Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Maher C, Feiner B, Baessler K, Adams EJ, Hagen S, Glazener CM (2010) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev (4):CD004014

  2. Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S (2008) Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn 27:3–12

    Article  PubMed  CAS  Google Scholar 

  3. Tramer MR, Reynolds DJ, Moore RA, McQuay HJ (1997) Impact of covert duplicate publication on meta-analysis: a case study. BMJ 315:635–640

    PubMed  CAS  Google Scholar 

  4. Easterbrook PJ, Berlin JA, Gopalan R, Matthews DR (1991) Publication bias in clinical research. Lancet 337:867–872

    Article  PubMed  CAS  Google Scholar 

  5. Baden WF, Walker TA (1972) Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol 15:1048–1054

    Article  PubMed  CAS  Google Scholar 

  6. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17

    Article  PubMed  CAS  Google Scholar 

  7. Ali S, Han HC, Lee LC (2006) A prospective randomized trial using Gynemesh PS (trademark) for the repair of anterior vaginal wall prolapse (Abstract number 292). Int Urogynecol J Pelvic Floor Dysfunct 17(Suppl 2):221

    Google Scholar 

  8. Allahdin S, Glazener C, Bain C (2008) A randomised controlled trial evaluating the use of polyglactin mesh, polydioxanone and polyglactin sutures for pelvic organ prolapse surgery. J Obstet Gynaecol 28:427–431

    Article  PubMed  CAS  Google Scholar 

  9. Al-Nazer MA, Ismail WA, Gomaa IA (2007) Comparative study between anterior colporraphy versus vaginal wall repair with mesh for management of anterior vaginal wall prolapse (Abstract number 84). Int Urogynecol J Pelvic Floor Dysfunct 18(Suppl 1):49–50

    Google Scholar 

  10. Borstad E, Abdelnoor M, Mogimi K, Sandved M, Majida M, Western K et al (2008) Surgery for concomitant pelvic organ prolapse and urinary stress incontinence. A multicenter prospective randomized trial to compare the results of an incontinence procedure performed at the time of prolapse repair or 3 months after. Neurourol Urodyn 27:713

    Google Scholar 

  11. Braun HF, Fernandez M, Dell’Oro A, Gonzalez F, Cuevas R, Rojas I (2007) Prospective randomised study to compare colposacropexy and Mayo McCall technique in the correction of severe genital central prolapse (Abstract number 19). Int Urogynecol J Pelvic Floor Dysfunct 18(Suppl 1):12

    Google Scholar 

  12. Costantini E, Zucchi A, Giannantoni A, Mearini L, Bini V, Porena M (2007) Must colposuspension be associated with sacropexy to prevent postoperative urinary incontinence? Eur Urol 51:788–794

    Article  PubMed  Google Scholar 

  13. Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M (2008) Burch colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence: a randomized surgical trial. J Urol 180:1007–1012

    Article  PubMed  Google Scholar 

  14. de Tayrac R, Mathe ML, Bader G, Deffieux X, Fazel A, Fernandez H (2008) Infracoccygeal sacropexy or sacrospinous suspension for uterine or vaginal vault prolapse. Int J Gynaecol Obstet 100:154–159

    Article  PubMed  Google Scholar 

  15. Dietz V, Schraffordt KS, Van der Graaf Y, Heintz P, Van der Vaart C (2008) Sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study (Abstract number 92). Int Urogynecol J Pelvic Floor Dysfunct 19(Suppl 1):94–96

    Google Scholar 

  16. Guerette NL, Aguirre O, Vandrie DM, Biller DH, Davila GW (2006) Multi-center, randomized, prospective trial comparing anterior colporrhaphy alone to bovine pericardium collagen matrix graft reinforced anterior colporrhaphy: 12-month analysis (Abstract number 11). Int Urogynecol J Pelvic Floor Dysfunct 17(Suppl 2):63–64

    Google Scholar 

  17. Lim JL, Carey MP, Higgs PJ, Goh J, Krause H, Leong A et al (2007) Vaginal colporrhaphy versus vaginal repair with mesh for pelvic organ prolapse: a randomised controlled trial. Int Urogynecol J Pelvic Floor Dysfunct 18(Suppl 1):38–39

    Google Scholar 

  18. Natale F, Mako A, Panei M, Weir J, Antomarchi F, Cervigni M (2007) Prospective randomized controlled study between two different procedures to suspend the vaginal vault: high levator myorrhaphy and uterosacral vaginal vault suspension (Abstract number 6). Neurourol Urodyn 26:608–609

