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The Manchester procedure: anatomical, subjective and sexual outcomes

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Abstract

Introduction and hypothesis

Classical native-tissue techniques for pelvic organ prolapse (POP) repairs, such as the Manchester procedure (MP), have been revitalized because of vaginal mesh complications. However, there are conflicting opinions regarding sufficient apical (mid-compartment) support by the MP and concerns about the risk of dyspareunia. The aims of this study were therefore to investigate anatomical and patient-reported outcomes 1 year after MP.

Methods

Prospective cohort study of 153 females undergoing an MP for anterior compartment POP between October 2014 and June 2016. Pre- and 1-year postoperative evaluations included POP-Q measurements and the questionnaires Pelvic Floor Distress Inventory Short Form 20 (PFDI-20) and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12).

Results

At 1 year, 97% (148/153) attended the follow-up. Significant anatomical improvements (p < 0.01) were obtained in all compartments. Mean Ba was −1.1 (± 1.4), mean C −5.9 (± 1.7) and mean D −7.0 (± 1.2) at follow-up. Point C ≤ −5 was present in 81.1%. POP-Q stage 0–1 was obtained in 99.3% in the mid-compartment (C < −1), but only in 48.6% in the anterior compartment (Ba < −1). A significant reduction in symptom scores was obtained for PFDI-20 (p < 0.01) and PISQ-12 (p = 0.01). No significant changes were seen in dyspareunia rates (q.5, PISQ-12), but 5.6% reported de novo dyspareunia. Concerning POP symptoms, 96.0% reported being cured or significantly improved.

Conclusions

The Manchester procedure provides adequate apical support, albeit inferior anatomical anterior compartment results, and 96.0% reported being subjectively cured or substantially better at 1-year follow-up, with no significant change in dyspareunia.

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Acknowledgements

The authors would like to thank Associate Prof. Jon Michael Gran, Biostatistician at OUS and UiO, for support with statistical analyses.

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Authors and Affiliations

  1. Department of Gynaecology, Oslo University Hospital, Ulleval, Pb 4956 Nydalen, 0424, Oslo, Norway

    Sissel Hegdahl Oversand, Anne C. Staff, Ellen Borstad & Rune Svenningsen

  2. Faculty of Medicine, University of Oslo, Oslo, Norway

    Sissel Hegdahl Oversand & Anne C. Staff

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  1. Sissel Hegdahl Oversand
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Correspondence to Sissel Hegdahl Oversand.

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Oversand, S.H., Staff, A.C., Borstad, E. et al. The Manchester procedure: anatomical, subjective and sexual outcomes. Int Urogynecol J 29, 1193–1201 (2018). https://doi.org/10.1007/s00192-018-3622-6

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