Surgery for posterior vaginal wall prolapse

Karram, M. and Maher, C. (2013) Surgery for posterior vaginal wall prolapse. International Urogynecology Journal and Pelvic Floor Dysfunction, 24 11: 1835-1841. doi:10.1007/s00192-013-2174-z

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Author Karram, M.
Maher, C.
Title Surgery for posterior vaginal wall prolapse
Journal name International Urogynecology Journal and Pelvic Floor Dysfunction   Check publisher's open access policy
ISSN 0937-3462
Publication date 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/s00192-013-2174-z
Open Access Status
Volume 24
Issue 11
Start page 1835
End page 1841
Total pages 7
Place of publication London, England, U.K.
Publisher Springer U K
Collection year 2014
Language eng
Subject 2748 Urology
2729 Obstetrics and Gynaecology
Abstract Introduction and hypothesis: The aim was to review the safety and efficacy of surgery for posterior vaginal wall prolapse. Methods: Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. Grade A recommendation usually depends on consistent level 1 evidence. Grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. Grade C recommendation usually depends on level 4 studies or "majority evidence‟ from level 2/3 studies or Delphi processed expert opinion. Grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Results: Level 1 and 2 evidence suggest that midline plication posterior repair without levatorplasty might have superior objective outcomes compared with site-specific posterior reopair (grade B). Higher dyspareunia rates are reported when levatorplasty is employed (grade C). The transvaginal approach is superior to the transanal approach for repair of posterior wall prolapse (grade A). To date, no studies have shown any benefit of mesh overlay or augmentation of a suture repair for posterior vaginal wall prolapse (grade B). While modified abdominal sacrocolpopexy results have been reported, data on how these results would compare with traditional transvaginal repair of posterior vaginal wall prolapse are lacking. Conclusion: Midline fascial plication without levatorplasty is the procedure of choice for posterior compartment prolapse. No evidence supports the use of polypropylene mesh or biological graft in posterior vaginal compartment prolapse surgery.
Keyword Posterior colporrhaphy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
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Created: Sun, 27 Apr 2014, 11:09:03 EST by Matthew Lamb on behalf of School of Medicine