries [16]. The Ba point represents the most distal position of the anterior vaginal wall and the focal point of an anterior wall prolapse repair.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Stratification in Pelvic Organ Prolapse: Can POP-Q Measurements Predict Surgical Outcome?

Levy¹,

Beck²,

From³

et al. 2019

Gynecol Reprod Health

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Objective: The study aimed to determine if a single preoperative objective measure of the Pelvic Organ Prolapse Quantification (POP-Q) system, the Ba, (which represents the distal leading point of the anterior vaginal wall), predicts a successful outcome in patients presenting with ≥ stage 3 pelvic organ prolapse (POP) who undergo a transvaginal repair. Methods: Patients with ≥ stage 3 POP managed with transvaginal mesh implantation were divided into 2 groups based on preoperative Ba measurement (Group 1; Ba = 2-3 cm and Group 2; Ba ≥ 4 cm). An anatomically successful outcome was defined as Ba <1cm. Results: There were 138 women surgically managed between 2009 and 2013 with complete follow-up available on 113 cases (median age 62.5 years; range 42-83 years). The median follow-up period was 29 months (range 8-38 months). Of 89 women with stage ≥ 3 POP there were 39 cases in Group 1 and 50 patients in Group 2. There was a significantly lower postoperative Ba in Group 1 cases when compared with Group 2 patients (-2.61 cm vs.-1.74 cm; P = 0.03). Logistic regression analysis failed to discern any effect on a successful outcome of factors normally responsible for prolapse (age, parity, BMI, prior surgery or operative delivery). Conclusion: A favorable anatomic outcome after transvaginal surgery for POP can be anticipated with a preoperative Ba < 4 cm. Future studies are required assessing the value of the preoperative POP-Q measurements in patients with ≥ 3rd degree POP using different types of surgery.

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Section: Discussionmentioning

confidence: 99%

Preoperative Stratification in Pelvic Organ Prolapse: Can POP-Q Measurements Predict Surgical Outcome?

Levy¹,

Beck²,

From³

et al. 2019

Gynecol Reprod Health

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“…Uterine-preserving mesh-based POP surgeries have gained attention over the past few years due to the lower theoretical risk of mesh exposure, blood loss, and surgical cost. A 2019 meta-analysis of 94 studies comparing all routes of hysteropexy against hysterectomy, including the use of TVM, shows a decrease in mesh exposure, operative time, blood loss, and surgical cost without a difference in POP recurrence 81. Specifically, the odds of urinary retention are 95% lower in women undergoing laparoscopic hysteropexy compared to vaginal or open hysteropexy approaches.…”

Section: Surgical Treatments For Popmentioning

confidence: 99%

<p>Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review</p>

Wu¹,

Welk²

2019

RRU

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Stress urinary incontinence (SUI) and pelvic organ prolapse (POP) affect many women in their lifetime. In this review, we describe and evaluate the latest treatment options for SUI and POP, including the controversy around transvaginal mesh (TVM) use. Growing evidence supports the utilization of pelvic floor muscle training as first-line treatment for both SUI and POP. Vaginal pessaries continue to be an effective and reversible option to manage SUI and POP symptoms. The midurethral sling remains the gold standard for surgical treatment of SUI, although patients and clinicians should acknowledge the potentially serious complications of TVM. Burch urethropexy and pubovaginal sling offer good SUI cure and may be preferred in women wishing to avoid mesh implants; however, their operative morbidities and more challenging surgical approach may limit their use. Sitespecific cystocele or rectocele repairs may be indicated for isolated anterior or posterior vaginal compartment prolapse; however, in women with more severe POP, evidence supports using a vaginal native-tissue repair involving apical suspension as the primary surgical technique. Although abdominal and laparoscopic sacrocolpopexies are both effective in treating POP, their failure and mesh complication rates increase with time. There is insufficient evidence to support the widespread use of uterine-preserving surgical POP repairs at present due to the lack of long-term data. Routine TVM use is not recommended in POP surgeries and should only be considered on a case-by-case basis by trained surgeons, primarily in women with multiple risk factors for POP recurrence. In general, clinicians should individualize SUI and POP treatment options for women based on their symptoms, comorbidities, and risk factors for mesh-related complications.

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“…Третьим аспектом герниологического парадокса стал тот факт, что лучшие результаты лечения выпадения женских половых органов сегодня достигнуты при применении влагалищной гистерэктомии [35] с последующей фиксацией культи влагалища к крестцово-остистой связке или сакрокольпопексией [36]. Этот выбор, тем не менее, представляется абсурдным с позиции герниологии, согласно которой удаление неизмененного грыжевого мешка недопустимо.…”

Section: гинекологияunclassified

Current Paradoxes in Perineology

Toktar¹,

Aryutin²,

Volkova³

et al. 2019

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Цель обзора: систематизация контраверсионных аспектов современной перинеологии и пролаптологии. Основные положения. Современная перинеология существует в условиях накопившихся парадоксальных фактов, мнений и решений, среди которых дидактический, эпидемиологический, экономический, анатомический, герниологический, тактический, эволюционный, акушерский, морфологический и другие парадоксы. Существуют два уязвимых места множества исследований, посвященных выпадению тазовых органов у женщин, которые мешают преодолеть упомянутые парадоксы. Первое из них-это представление о тазовом дне как о статичной структуре. Известно, что мышцы тазового дна рефлекторно сокращаются в ответ на любое повышение внутрибрюшного давления аналогично батуту, т. е. никогда не находятся в покое. В то же время внимание исследователей приковано в основном к соединительной ткани тазовых фасций и связок, а основной ткани, обеспечивающей функцию тазового дна-мышечной,-посвящены лишь единичные публикации. Второе уязвимое место современных научных работ-рассмотрение пролапса лишь в одной точке его развития, и, к сожалению, эта точка-конечная. Тактика оперировать только выраженный пролапс, не искать пути хирургической профилактики запутала самих исследователей. Очевидно, что следует изучать морфологические, иммуногистохимические и другие ультраструктурные характеристики тканей на этапе продромальной несостоятельности тазового дна, при синдроме широкого влагалища без манифестации пролапса, сопоставляя полученные данные с результатами применения неинвазивных методов диагностики. Заключение. Получив представление о ранних формах, а не только о выраженном пролапсе с уже сформировавшимися декомпенсаторными необратимыми изменениями тканей и анатомических взаимоотношений, можно попытаться обоснованно объяснить патогенез тазовой десценции и разрешить накопившиеся парадоксы перинеологии. Ключевые слова: пролапс тазовых органов, несостоятельность тазового дна, тазовая дисфункция, перинеология, пролаптология.

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Uterine-preserving surgeries for the repair of pelvic organ prolapse: a systematic review with meta-analysis and clinical practice guidelines

Cited by 40 publications

References 71 publications

Preoperative Stratification in Pelvic Organ Prolapse: Can POP-Q Measurements Predict Surgical Outcome?

Preoperative Stratification in Pelvic Organ Prolapse: Can POP-Q Measurements Predict Surgical Outcome?

<p>Revisiting current treatment options for stress urinary incontinence and pelvic organ prolapse: a contemporary literature review</p>

Current Paradoxes in Perineology

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