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Cited by 80Pelvic floor disorders treatmentsUterine Myomas and TreatmentsHernia repair and management

The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis

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Coolen, Anne-Lotte W. M., Bui, Bich Ngoc, Dietz, Viviane, Wang, Rui, van Montfoort, Aafke P. A., Mol, Ben Willem J., Roovers, Jan-Paul W. R., Bongers, Marlies Y.·2017·International Urogynecology Journal
DOI 10.1007/s00192-017-3493-2PMC PMC5705749
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Abstract

INTRODUCTION AND HYPOTHESIS: The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic is still lacking. The aim of this study is to compare the effectiveness of treatments for VVP. METHODS: We performed a systematic review and meta-analysis of the literature on the treatment of VVP found in PubMed and Embase. Reference lists of identified relevant articles were checked for additional articles. A network plot was constructed to illustrate the geometry of the network of the treatments included. Only RCTs reporting on the treatment of VVP were eligible, conditional on a minimum of 30 participants with VVP and a follow-up of at least 6 months. RESULTS: Nine RCTs reporting 846 women (ranging from 95 to 168 women) met the inclusion criteria. All surgical techniques were associated with good subjective results, and without differences between the compared technique, with the exception of the comparison of vaginal mesh (VM) vs laparoscopic sacrocolpopexy (LSC). LSC is associated with a higher satisfaction rate. The anatomical results of the sacrocolpopexy (laparoscopic, robotic [RSC]. and abdominal [ASC]) are the best (62-91%), followed by the VM. However, the ranges of the anatomical outcome of VM were wide (43-97%). The poorest results are described for the sacrospinal fixation (SSF; 35-81%), which also correlates with the higher reoperation rate for pelvic organ prolapse (POP; 5-9%). The highest percentage of complications were reported after ASC (2-19%), VM (6-29%), and RSC (54%). Mesh exposure was seen most often after VM (8-21%). The rate of reoperations carried out because of complications, recurrence prolapse, and incontinence of VM was 13-22%. Overall, sacrocolpopexy reported the best results at follow-up, with an outlier of one trial reporting the highest reoperation rate for POP (11%). The results of the RSC are too small to make any conclusion, but LSC seems to be preferable to ASC. CONCLUSIONS: A comparison of techniques was difficult because of heterogeneity; therefore, a network meta-analysis was not possible. All techniques have proved to be effective. The reported differences between the techniques were negligible. Therefore, a standard treatment for VVP could not be given according to this review.

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  • Sacrospinous ligament fixation is a safe, low-cost, and effective procedure in the management of apical prolapse.

    “Studies have shown sacrospinous ligament fixation as a safe, low-cost, and effective procedure in the management of apical prolapse [9,14-17].”

    From Recurrence Rate and Risk Factors for Apical Prolapse After Sacrospinous Ligament Fixation: A Prospective Cohort Study (2026) · cites this paper as [9]

    The Results > Meta-analysis reports one complication in the sacrospinous fixation group versus three with vaginal mesh, and the Discussion > Reoperation cautiously concludes that all techniques are effective for the post-hysterectomy vault prolapse studied. The paper does not establish that sacrospinous fixation is low-cost, and its Abstract > Results reports the poorest anatomical outcomes for that technique among those reviewed. Pages were not provided in our copy. (LLM, conf=0.88)

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  1. [4]Detollenaere RJ den Boon J Vierhout ME van Eijndhoven HWF Uterussparende chirurgie versus vaginale hysterectomie als behandeling van descensus uteri Ned Tijdschr Geneeskd 2011 155 A3623 22027462

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Authors
Coolen, A.-L. W. M., Bui, B. N., Dietz, V., Wang, R., van Montfoort, A. P. A., Mol, B. W. J., Roovers, J.-P. W. R., & Bongers, M. Y.
Affiliations
  • Máxima Medisch Centrum (NL)
  • Catharina Ziekenhuis (NL)
  • The University of Adelaide (AU)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Maastricht University (NL)
Corresponding author
Coolen, Anne-Lotte W. M.
ORCID
Venue
International Urogynecology Journal
Publisher
Springer Science and Business Media LLC
Published
2017-10-16
Volume
28
Issue
12
Pages
1767-1783
ISSN
  • 0937-3462 (ISSN-L)
  • 1433-3023
DOI
10.1007/s00192-017-3493-2
PMC
PMC5705749
OpenAlex
W2766887831
Cited by
80
References
35
Citations by year
2026: 6 · 2025: 9 · 2024: 8 · 2023: 7 · 2022: 12 · 2021: 9 · 2020: 15 · 2019: 10 · 2018: 4
FWCI
1.28
Type
journal article
Language
en
Open access
Licence
Locations
  • International Urogynecology Journal (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
Funders
Maastricht University
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Surgery › Hernia repair and management
Keywords
vaginal vault prolapse, hysterectomy complications, sacrocolpopexy, vaginal mesh, abdominal sacrocolpopexy, robotic sacrocolpopexy, pelvic organ prolapse, reoperation rate, mesh exposure, postoperative complications, patient satisfaction, network meta-analysis, treatment comparison
MeSH terms
Female, Humans, Hysterectomy, Laparoscopy, Postoperative Complications, Sacrum, Gynecologic Surgical Procedures, Surgical Mesh, Vagina, Treatment Outcome, Pelvic Organ Prolapse

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