Pelvic Organ Research Articles

132 - The influence of health status and age for outcomes after pelvic organ prolapse surgery – a nationwide register study

132 - The influence of health status and age for outcomes after pelvic organ prolapse surgery – a nationwide register study

Outcomes of laparoscopic sacrocolpopexy using self-cut mesh on pelvic organ prolapse

Objectives: The objective of the study was to investigate the long-term outcome and complication rate of laparoscopic sacrocolpopexy (LSC) using self-cut mesh as pelvic organ prolapse treatment. Methods: A retrospective cohort study on patients undergoing LSC was done at Kameda Medical Center from January 2013 to January 2018. Data for this study were taken from all women with pelvic organ prolapse who had undergone LSC using self-cut polypropylene mesh. Patients with a previous history of hysterectomy were excluded from the study. An evaluation was done preoperatively, on 6-month and 1-year postoperative follow-up period using Pelvic Organ Prolapse Quantification (POP-Q) and The International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) questionnaire. Results: There were 702 subjects who met the inclusion and exclusion criteria. The clinical characteristics of the subjects were recorded. The scores during admission, 6 months and 1 year postoperative are: POP Q scores: 6.50 ± 5.69 vs. 5.11 ± 4.85 vs. 4.78 ± 4.31, P = 0.049 and ICIQ SF scores: 2.92 ± 0.62 vs. 1.10 ± 0.36 vs. 1.13 ± 0.41, P < 0.001). A total of 17 (2.4%) perioperative and postoperative complications were observed on subjects. Conclusion: LSC using self-cut mesh could produce satisfactory results in pelvic organ prolapse patients on 6-month and 1-year follow-up period with minimal perioperative complications.

279 - Long term impact on physical performance, muscle strength, and skeletal muscle mass in patients undergoing pelvic organ prolapse surgery

279 - Long term impact on physical performance, muscle strength, and skeletal muscle mass in patients undergoing pelvic organ prolapse surgery

Long-term follow-up after laparoscopic reparation of pelvic organ prolapses in a large teaching gynecological center

ObjectiveTo provide a description of laparoscopic approach to correct pelvic organ prolapses and evaluate the risk factors associated with the prolapse recurrence Study designWe retrospectively analyzed 418 patients with symptomatic pelvic organ prolapse who underwent a laparoscopic reparation at our university center from 2010 to 2020. Prolapses were assessed by Baden-Walker system (stage I–IV). The association between the potential prognostic factors and the recurrence was analyzed using Cox regression. ResultsWe included 418 patients. Most patients (97.6 %) had at least one vaginal delivery and 92 (22 %) had a previous prolapse surgery. In 29.74 % of cases levator ani muscle avulsion was observed. We performed a cervicosacropexy in 336 (80.38 %) cases, a sacrohysteropexy in 13 (3.11 %), and a sacrocolpopexy in 69 (16.5 %). Also, concomitantly, 66 (15.79 %) patients with stress and occult urinary incontinence underwent TOT surgery. Surgical complications were low (9.51 %) and the majority were minor. Median follow-up was 37 months (IQR 10.5, 61.4 months), and the global recurrence rate was 9.57 %. Only 4.06 % of cases required reintervention. In Cox regression analysis only levator ani muscle avulsion remained as a recurrence-associated factor. ConclusionOur series is one of the largest and with the longest follow-up. Recurrence rate was low, and comparable to other large series. The only independent factor related to recurrence was the levator ani muscle avulsion.

Type III Collagen RNA Level Expression in Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis.

Changes in the expression of type III collagen have been linked to women's predisposition to pelvic organ prolapse (POP); however, the findings of prior studies have been conflicting. This study was aimed at investigating whether changes in the type III collagen gene expression levels occur in POP development. A systematic review and meta-analysis were conducted on research articles that evaluated type III collagen gene expression levels in patients with POP compared with those without the condition. The articles, published between January 2000 and February 2024, were obtained from PubMed, ScienceDirect, Semantic Scholar, and EBSCO databases. Data were analyzed using fixed-effect models, and the pooled standardized mean difference (SMD) was calculated. Cochrane's Review Manager 5.4 was used for the analysis. The aggregated SMD with 95% confidence interval (CI) regarding type III collagen gene expression levels relative to POP development was the main outcome measure. Results with p < 0.05 were considered statistically significant. Six studies were included in our analysis, comprising 229 POP cases and 139 non-POP cases. Our meta-analysis indicated that patients with POP had higher type III collagen gene expression levels than those without POP (SMD = 0.32; 95% CI: 0.07 to 0.56; p = 0.01). The results of this study provide evidence that a higher type III collagen gene expression levels is significantly associated with POP.

