/ /

  • linkedin
  • Increase Font
  • Sharebar

    The future of treating pelvic organ prolapse

     

    Summary

    Ob/gyns are often the first providers to identify and initiate treatment for POP. It is incumbent upon residency training programs to ensure that training in pelvic floor disorders continues to meet the high standards expected by patients. It is critically important for clinicians to understand and offer an array of treatment options to women with POP, taking into consideration a thorough review of each patient’s goals and expectations. The choice of treatment should be arrived at in consultation with a patient.

    Patient education, guidance from the provider, and an understanding of patient goals represents the future of treatment for POP.

    Dr Ninivagggio has no conflict of interest to report in respect to the content of this article. Dr Dunivan reports performing contracted research for Pelvalon.

     

    References

    1. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–1316.

    2. Dieter AA, Wilkins MF, Wu JM. Epidemiological trends and future care needs for pelvic floor disorders. Curr Opin Obstet Gynecol. 2015. 27(5):380–384.

    3. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson Funk M. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6): 1201–1206.

    4. Bovbjerg VE, Trowbridge ER, Barber MD, Martirosian TE, Steers WD, Hullfish KL. Patient-centered treatment goals for pelvic floor disorders: association with quality-of-life and patient satisfaction. Am J Obstet Gynecol. 2009;200(5):568.e1-6.

    5. Foundation TIMD. Advance shared decision making. March 13, 2016; Available at: http://www.informedmedicaldecisions.org/what-is-shared-decision-making/.

    6. Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992;267(16):2221–2226.

    7. Culligan PJ. Nonsurgical management of pelvic organ prolapse. Obstet Gynecol. 2012;119(4):852–860.

    8. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027–1038.

    9. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gyneco.l 2004;190(1)27–32.

    10. Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109(4):848–854.

    11. Betschart C, Cervigni M, Contreras Ortiz O, et al. Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report. Neurourol Urodyn. 2015.

    12. Handa VL,Jones M. Do pessaries prevent the progression of pelvic organ prolapse? IntUrogynecol J Pelvic Floor Dysfunct. 2002;13(6):349–351; discussion 352.

    13. Lone F, Thakar R, Sultan AH, Karamalis G. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114(1):56–59.

    14. Clemons JL, Aguilar VC, Sokol ER, Jackson ND, Myers DL. Patient characteristics that are associated with continued pessary use versus surgery after 1 year. Am J Obstet Gynecol. 2004;191(1):159–164.

    15. Meriwether KV, Komesu YM, Craig E, Qualls C, Davis H, Rogers RG. Sexual function and pessary management among women using a pessary for pelvic floor disorders. J Sex Med. 2015;12(12):2339–2349.

    16. Braekken IH, Majida M, Engh ME, Bo K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e1-7.

    17. Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2009;20(1):45–51.

    18. Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J. 2016;27(7):981–992.

    19. Due U, Brostrom S, Lose G. Lifestyle advice with or without pelvic floor muscle training for pelvic organ prolapse: a randomized controlled trial. Int Urogynecol J 2016;27(4):555–563.

    20. ACOG Committee Opinion No. 578: Elective surgery and patient choice. Obstet Gynecol. 2013;122(5):1134–1138.

    21. DeLancey JO, Morley GW. Total colpocleisis for vaginal eversion. Am J Obstet Gynecol. 1997;176(6)1228–1232; discussion 1232–1235.

    22. Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–1034.

    23. Barber MD, Maher C. Apical prolapse. Int Urogynecol J. 2013;24(11):1815–1833.

    24. Pan K, Zhang Y, Wang Y, Wang Y, Xu H. A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy. Int J Gynaecol Obstet. 2016;132(3):284–291.

    25.  Maher C, Feinfer B, Bae, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;4:Cd004014.

    26. Nygaard I, Brubaker l, Zyczynski HM, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–2024.

    27. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:Cd012079.

    28. Abbasy S,Kenton K. Obliterative procedures for pelvic organ prolapse. Clin Obstet Gynecol. 2010;53(1):86–98.

    29. FitzGerald MP, Brubaker L. Colpocleisis and urinary incontinence. Am J Obstet Gynecol. 2003;189(5):1241–2144.

    30. FitzGerald MP, Richter HE, Siddique S, Thompson P, Zyczynski H, Ann Weber for the Pelvic Floor Disorders Network. Colpocleisis: a review. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):261–271.

    31. Hanson GE, Keettel WC. The Neugebauer-Le Fort operation. A review of 288 colpocleises. Obstet Gynecol. 1969;34(3):352–357.

    32. Hoffman MS, Cardosi RJ, Lockhart J, Hall DC, Murphy SJ. Vaginectomy with pelvic herniorrhaphy for prolapse. Am J Obstet Gynecol, 2003;189(2):364–370; discussion 370–371.

    33. Fitzgerald MP, Richter HE, Bradley CS, et al. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1603–1609.

    34. Wang LC, Al Hussein Al, Awamlh B, et al. Trends in mesh use for pelvic organ prolapse repair from the Medicare database. Urology. 2015;86(5):885–891.

    35. FDA. 2011. UPDATE on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse: FDA Safety Communication.

    36. Feiner B, Jelovsek JE, Maher C. Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review. BJOG. 2009;116(1):15–24.

    37. Pelvic Floor Disorders Registry. http://www.pfdr.org.

    38. Jacoby VL, Autry A, Jacobson G, Domush R, Nakagawa S, Jacoby A. Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol. 2009;114(5):1041–1048.

    39. Ridgeway BM. Does prolapse equal hysterectomy? The role of uterine conservation in women with uterovaginal prolapse. Am J Obstet Gynecol. 2015;213(6):802–809.

    40. Frick AC, Barber MD, Paraiso MF, Ridgeway B, Jelovsek JE, Walters MD. Attitudes toward hysterectomy in women undergoing evaluation for uterovaginal prolapse. Female Pelvic Med Reconstr Surg. 2013;19(2):103–109.

    41. Korbly NB, Kassis NC, Good MM, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(5):470.e1-6.

    42. Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P. Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J Pelvic Floor Dysfunc.t 2001;12(6):381–384; discussion 384–385.

    43. Dietz V, van der Vaart CH, van der Graaf Y, Heintz P, Schraffordt Koops SE. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J. 2010;21(2):209–216.

    44. Detollenaere RJ, den Boon J, Stekelenburg J, et al. 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. BMJ. 2015;351:h3717.

    45. Jirschele K, Seitz M, Zhou Y, Rosenblatt P, Culligan P, Sand P. A multicenter, prospective trial to evaluate mesh-augmented sacrospinous hysteropexy for uterovaginal prolapse. Int Urogynecol J. 2015;26(5):743–748.

    46. Costantini E, Mearini L, Bini V, Zucchi A, Mearini E, Porena M. Uterus preservation in surgical correction of urogenital prolapse. Eur Urol. 2005;48(4):64–69.

    47. Maher CF, Carey MP, Murray CJ. Laparoscopic suture hysteropexy for uterine prolapse. Obstet Gynecol. 2001;97(6):1010–1014.

    Cara Ninivaggio, MD, FACOG
    Dr Ninivaggio is a fellow in the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, ...
    Gena Dunivan, MD, FACOG
    Dr Dunivan is an Associate Professor and Fellowship Program Director in the Division of Female Pelvic Medicine & Reconstructive Surgery, ...

    0 Comments

    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available

    Poll

    Latest Tweets Follow