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International Urogynecology Journal
Published in: International Urogynecology Journal 2/2014

01-02-2014 | Review Article

Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis

Authors: Mahdyie Doaee, Maziar Moradi-Lakeh, Abbas Nourmohammadi, Seid Kazem Razavi-Ratki, Marzieh Nojomi

Published in: International Urogynecology Journal | Issue 2/2014

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Abstract

Introduction and hypothesis

One of the main outcomes in the assessment of the treatment of pelvic organ prolapse in women is quality of life. Using quality of life as an outcome measure is increasing in the majority of clinical trials. The aim of current study was to determine the effects of the treatment of pelvic organ prolapse on patients’ quality of life using systematic review and meta-analysis.

Methods

A systematic search for finding randomized controlled studies on pelvic organ prolapse published before October 2012 was conducted. The JAMA users’ guide to the medical literature quality assessment scales for randomized clinical trials was used to assess the quality of included articles. The mean difference in total quality of life score between before and after intervention (surgical or pelvic floor training) with 95 % confidence interval (CI) was considered as a primary summary measure. Egger’s test was used to evaluate the publication bias. Heterogeneity was assessed using I2 Index.

Results

Fifty-seven RCT were critically appraised. Thirty-two articles were eligible after critical evaluation. Mean difference in change in the total quality of life score with 95 % CI for surgical treatment was 74.03 (66.3–81.6) by PFDI-20 and was 44.57 (22.53–66.65) by PFIQ-7. The mean difference in changed in the total quality of life score with 95 % CI was 1.32 (−2.8–5.4) for pelvic floor training (PFT).