131 - A randomised controlled trial of the clinical and cost-effectiveness of vaginal pessary self-management vs clinic based care for pelvic organ prolapse: four year follow up data

131 - A randomised controlled trial of the clinical and cost-effectiveness of vaginal pessary self-management vs clinic based care for pelvic organ prolapse: four year follow up data

Diagnosis and treatment of abdominally inserted (sacrocolpopexy/sacrohysteropexy) mesh complications for vault/uterine prolapse

Background:Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms. Objective:A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus. Conclusion:The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove meshcarries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.

Hysterectomy versus Uterine Preservation for Pelvic organ prolapse Surgery (HUPPS): A prospective cohort study

One in five females will have surgery to treat pelvic organ prolapse in their lifetime. Uterine-preserving surgery involving suspension of the uterus is an increasingly popular alternative to the traditional use of hysterectomy with vaginal vault suspension to treat pelvic organ prolapse; however, comparative evidence with native tissue repairs remains limited in scope and quality. To compare 1-year outcomes between hysterectomy-based and uterine-preserving native tissue prolapse surgeries performed through minimally invasive approaches. We used a non-randomized design with patients self-selecting their surgical group to integrate a pragmatic, patient-centred, and autonomy-focused approach. Participants chose between uterine-preserving surgery or hysterectomy-based surgery, guided by neutral, evidence-based discussions and individualized decision-making, with support from fellowship-trained urogynecologists. Inverse probability of treatment weighting based on high-dimensional propensity scores was used to balance baseline differences across surgical groups in an effort to resemble a randomized clinical trial. A prospective cohort study of 321 participants with stage ≥2 prolapse involving the uterus who desired surgical treatment were recruited between 2020 and 2022 and followed to 1 year (retention >90%). Patients chose to receive uterine-preserving POP surgery through hysteropexy (n=151) or hysterectomy with vaginal vault suspension (n=170; reference group), with repair of anterior and/or posterior prolapse if indicated. The primary outcome was anatomic prolapse recurrence within one year, defined as apical descent ≥50% of the total vaginal length. Secondary outcomes were peri-operative, functional, clinical, and healthcare outcomes measured at 6 weeks and 1 year. Inverse probability of treatment weighted linear regression and modified Poisson regression were used to estimate adjusted mean differences (aMD) and relative risks (aRR), respectively. Apical anatomic recurrence rates at 1 year were 17.2% following hysterectomy and 7.5% following uterine-preservation, resulting in an adjusted relative risk of 0.35 (95% CI 0.15, 0.83). Uterine-preserving surgery was associated with shorter length of surgery (aMD -0.68 hours [-0.80, -0.55]) and hospitalization (aMD -4.34 hours [-7.91, -0.77]), less use of any opioids within 24 hours (aRR 0.79 [0.65, 0.97]), and fewer procedural complications (aRR 0.19 [0.04, 0.83]) than hysterectomy. Up to 1 year, uterine-preserving surgery was associated with lower risk of composite recurrence (stage ≥2 prolapse in any compartment or retreatment; aRR 0.47 [0.32, 0.69]) than hysterectomy, driven by anatomic outcomes. There were no clinically meaningful differences in functional or healthcare outcomes between surgical groups. This study adds real-world evidence to the growing body of research supportive of uterine-preserving surgery as a safe, efficient, and effective alternative to hysterectomy during native tissue prolapse repair. Given mounting evidence on safety, efficiency, and effectiveness of uterine-preserving surgery and its alignment with the preferences of approximately half of patients to keep their uterus, the standard of care should include routine offering and patient choice between uterine-preserving and hysterectomy-based surgery for pelvic organ prolapse.

