Pelvic Organ Prolapse Surgeries Equally Effective

A new study has found that popular transvaginal surgeries for treating pelvic organ prolapse deliver comparable rates of success, while pelvic floor muscle training (BPMT) did not alter outcomes.

Researchers at the Cleveland Clinic (OH, USA), Duke University (Durham, NC, USA), and other institutions conducted a study to compare sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS), the two most commonly performed transvaginal surgeries to correct apical vaginal prolapse and stress urinary incontinence. The multicenter study randomized 186 women with vaginal prolapse in stage 2, 3, or 4, to SSLF and 188 to ULS between 2008 and 2013 at nine US medical centers. The behavioral intervention was randomization to receive perioperative BPMT (186 patients), or usual care (188 patients).The two-year follow-up rate was 84.5%.

The results showed that two years after surgery, women who underwent SSLF and ULS had similar rates of success (60.5% and 59.2%, respectively), and similar rates of adverse events (16.7% and 16.5%). In addition, BPMT did not improve urinary symptoms at six months or prolapse outcomes at two years. The authors cautioned that their findings may not apply to women who do not undergo concomitant midurethral sling for treatment of stress incontinence, or to women undergoing transvaginal mesh or abdominal mesh augmented prolapse repairs. The study was published on March 11, 2014, in JAMA.

“Most pelvic surgeons have a personal preference for SSLF or ULS,” said lead author Matthew Barber, MD. “The study results suggest that surgeons can stick with the procedure they are most comfortable with or tailor one of the two surgeries to the individual patient, and expect similar results.”

Female pelvic floor disorders are a spectrum of conditions including pelvic organ prolapse and urinary incontinence. Approximately 300,000 surgeries for prolapse are performed annually in the United States alone, with SSLF and ULS being the two most widely used vaginal procedures. The SSLF procedure suspends the vaginal apex to the sacrospinous ligament using an extraperitoneal approach, whereas the ULS suspends the vaginal apex bilaterally to the proximal remnants of the uterosacral ligaments using an intraperitoneal approach. As a stand-alone therapy, BPMT is an effective treatment for pelvic floor symptoms with incontinence cure rates as high as 78% and improved prolapse stage in up to 17%.

Related Links:
Cleveland Clinic
Duke University