Conclusion

We found that surgical interventions on prolapse can improve the quality of life of women. There was a relative effect of PFT on the quality of life of women with prolapse in systematic review. This effect was not seen in meta-analysis, probably because of finding few eligible studies to pool the effect size.
Literature
1.
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. (2010) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 21(1):5–26
2.
Hagen S, Stark D, Glazener C, Sinclair L, Ramsay I (2009) A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 20(1):45–51PubMedCrossRef
3.
Ghanbari Z, Eftekhar T, Goodarzi SH, Haj Baratali B, Bashiri SA, Shariat M (2009) Posterior intravaginal slingplastyversus abdominal sacrocolpopexy for the treatment of vaginal prolapse. Tehran Univ Med J (TUMJ) 67(3):215–220
4.
Elias Kovoor PH (2008) Assessment and management of pelvic organ prolapse. Obstet Gynaecol Reprod Med 18(9):241–246CrossRef
5.
Borello-France DFHV, Brown MB, Goode P, Kreder K, Scheufele LL, Weber AM (2007) Pelvic-floor muscle function in women with pelvic organ prolapse. Phys Ther 87(4):399–407PubMedCrossRef
6.
Smith DA (2007) Pelvic organ prolapse. A new option offers effectiveness and ease of use. Adv Nurse Pract 15(8):39–42PubMed
7.
8.
Abdel-Fattah M, Ramsay I, Pringle S, Hardwick C, Ali H, Young D et al (2011) Evaluation of transobturator tension-free vaginal tapes in management of women with recurrent stress urinary incontinence. Urology 77(5):1070–1075PubMedCrossRef
9.
Sotirios Vimplis PH (2005) Assessment and management of pelvic organ prolapse. Curr Obstet Gynaecol 15:387–393CrossRef
10.
Natale F, La Penna C, Padoa A, Agostini M, Panei M, Cervigni M (2010) High levator myorraphy versus uterosacral ligament suspension for vaginal vault fixation: a prospective, randomized study. Int Urogynecol J 21(5):515–522PubMedCrossRef
11.
Jelovsek JEBM (2006) Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol 194(5):1455–1461PubMedCrossRef
12.
Hagen S, Stark D (2011) Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev 7(12):CD003882
13.
Lopes ED, Lemos NL, Carramao Sda S, Lunardelli JL, Ruano JM, Aoki T et al (2010) Transvaginal polypropylene mesh versus sacrospinous ligament fixation for the treatment of uterine prolapse: 1-year follow-up of a randomized controlled trial. Int Urogynecol J 21(4):389–394PubMedCrossRef
14.
Stüpp L, Resende AP, Oliveira E, Castro RA, Girao MJ, Sartori MG (2011) Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J 22(10):1233–1239PubMedCrossRef
15.
Hendrix SLCA, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166PubMedCrossRef
16.
Paraiso MF, Jelovsek JE, Frick A, Chen CC, Barber MD (2011) Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol 118(5):1005–1013PubMedCrossRef
17.
Sokol AI, Iglesia CB, Kudish BI, Gutman RE, Shveiky D, Bercik R et al (2012) One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. Am J Obstet Gynecol 206(1):86 e1–86 e9
18.
Nguyen JN, Burchette RJ (2008) Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol 111(4):891–898PubMedCrossRef
19.
Paraiso MF, Barber MD, Muir TW, Walters MD (2006) Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol 195(6):1762–1771PubMedCrossRef
20.
Iglesia CB, Sokol AI, Sokol ER, Kudish BI, Gutman RE, Peterson JL et al (2010) Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol 116(2 Pt 1):293–303PubMedCrossRef
21.
Manonai J, Harnsomboon T, Sarit-apirak S, Wattanayingcharoenchai R, Chittacharoen A, Suthutvoravut S (2012) Effect of Colpexin Sphere on pelvic floor muscle strength and quality of life in women with pelvic organ prolapse stage I/II: a randomized controlled trial. Int Urogynecol J 23(3):307–312PubMedCrossRef
22.
Dinnes JDJ, Kirby J, Roderick P (2005) A methodological review of how heterogeneity has been examined in systematic reviews of diagnostic test accuracy. Health Technol Assess 9(12):1–113
23.
Huedo-Medina T, Sanchez-Meca J, Marin-Martinez, F, Botella, J (2006) Assessing heterogeneity in metaanalysis: Q statistic or I2 index? CHIP Documents. Paper 19
24.
Sivaslioglu AA, Unlubilgin E, Dolen I (2008) A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct 19(4):467–471PubMedCrossRef
25.
Roovers JP, van der Bom JG, van der Vaart CH, van Leeuwen JH, Scholten PC, Heintz AP (2005) A randomized comparison of post-operative pain, quality of life, and physical performance during the first 6 weeks after abdominal or vaginal surgical correction of descensus uteri. Neurourol Urodyn 24(4):334–340PubMedCrossRef
26.
Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ (2004) Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 190(1):20–26PubMedCrossRef
27.
Guerette NL, Peterson TV, Aguirre OA, VanDrie DM, Biller DH, Davila GW (2009) Anterior repair with or without collagen matrix reinforcement a randomized controlled trial. Obstet Gynecol 114(1):59–65PubMed
28.
Feldner PC Jr, Castro RA, Cipolotti LA, Delroy CA, Sartori MG, Girao MJ (2010) Anterior vaginal wall prolapse: a randomized controlled trial of SIS graft versus traditional colporrhaphy. Int Urogynecol J 21(9):1057–1063PubMedCrossRef
29.
Natale F, La Penna C, Padoa A, Agostini M, De Simone E, Cervigni M (2009) A prospective, randomized, controlled study comparing Gynemesh®, a synthetic mesh, and Pelvicol®, a biologic graft, in the surgical treatment of recurrent cystocele. Int Urogynecol J Pelvic Floor Dysfunct 20(1):75–81PubMedCrossRef
