For women undergoing surgery for vaginal prolapse and stress urinary incontinence, outcomes for two common transvaginal approaches are comparable, and perioperative behavioral therapy with pelvic floor muscle training (BPMT) does not improve surgical outcomes, according to a study published in the Journal of the American Medical Association.
Matthew D. Barber, M.D., M.H.S., from the Cleveland Clinic, and colleagues compared outcomes for sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) and for perioperative BPMT versus usual care for 374 women undergoing surgery for vaginal prolapse. Participants were randomized to SSLF (186 women) or ULS (188 women) and to perioperative BPMT or usual care (186 and 188 women, respectively).
The researchers observed no significant associations between surgical group and surgical success rates (adjusted odds ratio [aOR], 0.9; 95 percent confidence interval [CI], 0.6 to 1.5) or serious adverse events (aOR, 0.9; 95 percent CI, 0.5 to 1.6). There was no evidence of greater improvement in urinary scores at six months, prolapse scores at 24 months, or anatomic success at 24 months with perioperative BPMT.
“Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS nor SSLF was significantly superior to the other for anatomic, functional, or adverse event outcomes,” the authors write. “Perioperative BPMT did not improve urinary symptoms at six months or prolapse outcomes at two years.”
Several authors disclosed financial ties to the pharmaceutical and medical device industries.