Surgery for women with posterior compartment prolapse

Area of Science:

• Urogynecology
• Pelvic Floor Disorders
• Surgical Interventions

Background:

• Posterior vaginal wall prolapse can cause bulge sensation, obstructed defecation, and sexual dysfunction.
• Conservative management includes lifestyle changes, pelvic floor muscle training, and pessary use.
• Surgical management options are being evaluated for effectiveness and safety.

Purpose of the Study:

• To evaluate the safety and effectiveness of surgical interventions for posterior vaginal wall prolapse.
• To compare different surgical techniques against each other.

Main Methods:

• Conducted a systematic review of randomized controlled trials (RCTs).
• Searched major databases including Cochrane, MEDLINE, and ClinicalTrials.gov.
• Primary outcomes included subjective prolapse awareness, repeat surgery, and objective prolapse recurrence.

Main Results:

• Transvaginal repair likely results in less prolapse recurrence and awareness compared to transanal repair, though data on adverse effects were limited.
• Evidence is insufficient to conclude differences between biological graft and native tissue repair for prolapse recurrence.
• Postoperative complications were more frequent with biological graft repair; mesh exposure rates were 7% in synthetic graft vs. native tissue repair.

Conclusions:

• Transvaginal repair may be superior to transanal repair for posterior vaginal wall prolapse regarding recurrence.
• Current evidence does not support the use of mesh or graft materials in posterior vaginal repair.
• Limited data and mesh kit withdrawals may affect the generalizability of findings.