Abstract:Our data shows that repair with mesh is superior to anterior colporrhaphy with more satisfactory outcome to the patients. Due to the small size of our study and uncertainty of the long-term safety and resilience of the mesh, we recommend larger studies to confirm our preliminary results.
“…Forty RCTs remained after removal of duplicates and studies not matching the eligibility criteria (Table 1 ). The indications for AC were urinary incontinence [ 10 – 12 ], pelvic organ prolapse [ 13 , 15 , 16 , 19 – 23 , 25 – 27 , 29 – 38 , 40 , 41 , 43 – 49 ] or both [ 14 , 17 , 18 , 24 , 28 , 39 , 42 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…In 12 studies (30.0%) fluid infiltration of the operating field was performed before the incision. A vasoconstricting solution was used in two studies (vasopressin in two [ 19 , 47 ], adrenaline in two [ 16 , 38 ]), and the type of agent used was not given in two studies [ 36 , 41 ]. A mixture of anesthetics and vasoconstricting solution was used in six studies (lidocaine and adrenaline in four [ 21 , 26 , 33 , 40 ], adrenalin and bupivacaine in two [ 22 , 31 ]).…”
IntroductionAnterior colporrhaphy (AC) is considered a standard procedure and is performed all over the world. However, not a single step of the procedure has ever been truly standardized and the rates of failure show a wide range in the literature from 0% up to 92%. The aim of this systematic review was to evaluate the differences in technique and procedure worldwide.MethodsWe performed a systematic literature search up to March 2016 using the MeSH terms “(anterior AND (colporrhaph* or colporhaph* or repair* or cystocel*)” using Preferred Reporting Items for Sytematic Reviews and Meta-Analyses (PRISMA). Only randomized controlled trials (RCT) were included in the systematic review. A 14-point checklist was used to assess the quality of surgery undertaken in each RCT.ResultsForty RCTs from all over the world were included in the review. The indication for AC was urinary incontinence and/or pelvic organ prolapse. A detailed description of colporrhaphy was not provided even in the well-conducted RCTs. The review showed differences in each step of the procedure, in perioperative care, in anesthesia and in surgeon’ experience.ConclusionOur results highlight the problems concerning AC with the great range in postoperative outcomes. There is diversity in the anatomical structures used in the repair, in perioperative care and in the procedure itself.
“…Forty RCTs remained after removal of duplicates and studies not matching the eligibility criteria (Table 1 ). The indications for AC were urinary incontinence [ 10 – 12 ], pelvic organ prolapse [ 13 , 15 , 16 , 19 – 23 , 25 – 27 , 29 – 38 , 40 , 41 , 43 – 49 ] or both [ 14 , 17 , 18 , 24 , 28 , 39 , 42 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…In 12 studies (30.0%) fluid infiltration of the operating field was performed before the incision. A vasoconstricting solution was used in two studies (vasopressin in two [ 19 , 47 ], adrenaline in two [ 16 , 38 ]), and the type of agent used was not given in two studies [ 36 , 41 ]. A mixture of anesthetics and vasoconstricting solution was used in six studies (lidocaine and adrenaline in four [ 21 , 26 , 33 , 40 ], adrenalin and bupivacaine in two [ 22 , 31 ]).…”
IntroductionAnterior colporrhaphy (AC) is considered a standard procedure and is performed all over the world. However, not a single step of the procedure has ever been truly standardized and the rates of failure show a wide range in the literature from 0% up to 92%. The aim of this systematic review was to evaluate the differences in technique and procedure worldwide.MethodsWe performed a systematic literature search up to March 2016 using the MeSH terms “(anterior AND (colporrhaph* or colporhaph* or repair* or cystocel*)” using Preferred Reporting Items for Sytematic Reviews and Meta-Analyses (PRISMA). Only randomized controlled trials (RCT) were included in the systematic review. A 14-point checklist was used to assess the quality of surgery undertaken in each RCT.ResultsForty RCTs from all over the world were included in the review. The indication for AC was urinary incontinence and/or pelvic organ prolapse. A detailed description of colporrhaphy was not provided even in the well-conducted RCTs. The review showed differences in each step of the procedure, in perioperative care, in anesthesia and in surgeon’ experience.ConclusionOur results highlight the problems concerning AC with the great range in postoperative outcomes. There is diversity in the anatomical structures used in the repair, in perioperative care and in the procedure itself.
“…This meta-analysis showed that the use of meshes for the treatment of anterior vaginal wall prolapse is superior to native tissue surgical repair, when objective cure through POP-Q assessment is considered. [14][15][16][17][18][19][20][21][22][23][24][25] All of the articles included in this meta-analysis considered as an objective cure criterion a post-surgical POP-Q stage inferior to 2 in the pelvic examination. This definition of cure, that is, when the prolapse's maximum extent stays at least 1 cm above the hymenal ring, is based on the recommendations of the US National Institute of Health (NIH) workshop.…”
Keywords► anterior pelvic organ prolapse ► cystocele ► surgery ► mesh ► colporrhaphy ► meta-analysis
AbstractPurpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6-8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used, with or without the use of vaginal meshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] ¼ 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] ¼ 45,98 [9,[72][73][74][75][76][77][78][79][80][81][82]25]), longer surgery time (MD ¼ 15,08 [0,67]), but less prolapse recurrence (OR ¼ 0,22 [01,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different.
“…In studies with apical fixation or concomitant apical surgery [71][72][73][74][75][76][77][78][79], anterior repair using a synthetic mesh (excluding Prolift ® and Perigee ® ) had a cumulative success rate of 93 %; the cumulative success rate of studies without apical fixation or without standard apical surgery [80][81][82][83][84][85][86][87][88][89] was 83 %. The cumulative rate of mesh erosion was 8 % (137/1740); the cumulative rate for chronic pain and de novo dyspareunia was 7% (59/846).…”
Section: Level Of Evidence 3 Grade Of Recommendation Bmentioning
Ziel: Erstellung einer offiziellen, internationalen, interdisziplinären Leitlinie, publiziert und koordiniert von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Die Leitlinie wurde für den deutschsprachigen Raum entwickelt und wird neben der DGGG auch von der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG) und der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) mitgetragen. Das Ziel dieser Leitlinie, die von der DGGG publiziert und koordiniert wurde, ist es, durch die Evaluation der relevanten Literatur einen evidenzbasierten Überblick über die Diagnostik sowie konservative und operative Therapie des Descensus genitalis der Frau mit oder ohne Belastungsinkontinenz zu geben. Methoden: Es erfolgte ein systematischer Review sowie Synthese von Daten, anteilig mit Metaanalyse (S2e). Es wurde eine umfassende Literatursuche in MEDLINE, Embase, Cinahl, Pedro und im Cochrane-Register, in Referenzlisten und in den Abstracts der Annual Meetings der International Continence Society und der International Urogynecological Association durchgeführt. Abstracts wurden eingeschlossen, wenn es sich um randomisierte Studien handelte, die als Podiumpräsentation vorgestellt und diskutiert wurden. Es wurden Originalarbeiten seit 2008 eingeschlossen, deren Nachkontrollzeitraum bei mindestens 12 Monaten lag. Für die Beschreibung von perioperativen Komplikationen wurden jegliche Daten herangezogen. Empfehlungen: Es werden Empfehlungen zur Diagnostik, konservativen und operativen Therapie des Genitaldeszensus gegeben, wobei die 3 urogynäkologischen Kompartimente, Prävention oder Behandlung von Belastungsinkontinenz, Vor-und Nachteile von Netzaugmentationen sowie uteruserhaltende Optionen, berücksichtigt
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