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International Urogynecology Journal
Published in: International Urogynecology Journal 12/2017

Open Access 01-12-2017 | Review Article

The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis

Authors: Anne-Lotte W. M. Coolen, Bich Ngoc Bui, Viviane Dietz, Rui Wang, Aafke P. A. van Montfoort, Ben Willem J. Mol, Jan-Paul W. R. Roovers, Marlies Y. Bongers

Published in: International Urogynecology Journal | Issue 12/2017

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Abstract

Introduction and hypothesis

The treatment of post-hysterectomy vaginal vault prolapse (VVP) has been investigated in several randomized clinical trials (RCTs), but a systematic review of the topic is still lacking. The aim of this study is to compare the effectiveness of treatments for VVP.

Methods

We performed a systematic review and meta-analysis of the literature on the treatment of VVP found in PubMed and Embase. Reference lists of identified relevant articles were checked for additional articles. A network plot was constructed to illustrate the geometry of the network of the treatments included. Only RCTs reporting on the treatment of VVP were eligible, conditional on a minimum of 30 participants with VVP and a follow-up of at least 6 months.

Results

Nine RCTs reporting 846 women (ranging from 95 to 168 women) met the inclusion criteria. All surgical techniques were associated with good subjective results, and without differences between the compared technique, with the exception of the comparison of vaginal mesh (VM) vs laparoscopic sacrocolpopexy (LSC). LSC is associated with a higher satisfaction rate. The anatomical results of the sacrocolpopexy (laparoscopic, robotic [RSC]. and abdominal [ASC]) are the best (62–91%), followed by the VM. However, the ranges of the anatomical outcome of VM were wide (43–97%). The poorest results are described for the sacrospinal fixation (SSF; 35–81%), which also correlates with the higher reoperation rate for pelvic organ prolapse (POP; 5–9%). The highest percentage of complications were reported after ASC (2–19%), VM (6–29%), and RSC (54%). Mesh exposure was seen most often after VM (8–21%). The rate of reoperations carried out because of complications, recurrence prolapse, and incontinence of VM was 13–22%. Overall, sacrocolpopexy reported the best results at follow-up, with an outlier of one trial reporting the highest reoperation rate for POP (11%). The results of the RSC are too small to make any conclusion, but LSC seems to be preferable to ASC.

Conclusions

A comparison of techniques was difficult because of heterogeneity; therefore, a network meta-analysis was not possible. All techniques have proved to be effective. The reported differences between the techniques were negligible. Therefore, a standard treatment for VVP could not be given according to this review.
Appendix
Available only for authorised users
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Metadata
Title
The treatment of post-hysterectomy vaginal vault prolapse: a systematic review and meta-analysis
Authors
Anne-Lotte W. M. Coolen
Bich Ngoc Bui
Viviane Dietz
Rui Wang
Aafke P. A. van Montfoort
Ben Willem J. Mol
Jan-Paul W. R. Roovers
Marlies Y. Bongers
Publication date
01-12-2017
Publisher
Springer London
Published in
International Urogynecology Journal / Issue 12/2017
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-017-3493-2

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