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 firstname.lastname@example.org Medical University of South Carolina, Charleston, SC, USA
International Urogynecology Journal – Springer Journals
Published: May 12, 2017
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