Prolapse Procedures Show Comparable Efficacy

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A study found similar success rates with ligament suspension and ligament fixation.
A study found similar success rates with ligament suspension and ligament fixation.

Two common transvaginal surgical approaches for the treatment of pelvic organ prolapse lead to similar outcomes, according to a new study.

“Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS [uterosacral ligament suspension] nor SSLF [sacrospinous ligament fixation] was significantly superior to the other for anatomic, functional, or adverse event outcomes,” concluded Linda Brubaker, MD, MS, dean of the Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, and coauthors in JAMA (2014;311:1023-1034).

As Dr. Brubaker and colleagues noted in their report, ULS and SSLF are transvaginal surgeries commonly performed to correct apical prolapse, yet little is known about how they compare with each other in terms of efficacy and safety.

To learn more, the investigators randomized 374 women with both apical vaginal prolapse and stress urinary incontinence to either SSLF (186 women) or ULS (188 women), performed at one of nine U.S. medical centers from 2008 to 2013.

The primary outcome of surgical success was defined as no apical descent greater than one-third into the vaginal canal or the anterior or posterior vaginal wall behind the hymen (anatomic success); no bothersome vaginal bulge symptoms; and no retreatment for prolapse at the two-year mark.

The two-year follow-up rate was 84.5%. At that time, surgical success rates were 60.5% for SSLF and 59.2% for ULS. Rates of serious adverse events were also very close, at 16.7% for SSLF and 16.5% for ULS.

Dr. Brubaker's group also used the study to determine whether perioperative behavioral therapy with pelvic floor muscle training (BPMT) improves outcomes of prolapse surgery compared with usual care. For this part of the project, the participants were randomized to perioperative BPMT (186 women) or to usual care (188 women). BPMT involved one visit two to four weeks before surgery and four postoperative visits.

At each visit, women in this group underwent pelvic floor muscle training, individualized progressive pelvic floor muscle exercise, and education on behavioral strategies to reduce urinary and colorectal symptoms. Usual care included routine perioperative teaching and standardized postoperative instructions.

Primary outcomes for this part of the study were urinary symptom scores at six months, prolapse symptom scores at two years, and anatomic success at two years. The researchers found that perioperative BPMT did not significantly improve any of these measures compared with usual care.

Dr. Brubaker's team pointed out that although their results do not support routinely offering perioperative BPMT to women undergoing vaginal surgery for prolapsed and stress urinary incontinence, previous evidence “supports offering individualized treatment, including behavioral or physical therapy, to those who report new or unresolved pelvic floor symptoms.”

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