Interaction Among Apical Support, Levator Ani Impairment, and Anterior Vaginal Wall Prolapse

Chen, Luyun; Ashton‐Miller, James A.; Hsu, Yvonne; DeLancey, John O.L.

doi:10.1097/01.aog.0000227786.69257.a8

Cited by 167 publications

(116 citation statements)

References 25 publications

(15 reference statements)

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“…Indications for pessary therapy can include patient preference for conservative treatment, temporary family planning when the patient intends to have more children, and an increased risk of perioperative complications due to co-morbidities [65]. Prolapse of the anterior vaginal wall is commonly associated with an apical defect, so that surgical repair of the middle compartment should be considered in these patients [66]. Success rates for anterior vaginal wall repair were reported in 22 randomized studies; they varied strongly and also depended on the additional surgical procedures carried out concomitantly.…”

Section: Pessary Therapymentioning

confidence: 99%

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

Baeßler

Aigmüller

Albrich

et al. 2016

Geburtshilfe Frauenheilkd

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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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Section: Pessary Therapymentioning

confidence: 99%

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

Baeßler

Aigmüller

Albrich

et al. 2016

Geburtshilfe Frauenheilkd

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“…Finite element (FE) method is a non-invasive and repetitive numerical simulation method which makes it effective for this kind of studies. Chen et al [7] established a two-dimensional (2D) biomechanical model of the anterior vaginal wall and its support system. The results showed that if the pubovisceral impairment reached at a certain level, the anterior vaginal wall would prolapse; at 60% pubovisceral muscle impairment, a 90% impairment of apical support caused the prolapse to increase from 0.3 to 1.9 cm.…”

mentioning

confidence: 99%

“…The anterior vaginal wall was usually modeled as a separated part from the posterior compartment, which was entirely made up of the posterior vaginal wall and rectum. In addition, the ligaments were simulated by passive elastic springs [7] or 3D truss elements [8]. The oversimplification made it impossible to evaluate the shear stress in the lateral vaginal walls, which is, however, eagerly needed clinically.…”

mentioning

confidence: 99%

“…In previous studies, the pelvis was usually assumed to be fixed. The origins of the levator ani muscle and the cardinal and uterosacral ligaments from the pelvic wall were set stationary in 2D simulation [7], rotatable but not translatable in 3D simulation [8]. The problem located in the perineal body, which was usually assumed to be stationary [7].…”

mentioning

confidence: 99%

“…The existing FE studies of POP [7,8] applied a constant pressure on the anterior vaginal wall to simulate Valsalva maneuver. However, abdominal pressure is filling the whole pelvic floor in reality.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Biomechanics of pelvic organ prolapse

Ren

Xie

Wang

et al. 2015

Sci. China Life Sci.

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Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy for Apical Vaginal Prolapse

Barber

Brubaker

Burgio

et al. 2014

JAMA

368

236

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IMPORTANCE Over 300,000 surgeries are performed annually in the United States for pelvic organ prolapse. Sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are commonly performed transvaginal surgeries to correct apical prolapse. Little is known about their comparative efficacy and safety, and it is unknown whether perioperative behavioral therapy with pelvic floor muscle training (BPMT) improves outcomes of prolapse surgery. OBJECTIVE To compare outcomes between 1) SSLF and ULS and 2) perioperative BPMT and usual perioperative care in women undergoing surgery for vaginal prolapse and stress urinary incontinence. DESIGN, SETTING AND PARTICIPANTS Multi-center, 2×2 factorial randomized trial of 374 women undergoing surgery to treat both apical vaginal prolapse and stress urinary incontinence was conducted between 2008 and 2013 at 9 U.S. medical centers. Two-year follow-up rate was 84.5%. INTERVENTIONS Surgical intervention: Transvaginal surgery including mid-urethral sling with randomization to SSLF (n = 186) or ULS (n=188); Behavioral intervention: Randomization to perioperative BPMT (n = 186) or usual care (n=188). MAIN OUTCOME MEASURES The primary outcome for the surgical intervention (surgical success) was defined as: 1) no apical descent greater than one-third into vaginal canal or anterior or posterior vaginal wall beyond the hymen (anatomic success); 2) no bothersome vaginal bulge symptoms and 3) no retreatment for prolapse at 2 years. For the behavioral intervention, primary outcome at 6 months was urinary symptom scores (Urinary Distress Inventory; range 0–300, higher scores worse), and primary outcomes at 2 years were prolapse symptom scores (Pelvic Organ Prolapse Distress Inventory; range 0–300, higher scores worse) and anatomic success. RESULTS At 2 years, surgical group was not significantly associated with surgical success rates [ULS 59.2% (93/154) vs. SSLF 60.5% (92/152), OR 0.9 (95% CI 0.6, 1.5)] or serious adverse event rates [ULS 16.5% (31/188) vs. SSLF 16.7% (31/186), OR 0.9 (95% CI 0.5, 1.6)]. BPMT was not associated with greater improvements in urinary scores at 6 months [treatment difference −6.7 (95% CI −19.7, 6.2)], prolapse scores at 24 months [treatment difference −8.0 (95% CI −22.1, 6.1)] or anatomic success at 24 months. CONCLUSIONS AND RELEVANCE Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS nor SSLF was significantly superior to the other for anatomic, functional, and or adverse event outcomes. Perioperative BPMT did not improve urinary symptoms at 6 months or prolapse outcomes at 2 years.

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Interaction Among Apical Support, Levator Ani Impairment, and Anterior Vaginal Wall Prolapse

Abstract: These results suggest that a prolapse can develop as a result of impairment of the muscular and apical supports of the anterior vaginal wall.

Cited by 167 publications

References 25 publications

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016)

Biomechanics of pelvic organ prolapse

Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy for Apical Vaginal Prolapse

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