Epidemiology and outcome assessment of pelvic organ prolapse
Top Cited Papers
- 19 October 2013
- journal article
- review article
- Published by Springer Science and Business Media LLC in International Urogynecology Journal
- Vol. 24 (11), 1783-1790
- https://doi.org/10.1007/s00192-013-2169-9
Abstract
The aim was to determine the incidence and prevalence of pelvic organ prolapse surgery and describe how outcomes are reported. Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews, level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. A grade A recommendation usually depends on consistent level 1 evidence. A grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs. A grade C recommendation usually depends on level 4 studies or “majority evidence” from level 2/3 studies or Delphi processed expert opinion. A grade D “no recommendation possible” would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi . Pelvic organ prolapse (POP) when defined by symptoms has a prevalence of 3–6 % and up to 50 % when based upon vaginal examination. Surgery for prolapse is performed twice as commonly as continence surgery and prevalence varies widely from 6 to 18%. The incidence of POP surgery ranges from 1.5 to 1.8 per 1,000 women years and peaks in women aged 60–69. When reporting outcomes of the surgical management of prolapse, authors should include a variety of standardised anatomical and functional outcomes. Anatomical outcomes reported should include all POP-Q points and staging, utilising a traditional definition of success with the hymen as the threshold for success. Assessment should be prospective and assessors blinded as to the surgical intervention performed if possible and without any conflict of interest related to the assessment undertaken (grade C). Subjective success postoperatively should be defined as the absence of a vaginal bulge (grade C). Functional outcomes are best reported using valid, reliable and responsive symptom questionnaires and condition-specific HRQOL instruments (grade C). Sexual function is best reported utilising validated condition-specific HRQOL that assess sexual function or validated sexual function questionnaires such as the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ) or the Female Sexual Function Index (FSFI). The sexual activity status of all study participants should be reported pre- and postoperatively under the following categories: sexually active without pain, sexually active with pain or not sexually active (grade C). Prolapse surgery should be defined as primary surgery, and repeat surgery sub-classified as primary surgery different site, repeat surgery, complications related to surgery and surgery for non-prolapse-related conditions (grade C). Significant variation exists in the prevalence and incidence of pelvic organ prolapse surgery and how the outcomes are reported. Much of the variation may be improved by standardisation of definitions and outcomes of reporting on pelvic organ prolapse surgery.Keywords
This publication has 62 references indexed in Scilit:
- Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of successAmerican Journal of Obstetrics and Gynecology, 2011
- Defining Success After Surgery for Pelvic Organ ProlapseObstetrics & Gynecology, 2009
- Prevalence of Symptomatic Pelvic Floor Disorders in US WomenJAMA, 2008
- Two-Year Outcomes After Sacrocolpopexy With and Without Burch to Prevent Stress Urinary IncontinenceObstetrics & Gynecology, 2008
- Pelvic Organ Support Study (POSST): The distribution, clinical definition, and epidemiologic condition of pelvic organ support defectsAmerican Journal of Obstetrics and Gynecology, 2005
- A Comparison of Different Pelvic Reconstruction Surgeries Using Mesh for Pelvic Organ Prolapse PatientsYonsei Medical Journal, 2005
- Paper 10: Burch Colposuspension at the Time of Sacrocolpopexy in Stress Continent Women Reduces Bothersome Stress Urinary Symptoms: The Care Randomized TrialJournal of Pelvic Medicine and Surgery, 2005
- Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse?American Journal of Obstetrics and Gynecology, 2003
- Urodynamic Evaluation after Vaginal Repair and ColposuspensionBJU International, 1982
- Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with and without incontinenceBJOG: An International Journal of Obstetrics and Gynaecology, 1982