Comparison of 2 Transvaginal Surgical Approaches and Perioperative Behavioral Therapy for Apical Vaginal Prolapse: The OPTIMAL Randomized Trial
Open accessAbstract
IMPORTANCE: More than 300,000 surgeries are performed annually in the United States for pelvic organ prolapse. Sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are commonly performed transvaginal surgeries to correct apical prolapse. Little is known about their comparative efficacy and safety, and it is unknown whether perioperative behavioral therapy with pelvic floor muscle training (BPMT) improves outcomes of prolapse surgery. OBJECTIVE: To compare outcomes between (1) SSLF and ULS and (2) perioperative BPMT and usual care in women undergoing surgery for vaginal prolapse and stress urinary incontinence. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, 2 × 2 factorial, randomized trial of 374 women undergoing surgery to treat both apical vaginal prolapse and stress urinary incontinence was conducted between 2008 and 2013 at 9 US medical centers. Two-year follow-up rate was 84.5%. INTERVENTIONS: The surgical intervention was transvaginal surgery including midurethral sling with randomization to SSLF (n = 186) or ULS (n = 188); the behavioral intervention was randomization to receive perioperative BPMT (n = 186) or usual care (n = 188). MAIN OUTCOMES AND MEASURES: The primary outcome for the surgical intervention (surgical success) was defined as (1) no apical descent greater than one-third into vaginal canal or anterior or posterior vaginal wall beyond the hymen (anatomic success), (2) no bothersome vaginal bulge symptoms, and (3) no re-treatment for prolapse at 2 years. For the behavioral intervention, primary outcome at 6 months was urinary symptom scores (Urinary Distress Inventory; range 0-300, higher scores worse), and primary outcomes at 2 years were prolapse symptom scores (Pelvic Organ Prolapse Distress Inventory; range 0-300, higher scores worse) and anatomic success. RESULTS: At 2 years, surgical group was not significantly associated with surgical success rates (ULS, 59.2% [93/157] vs SSLF, 60.5% [92/152]; unadjusted difference, -1.3%; 95% CI, -12.2% to 9.6%; adjusted odds ratio [OR], 0.9; 95% CI, 0.6 to 1.5) or serious adverse event rates (ULS, 16.5% [31/188] vs SSLF, 16.7% [31/186]; unadjusted difference, -0.2%; 95% CI, -7.7% to 7.4%; adjusted OR, 0.9; 95% CI, 0.5 to 1.6). Perioperative BPMT was not associated with greater improvements in urinary scores at 6 months (adjusted treatment difference, -6.7; 95% CI, -19.7 to 6.2), prolapse scores at 24 months (adjusted treatment difference, -8.0; 95% CI, -22.1 to 6.1), or anatomic success at 24 months. CONCLUSIONS AND RELEVANCE: Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS nor SSLF was significantly superior to the other for anatomic, functional, or adverse event outcomes. Perioperative BPMT did not improve urinary symptoms at 6 months or prolapse outcomes at 2 years. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00597935.
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A lack of individualized progression and of reporting adherence may explain the limited benefit of pelvic floor muscle training on postoperative pelvic floor muscle function in those studies.
“The lack of individualized progression and reporting of adherence might be a reason for the limited benefit of PFMT on the postoperative PFM function found in those studies.14,38,39”
From Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial (2022) · cites this paper as [39]
The Results (Behavioral Intervention Outcomes; page not specified) found no difference in pelvic floor muscle strength between groups, but the proposed explanation is contrary to this trial’s Methods. The Methods (Study Interventions; page not specified) state that exercises were individually progressed and adherence was assessed; the Results report adherence at 6 and 24 months. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThis trial's finding of improved strength but not EMG differs from Frawley, Barber, and Duarte, who found no improvement in pelvic floor muscle strength or EMG.
“This differs from the findings of Frawley and colleagues, Barber and colleagues, and Duarte and colleagues, 14,39,40 who did not find improvement in PFM strength or EMG measures.”
From Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial (2022) · cites this paper as [39]
The Results (Behavioral Intervention Outcomes; page not provided) report no between-group difference in change in pelvic floor muscle strength at 6 or 24 months. The Methods (Outcomes; page not provided) identify strength as a Brink-scale measure, but the paper does not report EMG measures, so it cannot support that part of the attributed finding. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe trial's quality-of-life and symptom results were similar to those of most earlier studies.
“The findings of this study regarding the effect on QOL and symptoms are similar to those of most previous studies.13,14,38 -40”
From Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial (2022) · cites this paper as [39]
The Results (Behavioral Intervention Outcomes; page unavailable) report changes in urinary and prolapse symptoms, so this trial provides an earlier symptom finding for comparison. The paper does not report its own quality-of-life result or establish that its findings were similar to those of most previous studies; its Discussion also notes a prior trial with contrasting results. (LLM, conf=0.77)
Experimental — accuracy not yet measuredMcClurg and colleagues and Barber and colleagues, like the current trial, used individualized pelvic floor muscle exercises rather than a standard protocol.
“Like Barber and colleagues 39 and the current study, they included individualized PFM exercises instead of a standard protocol.”
From Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial (2022) · cites this paper as [39]
The Methods (Study Interventions; page unavailable) describe individualized progressive pelvic floor muscle exercises. But the Discussion (page unavailable) says the individualized intervention used a standard protocol, contrary to the claim that it was used instead of one. (LLM, conf=0.89)
Experimental — accuracy not yet measuredA single trial reported no difference in rate of transfusion between uterosacral and sacrospinous colpopexy (RR 1.67, 95% CI 0.50 to 5.60; n = 30).
“A single trial (Barber 2014) reported no difference in rate of transfusion between the uterosacral and sacrospinous colpopexy (RR 1.67 95% CI 0.50 to 5.60; n=30; Analysis 6.14).”
From Surgery for women with apical vaginal prolapse (2023) · cites this paper as Barber 2014
The Results (Surgical Intervention Outcomes; page unavailable) report no significant difference between uterosacral and sacrospinous groups in estimated blood loss or overall serious adverse events. Our copy does not report a transfusion-rate comparison or the stated RR and confidence interval; the Results (Study Populations and Treatment Assignments; page unavailable) give 374 participants in the surgical comparison, not n=30. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Three trials found no differences between uterosacral colpopexy and alternative native tissue apical suspensions in anatomical, functional and perioperative outcomes.
“Three trials were included: Barber 2014 and Martins 2020 compared uterosacral and sacrospinous colpopexy, and Natale 2010 compared uterosacral colpopexy and levator myorrhaphy with no differences identified between the groups in anatomical, functional and perioperative outcomes.”
From Surgery for women with apical vaginal prolapse (2023) · cites this paper as Barber 2014
Barber 2014 compares uterosacral ligament suspension with sacrospinous fixation and reports no significant difference in overall surgical success or most operative measures (Results, Surgical Intervention Outcomes; page unavailable). But its Results also report significantly more neurologic pain requiring intervention after sacrospinous fixation and ureteral obstruction after uterosacral suspension, so an unqualified claim of no perioperative differences overstates this trial. This paper does not establish the findings of the other two named trials. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the Barber et al. (2014) study there was no effect of PFMT on either PFM strength or POP.
“However, there was no effect of PFMT in this study on either PFM strength or POP.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [62]
The Results (Behavioral Intervention Outcomes; page unavailable) report no significant difference in pelvic floor muscle strength or prolapse symptom scores between BPMT and usual care. However, they also report a significant interaction with surgical approach: women receiving one procedure had greater apical descent with BPMT. Thus, saying there was no effect on POP without qualification overstates the findings. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIf there was no short-term effect of a PFMT program, long-term effects are unlikely.
