Surgical management of pelvic organ prolapse in women

C. Maher, K. Baessler, C. M. A. Glazener, E. J. Adams, S. Hagen

Research output: Contribution to journalArticle

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 prolapse.
Objectives

To determine the effects of surgery in the management of pelvic organ prolapse.
Search strategy

We searched the Cochrane Incontinence Group trials register (8 June 2004) 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 at least two reviewers. Four investigators were contacted for additional information with two responding.
Main results

Fourteen randomised controlled trials were identified evaluating 1004 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), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were to evaluate other clinical outcomes and adverse events.

For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by Vicryl mesh overlay (RR 1.39, 95% CI 1.02 to 1.90) but data on morbidity and other clinical outcomes were too few for reliable comparisons.

For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh overlay on the risk of recurrent rectocele were insufficient for meta-analysis.

Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new symptoms after surgery. However, more women with occult stress urinary incontinence developed postoperative stress urinary incontinence after endopelvic fascia plication alone than after endopelvic fascia plication and tension-free vaginal tape (RR 5.5, 95% CI 1.36 to 22.32).
Authors' conclusions

Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of a polyglactin mesh overlay at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. Adequately powered randomised controlled clinical trials are urgently needed.
Original languageEnglish
Article numberCD004014
Number of pages14
JournalCochrane Database of Systematic Reviews
Issue number4
DOIs
Publication statusPublished - 18 Oct 2004

Fingerprint

Pelvic Organ Prolapse
Prolapse
Polyglactin 910
Rectocele
Cystocele
Uterine Prolapse
Dyspareunia
Stress Urinary Incontinence
Randomized Controlled Trials
Fascia
Activities of Daily Living
Meta-Analysis
Research Personnel
Suburethral Slings
Postoperative Hemorrhage
Narcotics
Hernia
Morbidity
Costs and Cost Analysis
Recurrence

Cite this

Surgical management of pelvic organ prolapse in women. / Maher, C.; Baessler, K.; Glazener, C. M. A.; Adams, E. J.; Hagen, S.

In: Cochrane Database of Systematic Reviews, No. 4, CD004014, 18.10.2004.

Research output: Contribution to journalArticle

@article{3c1650ca756849c1b7b59d10ac3e281a,
title = "Surgical management of pelvic organ prolapse in women",
abstract = "BackgroundPelvic organ prolapse may occur in up to 50{\%} of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse.ObjectivesTo determine the effects of surgery in the management of pelvic organ prolapse.Search strategyWe searched the Cochrane Incontinence Group trials register (8 June 2004) and reference lists of relevant articles. We also contacted researchers in the field.Selection criteriaRandomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse.Data collection and analysisTrials were assessed and data extracted independently by at least two reviewers. Four investigators were contacted for additional information with two responding.Main resultsFourteen randomised controlled trials were identified evaluating 1004 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), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95{\%} CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were to evaluate other clinical outcomes and adverse events.For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by Vicryl mesh overlay (RR 1.39, 95{\%} CI 1.02 to 1.90) but data on morbidity and other clinical outcomes were too few for reliable comparisons.For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95{\%} CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh overlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10{\%} of women developed new symptoms after surgery. However, more women with occult stress urinary incontinence developed postoperative stress urinary incontinence after endopelvic fascia plication alone than after endopelvic fascia plication and tension-free vaginal tape (RR 5.5, 95{\%} CI 1.36 to 22.32).Authors' conclusionsAbdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of a polyglactin mesh overlay at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. Adequately powered randomised controlled clinical trials are urgently needed.",
author = "C. Maher and K. Baessler and Glazener, {C. M. A.} and Adams, {E. J.} and S. Hagen",
year = "2004",
month = "10",
day = "18",
doi = "10.1002/14651858.CD004014.pub2",
language = "English",
journal = "Cochrane Database of Systematic Reviews",
issn = "1469-493X",
publisher = "Wiley",
number = "4",

}

TY - JOUR

T1 - Surgical management of pelvic organ prolapse in women

AU - Maher, C.

AU - Baessler, K.

AU - Glazener, C. M. A.

AU - Adams, E. J.

AU - Hagen, S.

PY - 2004/10/18

Y1 - 2004/10/18

N2 - BackgroundPelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse.ObjectivesTo determine the effects of surgery in the management of pelvic organ prolapse.Search strategyWe searched the Cochrane Incontinence Group trials register (8 June 2004) and reference lists of relevant articles. We also contacted researchers in the field.Selection criteriaRandomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse.Data collection and analysisTrials were assessed and data extracted independently by at least two reviewers. Four investigators were contacted for additional information with two responding.Main resultsFourteen randomised controlled trials were identified evaluating 1004 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), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were to evaluate other clinical outcomes and adverse events.For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by Vicryl mesh overlay (RR 1.39, 95% CI 1.02 to 1.90) but data on morbidity and other clinical outcomes were too few for reliable comparisons.For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh overlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new symptoms after surgery. However, more women with occult stress urinary incontinence developed postoperative stress urinary incontinence after endopelvic fascia plication alone than after endopelvic fascia plication and tension-free vaginal tape (RR 5.5, 95% CI 1.36 to 22.32).Authors' conclusionsAbdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of a polyglactin mesh overlay at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. Adequately powered randomised controlled clinical trials are urgently needed.

AB - BackgroundPelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse.ObjectivesTo determine the effects of surgery in the management of pelvic organ prolapse.Search strategyWe searched the Cochrane Incontinence Group trials register (8 June 2004) and reference lists of relevant articles. We also contacted researchers in the field.Selection criteriaRandomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse.Data collection and analysisTrials were assessed and data extracted independently by at least two reviewers. Four investigators were contacted for additional information with two responding.Main resultsFourteen randomised controlled trials were identified evaluating 1004 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), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were to evaluate other clinical outcomes and adverse events.For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by Vicryl mesh overlay (RR 1.39, 95% CI 1.02 to 1.90) but data on morbidity and other clinical outcomes were too few for reliable comparisons.For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh overlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new symptoms after surgery. However, more women with occult stress urinary incontinence developed postoperative stress urinary incontinence after endopelvic fascia plication alone than after endopelvic fascia plication and tension-free vaginal tape (RR 5.5, 95% CI 1.36 to 22.32).Authors' conclusionsAbdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of a polyglactin mesh overlay at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. Adequately powered randomised controlled clinical trials are urgently needed.

U2 - 10.1002/14651858.CD004014.pub2

DO - 10.1002/14651858.CD004014.pub2

M3 - Article

JO - Cochrane Database of Systematic Reviews

JF - Cochrane Database of Systematic Reviews

SN - 1469-493X

IS - 4

M1 - CD004014

ER -