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Int Urogynecol J. 2018 Nov;29(11):1697-1704. doi: 10.1007/s00192-018-3755-7. Epub 2018 Aug 24.

Systematic review of definitions for success in pelvic organ prolapse surgery.

Author information

1
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr. PFP OBGYN, Iowa City, IA, 52245, USA. joseph-kowalski@uiowa.edu.
2
Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Dr. PFP OBGYN, Iowa City, IA, 52245, USA.
3
Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

Abstract

INTRODUCTION AND HYPOTHESIS:

The current literature on pelvic organ prolapse (POP) employs wildly varying definitions of surgical success. Understanding which definitions of success have been used and how these may impact reported outcomes is critical. Therefore, we performed a systematic review to identify and summarize these definitions and how they have changed over time.

MATERIALS AND METHODS:

A PubMed search was performed for studies reporting POP surgical outcomes (1996 and later). Inclusion criteria were: original research, English, adult women with POP, nonobliterative surgical treatment, comparison group, reported prolapse-specific outcomes, and clear definition of treatment success. This definition was categorized according to presence of anatomic, subjective, retreatment, or other components and whether these components were evaluated individually or in a composite definition (in which all components must be present for success).

RESULTS:

One-hundred forty articles were included. The number of included studies increased over time (r = 0.90, p < 0.00001). Ninety-five studies (67.9%) reported an anatomic-only definition of success, 43 (30.7%) included a subjective component to their definition of success, and 23 (16.4%) reported a composite definition of success, including 11 (7.9%) containing anatomic, symptomatic, and retreatment components. The most common definition of anatomic success was Pelvic Organ Prolapse Quantification (POP-Q) stage ≤ 1. The report of a significant difference between treatment groups (positive study) was most common in studies using an anatomic-only definition of success (p = 0.037).

CONCLUSION:

The number of comparative studies evaluating POP surgical outcomes has increased from 1996 to 2016. Most use definitions of success based solely on anatomic criteria despite increasing awareness of the importance of reporting subjective outcomes and retreatment rates.

KEYWORDS:

Prolapse; Surgery; Systematic review

PMID:
30143852
DOI:
10.1007/s00192-018-3755-7
[Indexed for MEDLINE]

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