Genital prolapse in women
INTRODUCTION: Prolapse of the uterus or vagina is usually the result of loss of pelvic support, and causes mainly non-specific symptoms. It may affect over half of women aged 50 to 59 years, but spontaneous regression may occur. Risks of genital prolapse increase with advancing parity and age, increasing weight of the largest baby delivered, and hysterectomy. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments in women with genital prolapse? What are the effects of surgical treatments in women with anterior vaginal wall prolapse? What are the effects of surgical treatments in women with posterior vaginal wall prolapse? What are the effects of surgical treatments in women with upper vaginal wall prolapse? What are the effects of using different surgical materials in women with genital prolapse? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review, we present information relating to the effectiveness and safety of the following interventions: abdominal Burch colposuspension; abdominal sacral colpopexy; abdominal sacrohysteropexy; anterior colporrhaphy with mesh reinforcement; laparoscopic surgery; mesh or synthetic grafts; native (autologous) tissue; open abdominal surgery; pelvic floor muscle exercises; posterior colporrhaphy (with or without mesh reinforcement); posterior intravaginal slingplasty (infracoccygeal sacropexy); sacrospinous colpopexy (vaginal sacral colpopexy); sutures; traditional anterior colporrhaphy; transanal repair; ultralateral anterior colporrhaphy alone or with cadaveric fascia patch; vaginal hysterectomy; vaginal oestrogen; vaginal pessaries; and vaginal sacrospinous colpopexy.
Onwude JL. Genital prolapse in women. Clinical Evidence 2012; 03:817.
Vaginal oestrogen One Cochrane systematic review added. Categorisation unchanged (Unknown effectiveness), as there remains insufficient evidence to assess the effectiveness of this intervention.
Traditional anterior colporrhaphy versus abdominal Burch colposuspension in women with anterior vaginal wall prolapse One systematic review updated, new data added. Categorisation unchanged (Beneficial).
Anterior colporrhaphy with mesh reinforcement versus traditional anterior colporrhaphy in women with anterior vaginal wall prolapse New evidence added, and one Cochrane systematic review updated. Categorisation unchanged (Beneficial).
Posterior colporrhaphy with mesh versus posterior colporrhaphy without mesh reinforcement in women with posterior vaginal wall prolapse New evidence added, including one updated Cochrane systematic review, which added no new trials. Categorisation changed from Unlikely to be beneficial to Unknown Effectiveness.
Abdominal sacral colpopexy versus sacrospinous colpopexy One Cochrane systematic review updated. New data added. Categorisation unchanged (Beneficial).
Different types of suture versus each other One systematic review updated. New data added. Categorisation unchanged (Unknown effectiveness).