Surgical management of pelvic organ prolapse in women (Review)

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Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2007; 4(3):CD004014. DOI: 10.1002/14651858.CD004014.pub3
Source: PubMed


There was not enough evidence about the effects of different types of surgery for pelvic organ prolapse. Pelvic organs, such as the uterus, bladder or bowel, may protrude into the vagina due to weakness in the tissues that normally support them. The symptoms that they cause vary, depending on the type of prolapse. The types of surgery also vary, depending on the type of prolapse and associated symptoms. The impact of pelvic organ prolapse surgery on bowel, bladder and sexual function can be unpredictable. The review of trials demonstrated that abdominal sacral colpopexy may be better than the vaginal sacrospinous colpopexy for uterine or vault prolapse. Limited evidence suggests that vaginal surgery may be better than transanal surgery for posterior vaginal wall prolapse. However, there was not enough evidence about most types of common prolapse surgery.

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    • "Favorable long-term objective and subjective outcomes with improved quality of life with vaginal sacrospinous ligament fixation (SSF) surgery have been shown [9]. Moreover, concomitant use of mesh for anterior vaginal wall repair may reduce risk of recurrent cytocoele [10]. The objective of this study was to estimate the association of age with outcomes of vaginal SSF and anterioretransobturator mesh repair surgery for advanced pelvic organ prolapse. "
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    ABSTRACT: Objective The objective of this study was to estimate the association of vaginal sacrospinous ligament fixation with anterior-transobturator mesh repair surgery for advanced pelvic organ prolapse in patients of two different age groups. Materials and methods Vaginal sacrospinous ligament fixation with anterior mesh repair as primary prolapse surgery was performed on 225 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was determined according to feedback of POPDI-6 (Questions 2 and 3). Patients provided responses to UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and postsurgery. Outcome measures were observed in cohorts of two age groups (<75 years and ≥75 years). Results Postoperative data of 217 patients were available. The cumulative objective cure rates were 93.0% and 92.5% for patients aged ≥75 years and <75 years, respectively, with mean follow-up of 33.93 ± 18.52 months and 36.44 ± 19.34 months respectively. The UDI-6, IIQ-7, POPDI-6, and PISQ-12 scores within each of the two age groups improved significantly after surgery. Comparatively, the POPDI-6 score was better whereas the PISQ-12 score was poorer among patients aged ≥75 years. Older women had significantly more preoperative comorbidities. The operative time, perioperative complications, and length of hospital stay showed no difference between the two groups. The intraoperative blood loss was significantly less in the older group and neither group had mortality. Conclusion This study showed that adequately optimized older patients undergoing pelvic organ prolapse surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.
    Taiwanese Journal of Obstetrics and Gynecology 09/2014; 53(3):348–354. DOI:10.1016/j.tjog.2013.08.004 · 0.99 Impact Factor
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    • "Certaines de ces complications, parfois sévères et pouvant engager le pronostic vital, pourraient être spécifiques de la coelioscopie comme par exemple les occlusions postopératoires ou l'hémorragie incoercible par plaie des vaisseaux iliaques. Ainsi, le risque de complications graves pourrait être augmenté dans la coelioscopie par rapport à la voie vaginale, mais là-aussi aucune donnée comparative de qualité satisfaisante ne permet d'étayer cette hypothèse [9]. Ces critères (complications liées ou non aux prothèses, dyspareunie, algies pelviennes chroniques, signes fonctionnels ) sont des critères de tolérance. "
    Journal de Gynécologie Obstétrique et Biologie de la Reproduction 09/2013; 42(5):499-501. · 0.56 Impact Factor
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    • "Available treatment options include conservative, mechanical or surgical interventions. Surgical treatment is generally considered for women with symptomatic prolapse, those medically fit for surgery, and those willing to undergo surgery [15]. Vaginal hysterectomy is one of several surgical procedures to treat advanced POP [16]. "
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    ABSTRACT: Background Pelvic organ prolapse (POP) is a common gynecological condition that can affect quality of life (QOL) in women. In Nepal, the prevalence of POP is high, but many affected women are still deprived of treatment. Vaginal hysterectomy with pelvic floor repair is one of the common treatment options for advanced POP. However, QOL outcomes after surgery have not been reported in low-income countries. Thus, we aimed to examine changes in QOL among Nepalese women with POP after such surgery. Methods This longitudinal study was conducted in the selected central and peripheral hospitals in Nepal where vaginal hysterectomy was being performed free of cost for POP. A baseline study first measured the QOL domains (physical, psychological, social relationships and environment) among 252 women with advanced POP. Follow-up data was then collected at six weeks and three months after surgery. Among the 177 women that were available at six weeks post-surgery, 166 participated in the follow-up study at three months post-surgery. To evaluate QOL at baseline, 142 women with no history of POP were included as a comparison group. Results The mean scores across QOL domains improved from baseline to 3 months after surgery. The baseline score for the physical domain increased from 11.2 to 12.8 at six weeks and 13.5 at three months post-surgery (p < 0.001); the psychological domain score increased from 11.6 to 13.1 at six weeks and 13.8 at three months post-surgery (p < 0.001); the social relationships domain score increased from 13.6 to 14.4 at six weeks and 15.0 at three months post-surgery (p < 0.001); and the environmental domain score increased from 12.9 to 13.9 at six weeks and 14.0 at three months post-surgery (p < 0.001). Conclusion QOL progressively improved among women undergoing surgery for POP. Such surgical services need to be scaled up for treatment of advanced POP in low-income countries.
    BMC Women's Health 05/2013; 13(1):22. DOI:10.1186/1472-6874-13-22 · 1.50 Impact Factor
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