Introduction: Chronic pelvic pain (CPP) occurs in approximately 20% of women. Pathophysiology includes peripheral and central hypersensitisation. The CPP syndrome variously encompasses chronic pelvic pain, urinary urgency, frequency, nocturia or faecal incontinence, causally linked to lax apical support of the vagina. Aim: To test the hypothesis that surgical repair of the apical support of the vagina improves CPP, urinary urgency, frequency, nocturia and/ or faecal incontinence. Materials and methods: Multicenter, multinational, prospective cohort study including female patients attending pelvic floor centers, presenting with apical vaginal prolapse and at least two symptoms of CPP, urinary urgency, frequency or nocturia. Pelvic floor reconstruction performed vaginally, using two different posterior sling techniques restoring apical support: Infracoccygeal sacropexy (PIVS) and Tissue Fixation System (TFS) of uterosacral and cardinal ligaments. Assessments at baseline and 12 months after surgery using the Integral Theory Symptom Questionaire and the half-way system. Primary endpoint was improvement of symptoms. Statistical analysis by paired binary response data (per-patient presence/absence of specific sign/symptom before vs. after surgery) using McNemars test, with null hypothesis of no treatment effect. Results: 1420 patients from 8 pelvic floor centers were included. 809 patients had PIVS, 611 TFS surgery. % cure/improvement at 12 months in the PIVS (TFS) cohort was as follows: pelvic pain 68 (78) nocturia 63 (83), urge incontinence 70 (85), frequency 79 (82), faecal incontinence 76 (65), apical prolapse 93 (90). Limitation was the non-randomized design. Conclusions: Restoration of apical support improves CPP, nocturia, urgency/ urge incontinence and/or non-sphincteric fecal incontinence.
Corresponding Author: WAGENLEHNER F.|