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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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.
