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

Alas, Alexandriah N.a; Anger, Jennifer T.b

Current Opinion in Obstetrics & Gynecology: October 2014 - Volume 26 - Issue 5 - p 386–392
doi: 10.1097/GCO.0000000000000105
UROGYNECOLOGY: Edited by Narender Bhatia

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.

aDepartment of Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic Florida, Weston, FL

bDepartment of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States

Correspondence to Jennifer T. Anger, MD, MPH, Associate Professor of Surgery, Associate Director of Urological Research, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Adjunct Assistant Professor of Urology, UCLA, 99N. La Cienega Blvd., #307, Beverly Hills, CA 90211, United States. Tel: +1 310 385 2992; fax: +1 310 385 2973; e-mail:

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