Risk factors for prolapse recurrence: systematic review and meta-analysis

Friedman, Talia; Eslick, Guy D.; Dietz, Hans Peter

doi:10.1007/s00192-017-3475-4

Cited by 158 publications

(126 citation statements)

References 48 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…Several previous studies have shown an association between avulsions and anterior compartment POP recurrence, even within a relatively short follow‐up time . Not finding such differences in the present study might therefore be surprising.…”

Section: Discussioncontrasting

confidence: 66%

Impact of levator muscle avulsions on Manchester procedure outcomes in pelvic organ prolapse surgery

Oversand

Staff

Volløyhaug

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

Introduction Levator ani muscle avulsions potentially increase recurrence after anterior colporrhaphies. We aimed at evaluating the impact of avulsions on anatomical and patient‐reported outcomes 1 year after the Manchester procedure for primary anterior compartment pelvic organ prolapse. Material and methods Prospective cohort study of 189 women undergoing the Manchester procedure between October 2014 and January 2017. Avulsions were diagnosed by transperineal ultrasound. Women with and without avulsions were compared for 1‐year postoperative outcomes; Pelvic Organ Prolapse Quantification measurements, subjective satisfaction (1—worse to 4—cured), failure (new prolapse treatment), response to validated questionnaires on pelvic floor distress and sexual function, and a composite outcome (subjectively cured and optimal anterior compartment outcome (stage 0‐I)). Optimal mid‐compartment outcome was defined as cervix ≥5 cm above the hymen. Factors potentially associated with poor anatomical outcomes (anterior compartment stage ≥II) or pelvic floor distress were analyzed using regression analyses. Results Fewer women with avulsions (present in 50.8%) obtained optimal mid‐compartment outcomes (88.2% vs 77.1%; P = 0.05). The groups were otherwise similar in terms of mid‐compartment reduction, anterior compartment results, failure rate, subjective satisfaction, pelvic floor/sexual symptoms, and combined optimal subjective and anatomical outcome. Only preoperative anterior compartment stage ≥III was associated with poor anatomical outcome (P < 0.01). A high preoperative symptom score was associated with a high postoperative symptom score (P < 0.001). Conclusions Although fewer women with avulsions obtained optimal mid‐compartment results, avulsions had no impact on other anatomical or symptomatic outcomes 1 year after the Manchester procedure for primary anterior compartment prolapse.

show abstract

Section: Discussioncontrasting

confidence: 66%

Impact of levator muscle avulsions on Manchester procedure outcomes in pelvic organ prolapse surgery

Oversand

Staff

Volløyhaug

et al. 2019

Acta Obstet Gynecol Scand

View full text Add to dashboard Cite

show abstract

“…distensibility) of the levator ani muscle clearly affects the hiatus causing a change in its dimensions, and hence, it is likely to be one of the etiological factors of POP development. Excessive distensibility of the hiatus, termed ballooning, is associated with occurrence and recurrence of POP.…”

Section: Discussionmentioning

confidence: 99%

Does levator ani hiatal area configuration affect pelvic organ prolapse?

Xuan

Friedman

Dietz

2019

Ultrasound in Obstet & Gyne

View full text Add to dashboard Cite

Objective Levator ani trauma and hiatal overdistension have been shown to be associated with female pelvic organ prolapse (POP); however, the role of the shape of the levator hiatus in POP has not been examined to date. The aim of this study was to investigate the association between the configuration of the levator ani hiatus and POP. Methods This was a retrospective study of 547 women who attended a tertiary urogynecological center for symptoms of pelvic floor and lower urinary tract dysfunction between October 2014 and August 2016. All women underwent a standardized interview and prolapse assessment using the International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP‐Q) method and four‐dimensional translabial ultrasound (TLUS). Measurements of the hiatal anteroposterior diameter (APD), coronal diameter (CD) and hiatal area (HA), at rest and on maximal Valsalva maneuver, and those of organ descent were performed offline at a later date by an investigator blinded to all other data. Hiatal configuration was defined as the ratio APD/CD. Associations between HA and HA adjusted by APD/CD at rest and on maximal Valsalva and symptoms and signs of prolapse were analyzed statistically using logistic regression modelling. Results The mean age of the women was 54 ± 13.6 (range, 16–89) years. Of the 547 women included, 241 (44%) presented with prolapse symptoms. Clinically significant POP was detected in 406 (74%) patients and significant prolapse on TLUS was detected in 331 (61%). Hiatal ballooning was observed in 310 (57%) women and this was strongly associated with signs and symptoms of POP. HA at rest and on Valsalva was associated with significant POP both on clinical examination and on TLUS. Adjusted odds ratios for hiatal shape showed no effect of the hiatal configuration on the association between HA and POP. Conclusion Hiatal shape does not seem to influence the association between HA and symptoms and signs of prolapse. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

show abstract

“…The findings of this review suggest that there is no impact—improvement or deterioration—on PFM function as a result of POP/UI surgery. Given this, and the current lack of evidence to support perioperative PFM training, we may need to be guided by findings from studies that have shown a strong association between poorer preoperative PFM status and poorer postoperative PFM function . Therefore, focusing intervention on women with poor PFM function preoperatively, who are most likely to respond may be the best approach to achieve more effective outcomes from perioperative PFM interventions.…”

Section: Discussionmentioning

confidence: 99%

The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

Mastwyk

McClelland

Rosamilia

et al. 2019

Neurourology and Urodynamics

View full text Add to dashboard Cite

Aims To systematically review the evidence for the effect of pelvic organ prolapse (POP) and/or continence surgery on pelvic floor muscle (PFM) morphometry and function in women, and to investigate whether a relationship exists between PFM measures and clinician‐reported objective pelvic floor outcomes postoperatively. Methods Six electronic databases were searched until March 2018. Studies were included if they examined the effect of POP and/or continence surgery on the PFM in women, and reported pre‐ and postoperative data. Methodological quality was assessed using a modified Downs and Black checklist. Three meta‐analyses were planned based on postoperative follow‐up time. Results Twenty‐one studies met the inclusion criteria. Varied surgical interventions and 33 different PFM measures were represented. The methodological quality of included studies varied considerably. The 0 to 6 weeks postoperative meta‐analysis showed no statistically significant change in PFM function (SMD = 0.04; 95% confidence interval [CI] = −0.26 to 0.33). This was consistent at 3 and 6 or more months (SMD = 1.13; 0.35 95% CI = −0.34 to 2.60, − 0.42 to 1.12 respectively). None of the included studies investigated the relationship between PFM measures and clinician‐reported objective outcomes postoperatively. Conclusions This review did not show a clear effect of POP and/or continence surgery on PFM morphometry or function in women and was unable to show a relationship with outcomes such as objective prolapse score and urodynamic findings. This could be because surgery does not measurably impact on the PFM or due to the poor quality and heterogeneity of studies. Future well‐designed research is needed to specifically investigate change in the PFM following surgery.

show abstract

Risk factors for prolapse recurrence: systematic review and meta-analysis

Abstract: Levator avulsion, prolapse stage, and family history are significant risk factors for prolapse recurrence.

Cited by 158 publications

References 48 publications

Impact of levator muscle avulsions on Manchester procedure outcomes in pelvic organ prolapse surgery

Impact of levator muscle avulsions on Manchester procedure outcomes in pelvic organ prolapse surgery

Does levator ani hiatal area configuration affect pelvic organ prolapse?

The impact of pelvic organ prolapse and/or continence surgery on pelvic floor muscle function in women: A systematic review

Contact Info

Product

Resources

About