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 March 2014 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.