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Cervicosacropexy or vaginosacropexy for urinary incontinence and apical prolapse: A systematic review

  • Ann-Sophie Page
    Correspondence
    Corresponding author at: UZ Leuven, Herestraat 49, 3001 Leuven, Belgium.
    Affiliations
    Department Obstetrics & Gynecology, Pelvic Floor Unit, University Hospitals KU Leuven, and Academic Department Development and Regeneration, Cluster Urogenital Surgery, KU Leuven, Leuven, Belgium
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  • Geert Page
    Affiliations
    Department Obstetrics & Gynecology, Jan Yperman Hospital, Ypres, Belgium
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  • Jan Deprest
    Affiliations
    Department Obstetrics & Gynecology, Pelvic Floor Unit, University Hospitals KU Leuven, and Academic Department Development and Regeneration, Cluster Urogenital Surgery, KU Leuven, Leuven, Belgium
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Published:October 06, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.10.004

      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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