165 - Minority Women Undergo Surgical Treatment of Pelvic Organ Prolapse at Similar Rates to Non-Minorities in a Hispanic Minority-Majority Population

165 - Minority Women Undergo Surgical Treatment of Pelvic Organ Prolapse at Similar Rates to Non-Minorities in a Hispanic Minority-Majority Population

Результаты хирургического лечения проляпса в области заднего сегмента тазового дна у пациенток с раком молочной железы на фоне эндокринной терапии

The cause of pelvic organ ptosis in women is damage or weakening of the connective tissue and muscle structures of the pelvic floor, which normally serve as a supporting framework for pelvic organs and are estrogen-dependent. Most women with receptor-positive breast cancer are prescribed adjuvant endocrine therapy after surgery to suppress estrogen levels. The authors investigated the results of surgery of posterior pelvic floor segment prolapse in this category of patients (n = 50). The study was conducted in a comparative aspect with a group of patients who do not suffer from breast cancer (n = 50). For anatomical correction of prolapse, posterior colporaphy, anterior levatoroplasty or sphincterolevatoroplasty, resection of rectal mucosa prolapse using the STARR method, sacrocolporectopexy, depending on the pathology of certain structures of the pelvic floor, were performed. The evaluation of the treatment results was carried out after 3 years using clinical, radiological (defecography) and physiological methods (anorectal functional tests) studies. The authors showed that the symptoms of obstructive defecation and anal incontinence were less amenable to correction in patients with endocrine therapy. The authors concluded that it is necessary to prevent pelvic organ prolapse and the advantages of surgical correction of the initial forms of prolapse in this group of patients.

Genome-wide association studies for pelvic organ prolapse in the Japanese population

Pelvic organ prolapse (POP) affects approximately 40% of elderly women, characterized by the descent of the pelvic organs into the vaginal cavity. Here we present the results of a genome-wide association study (GWAS) for susceptibility to POP comprising 771 cases and 76,625 controls in the Japanese population. We identified a significant association of WT1 locus with POP in the Japanese population; rs10742277; odds ratio (OR) = 1.48, 95% confidence interval (CI), 1.29–1.68, P = 6.72 × 10−9. Subsequent cross-ancestry GWAS meta-analysis combining the Japanese data and previously reported European data, including 28,857 cases and 622,916 controls, identified FGFR2 locus as a novel susceptibility locus to POP (rs7072877; OR = 1.06, 95% CI, 1.04–1.08, P = 4.11 × 10−8). We also observed consistent directions of the effects for 21 out of 24 European GWAS derived loci (binomial test P = 2.8 × 10−4), indicating that most of susceptibility loci for POP are shared across the Japanese and European populations.

Association between genetic polymorphisms in chromosome region 9q21 and pelvic organ prolapse in Northwestern Chinese women.

This study aimed to explore the association between genetic polymorphisms in the chromosome region 9q21 and the risk of pelvic organ prolapse (POP) in Northwestern Chinese women. A case-control study was conducted with 241 POP patients and 268 healthy controls, analyzing ten single nucleotide polymorphisms (SNPs) across five genes using PCR amplification and Sequenom MassArray. The results revealed significant associations between three SNPs-rs2297002 in GOLM1, rs7450 in MAK10, and rs3814535 in TLE1-and POP. Specifically, the TC genotype of rs2297002, the GA genotype of rs7450, and the AA genotype of rs3814535 were linked to an increased or decreased risk of POP. The study suggests that these genetic variants might contribute to the pathogenesis of POP in this population, offering potential markers for early diagnosis and further investigation into the molecular mechanisms underlying POP.

The International Consultation on Incontinence Questionnaire Short Form as a Substitute for 1-Hour Pad Weight Testing in the Evaluation of Urinary Incontinence in Patients With Pelvic Organ Prolapse Undergoing Surgery.

Stress urinary incontinence is a postoperative complication occurring in patients with pelvic organ prolapse (POP). Although the 1-hour pad test measures the degree of urinary incontinence qualitatively and quantitatively, some elderly women undergoing POP surgery do not have the daily activities of living to perform the pad test. Therefore, we examined whether the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) could be used as an alternative tool for pad tests. We retrospectively evaluated 132 patients with POP. In our hospital, 57 patients were treated by laparoscopic sacrocolpopexy (LSC), whereas 75 were treated by transvaginal mesh surgery (TVM). We measured the changes in symptoms preand postoperatively using the ICIQ-SF and 1-hour pad weight testing, and investigated the correlation between the total plus component question scores of the ICIQ-SF and 1-hour pad weight. The preoperative ICIQ total scores in all patients decreased significantly as the amount of leakage on the 1-hour pad weight decreased. The component question scores also decreased significantly with decreasing levels of 1-hour pad weight. The LSC and TVM groups had decreased ICIQ-SF total and component question scores as pad weight decreased. At 12 months postoperatively, the ICIQ total scores in all patients significantly declined as the amount of leakage on the 1-hour pad weight decreased. In the LSC group, the ICIQ-SF total and component question scores also decreased with decreased pad weight, but the differences were not always significant between ICIQ scores and pad weight. In the TVM group, the ICIQ-SF total and component question scores also significantly decreased as the pad weight decreased. The ICIQ-SF could be an appropriate substitute for the 1-hour pad weight testing in predicting the severity of urinary incontinence. In the future, we hope to predict the level of urine leakage based on the ICIQ-SF score.

Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy

AbstractAimVery few studies have compared laparoscopic pelvic organ prolapse suspension (POPS) and laparoscopic ventral mesh rectopexy (LVMR) in the treatment of rectal prolapse, particularly regarding the comparison of improvement rates in obstructed defecation syndrome (ODS). This study aimed to compare the anatomical and functional outcomes of these two methods over a long‐term follow‐up period.Patients and methodsThis retrospective study was conducted on 120 female patients diagnosed with rectal prolapse who underwent surgery at the Colorectal Surgery Department of Shahid Faqihi Hospital in Shiraz, Iran, between October 2015 and October 2022. The patients were categorised into two groups based on their surgical procedures: 58 underwent LVMR in the first group, and 62 underwent POPS in the second group.ResultsRecurrence of prolapse occurred in 7 (12.1%) patients in the LVMR group and 5 (8.1%) patients in the POPS group (P = .550). The mean operation time, mean length of hospital stay, Visual Analogue Scale score, early and late post‐operative complications, Cleveland Clinic Incontinence Score, ODS symptoms, and Wexner Constipation Scores did not differ significantly between the two groups.ConclusionBoth laparoscopic POPS and LVMR techniques significantly improved the anatomical and functional outcomes in the treatment of rectal prolapse and obstructed defecation. LVMR and POPS can each be considered first‐line treatment options for rectal prolapse, depending on the specific case.

The Integral Theory, Pelvic Floor Biomechanics, and Binary Innervation.

The pelvic floor biomechanics and sphincter functioning are essential for understanding pelvic floor dysfunction and the pathophysiology of the pelvic organs. The pelvic floor consists of muscles, fascial connections and ligaments. The Integral Theory Paradigm (ITP) explains the musculoskeletal entity of the sphincter mechanism and the pathophysiology of pelvic organ function. The ITP explains the pelvic floor function determined by 3 directional muscle forces: forward, backwards and downward-acting muscle vector forces that form an anterior and posterior resultant. The resultant equilibrium is essential for urinary continence, voiding and defecation. Loose ligaments disturb the equilibrium of the pelvic floor's muscular function with consequences for the organ function's continence, evacuation, and sensory perception.

The "Ins and Outs" of Dynamic Magnetic Resonance Imaging for Female Pelvic Organ Prolapse.

Concurrent pelvic organ and rectal prolapse have an incidence of 38%. Dynamic pelvic magnetic resonance imaging (MRI) is the modality of choice for workup. We discuss dynamic pelvic MRI indications, interpretation, and clinical application to pelvic floor disorders. The pubococcygeal line (PCL) extends from the pubic symphysis to the last coccygeal joint. The "H line" demonstrates the levator hiatus size, drawn from the inferior pubic symphysis to the posterior rectal wall at the anorectal junction. The "M line" represents vertical descent of the levator hiatus and extends perpendicularly from the PCL to the posterior aspect of the H line. With rectovaginal fascial defects, the small bowel, the peritoneum, and the sigmoid colon can prolapse. Posterior compartment abnormalities include rectocele, rectal prolapse, and descending perineal syndrome. Pelvic MRI can evaluate functional disorders such as anismus, where the anorectal angle is narrowed and associated with lack of pelvic floor descent and incomplete evacuation. Particularly for patients with concurrent urogynecological and colorectal complaints, previous pelvic reconstructive surgery, or when clinical symptomatology does not correlate with physical examination, dynamic pelvic MRI can impact management. It is critical for pelvic reconstructive surgeons to be familiar with this imaging modality to counsel patients and interpret radiographic findings.

Prolapse Treatment-Related Decisional Conflict After New Patient Visits.

