Onwude Joseph Loze
Springfield Hospital, Chelmsford, United Kingdom.
BMJ Clin Evid. 2012 Mar 14;2012:0817.
Prolapse of the uterus or vagina is usually the result of loss of pelvic support, and causes mainly non-specific symptoms. It may affect over half of women aged 50 to 59 years, but spontaneous regression may occur. Risks of genital prolapse increase with advancing parity and age, increasing weight of the largest baby delivered, and hysterectomy.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-surgical treatments in women with genital prolapse? What are the effects of surgical treatments in women with anterior vaginal wall prolapse? What are the effects of surgical treatments in women with posterior vaginal wall prolapse? What are the effects of surgical treatments in women with upper vaginal wall prolapse? What are the effects of using different surgical materials in women with genital prolapse? We searched: Medline, Embase, The Cochrane Library, and other important databases up to August 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: abdominal Burch colposuspension; abdominal sacral colpopexy; abdominal sacrohysteropexy; anterior colporrhaphy with mesh reinforcement; laparoscopic surgery; mesh or synthetic grafts; native (autologous) tissue; open abdominal surgery; pelvic floor muscle exercises; posterior colporrhaphy (with or without mesh reinforcement); posterior intravaginal slingplasty (infracoccygeal sacropexy); sacrospinous colpopexy (vaginal sacral colpopexy); sutures; traditional anterior colporrhaphy; transanal repair; ultralateral anterior colporrhaphy alone or with cadaveric fascia patch; vaginal hysterectomy; vaginal oestrogen; vaginal pessaries; and vaginal sacrospinous colpopexy.
子宫或阴道脱垂通常是盆腔支持结构丧失的结果，主要引起非特异性症状。50至59岁的女性中超过半数可能受其影响，但可能会发生自然缓解。生殖器脱垂的风险随着产次增加、年龄增长、分娩的最大婴儿体重增加以及子宫切除术而升高。
我们进行了一项系统评价，旨在回答以下临床问题：非手术治疗对生殖器脱垂女性有何影响？手术治疗对阴道前壁脱垂女性有何影响？手术治疗对阴道后壁脱垂女性有何影响？手术治疗对阴道上壁脱垂女性有何影响？使用不同手术材料对生殖器脱垂女性有何影响？我们检索了：截至2011年8月的Medline、Embase、Cochrane图书馆及其他重要数据库（Clinical Evidence综述会定期更新；请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品与保健品监管局（MHRA）等相关机构的危害警示。
我们发现15项系统评价、随机对照试验或观察性研究符合我们的纳入标准。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们呈现了以下干预措施的有效性和安全性相关信息：腹式Burch阴道悬吊术；腹式骶骨阴道固定术；腹式骶骨子宫固定术；带网片加固的前路阴道修补术；腹腔镜手术；网片或合成移植物；自体（自身）组织；开腹手术；盆底肌锻炼；后路阴道修补术（带或不带网片加固）；后路经阴道吊带成形术（尾骨下骶骨固定术）；骶棘韧带阴道固定术（阴道骶骨固定术）；缝线；传统前路阴道修补术；经肛门修补术；单纯或联合尸体筋膜补片的超外侧前路阴道修补术；经阴道子宫切除术；阴道雌激素；阴道子宫托；以及阴道骶棘韧带阴道固定术。
