Surgery for women with posterior compartment prolapse

Mowat, Alex; Maher, Declan J.; Baeßler, Kaven; Christmann-Schmid, Corina; Haya, Nir; Maher, Christopher

doi:10.1002/14651858.cd012975

Cited by 73 publications

(76 citation statements)

References 32 publications

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“…Due to different methods and outcomemeasure reporting, comparing the results between this study and the RCT results is challenging, as these Original Research GYNECOLOGY ajog.org randomized studies have evaluated the outcomes of a selected vaginal compartment repair with selected surgical methods. 11,21,22 Furthermore, as RCTs are designed to evaluate the efficacy of an intervention, they have lower heterogeneity, and due to exclusion and inclusion criteria (such as certain degree of prolapse in a specific compartment), the patients often have greater potential for improvement than in a more heterogeneous, real-world sample; therefore, the benefits observed in RCTs often are diluted. In reality, prolapse often involves multiple vaginal compartments and the surgical method is chosen based on clinical judgment.…”

Section: Results Of the Study In The Context Of Other Observationsmentioning

confidence: 99%

Pelvic organ prolapse surgery and quality of life—a nationwide cohort study

Mattsson

Karjalainen

Tolppanen

et al. 2020

American Journal of Obstetrics and Gynecology

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BACKGROUND: Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE: To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN: This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS: In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of Improvement-I. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58e2.70) and vaginal bulge (1.90, 1.30e2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02e2.81). CONCLUSION: Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.

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Section: Results Of the Study In The Context Of Other Observationsmentioning

confidence: 99%

Pelvic organ prolapse surgery and quality of life—a nationwide cohort study

Mattsson

Karjalainen

Tolppanen

et al. 2020

American Journal of Obstetrics and Gynecology

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“…This is the first step toward development of a core outcome set based on Delphi surveys and consensus meetings for posterior vaginal wall prolapse interventions. When the prevalence of the considered clinical situation or treatment is low and when the variables are many, defining a priori the outcomes and the outcome measures is a crucial requirement . It has been suggested that questionnaires could be divided into groups of specific questions to measure one domain of outcome (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…High quality meta‐analyses are lacking due to trial heterogeneity . Controversy exists on the efficacy of the interventions due to this heterogeneity and variation in outcome measures utilized in different studies.…”

Section: Introductionmentioning

confidence: 99%

“…Controversy exists on the efficacy of the interventions due to this heterogeneity and variation in outcome measures utilized in different studies. A Cochrane review from 2018 concluded that transvaginal repair may be more effective than transanal repair at preventing recurrence, but there is a lack of evidence regarding complications . The review highlighted this range of outcomes and the lack of evidence to allow comparisons of surgical treatments for posterior prolapse in terms of effectiveness, safety, and adverse effects, and recommended improvements in the design of future trials …”

Section: Introductionmentioning

confidence: 99%

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A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set

Lourenço

Pergialiotis

Durnea

et al. 2020

Intl J Gynecology & Obste

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Background: Recent systematic reviews have demonstrated wide variations on outcome measure selection and outcome reporting in trials on surgical treatments for anterior, apical and mesh prolapse surgery. A systematic review of reported outcomes and outcome measures in posterior compartment vaginal prolapse interventions is highly warranted in the process of developing core outcome sets. Objective: To evaluate outcome and outcome measures reporting in posterior prolapse surgical trials. Search strategy: We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Selection criteria: Randomized trials evaluating the efficacy and safety of different surgical interventions for posterior compartment vaginal prolapse.Data collection and analysis: Two researchers independently assessed studies for inclusion, evaluated methodological quality, and extracted relevant data. Methodological quality, outcome reporting quality and publication characteristics were evaluated.

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“…The traditional compartmentalized single-specialty approach to PFD meant that patients with symptoms and pathology affecting the female reproductive organs, the lower urinary and/or the gastrointestinal tracts were seen only by a single specialist, whose expertise did not necessarily span all three domains. This has been associated with inferior outcomes, including incomplete resolution of symptoms and high failure rates after surgery 6,11. As a result, the National Institute for Health and Clinical Excellence (NICE) recommended multidisciplinary team (MDT) management of patients with PFD to standardize treatment and improve patient outcomes 12…”

Section: Introductionmentioning

confidence: 99%

<p>The impact of pelvic floor multidisciplinary team on patient management: the experience of a tertiary unit</p>

Pandeva¹,

Biers²,

Pradhan³

et al. 2019

JMDH

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PurposePelvic floor dysfunction is a common and heterogenous condition with numerous clinical manifestations, making the optimal management challenging. The traditional single-specialty approach may fail to address its complex nature. Currently, there are no published data on the impact of joint pelvic floor multidisciplinary team (MDT) meetings on patient management.Patients and methodsThis study represents a retrospective analysis of prospectively collected data on female patients discussed at a joint pelvic floor MDT over a 12-month period in a tertiary referral center.ResultsOne hundred fifty-two cases were included with a median age of 55 years (range 18–83) and a BMI of 32 kg/m2 (range 17–58). Lower urinary tract dysfunction was the predominant symptom in 75% (114/152). The pelvic organ prolapse symptom of a vaginal bulge was present in 11% (17/152). All cases of vaginal prolapse were accompanied by either urinary incontinence, 59% (10/17), or obstructive defecation, 41% (7/17). Fecal incontinence was recorded in 10% (15/152). Mesh-related complications were reported in 3% (4/152). The MDT recommended a change in the initial management plan in 20% (31/152) of cases, of whom 80% (25/31) were patients with complex urinary incontinence. The MDT agreed a change in the primary care team in 16% (25/152) of cases.ConclusionThere is an increasing regulatory requirement for patients with pelvic floor dysfunction to be discussed in an MDT setting. Findings demonstrate that joint pelvic floor MDT meetings are feasible and contribute to a change in the management of complex patients.

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Surgery for women with posterior compartment prolapse

Cited by 73 publications

References 32 publications

Pelvic organ prolapse surgery and quality of life—a nationwide cohort study

Pelvic organ prolapse surgery and quality of life—a nationwide cohort study

A systematic review of reported outcomes and outcome measures in randomized trials evaluating surgical interventions for posterior vaginal prolapse to aid development of a core outcome set

<p>The impact of pelvic floor multidisciplinary team on patient management: the experience of a tertiary unit</p>

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