Highlights:
- •Evidence on the efficacy and safety of CESA/VASA is scarce and of low certainty.
- •Further scientific appraisal is needed to guide further research and implementation in practice.
Abstract
Several anatomic theories suggest that lax uterosacral ligaments may result in apical
prolapse and urinary incontinence. Therefore, prolapse repair such as cervicosacropexy
or vaginosacropexy, may resolve urinary incontinence. Shortcomings in current treatment
options endorse further exploration of the potential benefit of a surgical alternative.
This systematically review of the literature aimed to summarize the evidence on the
efficacy and safety of cervicosacropexy and vaginosacropexy as alternative surgical
treatment options for urge and/or mixed urinary incontinence and apical prolapse.
The PRISMA 2020 statement was followed and the review protocol was registered with
PROSPERO (CRD42021267941). Studies from inception to 9/2021 were systematically reviewed
and included. Data collection, risk of bias, and certainty of evidence were assessed
using the standard Cochrane methods. The primary outcome measures were improvements
in prolapse and urinary symptoms. Secondary outcomes included surgical safety and
reintervention rates for complications and recurrence.
The included studies showed a moderate-to-high risk of bias and low certainty of evidence.
Owing to their heterogeneity, no meta-analysis was performed. Cure rates for mixed
and urge urinary incontinence and apical prolapse were 47.5 % (CI95%:42.4–52.6), 73.8 %
(CI95%:61.9–85.7) and 97–100 % respectively, at a mean follow-up of 9.7 ± 7.3 months.
Additional incontinence surgery in 38.9 % (216/555) of women with initial urinary
incontinence, and concomitant or subsequent surgery for prolapse was performed in
4.4 % (13/299).
Cervicosacropexy or vaginosacropexy may remedy symptoms of urge and mixed urinary
incontinence and seem to correct apical prolapse in the short term. Nevertheless,
the overall level of evidence is low. Therefore, further clinical trials, integrated
in the IDEAL framework, targeting better-identified patient selection, and using validated
outcome measures are needed.
Abbreviations:
BMI (Body Mass Index), CI (Confidence Interval), CESA (Cervicosacropexy), LSCP (Laparoscopic Sacrocolpopexy), MUI (Mixed Urinary Incontinence), NRS (Non-Randomized Studies), PFE (Pelvic Floor Exercises), POP (Pelvic Organ Prolapse), POP-Q (Pelvic Organ Prolapse Quantification), PVDF (Polyvinylidene Fluoride), RCT (Randomized Controlled Trial), ROB (Risk Of Bias), SUI (Stress Urinary Incontinence), TOT (trans-Obturator Tape), UI (Urinary Incontinence), USL (Uterosacral Ligaments), UUI (Urge Urinary Incontinence), VASA (Vaginosacropexy)Keywords
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References
Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2004:Cd004014.
- Pelvic organ prolapse in the Women's Health Initiative: gravity and gravidity.Am J Obstet Gynecol. 2002; 186: 1160-1166
- The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society.Am J Obstet Gynecol. 2002; 187: 116-126
- International urogynecology consultation chapter 1 committee 2: Epidemiology of pelvic organ prolapse: prevalence, incidence, natural history, and service needs.Int Urogynecol J. 2022; 33: 173-187
- Pelvic organ prolapse and overactive bladder.Neurourology Urodynamics. 2010; 29: 30-39
- Urodynamics mixed type urinary incontinence with advanced pelvic organ prolapse, management and outcomes.Sci Rep. 2020; 10: 1944
- Current treatment of pelvic organ prolapse correlated with chronic pelvic pain, bladder and bowel dysfunction.Curr Opin Urol. 2017; 27: 274-281
- Cystocele and functional anatomy of the pelvic floor: review and update of the various theories.Int Urogynecol J. 2016; 27: 1297-1305
- Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis.Am J Obstet Gynecol. 1994; 170: 1713-1723
Petros PEP, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence; 1993.
- Surgery versus physiotherapy for stress urinary incontinence.N Engl J Med. 2013; 369: 1124-1133
- Surgery for women with pelvic organ prolapse with or without stress urinary incontinence.Cochrane Database Syst Rev. 2018;
- Medium-term outcome of laparoscopic sacrocolpopexy using polivinylidene fluoride as compared to a hybrid polyglecaprone and polypropylene mesh: a matched control study.Neurourol Urodyn. 2019; 38: 1874-1882
Ludwig S, Becker I, Mallmann P, Jager W. Comparison of Solifenacin and Bilateral Apical Fixation in the Treatment of Mixed and Urgency Urinary Incontinence in Women: URGE 1 Study, A Randomized Clinical Trial. In Vivo 2019;33:1949–57.
