MAYWOOD, Ill. – 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 than 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 group of these 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. BPMT includes pelvic-floor-muscle training, individualized and 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 six months or prolapse at two years compared with usual care in study participants. Usual care included routine teaching and standardized post-operative 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 Health Care; 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 System; Peggy Norton, MD, University of Utah Health Care; 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.
Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola’s Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.