“Furthermore, if there was no short-term effect of a PFMT program [49, 50, 62, 67, 71, 75], then long-term effects are unlikely.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [62]
The Results (Behavioral Intervention Outcomes; page not provided) report no significant difference between perioperative BPMT and usual care at either 6 or 24 months. That supports the short- and longer-term pattern in this trial, but the paper does not establish the general prediction that a PFMT program without a short-term effect is unlikely to have long-term effects. The Discussion also cautions against extrapolating its findings beyond the women studied. (LLM, conf=0.84)
Experimental — accuracy not yet measuredHigh-quality randomised controlled trial data suggest that vaginal hysterectomy with apical suspension might be associated with a high surgical failure rate of up to 35% at 2 years.
“However, high-quality randomised controlled trial (RCT) data suggest that this approach might be associated with a high surgical failure rate of up to 35% at 2 years [5].”
From Laparoscopic sacrohysteropexy versus vaginal hysterectomy and apical suspension: 7-year follow-up of a randomized controlled trial (2022) · cites this paper as [5]
The Results (Surgical Intervention Outcomes; page unavailable) report two-year composite surgical success of 59.2% and 60.5%, implying failure rates of about 41% and 40%, not up to 35%. The Methods (Study Interventions; page unavailable) say that all participants with uterine prolapse underwent vaginal hysterectomy, but the reported success rates are for the surgical groups overall, not specifically for those who had a hysterectomy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredTwo trials exclusively assessed women undergoing primary prolapse repairs only (Barber 2014; Duarte 2020), with no other trials excluding previous prolapse surgeries.
“Two trials exclusively assessed women undergoing primary prolapse repairs only (Barber 2014; Duarte 2020), with no other trials excluding previous prolapse surgeries.”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn women undergoing POP surgery, pelvic floor muscle training versus no PFMT may result in no clinically relevant difference in POPQ Point C (OR 0.62, 95% CI 0.25 to 1.74; 1 study, 307 women; low-certainty evidence).
“Based on data from a single trial (Barber 2014), there may be no clinically relevant difference in POPQ assessment for Point C with or without pelvic floor training (OR 0.62, 95% CI 0.25 to 1.74; 1 study, 307 women; low‐certainty evidence; Analysis 1.4).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
The Results (Behavioral Intervention Outcomes; page unavailable) report no significant overall difference in anatomic outcomes between pelvic muscle training and usual care, supporting the claim’s cautious general conclusion. However, the copy does not report the cited Point C odds ratio, confidence interval, or 307-woman analysis; it also reports an interaction in apical descent by surgical approach. The low-certainty rating appears to be the citing authors’ assessment, not a finding attributed to the trial. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn women undergoing POP surgery, pelvic floor muscle training versus no PFMT may result in no clinically relevant difference in repeat surgery for recurrent prolapse at 3 to 24 months (OR 0.86, 95% CI 0.23 to 3.26; P = 0.82; 1 study, 316 women; low-certainty evidence).
“Based on data from a single trial (Barber 2014), there may be no clinically relevant difference in repeat surgery for prolapse with or without pelvic floor training (OR 0.86, 95% CI 0.23 to 3.26; P = 0.82; 1 study, 316 women; low‐certainty evidence; Analysis 1.2).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
The Results (Behavioral Intervention Outcomes; page unavailable) report no significant difference between pelvic floor muscle training and usual care in retreatment for prolapse. But the reported outcome includes retreatment beyond repeat surgery, and its OR is 2.5 (95% CI 0.8–7.6), not the quoted OR 0.86; the cited paper also does not provide the quoted P value or low-certainty rating. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn women undergoing POP surgery, pelvic floor muscle training versus no PFMT may result in no clinically relevant difference in POPQ Point Ba (OR 0.92, 95% CI 0.49 to 1.74; 1 study, 308 women; low-certainty evidence).