Patients with pelvic organ prolapse are often tasked with deciding between treatments. Decisional conflict is a measure of factors that go into effective decision making. This study aimed to compare prolapse treatment-related decisional conflict reported by underrepresented patients (URPs) to non-URPs after new patient visits. A multicenter cohort study of new patients counseled regarding management of prolapse from July 2021 to December 2022 was performed. Participants completed the Decisional Conflict Scale (DCS), a validated measure of modifiable factors in decision making. Higher scores indicate feeling less comfortable with decisions. Race and ethnicity were viewed as social constructs. A URP was defined as self-identification with a non-White race or Hispanic ethnicity. Alpha was set at 0.05, power 80%, to detect an effect size of 0.4 between mean DCS scores. A total of 207 participants (103 URPs, 49.8%), with a mean age of 63.4 ± 11.9 years and mean body mass index of 29.7 ± 6.9 (calculated as weight in kilograms divided by height in meters squared), completed the study. Much of the URP group self-identified as Hispanic (50/103, 48.5%) and/or Black (39/103, 37.9%), and 30 of 103 (29.1%) had an interpreter at their visit. A greater proportion of non-URPs had a prior hysterectomy (16.1% difference; P = 0.017) and prolapse surgery (18/204, 10.5% difference; P = 0.020). A greater proportion of URPs had hypertension (23.6% difference; P = <0.001). There were no differences in the other pelvic floor disorders, prolapse stage, or treatments selected (all P > 0.05). The mean DCS scores were not different between groups (URP, 12.9 ± 12.3 vs non-URP, 11.6 ± 14.9; P = 0.31). Household income, education, and insurance were not associated with DCS scores (all P > 0.05). Decisional Conflict Scale scores were not significantly different between groups. Possible differences between subgroups warrant further investigation.

Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review.

Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH). To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process. We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar. We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available. A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0. We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I2 = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I2 = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I2 = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I2 = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I2 = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively). LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation. CRD42024537270.

Preventing the Next Neglected Pessary: A Quality Improvement Initiative.

Pessaries are commonly used to manage pelvic organ prolapse. Pessary management can be done by a medical professional or the patient themselves. Pessary complications are rare. However, pessaries can be difficult to track, and patients who are lost to follow-up are at an increased risk of complications such as vaginal ulceration, pessary embedment, and fistulization. To create and implement a quality improvement initiative focusing on preventing neglected pessaries. Through the electronic medical record, we implemented a quality improvement initiative focused on creating a workflow where a pessary can be designated as an implant when inserted. A year after implementation, data was gathered. We identified 37% (55/147) of patients without follow-up in the 3 months after pessary placement. Of those, 24% were no longer using pessaries, 24% were self-maintaining or having surveillance with their primary OB/GYN, 16% had surgery for pelvic organ prolapse since placement of the pessary, 15% were lost to follow-up and were considered to be patients "at risk," and 12% did not have a pessary placed to begin with. Review showed 53% of patients with proper documentation and designation of pessary as an implant. This quality improvement initiative can identify patients lost to follow-up, leading to improved patient care and potential to prevent complications.

Use of the senolytics dasatinib and quercetin for prevention of pelvic organ prolapse in a mouse animal model.

Senolytic agents have the potential to target age-related pathology associated with cellular senescence and reduce senescent cell activity in several disease processes. We utilized a mouse model of pelvic organ prolapse, Fibulin-5 knockout (Fbln-5-/-) mice, to assess the ability of dasatinib and quercetin (D+Q) to prevent development of prolapse. Four-week-old female Fbln-5-/- (n=63) and wild-type (WT) mice (n=54) were assigned to control (vehicle injection) or treatment (D = 5 mg/kg, Q = 50 mg/kg) groups. Weekly oral gavage injections were administered from weeks 4-8 of life. Pelvic organ prolapse quantification system measurements were obtained weekly. Vaginal tissue was harvested at 10, 12 and 20 weeks. Tissue analysis included immunostaining for cell cycle inhibitors, multiplex cytokine analysis, senescence-associated-β-galactosidase (SA-β-Gal) and histologic analysis of extracellular matrix proteins. Perineal body length was significantly longer in Fbln-5-/- treatment mice at 20 weeks. Expression of p16 and p53 was decreased in Fbln-5-/- treatment mice compared to controls (4.0% vs. 26.7%, p=0.0124 and 2.9% vs. 16.8%, p=0.272) at 20 weeks. Expression of SA-β-Gal and senescence-associated cytokines did not vary significantly between groups. At 20 weeks, vaginal tissue elastin content in Fbln-5-/- treatment mice increased compared to controls (1.04% vs. 0.84%, p=0.999). D+Q injections did not result in clinically significant differences in prolapse development but did demonstrate decreased expression of cellular senescence markers in Fbln-5-/- mice. This suggests senolytic agents may mitigate contributions of cellular senescence to tissue dysfunction associated with prolapse. Further studies are needed to confirm ideal timing, dosage, and route of senolytics in prevention of prolapse.