For Vaginal Prolapse, Is One Type of Surgery Any Better Than the Other?

Brent E. Seibel, MD

Trial outcomes were similar for two kinds of transvaginal surgery, with or without perioperative pelvic floor therapy.

Pelvic organ prolapse accounts for 300,000 surgeries annually in the U.S., but little is known about the comparative efficacy of surgical techniques or the role of perioperative pelvic floor therapy. In the Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) trial, 374 women with vaginal prolapse and stress urinary incontinence were randomized first to perioperative behavioral therapy with pelvic floor muscle training (BPMT) or usual care and second to sacrospinous ligament fixation (SSLF) or uterosacral ligament vaginal vault suspension (ULS), with all participants undergoing concomitant retropubic midurethral sling placement. Surgical success was evaluated at 2 years using a composite of objective anatomic results, patient-reported symptoms, and need for re-treatment. BPMT outcomes were assessed at 6 and 24 months with a similar composite.

Two years after surgery, success rates for SSLF (60.5%) and ULS (59.2%) were similar, as were rates of serious adverse events (16.7% and 16.5%, respectively). Perioperative BPMT did not improve incontinence symptoms at 6 months or anatomic success rates at 24 months.

Citation(s):

Barber MD et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: The OPTIMAL randomized trial. JAMA 2014 Mar 12; 311:1023.