“Based on data from a single trial (Barber 2014), there may be no clinically relevant difference in POPQ assessment for Point Ba with or without pelvic floor training (OR 0.92, 95% CI 0.49 to 1.74; 1 study, 308 women; low‐certainty evidence; Analysis 1.4).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
The Results (Behavioral Intervention Outcomes; page not provided) report no significant difference in anterior vaginal prolapse beyond the hymen between BPMT and usual care (14.1% versus 15.1%; OR 0.9, 95% CI 0.5–1.8). This supports the claim’s general direction, but our copy does not identify this comparison specifically as POPQ Point Ba or report the cited OR 0.92, CI 0.49–1.74, or low-certainty rating. (LLM, conf=0.85)
Experimental — accuracy not yet measuredIn women undergoing POP surgery, pelvic floor muscle training versus no PFMT may result in no clinically relevant difference in POPQ Point Bp (OR 0.66, 95% CI 0.25 to 1.76; 1 study, 308 women; low-certainty evidence).
“Based on data from a single trial (Barber 2014), there may be no clinically relevant difference in POPQ assessment for Point Bp with or without pelvic floor training (OR 0.66, 95% CI 0.25 to 1.76; 1 study, 308 women; low‐certainty evidence; Analysis 1.4).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
The Methods (Study Interventions and Outcomes; page unavailable) describe perioperative pelvic floor muscle training versus usual care and POPQ assessments. The Results (Behavioral Intervention Outcomes; page unavailable) report no detected group difference in anatomic failure due to posterior prolapse. Our copy does not report a Point Bp-specific result or the stated OR, confidence interval, and 308-person analysis; low certainty is the citing review’s appraisal, not a trial finding. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn women undergoing POP surgery, pelvic floor muscle training versus no PFMT may result in no clinically relevant difference in objective failure at any site at 3 to 24 months (OR 1.24, 95% CI 0.67 to 2.29; P = 0.49; 1 study, 307 women; low-certainty evidence).
“Based on data from a single trial (Barber 2014), there may be no clinically relevant difference in recurrent prolapse on examination with or without pelvic floor training (OR 1.24, 95% CI 0.67 to 2.29; P = 0.49; 1 study, 307 women; low‐certainty evidence; Analysis 1.3).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredIn women undergoing POP surgery, pelvic floor muscle training versus no PFMT results in no clinically relevant difference in awareness of prolapse at 3 to 24 months (OR 1.07, 95% CI 0.61 to 1.87; 1 study, 305 women; low-certainty evidence).
“Based on data from a single trial (Barber 2014), there was no clinically relevant difference in patient awareness of prolapse with or without pelvic floor training (OR 1.07, 95% CI 0.61 to 1.87; 1 study, 305 women; low‐certainty evidence; Analysis 1.1).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
The Results (Behavioral Intervention Outcomes; page unavailable) report no significant difference in prolapse-symptom scores between perioperative pelvic floor muscle training and usual care at 24 months. The Results (Surgical Intervention Outcomes; page unavailable) report bothersome vaginal bulge symptoms in 55 of 305 women, but do not give the claimed OR or confidence interval for the training comparison. The Methods (Study Interventions; page unavailable) list assessments at 6, 12, and 24 months, not 3 months; the paper also does not assign a low-certainty evidence rating. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThis trial's finding of improved strength with few sessions contradicts studies with many postoperative follow-up sessions that found limited benefit of pelvic floor muscle training on strength.
“This contradicts the results of studies with a high number of postoperative follow-up sessions, 39,40 which have demonstrated a limited benefit of PFMT on strength measures.”
From Postoperative Physiotherapy in Women Undergoing Pelvic Floor Reconstructive Surgery: A Randomized Controlled Clinical Trial (2022) · cites this paper as [39]
Uterosacral and sacrospinous ligament suspensions have been shown to be essentially equivalent in efficacy.
“These have been shown to be essentially equivalent in efficacy.9”
From Characteristics Associated With Surgical Failure After Native Tissue Apical Prolapse Repair (2024) · cites this paper as [9]
There was no effect of the original training program in this study, and a long-term effect may therefore not be expected.
“Furthermore, there was no effect of the original training program in this study [62], and a long-term effect may therefore not be expected.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [62]
Two trials reported on objective failure at any site (Barber 2014; Mueller 2017).
“Two trials reported on objective failure at any site (Barber 2014; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
Eleven full publications or meeting abstracts published from 2005 until 2021 were included in the review of PFMT in connection with POP surgery.
“Eleven full publications or meeting abstracts which were published from 2005 until 2021 [62–72] were included.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [62]
Among the POP studies in the present review, only Barber et al. (2014) reported long-term adherence to PFMT.
“only Barber et al. (2014) [62] reported long-term adherence to PFMT”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [62]
In Barber et al. (2014), 93.4% reported adhering to PFMT 6 months after the intervention and 81.4% at 2 years.
“They found that 93.4% reported to adhere to PFMT 6 months after the intervention and 81.4% at 2 years.”
From International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training (2022) · cites this paper as [62]
Suspensory ligament types have comparable outcomes.
“given comparable outcomes), 69”
From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [69]
In Barber et al. (2014), perioperative behavioral therapy combined with PFMT did not significantly improve urinary or prolapse symptom scores or anatomical outcomes at two years.
“At two years, BPMT did not significantly improve urinary or prolapse symptom scores (UDI, POPDI) or anatomical outcomes.”
From Pelvic Floor Muscle Training Following Surgery for Pelvic Organ Prolapse: Recommendation from Scientific Literature (2026) · cites this paper as [33]
Concomitant stress incontinence was an inclusion criterion in Barber 2014, and an exclusion criterion in Bray 2017.
“Concomitant stress incontinence was an inclusion criterion in Barber 2014, and an exclusion criterion in Bray 2017.”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
The length of follow-up varied from a few days of postoperative follow-up in Chan 2014 and Henn 2016 to 24 months in Barber 2014.
“The length of follow‐up varied, from a few days of postoperative follow‐up in Chan 2014 and Henn 2016, to 24 months in Barber 2014.”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
Seven trials with a total of 1032 women evaluated POP surgery with or without pelvic floor muscle training (PFMT).
“POP surgery with or without pelvic floor muscle training (PFMT): seven trials with a total of 1032 women (Barber 2014; Brandt 2019; Duarte 2020; Mathew 2021; McClurg 2014; Nyhus 2020; Pauls 2013).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
Seven trials reported on patient-reported outcome measures (PROMs) (Antosh 2013; Arunachalam 2019; Barber 2014; Duarte 2020; Mueller 2017; Pauls 2013; Russo 2020).
“Seven trials reported on PROMs (Antosh 2013; Arunachalam 2019; Barber 2014; Duarte 2020; Mueller 2017; Pauls 2013; Russo 2020).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
One trial reported on repeat surgery for recurrent prolapse (Barber 2014).
“One trial reported on repeat surgery for recurrent prolapse (Barber 2014).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
Three trials reported on awareness of prolapse (Ballard 2014; Barber 2014; Mueller 2017).
“Three trials reported on awareness of prolapse (Ballard 2014; Barber 2014; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
Two trials reported on POPQ assessments (Barber 2014; Mueller 2017).
“Two trials reported on POPQ assessments (Barber 2014; Mueller 2017).”
From Perioperative interventions in pelvic organ prolapse surgery (2025) · cites this paper as Barber 2014
The OPTIMAL trial was unable to demonstrate a clear superiority of one apical suspension technique over the other in terms of success rates or complication rates.
“the OPTIMAL trial was also unable to demonstrate a clear superiority of one apical suspension technique over the other in terms of either success rates or complication rates [32”
From The uterus debate in vaginal native tissue repair for pelvic organ prolapse: Hysteropexy versus hysterectomy – A systematic review and meta-analysis (2025) · cites this paper as [32]
The mismatch between expectations and goals may be influenced by inadequate counselling, poor 'customer' care, consideration of the impact of prolapse on body image, sexual function, and perhaps other indirect effects; those on a woman's anxiety, depression, and cognitive state.
“This mismatch, and that between expectations and goals, may be influenced by inadequate counselling, poor ‘customer’ care, consideration of the impact of prolapse on body image, sexual function, and perhaps other indirect effects; those on a woman's anxiety, depression, and cognitive state [25, 26, 27, 28, 29].”
From How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025 (2026) · cites this paper as [26]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThe incidence of serious adverse events in other pelvic floor disorder trials ranges from 11.6% to 16.7%.
