Pelvic organ prolapse (POP) is a weakening of the pelvic organs, causing organs (ie. vagina, uterus, bladder, rectum) to fall out of place. In women, the condition is often caused by a laborious childbirth, obesity, hysterectomy, and frequent constipation. People affected by this condition are often riddled with fecal and urinary incontinence problems, as well as painful sex. Common surgical treatments for pelvic organ prolapse include sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS). Both of these procedures involve stitching up loose ends to hold the vagina up.
In a new study, researchers from the Cleveland Clinic and Loyola University in Chicago aimed to compare the effectiveness between SSLF and ULS. Results showed that both procedures are equally effective and safe for women with pelvic problems. The study was published March 12 online in The Journal of the American Medical Association (JAMA).
“Little has been known until now about how these procedures compare to each other,” said Linda Brubaker, MD, MS, study co-author and dean, Loyola University Chicago Stritch School of Medicine. “This study provides guidance to physicians on the benefits and risks of two widely used surgical interventions without vaginal prolapse mesh.”
The study included 374 women who were randomly selected to have one of the two surgeries between 2008 and 2013. Nearly half (n = 188) of the women had the ULS procedure, while the rest (n = 186) underwent SSLF surgery. After a 2-year follow up, the researchers found that the two procedures fared similar results in success rate (about 60% in both cases).
Researchers also found that behavioral and pelvic floor muscle therapy (BPMT) after surgery did not help improve incontinence or prolapse symptoms in the study participants. This type of therapy includes pelvic floor muscle therapy, which is often regarded as the first line of behavioral treatment for stress incontinence and also used to treat POP. Pelvic floor therapy is designed to help strengthen the patient’s pubococcygeus muscle, which is found in both men and women, and helps control the flow of urine.
Based on the results, the researchers encourage surgeons to choose the best surgical option for their patient, taking note of possible side effects of each procedure.