Surgery for women with apical vaginal prolapse

Summary

A meta-analysis «Larouche M, Belzile E, Geoffrion R. Surgical Management of Symptomatic Apical Pelvic Organ Prolapse: A Systematic Review and Meta-analysis. Obstet Gynecol 2021;137(6):1061-1073. »2 included 50 trials (62 articles with 22 792 patients). Median follow-up was 1-5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22 to 2.74 and RR 2.70, 95% CI 1.33 to 5.50), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47 to 0.75 and RR 0.59, 95% CI 0.44 to 0.80, respectively). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures.

A Cochrane review «Surgery for women with apical vaginal prolapse»1 «Maher C, Yeung E, Haya N, ym. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev 2023;7(7):CD012376 »1 included 59 studies with a total of 6705 subjects. Vaginal procedures versus sacral colpopexy: After vaginal procedures, awareness of prolapse, recurrent prolapse, repeat surgery for prolapse, and stress urinary incontinence (SUI) were more common (table «Vaginal procedure versus sacral colpopexy for the repair of apical prolapse»1). There was no conclusive evidence that vaginal procedures increased bladder injury or repeat surgery for SUI (table). Vaginal surgery with mesh versus without mesh: There was no clear difference in awareness of prolapse, recurrent prolapse, or repeat surgery for prolapse (table «Vaginal mesh compared with no vaginal mesh for women with apical vaginal prolapse»2). The confidence interval were very wide. There is probably little or no difference between the groups in rates of SUI (de novo) or dyspareunia; moderate-quality evidence).