30.
Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M (2008) Burch colposuspension does not provide any additional benefit to pelvic organ prolapse repair in patients with urinary incontinence: a randomized surgical trial. J Urology 180(3):1007–1012CrossRef
31.
Brækken IH, Majida M, Engh ME, Bø K (2010) Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol 203(2):170.e1–170.e7
32.
Menefee SA, Dyer KY, Lukacz ES, Simsiman AJ, Luber KM, Nguyen JN (2011) Colporrhaphy compared with mesh or graft-reinforced vaginal paravaginal repair for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol 118(6):1337–1344PubMedCrossRef
33.
Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A et al (2008) Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet Gynecol 112(6):1253–1261PubMedCrossRef
34.
De Tayrac R, Mathé ML, Bader G, Deffieux X, Fazel A, Fernandez H (2008) Infracoccygeal sacropexy or sacrospinous suspension for uterine or vaginal vault prolapse. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 100(2):154–159CrossRef
35.
Paraiso MF, Walters MD, Karram MM, Barber MD (2004) Laparoscopic Burch colposuspension versus tension-free vaginal tape: a randomized trial. Obstet Gynecol 104(6):1249–1258PubMedCrossRef
36.
Maher CF, Feiner B, DeCuyper EM, Nichlos CJ, Hickey KV, O’Rourke P (2011) Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol 204(4):360 e1–360 e7
37.
Dietz V, van der Vaart CH, van der Graaf Y, Heintz P, Schraffordt Koops SE (2010) One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J 21(2):209–216PubMedCentralPubMedCrossRef
38.
Costantini E, Lazzeri M, Bini V, Del Zingaro M, Zucchi A, Porena M (2011) Pelvic organ prolapse repair with and without prophylactic concomitant Burch colposuspension in continent women: a randomized, controlled trial with 8-year followup. J Urol 185(6):2236–2240PubMedCrossRef
39.
Jarvis SK, Hallam TK, Lujic S, Abbott JA, Vancaillie TG (2005) Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: results of a randomised controlled trial. Aust N Z J Obstet Gynaecol 45(4):300–303PubMedCrossRef
40.
Frawley HC, Phillips BA, Bo K, Galea MP (2010) Physiotherapy as an adjunct to prolapse surgery: an assessor-blinded randomized controlled trial. Neurourol Urodynam 29(5):719–725CrossRef
41.
Vollebregt A, Fischer K, Gietelink D, van der Vaart CH (2011) Primary surgical repair of anterior vaginal prolapse: a randomised trial comparing anatomical and functional outcome between anterior colporrhaphy and trocar-guided transobturator anterior mesh. BJOG Int J Obstet Gynaecol 118(12):1518–1527CrossRef
42.
Ward KL, Hilton P, UK and Ireland TVT Trial Group (2008) Tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence: 5-year follow up. BJOG Int J Obstet Gynaecol 115(2):226–233CrossRef
43.
Schierlitz L, Dwyer PL, Rosamilia A, Murray C, Thomas E, De Souza A et al (2012) Three-year follow-up of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency. Obstet Gynecol 119(2 Pt 1):321–327PubMedCrossRef
44.
Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME (2011) Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol 117(2 Pt 1):242–250PubMedCrossRef
45.
Carey M, Higgs P, Goh J, Lim J, Leong A, Krause H et al (2009) Vaginal repair with mesh versus colporrhaphy for prolapse: a randomised controlled trial. BJOG Int J Obstet Gynaecol 116(10):1380–1386CrossRef
46.
Madhuvrata P, Glazener C, Boachie C, Allahdin S, Bain C (2011) A randomised controlled trial evaluating the use of polyglactin (Vicryl) mesh, polydioxanone (PDS) or polyglactin (Vicryl) sutures for pelvic organ prolapse surgery: outcomes at 2 years. J Obstet Gynaecol 31(5):429–435PubMedCrossRef
47.
Guerette NL, Peterson T, Aguirre OA, Vandrie DM, Biller DH, Davila GW (2009) Anterior repair with or without collagen matrix reinforcement: a randomized controlled trial. Obstet Gynecol 114(1):59–65PubMed
48.
Bui CBM, Chereau E, Guillo E, Darai E (2010) Résultats fonctionnels et qualité de vie après double promontofixation coelioscopique pour la cure du prolapsus génital. Gynecol Obstet Fertil 38(10):563–568PubMedCrossRef
49.
Cundiff GW, Amundsen CL, Bent AE, Coates KW, Schaffer JI, Strohbehn K et al (2007) The PESSRI study: symptom relief outcomes of a randomized crossover trial of the ring and Gellhorn pessaries. Am J Obstet Gynecol 196(4):405 e1–405 e8CrossRef
50.
Culligan PJ, Goldberg RP, Sand PK (2003) A randomized controlled trial comparing a modified Burch procedure and a suburethral sling: long-term follow-up. Int Urogynecol J Pelvic Floor Dysfunct 14(4):229–233, discussion 233PubMedCrossRef
51.
Ghroubi S, Kharrat O, Chaari M, Ben Ayed B, Guermazi M, Elleuch MH (2008) Effect of conservative treatment in the management of low-degree urogenital prolapse. Ann Readapt Med Phys 51(2):96–102PubMedCrossRef
Metadata
Title
Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis
Authors
Mahdyie Doaee
Maziar Moradi-Lakeh
Abbas Nourmohammadi
Seid Kazem Razavi-Ratki
Marzieh Nojomi
Publication date
01-02-2014
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 2/2014
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-013-2141-8

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