Prolapse of the uterus or vagina is usually the result of loss of pelvic support, and causes mainly non-specific symptoms. It may affect over half of women aged 50 to 59 years, but spontaneous regression may occur. Risks of genital prolapse increase with advancing parity and age, increasing weight of the largest baby delivered, and hysterectomy.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments in women with genital prolapse? What are the effects of surgical treatments in women with anterior vaginal wall prolapse? What are the effects of surgical treatments in women with posterior vaginal wall prolapse? What are the effects of surgical treatments in women with upper vaginal wall prolapse? What are the effects of using different surgical materials in women with genital prolapse? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2009 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: abdominal Burch colposuspension; abdominal sacral colpopexy; abdominal sacrohysteropexy; anterior colporrhaphy with mesh reinforcement; laparoscopic surgery; mesh or synthetic grafts; native (autologous) tissue; open abdominal surgery; pelvic floor muscle exercises; posterior colporrhaphy (with or without mesh reinforcement); posterior intravaginal slingplasty (infracoccygeal sacropexy); sacrospinous colpopexy (vaginal sacral colpopexy); sutures; traditional anterior colporrhaphy; transanal repair; ultralateral anterior colporrhaphy alone or with cadaveric fascia patch; vaginal hysterectomy; vaginal oestrogen; vaginal pessaries; and vaginal sacrospinous colpopexy.
Prolapse of the uterus or vagina is usually the result of loss of pelvic support, and causes mainly non-specific symptoms. It may affect over half of women aged 50 to 59 years, but spontaneous regression may occur.
Risks of genital prolapse increase with advancing parity and age, increasing weight of the largest baby delivered, and hysterectomy.
We don't know whether pelvic floor muscle exercises or vaginal oestrogen improve symptoms in women with genital prolapse, as we found no studies of adequate quality.
The consensus is that vaginal pessaries are effective for relief of symptoms in women waiting for surgery, or in whom surgery is contraindicated, but we don't know this for sure.
In women with anterior vaginal wall prolapse, anterior vaginal wall repair may be more effective than Burch colposuspension, and recurrence can be further reduced by adding mesh reinforcement to anterior colporrhaphy.
In women with posterior vaginal wall prolapse, posterior colporrhaphy is more likely to prevent recurrence than transanal repair of rectocoele or enterocoele.
We don't know whether adding mesh reinforcement improves success rates in women having posterior colporrhaphy.
In women with upper vaginal wall prolapse, abdominal sacral colpopexy reduces the risk of recurrent prolapse, dyspareunia, and stress incontinence compared with sacrospinous colpopexy.
Posterior intravaginal slingplasty may be as effective as vaginal sacrospinous colpopexy at preventing recurrent prolapse.
Vaginal hysterectomy and repair may reduce the need for re-operation and may be more effective at reducing symptoms, compared with abdominal sacrohysteropexy.
We don't know how surgical treatment compares with non-surgical treatment in women with prolapse of the upper,
anterior, or posterior vaginal wall.