Definition of recurrence of pelvic organ prolapse: is it really important?

Abstract

Pelvic organ prolapse (POP) is becoming an important women's health priority worldwide because the cumulative lifetime risk for undergoing surgical intervention is estimated to be greater than 11% [1, 2]. Almost one third of these women will develop postoperative recurrence requiring further surgery, thus representing a significant public health problem [3]. Causes of recurrence of POP are poorly understood but include younger or older age, obesity, genetic predisposition for weakness of the pelvic floor, advanced prolapse, and performing an inappropriate primary procedure [4–6]. Although the etiology of recurrence of POP is frequently discussed in the literature, very few studies report on the outcome of surgical treatment in women with recurrent disease. In the published case series to date, data on the long-term outcome are often lacking or difficult to compare and therefore the cumulative surgical cure rate and/or independent efficacy of each surgical technique remain uncertain [3, 7]. This is usually attributed to the use of various and non-validated tools to measure the outcome of a large number of operative techniques, particularly the novel disposable surgical kits, in a small subset of patient cohorts. The lack of a uniformly accepted definition of recurrence including a detailed description of the anatomical location of the defect and whether this is in the same or different vaginal compartment may also be responsible [3, 6, 7]. It might therefore be helpful to have a standard definition and/or classification of recurrent POP as a separate clinicopathological entity from primary disease and are urgently needed by the urogynecologic community, similar to recent standardization reports [8]. This endeavor will increase the scientific validity of outcome measures of surgical intervention for recurrent POP with a potential for selecting the most effective procedures and will contribute to our understanding of the pathogenesis of recurrence. A standardized terminology of POP recurrence will also allow comparison of the results of surgical treatment between different surgeons and centers and will provide robust clinical evidence to assist in counseling women about the expected treatment outcome [9]. Hence, the ambiguous postoperative outcome measures that are currently used in the biomedical literature such as “surgical failure,” “persistent,” “recurrence,” “relapse,” or “de novo” should now be replaced by the appropriate medical terminology that facilitates interpretation of data obtained by different researchers in this field. There is also mounting evidence at present that anatomical evaluation, per se, does not often reflect patient perception of their condition and women with the same preoperative POP stage may have completely different expectations [9]. Moreover, the concept of restoring normal vaginal anatomy in women with POP using reconstructive pelvic surgery is S. Salvatore (*) Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy e-mail: stefanosalvatore@hotmail.com