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Cited by 54Pelvic floor disorders treatmentsUterine Myomas and TreatmentsUreteral procedures and complications

Surgical Management of Symptomatic Apical Pelvic Organ Prolapse: A Systematic Review and Meta-analysis

Larouche, Maryse, Belzile, Eric, Geoffrion, Roxana·2021·Obstetrics & Gynecology
DOI 10.1097/aog.0000000000004393
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Abstract

OBJECTIVE: To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP). DATA SOURCES: MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002–2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English. METHODS OF STUDY SELECTION: From 2,665 records, we included randomized controlled trials and comparative studies of interventions with or without hysterectomy, including abdominal apical reconstruction through open, laparoscopic, or robotic approaches and vaginal apical reconstructions. Repairs using transvaginal mesh, off-the-market products, procedures without apical suspension, and follow-up less than 6 months were excluded. TABULATION, INTEGRATION, AND RESULTS: Relative risk (RR) was used to estimate the effect of surgical procedure on each outcome. For each outcome and comparison, a meta-analysis was conducted to pool the RRs when possible. Meta-regression and bias tests were performed when appropriate. The GRADE (Grades for Recommendation, Assessment, Development and Evaluation) system for quality rating and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting were used. Sixty-two articles were included in the review (N=22,792) and 50 studies in the meta-analyses. There was heterogeneity in study quality, techniques used, and outcomes reported. Median follow-up was 1–5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22–2.74 and RR 2.70, 95% CI 1.33–5.50) (moderate), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47–0.75 and RR 0.59, 95% CI 0.44–0.80, respectively) (low). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures. CONCLUSION: Despite variations in anatomic outcomes, subjective outcomes and complications were similar for apical POP procedures at 1–5 years. Standardization of outcome reporting and comparative studies with longer follow-up are urgently needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019133869.

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Crossref · 10.1097/aog.0000000000004393

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Authors
Larouche, M., Belzile, E., & Geoffrion, R.
Affiliations
University of British Columbia (CA)
ORCID
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-05-04
Volume
137
Issue
6
Pages
1061-1073
ISSN
0029-7844 (ISSN-L)
DOI
10.1097/aog.0000000000004393
OpenAlex
W3158380852
Cited by
54
References
78
Citations by year
2026: 9 · 2025: 10 · 2024: 11 · 2023: 14 · 2022: 7 · 2021: 3
FWCI
1.43
Type
journal article
Language
en
Update notices
correction (2023-08-01)
Open access
closed
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Ureteral procedures and complications
Keywords
pelvic organ prolapse, apical pelvic organ prolapse, uterine prolapse, vaginal vault prolapse, apical suspension, sacrocolpopexy, hysterectomy, hysteropexy, prolapse recurrence, surgical complications, minimally invasive surgery, robotic surgery, laparoscopic surgery, anatomical success, subjective outcomes, reintervention
MeSH terms
Female, Humans, Hysterectomy, Laparoscopy, Postoperative Complications, Recurrence, Reoperation, Sacrum, Surgical Mesh, Vagina, Randomized Controlled Trials as Topic, Plastic Surgery Procedures, Pelvic Organ Prolapse, Observational Studies as Topic, Robotic Surgical Procedures

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