Abstract
Pelvic organ prolapse affects approximately 8% of women, and the demand for pelvic organ prolapse surgery is expected to increase by nearly 50% over the next 40 years. The surgical techniques used to correct pelvic organ prolapse have evolved over the last 10 years, with multiple well-designed studies addressing the risks, outcomes, reoperation rates, and optimal surgical approaches. Here we review the most recent evidence on the route of access, concomitant procedures, and synthetic materials for augmenting the repair. Ultimately, this review highlights that there is no optimal method for correcting pelvic organ prolapse and that the risks, benefits, and approaches should be discussed in a patient-centered, goal-oriented approach to decision-making.
Highlights
Pelvic organ prolapse (POP) is a progressive hernia- diaphragm that most commonly leads to symptoms tion of the pelvic organs through the urogenital of a vaginal bulge.[1,2] Women with prolapse beyondRambam Maimonides Med J | www.rmmj.org.ilSurgical Update on Pelvic Organ Prolapse the hymen may report lower urinary tract and bowel symptoms
In a paper by Rooney et al in which they studied the relationship between anterior and apical prolapse using the pelvic organ prolapse quantification system (POP-Q),[11] the investigators found a linear correlation between the positions of the apex (POP-Q point C) and the most prolapsed portion of the anterior vaginal wall (POP-Q point Ba).[9]
With increasing evidence that apical support is the cornerstone of prolapse surgery, the focus is shifting to identifying the optimal procedure to suspend the apex
Summary
Pelvic organ prolapse (POP) is a progressive hernia- diaphragm that most commonly leads to symptoms tion of the pelvic organs through the urogenital of a vaginal bulge.[1,2] Women with prolapse beyond. The estimated prevalence of POP is between 2.9% and 8% of the female population,[3,4,5] and recent estimates suggest women have a 12.6% lifetime risk of undergoing surgery for prolapse.[6] Approximately 300,000 women in the United States undergo surgical procedures for prolapse each year.[7]. A variety of surgical approaches have been developed and optimized over the last half century to enhance durability, minimize risks, and shorten recovery. The treatment of prolapse remains a matter of individualizing patient outcome goals while navigating the risks of hernia recurrence, surgical complications, and mesh complications. The objectives of this paper are to highlight some best practices that have emerged over the last decade and to expose several issues where our data are inconclusive and warrant further investigation
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