Role of apical support defect: Correction in women undergoing vaginal prolapse surgery

Alexandriah N. Alas, Jennifer T. Anger

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations

Abstract

Purpose of review: The aim was to review most recent literature and provide updates in clinical management and surgical treatment of apical pelvic organ prolapse. Recent findings: In patients who decline surgical intervention, formal referral to pelvic floor muscle training is beneficial over self-directed Kegel exercises. Systematic reviews revealed that sacrocolpopexy has better long-term outcomes than vaginal approaches. Uterosacral ligament suspension and sacrospinous ligament suspension have equal efficacy at 1 year. These procedures should be considered as acceptable alternatives to sacrocolpopexy. Two randomized controlled trials have demonstrated equal efficacy between robotic and laparoscopic sacrocolpopexy. Summary: Minimally invasive sacrocolpopexy should be considered the gold standard for apical prolapse, but these techniques are associated with longer operating times and higher complication rates and longer convalescence than nonmesh vaginal surgery. Surgeons must individualize surgical technique for each patient and should consider a vaginal approach in patients who do not desire laparotomy and are not candidates for minimally invasive surgery.

Original languageEnglish (US)
Pages (from-to)386-392
Number of pages7
JournalCurrent Opinion in Obstetrics and Gynecology
Volume26
Issue number5
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Keywords

  • Apical support
  • Apical suspension
  • Pelvic organ prolapse
  • Sacrocolpopexy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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