MAYWOOD – Two common procedures to treat pelvic organ prolapse without vaginal mesh are comparable in safety and efficacy, according to research published in the latest issue of the Journal of the American Medical Association. Researchers also found that behavioral and pelvic floor muscle therapy (BPMT) did not improve urinary incontinence or prolapse symptoms in affected women.
Pelvic organ prolapse occurs when the uterus and/or vaginal walls protrude outside of the body. Up to 73 percent of these women report other pelvic floor disorders such as incontinence. More then 300,000 surgeries are performed annually in the United States to correct pelvic organ prolapse. Two common prolapse procedures evaluated in this study included uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF).
"Little has been known until now about how these procedures compare to each other," said Linda Brubaker, MD, MS, study co-author and dean, Loyola University Chicago Stritch School of Medicine. "This study provides guidance to physicians on the benefits and risks of two widely used surgical interventions without vaginal prolapse mesh."
This study evaluated 374 women. A portion of the women underwent the ULS procedure (n = 188) while the other group had the SSLF surgery (n = 186). Success rates (59.2 percent versus 60.5 percent) and adverse events (16.5 percent versus 16.7 percent) were similar two years following the surgeries.
BPMT is an effective treatment for pelvic floor symptoms, which includes pelvic floor muscle training, individualized progressive pelvic floor muscle exercises and education on behavioral strategies to reduce incontinence. However, BPMT was not associated with greater improvements in incontinence symptoms at 6 months or prolapse at 2 years compared with usual care in study participants. Usual care included routine teaching and standardized postoperative instructions.
Other study authors included: Matthew D. Barber MD, Cleveland Clinic; Kathryn L. Burgio, PhD, University of Alabama at Birmingham and Department of Veterans Affairs; Holly E. Richter, PhD, MD, University of Alabama at Birmingham; Ingrid Nygaard, MD, University of Utah Medical Center; Alison C. Weidner, MD, Duke University Medical Center; Shawn A. Menefee, Southern California Kaiser Permanente; Emily S. Lukacz, MD, University of California-San Diego Health Systems; Peggy Norton, MD, University of Utah Medical Center; Joseph Schaffer, MD, University of Texas-Southwestern; John N. Nguyen, MD, Southern California Kaiser Permanente; Diane Borello-France PhD, Duquesne University; Patricia S. Goode, MD, University of Alabama at Birmingham and Department of Veterans Affairs; Sharon Jakus-Waldman, MD, Southern California Kaiser Permanente; Cathie Spino, ScD, University of Michigan; Lauren Klein Warren, MS, RTI International; Marie G. Gantz, PhD, RTI International; Susan F. Meikle, MD, Eunice Kennedy Shriver National Institute of Child Health and Human Development for the NICHD Pelvic Floor Disorders Network.
Journal
JAMA