55 research outputs found
Pelvic organ prolapse: self-management of pessaries can be a good option
No full textThe studyHagen S, Kearney R, Goodman K, et al. Clinical effectiveness of vaginal pessary self-management vs clinic-based care for pelvic organ prolapse (TOPSY): a randomised controlled superiority trial. eClinicalMedicine 2023;66:102326.To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/pelvic-organ-prolapse-self-management-of-pessaries-can-be-a-good-option/.</p
Conservative management of pelvic organ prolapse
No full textPelvic organ prolapse is a common condition with one in 10 women undergoing surgery during their lifetime. In the community 8% of women complain of the symptom of a vaginal bulge which is the symptom that most closely correlates with the finding of a prolapse on examination. Pelvic organ prolapse can impair urinary, bowel and sexual function. The most important part of prolapse management is obtaining a comprehensive pelvic floor history and understanding the woman's treatment goals and expectations. A standardised examination aids further decision making. Conservative treatment options include observation, lifestyle advice, pelvic floor muscle training and use of a pessary. Treatment choice is guided by patient preference.</p
Management of mesh complications following surgery for stress urinary incontinence or pelvic organ prolapse: a systematic review.
No full textBACKGROUND:Mesh surgery for stress urinary incontinence or pelvic organ prolapse can result in complications such as mesh exposure, mesh extrusion, voiding dysfunction, dyspareunia, and pain. There is limited knowledge or guidance on the effective management for mesh-related complications. OBJECTIVE:To determine the best management of mesh complications; a systematic review was conducted as part of the national clinical guideline 'Urinary incontinence (update) and pelvic organ prolapse in women: management'. SEARCH STRATEGY:Search strategies were developed for each indication for referral. SELECTION CRITERIA:Relevant interventions included complete or partial mesh removal, mesh division, and non-surgical treatments such as vaginal estrogen. DATA COLLECTION AND ANALYSIS:Characteristics and outcome data were extracted, and as a result of the heterogeneous nature of the data a narrative synthesis was conducted. MAIN RESULTS:Twenty-four studies were included; five provided comparative data and four studies stated the indication for referral. Reported outcomes (including pain, dyspareunia, satisfaction, quality of life, incontinence, mesh exposure, and recurrence) and the reported incidences of these varied widely. CONCLUSIONS:The current evidence base is limited in quantity and quality and does not permit firm recommendations to be made on the most effective management for mesh-related complications. Robust data are needed so that mesh complications can be managed effectively in the future. TWEETABLE ABSTRACT:Systematic review demonstrates that the outcomes following mesh revision surgery are highly variable
Conservative management of pelvic organ prolapse
No full textPelvic organ prolapse is a common condition with 1 in 10 women undergoing surgery during their lifetime. In the community 8% of women complain of the symptom of a vaginal bulge which is the symptom that most closely correlates with the finding of a prolapse on examination. Pelvic organ prolapse can impair urinary, bowel and sexual function. The NICE National Guideline Urinary Incontinence and Pelvic Organ prolapse in Women: Management makes recommendations on the assessment and treatment of pelvic organ prolapse. The most important part of prolapse management is obtaining a comprehensive pelvic floor history and understanding the woman's treatment goals and expectations. A standardised examination aids further decision making. Conservative treatment options include observation, lifestyle advice, pelvic floor muscle training and use of a pessary. Treatment choice is guided by patient preference.</p
Surgical management of stress urinary incontinence
No full textWomen are seeking treatment for stress urinary incontinence more readily due to increasing awareness of minimally invasive surgical solutions and greater expectations of pelvic floor health with advancing age. Concerns have been raised regarding the safety of tape procedures and clinicians need to be aware of the recent guidance published on this by the MHRA. Surgery for stress urinary incontinence should only be undertaken in women following a comprehensive assessment and when conservative treatments have failed after a multidisciplinary team discussion. The current evidence favours a retro-pubic mid-urethral tape procedure using the bottom-up approach, or colposuspension. Pubo-vaginal slings using autologous rectus sheath fascia have a good success rate, but also have significantly higher incidence of operative morbidity and voiding problems. Urethral bulking agents are a safe alternative, especially in those women where more invasive surgery is not desired. It is important to counsel that they have a lower success rate and repeat injections are often needed
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