Apical prolapse

Barber, M.D. and Maher, C. (2013) Apical prolapse. International Urogynecology Journal and Pelvic Floor Dysfunction, 24 11: 1815-1833. doi:10.1007/s00192-013-2172-1

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Author Barber, M.D.
Maher, C.
Title Apical prolapse
Journal name International Urogynecology Journal and Pelvic Floor Dysfunction   Check publisher's open access policy
ISSN 0937-3462
Publication date 2013-01-01
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/s00192-013-2172-1
Open Access Status Not yet assessed
Volume 24
Issue 11
Start page 1815
End page 1833
Total pages 19
Place of publication London, England, U.K.
Publisher Springer U K
Language eng
Subject 2748 Urology
2729 Obstetrics and Gynaecology
Abstract Introduction and hypothesis: The aim was to review the safety and efficacy of pelvic organ prolapse surgery for vaginal apical 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: Abdominal sacral colpopexy (ASC) has a higher success rate than sacrospinous colpopexy with less SUI and postoperative dyspareunia for vault prolapse. ASC had greater morbidity including operating time, inpatient stay, slower return to activities of daily living and higher cost (grade A). ASC has the lowest inpatient costs compared with laparoscopic sacral colpopexy (LSC) and robotic sacral colpopexy (RSC). LSC has lower inpatient costs than RSC (grade B).In single RCTs the RSC had longer operating time than both ASC and LSC (grade B). In small trials objective outcomes appear similar although postoperative pain was greater in RSC. LSC is as effective as ASC with reduced blood loss and admission time (grade C). The data relating to operating time are conflicting. ASC performed with polypropylene mesh has superior outcomes to fascia lata (level I), porcine dermis and small intestine submucosa (level 3; grade B). In a single RCT, LSC had a superior objective and subjective success rate and lower reoperation rate compared with polypropylene transvaginal mesh for vault prolapse (grade B).Level 3 evidence suggests that vaginal uterosacral ligament suspension, McCall culdoplasty, iliococcygeus fixation and colpocleisis are relatively safe and effective interventions (grade C). Conclusion: Sacral colpopexy is an effective procedure for vault prolapse and further data are required on the route of performance and efficacy of this surgery for uterine prolapse. Polypropylene mesh is the preferred graft at ASC. Vaginal procedures for vault prolapse are well described and are suitable alternatives for those not suitable for sacral colpopexy.
Keyword Sacral colpopexy
Sacrospinous colpopexy
Transvaginal mesh
Vault prolapse
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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Citation counts: TR Web of Science Citation Count  Cited 39 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 27 Apr 2014, 20:57:24 EST by Matthew Lamb on behalf of School of Medicine