Cornelia Betschart1, Mauro Cervigni2, Oscar Contreras Ortiz3, Stergios K Doumouchtsis4, Masayasu Koyama5, Carlos Medina6, Jorge Milhem Haddad7, Filippo la Torre8, Giuliano Zanni9. 1. Department of Gynecology, University Hospital, Zurich, Switzerland. 2. Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. 3. Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina. 4. Department of Gynecology, St. George's University of London, London, United Kingdom. 5. Department of Obstetrics and Gynecology, Osaka City Graduate School of Medicine, Osaka, Japan. 6. Department of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, Florida. 7. Gynecology Division, Universidade de São Paulo, São Paulo, SP, Brazil. 8. Surgical Department, Policlinico "Umberto I", Sapienza University, Rome, Italy. 9. Department of Obstetrics and Gynecology, Hospital of Vicenza, Vicenza, Italy.
Abstract
AIM: Apical prolapse includes descent of the uterus, vagina cuff, or rarely solely of the cervix. It is estimated that women have an 11-19% life-time risk of undergoing surgery for POP. This rate is projected to increase over the next 2-3 decades. In this FIGO working group report we address the conservative and surgical treatment options for apical prolapse. METHODS: The FIGO working group "Pelvic Floor Medicine and Reconstructive Surgery" describes the different treatments for apical prolapse based on the literature evidence, the cost-effectiveness, the degree of difficulty and summed them up with an experts recommendation. RESULTS: Among the conservative treatment options, pessaries are the most successful options since centuries with a low complication rate and low costs. Among the vaginal operative procedures the sacrospinous ligament fixation (SSLF) and the uterosacral ligament suspension (USLS) show comparable outcomes and efficacy with a different, however, rather low complication pattern and a favorable cost-benefit profile. Sacrocolpopexy, independent on the open abdominal, laparoscopic, or robotic-assisted laparoscopic technique has a good durability and quality of life performance. The minimal invasive techniques are as effective as the open abdominal techniques and there is no difference in mesh exposure. CONCLUSION: Vaginal procedures are well described procedures with favorable outcomes and cost-benefit profiles. Sacral colpopexy has a high-effectivity; data on the route of performance and long-term outcome are awaited. The cost with mesh implants are higher compared to the operations with autologous tissue or any conservative treatment and further studies are recommended to evaluate the cure rates in the span of decades and the possible long-term mesh complications. Neurourol. Urodynam. 36:507-513, 2017.
AIM: Apical prolapse includes descent of the uterus, vagina cuff, or rarely solely of the cervix. It is estimated that women have an 11-19% life-time risk of undergoing surgery for POP. This rate is projected to increase over the next 2-3 decades. In this FIGO working group report we address the conservative and surgical treatment options for apical prolapse. METHODS: The FIGO working group "Pelvic Floor Medicine and Reconstructive Surgery" describes the different treatments for apical prolapse based on the literature evidence, the cost-effectiveness, the degree of difficulty and summed them up with an experts recommendation. RESULTS: Among the conservative treatment options, pessaries are the most successful options since centuries with a low complication rate and low costs. Among the vaginal operative procedures the sacrospinous ligament fixation (SSLF) and the uterosacral ligament suspension (USLS) show comparable outcomes and efficacy with a different, however, rather low complication pattern and a favorable cost-benefit profile. Sacrocolpopexy, independent on the open abdominal, laparoscopic, or robotic-assisted laparoscopic technique has a good durability and quality of life performance. The minimal invasive techniques are as effective as the open abdominal techniques and there is no difference in mesh exposure. CONCLUSION: Vaginal procedures are well described procedures with favorable outcomes and cost-benefit profiles. Sacral colpopexy has a high-effectivity; data on the route of performance and long-term outcome are awaited. The cost with mesh implants are higher compared to the operations with autologous tissue or any conservative treatment and further studies are recommended to evaluate the cure rates in the span of decades and the possible long-term mesh complications. Neurourol. Urodynam. 36:507-513, 2017.
Keywords:
International Federation of Gynecology and Obstetrics (FIGO); apical compartment; conservative treatment; pelvic organ prolapse (POP); surgery
Authors: Emily A Slopnick; Andrey Petrikovets; David Sheyn; Simon P Kim; Carvell T Nguyen; Adonis K Hijaz Journal: Int Urogynecol J Date: 2018-10-03 Impact factor: 2.894