“The incidence of serious adverse events from other trials range from 11.6-16.7% [20, 21].”
From Outpatient visits versus telephone interviews for postoperative care: a randomized controlled trial (2019) · cites this paper as [21]
The failure rate of unilateral sacrospinous fixation is high (40-70%).
“Moreover, the failure rate of unilateral sacrospinous fixation is high (40–70%) [ 29 , 30 ].”
From Recurrent pelvic organ prolapse after hysterectomy; a 10-year national follow-up study (2024) · cites this paper as [29]
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Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214
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The American College of Obstetricians and Gynecologists and the American Urogynecologic Society INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect the US Food and Drug Administration order to stop the sale of transvaginal synthetic mesh products for the repair of pelvic organ prolapse. (2019) · Urogynecology · doi:10.1097/spv.0000000000000794 · Cited by 148 · see citing works
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Surgical management of pelvic organ prolapse
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Self-citationQuality of life and sexual function 2 years after vaginal surgery for prolapse.
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Self-citationGuideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women
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Self-citationPerioperative interventions in pelvic organ prolapse surgery
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“Furthermore, there was no effect of the original training program in this study [62], and a long-term effect may therefore not be expected.”
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Self-citationFemale pelvic floor biomechanics
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Self-citationPelvic organ prolapse management
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Phenazopyridine for Evaluation of Ureteral Patency
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Preoperative Prolapse Stage as Predictor of Failure of Sacrocolpopexy
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- Authors
- Barber, M. D., Brubaker, L., Burgio, K. L., Richter, H. E., Nygaard, I., Weidner, A. C., Menefee, S. A., Lukacz, E. S., Norton, P., Schaffer, J., Nguyen, J. N., Borello-France, D., Goode, P. S., Jakus-Waldman, S., Spino, C., Warren, L. K., Gantz, M. G., & Meikle, S. F.
- Affiliations
- Cleveland Clinic (US)
- Loyola University Chicago (US)
- University of Alabama at Birmingham (US)
- University of Utah (US)
- Duke University (US)
- Kaiser Permanente (US)
- UC San Diego Health System (US)
- The University of Texas Southwestern Medical Center (US)
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania
- University of Michigan (US)
- RTI International (US)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-03-12
- Volume
- 311
- Issue
- 10
- Pages
- 1023
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC4083455
- OpenAlex
- W2151316027
- Semantic Scholar
- c7221d0dc04ee3d48408809eb8d70e3f407683d0
- Cited by
- 428
- References
- 53
- Citations by year
- 2026: 21 · 2025: 34 · 2024: 31 · 2023: 35 · 2022: 31 · 2021: 40 · 2020: 51 · 2019: 37 · 2018: 41 · 2017: 37 · 2016: 38 · 2015: 16 · 2014: 13 · 2012: 1
- FWCI
- 28.81
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Pfizer
- GlaxoSmithKline
- Boston Scientific Corporation
- Astellas Pharma
- National Institutes of Health
- National Institute of Child Health and Human Development
- Office of Research on Women's Health
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10HD041261, U10HD054136, UG1HD041261, HD054214, U10HD054214, U01HD041249, U10HD054215, UG1HD054215, HD054241, U10HD069006, U01HD069031, HD041267, U10HD041267, U10HD054241, HD069031, HD041261, U10HD041250, UG1HD054214, UG1HD054241, UG1HD041267)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Keywords
- apical vaginal prolapse, sacrospinous ligament fixation, uterosacral ligament suspension, pelvic floor muscle training, stress urinary incontinence, midurethral sling, surgical success, pelvic organ prolapse, women's health, surgical outcomes comparison, retreatment
- MeSH terms
- Adult, Aged, Aged, 80 and over, Behavior Therapy, Exercise Therapy, Female, Humans, Middle Aged, Gynecologic Surgical Procedures, Urinary Incontinence, Stress, Urination, Uterine Prolapse, Treatment Outcome, Pelvic Floor, Suburethral Slings
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