So the First Pelvic Organ Prolapse Repair Failed…Now What?

Abstract

Surgical repair of pelvic organ prolapse (POP) is common and a significant number of women will experience POP recurrence. This paper provides a summary of management options for recurrent POP. Vaginal and abdominal approaches to recurrent POP utilizing native tissues, previously placed mesh, or a new mesh implant are all reasonable options for repair. Choice of surgical approach should be individualized to the patient. Without evidence from randomized controlled studies to help clinicians delineate the appropriate repair for each patient, there is still no perfect answer as to the best surgical treatment for recurrent POP. Similar to primary repairs, vaginal and abdominal approaches to recurrent POP utilizing either native tissues or polypropylene mesh (new or previously placed) are all reasonable options for repair. In the hands of an experienced pelvic reconstructive surgeon, complication rates from mesh implantation are limited while potential benefits of additional strength and durability are offered. Debate continues over the appropriate use of polypropylene mesh for pelvic reconstruction in women with prolapse; in the setting of recurrent bothersome prolapse mesh may offer a durable option.