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Abdominal and vaginal pelvic support with concomitant hysterectomy for uterovaginal pelvic prolapse: a comparative systematic review and meta-analysis

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Abstract

Introduction and hypothesis

While approximately 225,000 pelvic organ prolapse (POP) surgeries are performed annually in the US, there is no consensus on the optimal route for pelvic support for the initial treatment of uterovaginal prolapse (UVP). Our objective is to compare the outcomes of abdominal sacrocolpopexy (ASC) to vaginal pelvic support (VPS) with either uterosacral ligament suspension (USLS) or sacrospinous ligament fixation (SSF) in combination with hysterectomy for treating apical prolapse.

Methods

A systematic search was performed through March 2021. Studies comparing ASC with VPS for treatment of UVP were included in the review. The primary outcome was the rate of overall anatomic prolapse failure per studies' definition. Secondary outcomes included evaluating isolated recurrent vaginal wall prolapse, postoperative POP-Q points, total vaginal length (TVL), and Pelvic Floor Distress Inventory (PFDI-20) scores. Random effect analyses were generated utilizing R 4.0.2.

Results

Out of 4225 total studies, 4 met our inclusion criteria, including 226 patients in the ASC group and 199 patients in the VPS group. ASC was not found to be associated with a higher rate of vaginal wall prolapse recurrence (OR = 0.6; 95% CI = 0.2–2.4; P = 0.33). There was no significant difference between groups for anterior or apical vaginal wall prolapse recurrence (P = 0.58 and P = 0.97, respectively). ASC was associated with significantly longer TVL (mean difference [MD]: 1.01; 95% CI = 0.33–1.70; P = 0.02) and better POP-Q Ba scores [MD = −0.23; 95% CI = −0.37; −0.10; P = 0.01].

Conclusions

ASC and vaginal pelvic support (either USLS or SSF) have comparable anatomical outcomes. However, weak evidence of a difference in TVL and Ba was found. The strength of the evidence in this study is based on the small number of observational studies. A large, randomized trial is highly warranted.

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Abbreviations

POP:

Pelvic organ prolapse

UVP:

Uterovaginal prolapse

ASC:

Abdominal sacrocolpopexy

SSF:

Sacrospinous ligament fixation

USLS:

Uterosacral ligament suspension

GRADE:

Grading of Recommendations, Assessment, Development, and Evaluation

VPS:

Vaginal pelvic support

TVL:

Total vaginal length

PFDI-20:

Pelvic Floor Disability Index

PFIQ-7:

Pelvic Floor Impact Questionnaire

PISQ-12:

Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire

ICIQ:

International Consultation on Incontinence Questionnaire

HRQoL:

Health-related quality of life

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Acknowledgements

The authors would like to thank Amber Catherine Stout for her help with the search.

Author information

Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Anood Alfahmy, David Sheyn, Sherif A. El-Nashar & Adonis Hijaz

  2. Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Anood Alfahmy, Amr Mahran, Britt Conroy, Rosemary R. Brewka, David Sheyn & Adonis Hijaz

  3. Department of Surgery, Umm Al-Qura University, Mecca, Saudi Arabia

    Anood Alfahmy

  4. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Amr Mahran, Britt Conroy, David Sheyn, Sherif A. El-Nashar & Adonis Hijaz

  5. Assiut University Urology and Nephrology Hospital, Assiut, Egypt

    Amr Mahran & Sherif A. El-Nashar

  6. Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt

    Mostafa Ibrahim & Sherif A. El-Nashar

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  1. Anood Alfahmy
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Contributions

A Alfahmy: Data collection, Manuscript writing/editing.

A Mahran: Idea conceptualization, Data collection, Manuscript writing/editing, Data analysis and management

B Conroy: Manuscript writing/editing.

RR Brewka: Manuscript editing and development

M Ibrahim: Data collection and search strategy

D Sheyn: Manuscript editing and development

S El-Nashar: Idea conceptualization, Manuscript editing and development

AK Hijaz: Idea conceptualization, Protocol development, Manuscript editing and development

Corresponding author

Correspondence to Adonis Hijaz.

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Conflicts of interest

Adonis K Hijaz is a member of the Astellas, Inc. Speaker’s Bureau. David D Sheyn receives grant funding from Renalis. Anood Alfahmy, Amr Mahran, Britt Conroy, Rosemary R. Brewka, Mostafa Ibrahim, and Sherif A. El-Nashar declare that they have no conflict of interest.

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Alfahmy, A., Mahran, A., Conroy, B. et al. Abdominal and vaginal pelvic support with concomitant hysterectomy for uterovaginal pelvic prolapse: a comparative systematic review and meta-analysis. Int Urogynecol J 32, 2021–2031 (2021). https://doi.org/10.1007/s00192-021-04861-4

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