The Manchester procedure: anatomical, subjective and sexual outcomes

Oversand, Sissel Hegdahl; Staff, Anne Cathrine; Borstad, Ellen; Svenningsen, Rune

doi:10.1007/s00192-018-3622-6

Cited by 19 publications

(28 citation statements)

References 30 publications

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“…In 2018 Oversand et al published a prospective cohort study on 153 women who underwent the Manchester procedure in a Norweigan clinic, with a follow-up rate of 97% at one year postoperatively. 156 The procedure included an anterior colporrhaphy, cervical amputation and uterosacral/cardinal ligament shortening and plication proximal to the anterior part of the cervix stump. A perineal body reconstruction was performed in all cases.…”

Section: Study IImentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

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Section: Study IImentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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“…No further impact from LAM avulsions on 1‐year outcomes was found in terms of anatomical anterior or mid‐compartment changes, subjective satisfaction, symptom load, sexual distress or need for further POP treatment. Relatively strict definitions for optimal anatomical and symptomatic outcomes were used in this study to reveal differences between the groups, causing the overall outcomes to appear poorer than in other papers from our group …”

Section: Discussionmentioning

confidence: 99%

“…The standard surgical method for primary concomitant anterior and mid‐compartment prolapse at our Department is the Manchester procedure. A paper on postoperative outcomes after the Manchester procedure has already been published for parts of the cohort, but the cohort was extended following power calculations for the comparison of postoperative outcomes between women with and without LAM avulsions …”

Section: Methodsmentioning

confidence: 99%

“…Relatively strict definitions for optimal anatomical and symptomatic outcomes were used in this study to reveal differences between the groups, causing the overall outcomes to appear poorer than in other papers from our group. 12,14 Several previous studies have shown an association between avulsions and anterior compartment POP recurrence, even within a relatively short follow-up time. 9 TA B L E 1 Baseline data for women with and without levator ani muscle avulsions (n = 189) and recurrent anatomical POP at 5-year follow-up.…”

Section: Re Sultsmentioning

confidence: 98%

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

Oversand

Staff

Volløyhaug

et al. 2019

Acta Obstet Gynecol Scand

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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.

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“…Various studies have investigated changes in quality of life and sexual function of women with POP and cystocele undergoing surgical correction using vaginal mesh, with controversial results [20,31,32,41,42,45,[47][48][49][50][51]. In fact, according to some authors, surgical management of POP and cystocele significantly improves the long-term quality of life and sexual response of these patients even if surgical approaches involving abdominal or transvaginal mesh may result in a decline in sexual function and worsening dyspareunia [31,32,45,[52][53][54]; conversely, other studies describe worsen-ing of the patient's sexual function and dyspareunia following mesh treatments [48][49][50][51]. Faced with this evidence, in our opinion, a multidisciplinary approach in the treatment of women with POP and cystocele is of paramount importance.…”

Section: Pelvic Organ Prolapsementioning

confidence: 99%

Multidisciplinary management of women with pelvic organ prolapse, urinary incontinence and lower urinary tract symptoms. A clinical and psychological overview

Rosa

Ciebiera

Lin

et al. 2019

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Although female sexual dysfunctions are common among women with urogynecological conditions, they have not been thoroughly studied and there are still many questions without an answer. The recent evidence on sexual disorders in women with urogynecological diseases shows a quite wide spectrum of therapeutic approaches, which require the physicians to take into account not only the primary symptoms, but also all the associated factors negatively affected. It has been widely underlined that gynecological diseases are often associated with high stress and have a negative impact on quality of life and psychological well-being of women affected. For this reason, a multidisciplinary approach for the management of these diseases is highly recommended. Also in the case of urogynecological disorders, it is important to take into account psychological outcomes throughout the diagnostic and therapeutic process. In the light of these considerations, the aim of this short review is to evaluate the impact of the main urogynecological diseases and the currently available therapeutic options in order to improve quality of life and sexuality of these patients and to stress the need for a multidisciplinary approach in order to minimize the negative consequences of these diseases for the sexual well-being of women and their partners.

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The Manchester procedure: anatomical, subjective and sexual outcomes

Abstract: The Manchester procedure provides adequate apical support, albeit inferior anatomical anterior compartment results, and 96.0% reported being subjectively cured or substantially better at 1-year follow-up, with no significant change in dyspareunia.

Cited by 19 publications

References 30 publications

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

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

Multidisciplinary management of women with pelvic organ prolapse, urinary incontinence and lower urinary tract symptoms. A clinical and psychological overview

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