    Google Scholar 

  19. Natale F, La Penna C, Padoa A, Agostini M, De Simone E, Cervigni M (2009) A prospective, randomized, controlled study comparing Gynemesh, a synthetic mesh, and Pelvicol, a biologic graft, in the surgical treatment of recurrent cystocele. Int Urogynecol J Pelvic Floor Dysfunct 20:75–81

    Article  PubMed  CAS  Google Scholar 

  20. Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111:891–898

    Article  PubMed  Google Scholar 

  21. Nieminen K, Hiltunen R, Heiskanen E, Takala T, Niemi K, Merikari M et al (2008) Symptom resolution and sexual function after anterior vaginal wall repair with or without polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 19:1611–1616

    Article  PubMed  Google Scholar 

  22. Pantazis K, Freeman R, Thomson A, Frappell J, Bombieri L, Waterfield A (2008) Results from the LAS Trial, an RCT comparing open abdominal to laparoscopic sacrocolpopexy for the treatment of post hysterectomy vault prolapse (Abstract number 120). Int Urogynecol J Pelvic Floor Dysfunct 19(Suppl 1):101–102

    Google Scholar 

  23. Schierlitz L, Dwyer P, Rosamilia A, Murray C, Thomas E, Taylor N et al (2007) A prospective randomised controlled study comparing vaginal prolapse repair with and without tension free vaginal tape (TVT) in women with severe pelvic organ prolapse and occult stress incontinence (Abstract number 114). Neurourol Urodyn 26:743–744

    Google Scholar 

  24. Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19:467–471

    Article  PubMed  CAS  Google Scholar 

  25. Brubaker L, Nygaard I, Richter HE, Visco A, Weber AM, Cundiff GW et al (2008) Two-year outcomes after sacrocolpopexy with and without Burch to prevent stress urinary incontinence. Obstet Gynecol 112:49–55

    Article  PubMed  Google Scholar 

  26. Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff G, Fine P et al (2008) The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the Colpopexy and Urinary Reduction Efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct 19:607–614

    Article  PubMed  Google Scholar 

  27. Meschia M, Pifarotti P, Bernasconi F, Magatti F, Riva D, Kocjancic E (2007) Porcine skin collagen implants to prevent anterior vaginal wall prolapse recurrence: a multicenter, randomized study. J Urol 177:192–195

    Article  PubMed  Google Scholar 

  28. Roovers JP, van der Vaart CH, van der Bom JG, van Leeuwen JH, Scholten PC, Heintz AP (2004) A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function. Bjog 111:50–56

    Article  PubMed  Google Scholar 

  29. Benson JT, Lucente V, McClellan E (1996) Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol 175:1418–1421, discussion 1421–2

    Article  PubMed  CAS  Google Scholar 

  30. Culligan PJ, Blackwell L, Goldsmith LJ, Graham CA, Rogers A, Heit MH (2005) A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy. Obstet Gynecol 106:29–37

    Article  PubMed  Google Scholar 

  31. Jeng CJ, Yang YC, Tzeng CR, Shen J, Wang LR (2005) Sexual functioning after vaginal hysterectomy or transvaginal sacrospinous uterine suspension for uterine prolapse: a comparison. J Reprod Med 50:669–674

    PubMed  Google Scholar 

  32. Lo TS, Wang AC (1998) Abdominal colposacropexy and sacrospinous ligament suspension for severe uterovaginal prolapse: a comparison. J Gynecol Surg 14:59–64

    Article  Google Scholar 

  33. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ (2004) Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 190:20–26

    Article  PubMed  Google Scholar 

  34. Meschia M, Gattei U, Pifarotti P, Spennacchio M, Longatti D, Barbacini P. (2004) Randomized comparison between infracoccygeal sacropexy (posterior IVS) and sacrospinous fixation in the management of vault prolapse (abstract 614). Neurourol Urodyn 23:614

    Google Scholar 

  35. Bump RC, Hurt WG, Theofrastous JP, Addison WA, Fantl JA, Wyman JF et al (1996) Randomized prospective comparison of needle colposuspension versus endopelvic fascia plication for potential stress incontinence prophylaxis in women undergoing vaginal reconstruction for stage III or IV pelvic organ prolapse. The Continence Program for Women Research Group. Am J Obstet Gynecol 175:326–333, discussion 333–5

