Pelvic Floor Reconstructive Surgery in Ageing Women: Tailoring the Treatment to Each Woman’s Needs

Abstract

Tailoring surgical strategies is one of the most challenging aspects of pelvic floor surgery. This is especially true in elderly individuals, where a multitude of factors affect the final result of any reconstructive surgery. Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, or sexual dysfunction are common problems. The goal of surgical treatment is a functional reconstruction with symptoms management and anatomic defects secondly. The recent advancements in surgical treatment of pelvic floor dysfunction allow several good options in choosing best surgery for each patient. The vaginal procedure is traditionally the gold standard approach for elderly patients, but the abdominal surgery is increasing as mini-invasive approach and the robotic approach is gaining acceptance as treatment of pelvic floor dysfunctions. In elderly individuals, a multitude of factors affect the final result of any reconstructive surgery such as aging-associated changes in muscle tone and nerve function or changes in the function of the bladder or of the rectum: an understanding of the underlining functional status of pelvic organs is very important in aging women before proceeding to surgery. For these reasons, the pelvic floor dysfunction, particularly in elderly women, should be addressed in the context of multidisciplinary centers where urologists, gynacologists, and colorectal surgeons can interact to manage these complex patients.