Common surgeries equally effective for treating pelvic organ prolapse, says study

Two common procedures to repair vaginal prolapse have been found to lead to comparable outcomes, according to a new study published in The Journal of the American Medical Association.

Vaginal prolapse, or pelvic organ prolapse, is a condition where the vagina and/or the uterus can protrude into or through the opening of the vagina. Women typically feel bulging in their vaginal area, like a hernia, and prolapse can cause bowel and bladder problems, including urinary incontinence. Symptomatic prolapse, when medical treatment would be sought, affects 3 percent of women.

“It’s a very common problem women don’t talk about often,” study author Dr. Matthew Barber of the Cleveland Clinic, told “There are 300,000 surgeries yearly; more than knee surgery or ligament tears.”

In the first study to compare the outcomes of sacrospinous ligament fixation (SSLF) and uterosacral ligament vaginal vault suspension (ULS), researchers found the two corrective procedures to be equally effective and safe.

In the SSLF procedure, surgeons use an extraperitoneal approach to suspend the vaginal apex to the sacrospinous ligament. The ULS procedure uses an intraperitoneal approach to suspend the vaginal apex bilaterally to the proximal remnants of the uterosacral ligaments.

Researchers studied a group of 374 women all undergoing surgery to treat both vaginal prolapse and stress urinary incontinence. In the two years following their surgeries, for 85 percent of the participants, the success rate was similar between groups who had SSLF and those who underwent ULS.

Researchers did see differences in the types of complications with each surgery, though the complication rates were similar. With ULS, because of the location of the ligaments in the pelvis, there is a risk of obstructing the ureter, the tube connecting the kidney to the bladder, but that can be avoided by monitoring during surgery. For SSLF, patients were more likely to have nerve-related pain after surgery, though most resolved by six weeks after the procedure.

“Overall, they’re very similar and safe side effects,” Barber said.

In their study, researchers also measured the effectiveness of kegel exercises in providing improvement in surgical outcomes for vaginal prolapse procedures. Kegel exercises were not associated with greater improvements. However, researchers found they are a good standalone method for treating urinary incontinence.

One risk factor for vaginal prolapse is childbirth, though obesity and genetics are believed to play a role. During childbirth, damage can occur to the supporting structure of the vagina and uterus, especially the muscles at the pelvic floor. While most women recover, as they get older, the muscles and ligaments weaken with age, eventually leading to prolapse and bladder leakage. The average age of study participants was 57.

“It’s certainly a multi-factoral disease. It does look like some women are more predisposed than others,” Barber said.