Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report

Cornelia Betschart, Mauro Cervigni, Oscar Contreras Ortiz, Stergios K. Doumouchtsis, Masayasu Koyama, Carlos Medina, Jorge Milhem Haddad, Filippo la Torre, Giuliano Zanni

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Aim: Apical prolapse includes descent of the uterus, vagina cuff, or rarely solely of the cervix. It is estimated that women have an 11-19% life-time risk of undergoing surgery for POP. This rate is projected to increase over the next 2-3 decades. In this FIGO working group report we address the conservative and surgical treatment options for apical prolapse. Methods: The FIGO working group "Pelvic Floor Medicine and Reconstructive Surgery" describes the different treatments for apical prolapse based on the literature evidence, the cost-effectiveness, the degree of difficulty and summed them up with an experts recommendation. Results: Among the conservative treatment options, pessaries are the most successful options since centuries with a low complication rate and low costs. Among the vaginal operative procedures the sacrospinous ligament fixation (SSLF) and the uterosacral ligament suspension (USLS) show comparable outcomes and efficacy with a different, however, rather low complication pattern and a favorable cost-benefit profile. Sacrocolpopexy, independent on the open abdominal, laparoscopic, or robotic-assisted laparoscopic technique has a good durability and quality of life performance. The minimal invasive techniques are as effective as the open abdominal techniques and there is no difference in mesh exposure. Conclusion: Vaginal procedures are well described procedures with favorable outcomes and cost-benefit profiles. Sacral colpopexy has a high-effectivity; data on the route of performance and long-term outcome are awaited. The cost with mesh implants are higher compared to the operations with autologous tissue or any conservative treatment and further studies are recommended to evaluate the cure rates in the span of decades and the possible long-term mesh complications.

Original languageEnglish (US)
JournalNeurourology and Urodynamics
DOIs
StateAccepted/In press - 2015

Fingerprint

Uterine Prolapse
Prolapse
Cost-Benefit Analysis
Ligaments
Reconstructive Surgical Procedures
Pessaries
Costs and Cost Analysis
Pelvic Floor
Operative Surgical Procedures
Robotics
Vagina
Cervix Uteri
Uterus
Suspensions
Quality of Life
Medicine
Conservative Treatment
Therapeutics

Keywords

  • Apical compartment
  • Conservative treatment
  • International Federation of Gynecology and Obstetrics (FIGO)
  • Pelvic organ prolapse (POP)
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Urology

Cite this

Betschart, C., Cervigni, M., Contreras Ortiz, O., Doumouchtsis, S. K., Koyama, M., Medina, C., ... Zanni, G. (Accepted/In press). Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report. Neurourology and Urodynamics. https://doi.org/10.1002/nau.22916

Management of apical compartment prolapse (uterine and vault prolapse) : A FIGO Working Group report. / Betschart, Cornelia; Cervigni, Mauro; Contreras Ortiz, Oscar; Doumouchtsis, Stergios K.; Koyama, Masayasu; Medina, Carlos; Haddad, Jorge Milhem; la Torre, Filippo; Zanni, Giuliano.

In: Neurourology and Urodynamics, 2015.

Research output: Contribution to journalArticle

Betschart, C, Cervigni, M, Contreras Ortiz, O, Doumouchtsis, SK, Koyama, M, Medina, C, Haddad, JM, la Torre, F & Zanni, G 2015, 'Management of apical compartment prolapse (uterine and vault prolapse): A FIGO Working Group report', Neurourology and Urodynamics. https://doi.org/10.1002/nau.22916
Betschart, Cornelia ; Cervigni, Mauro ; Contreras Ortiz, Oscar ; Doumouchtsis, Stergios K. ; Koyama, Masayasu ; Medina, Carlos ; Haddad, Jorge Milhem ; la Torre, Filippo ; Zanni, Giuliano. / Management of apical compartment prolapse (uterine and vault prolapse) : A FIGO Working Group report. In: Neurourology and Urodynamics. 2015.
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T2 - A FIGO Working Group report

AU - Betschart, Cornelia

AU - Cervigni, Mauro

AU - Contreras Ortiz, Oscar

AU - Doumouchtsis, Stergios K.

AU - Koyama, Masayasu

AU - Medina, Carlos

AU - Haddad, Jorge Milhem

AU - la Torre, Filippo

AU - Zanni, Giuliano

PY - 2015

Y1 - 2015

N2 - Aim: Apical prolapse includes descent of the uterus, vagina cuff, or rarely solely of the cervix. It is estimated that women have an 11-19% life-time risk of undergoing surgery for POP. This rate is projected to increase over the next 2-3 decades. In this FIGO working group report we address the conservative and surgical treatment options for apical prolapse. Methods: The FIGO working group "Pelvic Floor Medicine and Reconstructive Surgery" describes the different treatments for apical prolapse based on the literature evidence, the cost-effectiveness, the degree of difficulty and summed them up with an experts recommendation. Results: Among the conservative treatment options, pessaries are the most successful options since centuries with a low complication rate and low costs. Among the vaginal operative procedures the sacrospinous ligament fixation (SSLF) and the uterosacral ligament suspension (USLS) show comparable outcomes and efficacy with a different, however, rather low complication pattern and a favorable cost-benefit profile. Sacrocolpopexy, independent on the open abdominal, laparoscopic, or robotic-assisted laparoscopic technique has a good durability and quality of life performance. The minimal invasive techniques are as effective as the open abdominal techniques and there is no difference in mesh exposure. Conclusion: Vaginal procedures are well described procedures with favorable outcomes and cost-benefit profiles. Sacral colpopexy has a high-effectivity; data on the route of performance and long-term outcome are awaited. The cost with mesh implants are higher compared to the operations with autologous tissue or any conservative treatment and further studies are recommended to evaluate the cure rates in the span of decades and the possible long-term mesh complications.

AB - Aim: Apical prolapse includes descent of the uterus, vagina cuff, or rarely solely of the cervix. It is estimated that women have an 11-19% life-time risk of undergoing surgery for POP. This rate is projected to increase over the next 2-3 decades. In this FIGO working group report we address the conservative and surgical treatment options for apical prolapse. Methods: The FIGO working group "Pelvic Floor Medicine and Reconstructive Surgery" describes the different treatments for apical prolapse based on the literature evidence, the cost-effectiveness, the degree of difficulty and summed them up with an experts recommendation. Results: Among the conservative treatment options, pessaries are the most successful options since centuries with a low complication rate and low costs. Among the vaginal operative procedures the sacrospinous ligament fixation (SSLF) and the uterosacral ligament suspension (USLS) show comparable outcomes and efficacy with a different, however, rather low complication pattern and a favorable cost-benefit profile. Sacrocolpopexy, independent on the open abdominal, laparoscopic, or robotic-assisted laparoscopic technique has a good durability and quality of life performance. The minimal invasive techniques are as effective as the open abdominal techniques and there is no difference in mesh exposure. Conclusion: Vaginal procedures are well described procedures with favorable outcomes and cost-benefit profiles. Sacral colpopexy has a high-effectivity; data on the route of performance and long-term outcome are awaited. The cost with mesh implants are higher compared to the operations with autologous tissue or any conservative treatment and further studies are recommended to evaluate the cure rates in the span of decades and the possible long-term mesh complications.

KW - Apical compartment

KW - Conservative treatment

KW - International Federation of Gynecology and Obstetrics (FIGO)

KW - Pelvic organ prolapse (POP)

KW - Surgery

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