- Surgical treatment of mixed and urge urinary incontinence in women.Gynecol Obstet Invest. 2012; 74: 157-164
Ludwig S, Neumann E, Becker I, Jäger W. Surgical treatment of urgency urinary incontinence, OAB (wet), mixed urinary incontinence, and total incontinence by cervicosacropexy or vaginosacropexy. Gynecol Obstet (Sunnyvale) 2016;6:2161-0932.1000404.
- Effects of the apical suspension of the upper vagina by cervicosacropexy or vaginosacropexy on stress and mixed urinary incontinence.Pelviperineology. 2021; 40: 32-38
- Standardized bilateral mesh supported uterosacral ligament replacement—Cervico-sacropexy (CESA) and vagino-sacropexy (VASA) operations for female genital prolapse.Pelviperineology. 2016; 35: 17-21
- A newsurgical method to cure urge urinary incontinence (UUI) in women.Gynecol Surg. 2013; 10: S12
- Laparoscopic bilateral cervicosacropexy and vaginosacropexy: new surgical treatment option in women with pelvic organ prolapse and urinary incontinence.J Endourol. 2018; 32: 1058-1064
Wichor M, Bramer DG, Gerdien B. de Jonge, Leslie Holland, Tanja Bekhuis. De-duplication of database search results for systematic reviews in EndNote.
- PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews.BMC Health Serv Res. 2014; 14: 579
- GRADE guidelines: 18. How ROBINS-I and other tools to assess risk of bias in nonrandomized studies should be used to rate the certainty of a body of evidence.J Clin Epidemiol. 2019; 111: 105-114
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366l4898
- Rating the certainty in evidence in the absence of a single estimate of effect.Evid Based Med. 2017; 22: 85-87
- Data collection form. EPOC (Effective Practice and Organisation of Care) Resources for review authors.Norwegian Knowledge Centre for the Health Services, Oslo2013
- Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline.BMJ. 2020; 368l6890
Higgins JPT GSe. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
- The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.Ann Intern Med. 2015; 162: 777-784
- PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews.Systematic Rev. 2021; 10: 39
Joukhadar R, Meyberg-Solomayer G, Hamza A, et al. A novel operative procedure for pelvic organ prolapse utilizing a MRI-visible mesh implant: safety and outcome of modified laparoscopic bilateral sacropexy. Biomed Res Int 2015;2015.
Elmantwe ANM, Assar TM. Cervico–sacropexy and vagino–sacropexy (CESA & VASA): a new procedures for pelvic organ prolapse.
- Standardizing abdominal sacrocolpopexy for the treatment of apical prolapse: One year on.Int J Gynaecol Obstet. 2019; 147: 49-53
- Pelvic Organ Prolapse Quantification System (POP-Q) – a new era in pelvic prolapse staging.J Med Life. 2011; 4: 75-81
- Association between pelvic organ prolapse and stress urinary incontinence with collagen.Exp Ther Med. 2014; 7: 1337-1341
- Definition and epidemiology of overactive bladder.Urology. 2002; 60 (discussion): 7-12
- New ambulatory surgical methods using an anatomical classification of urinary dysfunction improve stress, urge and abnormal emptying.Int Urogynecol J. 1997; 8: 270-277
- A ligamentous explanation for overactive bladder symptoms as defined by International Continence Society in the female.Cent European J Urol. 2018; 71: 105-107
- The definition, prevalence, and risk factors for stress urinary incontinence.Rev Urol. 2004; 6: S3
- Surgical management of symptomatic apical pelvic organ prolapse: a systematic review and meta-analysis.Obstet Gynecol. 2021; 137: 1061-1073
- The uterosacral ligament in postmenopausal women with or without pelvic organ prolapse.Neurourol Urodyn. 2006; 25: 533-534
- Uterosacral ligament: description of anatomic relationships to optimize surgical safety.Obstet Gynecol. 2001; 97: 873-879
- The IDEAL framework for evaluating surgical innovation: how it can be used to improve the quality of evidence.JAMA Surgery. 2019; 154: 685-686
- Beyond the RCT: when are randomized trials unnecessary for new therapeutic devices, and what should we do instead?.Ann Surg. 2022; 275: 324
Article info
Publication history
Published online: October 06, 2022
Accepted:
October 1,
2022
Received:
July 25,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
