Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review

Maher, Christopher M., Feiner, Benny, Baessler, Kaven and Glazener, Cathryn M. A. (2011). Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. In: 36th Annual Meeting of the International Urogynecological Association (IUGA), Lisbon, Portugal, (1445-1457). 28 June - 2 July 2011. doi:10.1007/s00192-011-1542-9


Author Maher, Christopher M.
Feiner, Benny
Baessler, Kaven
Glazener, Cathryn M. A.
Title of paper Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review
Conference name 36th Annual Meeting of the International Urogynecological Association (IUGA)
Conference location Lisbon, Portugal
Conference dates 28 June - 2 July 2011
Journal name International Urogynecology Journal   Check publisher's open access policy
Place of Publication London, United Kingdom
Publisher Springer U K
Publication Year 2011
Sub-type Fully published paper
DOI 10.1007/s00192-011-1542-9
ISSN 0937-3462
1433-3023
Volume 22
Issue 11
Start page 1445
End page 1457
Total pages 13
Language eng
Formatted Abstract/Summary
Introduction and hypothesis: A previous version of the Cochrane review for prolapse surgery in 2008 provided two conclusions: abdominal sacrocolpopexy had lower recurrent vault prolapse rates than sacrospinous colpopexy but this was balanced against a longer time to return to activities of daily life. An additional continence procedure at the time of prolapse surgery might be beneficial in reducing post-operative stress urinary incontinence; however, this was weighed against potential adverse effects. The aim of this review is to provide an updated summary version of the current Cochrane review on the surgical management of pelvic organ prolapse.

Methods: We searched the Cochrane Incontinence Group Specialised Register and reference lists of randomised or quasi-randomised controlled trials on surgery for pelvic organ prolapse. Trials were assessed independently by two reviewers.

Results: We identified 40 trials including 18 new and three updates. There were no additional studies on surgery for posterior prolapse. Native tissue anterior repair was associated with more anterior compartment failures than polypropylene mesh repair as an overlay (RR 2.14, 95% CI 1.23–3.74) or armed transobturator mesh (RR 3.55, 95% CI 2.29–5.51). There were no differences in subjective outcomes, quality of life data, de novo dyspareunia, stress urinary incontinence, reoperation rates for prolapse or incontinence, although some of these data were limited. Mesh erosions were reported in 10% (30/293). Including new studies on the impact of continence surgery at the time of prolapse surgery, meta-analysis revealed that concurrent continence surgery did not significantly reduce the rate of post-operative stress urinary incontinence (RR 1.39, 95% CI 0.53–3.70; random-effects model).

Conclusion: The inclusion of new randomised controlled trials showed that the use of mesh at the time of anterior vaginal wall repair reduced the risk of recurrent anterior vaginal wall prolapse on examination. However, this was not translated into improved functional or quality of life outcomes. The value of a continence procedure in addition to a prolapse operation in women who are continent pre-operatively remains uncertain. Adequately powered randomised controlled trials are needed and should particularly include women's perceptions of prolapse symptoms and functional outcome.
Keyword Pelvic organ prolapse
Stress urinary incontinence
Surgical management
Cochrane review
Systematic review
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Conference Paper
Collection: School of Medicine Publications
 
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