Clinical trial NCT01670682: Ischia Spinous Fascia Fixation Procedure Versus Modified Total Pelvic Floor Reconstructive Surgery for Pelvic Organ Prolapse Stage III
Official title: A Prospective，Multicenter Pilot Study to Compare Ischia Spinous Fascia Fixation Procedure With Modified Total Pelvic Floor Reconstruction Surgery For Pelvic Organ Prolapse Stage III
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Pelvic Organ Prolapse
Keywords: Stage III
Lead sponsor: Peking Union Medical College Hospital
Sponsor class: OTHER
First posted: 2012-08-22
Enrollment: 80
Sex: FEMALE
Minimum age (years): 55
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: Pelvic organ prolapse is a common problem. The primary treatment is surgery. Ischia spinous fascia fixation procedure and modified total pelvic floor reconstructive surgery with mesh are both developed in China for vaginal apex fixation, the former is native tissue repairs, and the latter is augmentation with mesh.

This study is designed to determine the effectiveness and safety of ischia spinous fascia fixation procedure compared with modified total pelvic floor reconstructive surgery with mesh for the treatment of pelvic organ prolapse stage III.

Patients enrolled into the study will be followed up for up to 3 years after surgery. Evaluation will take place during surgery and postoperative visit. Stage of prolapse before and after surgery, patient satisfaction through quality of life and sexual function questionnaires before and after surgery, and peri-operative complication rates will be evaluated.

Detailed description: Pelvic Organ prolapse (a feeling of bulge in the vagina) may cause some distressing symptoms such as loss of control of the bowel or bladder, and may also cause problems with patient's sex life. An ideal procedure for vaginal apical support should provide a durable suspension, have minimal complications, and not affect sexual or visceral function.

Vaginal procedures used for restoring the vaginal apex support include Ischia spinous fascia fixation procedure with native tissue and modified total pelvic floor reconstructive surgery with mesh. They are both developed and popular in China. Clinical practice showed that they were both safe, efficient and cost-effective. Recurrent rates of both procedures after 1 year follow-up were about 10%, and quality of life improved significantly from the baseline, while the.complications are different.

The purpose of this multicenter, prospective, and comparative study is to evaluate the effectiveness and safety of these two procedures in the treatment of symptomatic pelvic organ prolapse Stage III in China.

Eligibility criteria: Inclusion Criteria:

* Candidates with symptomatic pelvic organ prolapse of POP-Q Stage III, suitable for surgical repair.
* Vaginal hysterectomy and anti-incontinence procedures could be performed concurrently.
* Age ≥ 55 years.
* Agrees to participate in the study, including completion of all study-related procedures, evaluations and questionnaires.

Exclusion Criteria:

* Previous repair of pelvic organ prolapse involving insertion of mesh.
* Experimental drug or experimental medical device within 3 months prior to the planned procedure.
* Active genital, urinary or systemic infection at the time of the surgical procedure. Surgery may be delayed in such subjects until the infection is cleared.
* Coagulation disorder or on therapeutic anticoagulant therapy at the time of surgery.
* History of chemotherapy or pelvic radiation therapy.
* Systemic disease known to affect bladder or bowel function (e.g. Parkinson's disease, multiple sclerosis, spinal cord injury or trauma).
* Current evaluation or treatment for chronic pelvic pain (e.g. interstitial cystitis, endometriosis, coccydynia, vulvodynia).
* Nursing or pregnant or intends future pregnancy.
* Chronic cough not well-controlled.
* BMI ≥ 30.
* In the investigator's opinion, any medical condition or psychiatric illness that could potentially be life threatening or affect their ability to complete the study visits according to this protocol.

Primary outcomes:
measure: •Anatomical improvement according to POP-Q score.
timeFrame: 6 weeks
measure: •Anatomical improvement according to POP-Q score.
timeFrame: 1 year
measure: •Anatomical improvement according to POP-Q score.
timeFrame: 2 years
measure: •Anatomical improvement according to POP-Q score.
timeFrame: 3 years
Secondary outcomes:
measure: •Hospital data including operative time, estimated blood loss, length of stay, maximum temperature, time of voiding recovery.
timeFrame: At discharge, an expected average of 5 days after operation.
measure: •Pain score measured using Visual Analog Scale (VAS).
timeFrame: 24 hours post surgery and at the 6-week visit
measure: •Presence/absence of complications (composite score).
timeFrame: Up to 6 weeks.
measure: •Change from baseline in PFIQ-7 scores.
timeFrame: 1 year, 2 years and 3 years.
measure: •In subjects sexually active at baseline, assessment of sexual function using PISQ-12 (mean scores and change from baseline)
timeFrame: 1 year, 2 years and 3 years.
measure: •Subject global impression assessed on a 5 point Likert scale
timeFrame: 1 year, 2 years and 3 years.
measure: •Presence/absence of complications (composite score)
timeFrame: Up to 3 years.
Other outcomes:
Locations:
city: Foshan
country: China
facility: Foshan Maternal and Child Health Hospital
state: Guangdong
city: Shenzhen
country: China
facility: Peking University Shenzhen Hospital
state: Guangdong
city: Zhengzhou
country: China
facility: the Third Affiliated Hospital of Zhengzhou University
state: Henan
city: Shenyang
country: China
facility: Affiliated Shengjing Hospital of China Medical University
state: Liaoning
city: Beijing
country: China
facility: Peking Union Medical College Hospital
Study officials:
References: