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

Abstract

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.

Effect of preoperative pelvic floor muscle training on pelvic floor muscle contraction and symptomatic and anatomical pelvic organ prolapse after surgery: randomized controlled trial

“…The overall reduction of symptomatic and anatomical POP was expected after surgery, but the improvement in PFM contraction was somewhat surprising and not in line with results from a recently published systematic review, which concluded that there is no clear effect of POP surgery on PFM morphology or function 24 . However, only one of the studies included in this review had pelvic floor function as primary outcome, and the findings of this study are in concordance with our findings 42 .…”

“…Furthermore, previous publications have focused on perioperative and not preoperative PFMT, and there is a lack of studies evaluating the impact of PFMT on pelvic floor muscle (PFM) contraction assessed by ultrasound. In addition, the possible effect of POP surgery on measures of PFM contraction needs further evaluation, as the existing evidence is unclear 24 .…”

Effects of Pelvic-Floor Muscle Training in Patients with Pelvic Organ Prolapse Approached with Surgery vs. Conservative Treatment: A Systematic Review

“…While the overall reduction in symptoms and anatomical changes of POP were expected after surgery, the improvement in pelvic-floor contraction was somewhat surprising and is not in line with the results of a recently published systematic review. This review concluded that there is no clear effect of POP surgery on pelvic-floor morphology or function [ 38 ], although the studies included in this review were heterogeneous and of low quality. It is also surprising that adding a PFMT protocol to surgical treatment does not produce significant differences in pelvic-floor function.…”

Is PREHAB in Pelvic Floor Surgery Needed? A Topical Review

“…The analyzed studies are characterized by the heterogeneity of participants and surgical interventions, insufficiency in establishing associations between the strength of postoperative muscle contraction and the change in their morphometry, as well as the low rating of the grade of the evidence used. Thus, further well-designed prospective trials are necessary to assess the impact of urogynecological surgery on pelvic floor muscle efficiency, while PFM PREHAB is needed to improve surgical outcomes [24].…”