Urogynecology digest

Urogynecology digest Int Urogynecol J (2017) 28:1435 The International Urogynecological Association 2017 DOI 10.1007/s00192-017-3347-y Presented by Radhika Patnam How do we define apical vaginal support loss? the presence or absence of symptoms (50%). The reviewers Meister MRL, Sutcliffe S, Lowder JL. Definitions of apical found that indications for performing apical support procedures vaginal support loss: a systematic review. Am J Obstet and definitions of surgical success and failure were highly vari- Gynecol. 2017; 216(3):232.e1–232.e14 able. Although all studies included a POPQ score as an indication for surgery, nearly 30% omitted a baseline apical support/loss of This was a systematic review of the current literature regarding support score. In those who did include preoperative apical definitions of apical support loss utilized for inclusion, success, POPQ scores, the definition of prolapse varied significantly, and failure in surgical trials for the treatment of apical vaginal showing a lack of consensus amongst surgeons. The reviewers, prolapse. Apical support is often considered of paramount im- citing a normal vaginal length of 9–10 cm, found that some portance to overall female pelvic organ support; yet, there are no authors repaired prolapse when point C was −5 cm, whereas guidelines for when an apical support procedure should be per- others deferred until point C reached the hymen or beyond. formed. This systematic review sought to identify preoperative This often did not correlate with specific symptoms, despite definitions of apical prolapse, and definitions for the success and symptoms being a major part of the reason why surgeons failure of an apical prolapse procedure. A systematic review proceeded with surgery. On the other hand, those with significant using eight search engines found 3,660 publications, and limiting anatomical apical prolapse but no symptoms were still undergo- the analysis to randomized controlled trials (RCTs), resulted in ing an apical prolapse repair. Moreover, most lacked an anatom- 35 studies for analysis. Twenty-five of these studies provided a ical outcome definition of success or failure for apical support. definition of surgical success or failure, defined by anatomical The strengths of this study are that it is the first to assimilate the criteria or anatomical and systems-based criteria. Definitions of RCT data available. With any systematic review, studies that surgical success varied, and included Pelvic Organ Prolapse were not included may have helped to further define apical pro- Quantification (POPQ) stage 2 prolapse (29.4%), absence of lapse and outcome of repair, but were not included because they prolapse beyond the hymen (5.9%), or using a form of compar- were not part of the RCTs. Limitations include that the reviewers ison of apical support with total vaginal length, although again, include their own “expert opinion,” but do acknowledge that this this definition varied. Eight studies used an overall prolapse is not based on clear guidelines. The important conclusion is that POPQ most dependent point to define surgical success, </≤− 1 clear standardization needs to be created for multiple values, both or 0. Ten studies took symptoms into consideration, via validated anatomical and symptomatic, to clearly see if an apical repair is questionnaire responses (40%), quality of life outcomes (10%) or necessary and to define whether or not it was successful. * Radhika Patnam patnam@musc.edu Medical University of South Carolina, Charleston, SC, USA http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Urogynecology Journal Springer Journals

Urogynecology digest

1 page

Loading next page...
1 Page
Springer London
Copyright © 2017 by The International Urogynecological Association
Medicine & Public Health; Gynecology; Urology
Publisher site
See Article on Publisher Site

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.

DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

Monthly Plan

  • Read unlimited articles
  • Personalized recommendations
  • No expiration
  • Print 20 pages per month
  • 20% off on PDF purchases
  • Organize your research
  • Get updates on your journals and topic searches


Start Free Trial

14-day Free Trial

Best Deal — 39% off

Annual Plan

  • All the features of the Professional Plan, but for 39% off!
  • Billed annually
  • No expiration
  • For the normal price of 10 articles elsewhere, you get one full year of unlimited access to articles.



billed annually
Start Free Trial

14-day Free Trial