New study explores surgical treatment options for women with pelvic organ prolapse

Researchers from the University of Exeter are involved in a new study exploring surgical treatment options for women with pelvic organ prolapse. 

Funding of more than £500,000 has come from the National Institute of Health and Social Care Research Health Technology Assessment. The multi-method feasibility study will involve discussions with women and the clinicians who care for them to understand treatment decisions and preferences around surgical options for pelvic organ prolapse. 

Half of all women will experience pelvic organ prolapse in their lifetime. When the pelvic floor muscles work well, they hold the bladder, bowel, and vagina in the right position, and pelvic floor exercises can help women with mild to moderate prolapse. But for some women with severe prolapse more problems may arise, and the womb can bulge or hang down into the vagina. 

This type of prolapse is known as apical prolapse. There are currently two main types of surgery available to repair apical prolapse: colpocleisis and sacrospinous fixation. 

Colpocleisis involves pushing the prolapse back inside the pelvis and closing the top of the vagina. This is the simpler of the two surgeries but will remove a woman’s ability to have penetrative vaginal intercourse. The more complex surgery, sacrospinous fixation, avoids this problem by stitching the top of the vagina to a ligament in the pelvis. There is currently little evidence to indicate which surgery is the better option. 

The new study is being led by Dr Laura Jones, from the Institute of Applied Health at the University of Birmingham, in collaboration with University of Exeter, Glasgow Caledonian University, University of West of Scotland, Birmingham Women’s and Children NHS Trust, University Hospitals Plymouth NHS Trust and Royal College of Obstetricians and Gynaecologists. 

Researchers are also working closely with patient partners and a patient advisory group to explore whether it is possible to conduct a study comparing the two surgical treatment options, via a clinical trial, in the future. 

Women and clinicians will be identified from across the UK through NHS clinics, local community groups, national women’s voice groups and charities, to ensure that the researchers hear from those with different views and experiences. 

Clinicians will also keep track of the number of women with apical prolapse, who they see in their clinics over a six-month period, that would be eligible for a future trial of the two different types of surgery. 

Professor Sarah Dean and Research Fellow Dr Rohini Terry, from the Department of Health and Community Sciences at the University of Exeter’s Medical School, are involved in the study. 

Professor Dean said: “We want to talk to women and clinicians to find out if it will be possible to develop a clinical trial that compares the two different surgeries. The longer-term aim is to support the best possible health care for women with severe pelvic organ prolapse.”