Literature DB >> 21324143

Treatment of uterine prolapse stage 2 or higher: a randomized multicenter trial comparing sacrospinous fixation with vaginal hysterectomy (SAVE U trial).

Renée J Detollenaere1, Jan den Boon, Jelle Stekelenburg, Akeel H H Alhafidh, Robert A Hakvoort, Mark E Vierhout, Hugo W F van Eijndhoven.   

Abstract

BACKGROUND: Pelvic organ prolapse is a common health problem, affecting up to 40% of parous women over 50 years old, with significant negative influence on quality of life. Vaginal hysterectomy is currently the leading treatment method for patients with symptomatic uterine prolapse. Several studies have shown that sacrospinous fixation in case of uterine prolapse is a safe and effective alternative to vaginal hysterectomy. However, no large randomized trials with long-term follow-up have been performed to compare efficacy and quality of life between both techniques.The SAVE U trial is designed to compare sacrospinous fixation with vaginal hysterectomy in the treatment of uterine prolapse stage 2 or higher in terms of prolapse recurrence, quality of life, complications, hospital stay, post-operative recovery and sexual functioning. METHODS/
DESIGN: The SAVE U trial is a randomized controlled multi-center non-inferiority trial. The study compares sacrospinous fixation with vaginal hysterectomy in women with uterine prolapse stage 2 or higher. The primary outcome measure is recurrence of uterine prolapse defined as: uterine descent stage 2 or more assessed by pelvic organ prolapse quantification examination and prolapse complaints and/or redo surgery at 12 months follow-up. Secondary outcomes are subjective improvement in quality of life measured by generic (Short Form 36 and Euroqol 5D) and disease-specific (Urogenital Distress Inventory, Defecatory Distress Inventory and Incontinence Impact Questionnaire) quality of life instruments, complications following surgery, hospital stay, post-operative recovery and sexual functioning (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire). Analysis will be performed according to the intention to treat principle. Based on comparable recurrence rates of 3% and considering an upper-limit of 7% to be non-inferior (beta 0.2 and one sided alpha 0.025), 104 patients are needed per group. DISCUSSION: The SAVE U trial is a randomized multicenter trial that will provide evidence whether the efficacy of sacrospinous fixation is similar to vaginal hysterectomy in women with uterine prolapse stage 2 or higher. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR1866.

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Year:  2011        PMID: 21324143      PMCID: PMC3045971          DOI: 10.1186/1472-6874-11-4

Source DB:  PubMed          Journal:  BMC Womens Health        ISSN: 1472-6874            Impact factor:   2.809


  26 in total

1.  The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction.

Authors:  R C Bump; A Mattiasson; K Bø; L P Brubaker; J O DeLancey; P Klarskov; B L Shull; A R Smith
Journal:  Am J Obstet Gynecol       Date:  1996-07       Impact factor: 8.661

2.  Modeling valuations for EuroQol health states.

Authors:  P Dolan
Journal:  Med Care       Date:  1997-11       Impact factor: 2.983

3.  Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse?

Authors:  C F Maher; M P Cary; M C Slack; C J Murray; M Milligan; P Schluter
Journal:  Int Urogynecol J Pelvic Floor Dysfunct       Date:  2001

4.  Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study.

Authors:  J Mant; R Painter; M Vessey
Journal:  Br J Obstet Gynaecol       Date:  1997-05

5.  Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system.

Authors:  A F Hall; J P Theofrastous; G W Cundiff; R L Harris; L F Hamilton; S E Swift; R C Bump
Journal:  Am J Obstet Gynecol       Date:  1996-12       Impact factor: 8.661

Review 6.  Posthysterectomy vault prolapse.

Authors:  J W Barrington; G Edwards
Journal:  Int Urogynecol J Pelvic Floor Dysfunct       Date:  2000

7.  Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence.

Authors:  A L Olsen; V J Smith; J O Bergstrom; J C Colling; A L Clark
Journal:  Obstet Gynecol       Date:  1997-04       Impact factor: 7.661

8.  True incidence of vaginal vault prolapse. Thirteen years of experience.

Authors:  M Marchionni; G L Bracco; V Checcucci; A Carabaneanu; E M Coccia; F Mecacci; G Scarselli
Journal:  J Reprod Med       Date:  1999-08       Impact factor: 0.142

9.  Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept.

Authors:  M Hefni; T El-Toukhy; J Bhaumik; E Katsimanis
Journal:  Am J Obstet Gynecol       Date:  2003-03       Impact factor: 8.661

10.  Sacrospinous hysteropexy compared to vaginal hysterectomy as primary surgical treatment for a descensus uteri: effects on urinary symptoms.

Authors:  H J van Brummen; G van de Pol; C I M Aalders; A P M Heintz; C H van der Vaart
Journal:  Int Urogynecol J Pelvic Floor Dysfunct       Date:  2003-09-23
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  7 in total

Review 1.  Hysteropreservation versus hysterectomy in the surgical treatment of uterine prolapse: systematic review and meta-analysis.

Authors:  Sofia Andrade de Oliveira; Marcelo C M Fonseca; Maria A T Bortolini; Manoel J B C Girão; Matheus T Roque; Rodrigo A Castro
Journal:  Int Urogynecol J       Date:  2017-08-05       Impact factor: 2.894

2.  Surgical management of pelvic organ prolapse and uterine descent in the Netherlands.

Authors:  R J Detollenaere; J den Boon; K B Kluivers; M E Vierhout; H W F van Eijndhoven
Journal:  Int Urogynecol J       Date:  2012-09-22       Impact factor: 2.894

3.  Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial.

Authors:  Renée J Detollenaere; Jan den Boon; Jelle Stekelenburg; Joanna IntHout; Mark E Vierhout; Kirsten B Kluivers; Hugo W F van Eijndhoven
Journal:  BMJ       Date:  2015-07-23

4.  Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality.

Authors:  Salvatore Giovanni Vitale; Antonio Simone Laganà; Marco Noventa; Pierluigi Giampaolino; Brunella Zizolfi; Salvatore Butticè; Valentina Lucia La Rosa; Giuseppe Gullo; Diego Rossetti
Journal:  Biomed Res Int       Date:  2018-02-28       Impact factor: 3.411

5.  Concurrent Occurrence of Uterovaginal and Rectal Prolapse: An Uncommon Presentation.

Authors:  U A Umeh; E O Ugwu; S N Obi; J E Nnagbo
Journal:  Ann Med Health Sci Res       Date:  2015 Sep-Oct

6.  Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse.

Authors:  Assem A M Elbiaa; Ibrahim A Abdelazim; Mohamed M Farghali; M Hussain; A E Omu
Journal:  Prz Menopauzalny       Date:  2015-09-30

7.  Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial.

Authors:  Sascha F M Schulten; Renée J Detollenaere; Jelle Stekelenburg; Joanna IntHout; Kirsten B Kluivers; Hugo W F van Eijndhoven
Journal:  BMJ       Date:  2019-09-10
  7 in total

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