    Article  PubMed  CAS  Google Scholar 

  36. Cervigni M, Natale F, Weir J, Galante L, Panei M, Agostini A et al (2005) Prospective randomized trial of two new materials for the correction of anterior compartment prolapse: Pelvicol and Prolene Soft (Abstract). Neurourol Urodyn 24:585–586

    Google Scholar 

  37. Colombo M, Maggioni A, Scalambrino S, Vitobello D, Milani R (1997) Surgery for genitourinary prolapse and stress incontinence: a randomized trial of posterior pubourethral ligament plication and Pereyra suspension. Am J Obstet Gynecol 176:337–343

    Article  PubMed  CAS  Google Scholar 

  38. Colombo M, Maggioni A, Zanetta G, Vignali M, Milani R (1996) Prevention of postoperative urinary stress incontinence after surgery for genitourinary prolapse. Obstet Gynecol 87:266–271

    Article  PubMed  CAS  Google Scholar 

  39. Colombo M, Vitobello D, Proietti F, Milani R (2000) Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. Bjog 107:544–551

    Article  PubMed  CAS  Google Scholar 

  40. De Ridder D, Claerhout F, Verleyen P, Boulanger S, Deprest J (2004) Procine dermis xenograft as reinforcement for cystocele stage III repair: a prospective randomized controlled trial (Abstract). Neurourol Urodyn 23:435–436

    Google Scholar 

  41. Gandhi S, Goldberg RP, Kwon C, Koduri S, Beaumont JL, Abramov Y et al (2005) A prospective randomized trial using solvent dehydrated fascia lata for the prevention of recurrent anterior vaginal wall prolapse. Am J Obstet Gynecol 192:1649–1654

    Article  PubMed  Google Scholar 

  42. Meschia M, Pifarotti P, Spennacchio M, Buonaguidi A, Gattei U, Somigliana E (2004) A randomized comparison of tension-free vaginal tape and endopelvic fascia plication in women with genital prolapse and occult stress urinary incontinence. Am J Obstet Gynecol 190:609–613

    Article  PubMed  Google Scholar 

  43. Sand PK, Koduri S, Lobel RW, Winkler HA, Tomezsko J, Culligan PJ et al (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184:1357–1362

    Article  PubMed  CAS  Google Scholar 

  44. Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185:1299–1304, discussion 1304–6

    Article  PubMed  CAS  Google Scholar 

  45. Nieminen K, Hiltunen K, Laitinen J, Oksala J, Heinonen P (2003) Transanal or vaginal approach to retocele repair: results of a prospective randomised study. Neurourol Urodynam 22:547–548

    Google Scholar 

  46. Nieminen K, Hiltunen KM, Laitinen J, Oksala J, Heinonen PK (2004) Transanal or vaginal approach to rectocele repair: a prospective, randomized pilot study. Dis Colon Rectum 47:1636–1642

    Article  PubMed  Google Scholar 

  47. Kahn MA, Stanton SL, Kumar D, Fox SD (1999) Posterior colporrhaphy is superior to the transanal repair for treatment of posterior vaginal wall prolapse. Neurourol Urodyn 18:70

    Google Scholar 

  48. Paraiso MF, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195:1762–1771

    Article  PubMed  Google Scholar 

  49. Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S (2004) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev (3):CD004014

  50. Baessler K, Hewson AD, Tunn R, Schuessler B, Maher CF (2005) Severe mesh complications following intravaginal slingplasty. Obstet Gynecol 106:713–716

    Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Royal Brisbane and Wesley Hospitals Brisbane, Brisbane, Australia

    Christopher M. Maher

  2. Division of Urogynecology, Dept. of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel

    Benny Feiner

  3. Urogynaecology and Pelvic Floor Centre Charité Universitätsmedizin, Berlin, Germany

    Kaven Baessler

  4. Health Services Research Unit, University of Aberdeen, Aberdeen, UK

    Cathryn M. A. Glazener

  5. Pelvic Floor Centre Charité Universitätsmedizin, Dept. of Gynaecology Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    Kaven Baessler

Authors
  1. Christopher M. Maher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benny Feiner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kaven Baessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cathryn M. A. Glazener
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kaven Baessler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maher, C.M., Feiner, B., Baessler, K. et al. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review. Int Urogynecol J 22, 1445–1457 (2011). https://doi.org/10.1007/s00192-011-1542-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-011-1542-9

Keywords

Search

Navigation