Surgical management of pelvic organ prolapse in women

Abstract

Background Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with the prolapse. Objectives To determine the effects of the many different surgeries used in the management of pelvic organ prolapse. Search methods We searched the Cochrane Incontinence Group Specialised Register (9 February 2009) and reference lists of relevant articles. We also contacted researchers in the field. Selection criteria Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. Data collection and analysis Trials were assessed and data extracted independently by two review authors. Six investigators were contacted for additional information with five responding. Main results Forty randomised controlled trials were identified evaluating 3773 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86). However there was no statistically significant difference in re-operation rates for prolapse (RR 0.46, 95% CI 0.19 to 1.11). The vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The three trials contributing to this analysis were clinically heterogeneous. For anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented with a polyglactin mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.72, 95% CI 1.20 to 6.14); but data on morbidity and other clinical outcomes were lacking. Standard anterior repair was associated with more anterior compartment failures 1 Surgical management of pelvic organ prolapse in women (Review)

Uterus preservation in pelvic organ prolapse surgery

“…8,43,44 roovers et al 45 rEViEwS ligament complex. 45,46 recurrence was higher in the abdominal surgery group (22%) than in the vaginal hyster ectomy group (2.5%). Women who underwent abdominal sacrohysteropexy also reported more dis comfort caused by overactive bladder symptoms.…”

“…The results of com parison trials and prospective studies have confirmed that uterussparing surgery is feasible, with shorter oper ating times and hospital stays and similar outcomes com pared to hysterectomy. 33,46 Although the decision will be determined by the patient's preference and the surgeon's skills and experience, it is imperative that women fully understand the risks of incurring uterine and cervical pathology over time, and the need for continued routine surveillance measures to assess for such pathology.…”

“…However, variations in the operating technique, mesh size, shape and attach ment sites make comparison arduous. In a compari son study of sacrocolpopexy after hysterectomy and hystero colposacropexy with uterus preservation, Costantini et al 46 reported no significant difference in functional outcomes, including subjective and objec tive outcomes as well as patient satisfaction. uterus preservation was associated with a significantly shorter operating time and lower morbidity.…”

Biomechanical Properties of Vaginal Tissue in Women with Pelvic Organ Prolapse

“…Pelvic organ prolapse (POP) is an important issue in women's health care, occurring in up to 50% of parous women [1,2]. POP negatively impacts health-related quality of life by affecting daily activities, body image, and sexual function [3].…”

Prioritizing research: Patients, carers, and clinicians working together to identify and prioritize important clinical uncertainties in urinary incontinence

“…[30][31][32][33][34][35] In women undergoing prolapse repair surgery in whom SUI is preexisting, there is uncertainty as to whether a continence procedure such as suburethral tapes should be performed at the same time. 36,37…”