Significant Prolapse Research Articles

Pelvic floor disorders among women in Dabat district, northwest Ethiopia: a pilot study

Pelvic floor disorders affect many women in high-income countries. Since little is known about such disorders in Africa, this study aimed at assessing the prevalence and risk factors in an Ethiopian community. We also assessed the validity of a prolapse questionnaire. A community-based cross-sectional study was conducted among 395 women, recruited by a systematic random sampling technique. Women were interviewed about symptoms of urinary incontinence, faecal incontinence and pelvic organ prolapse by female nurses. Additionally, pelvic examinations were performed in 294 (74.2%) participants to assess anatomical prolapse using the simplified Pelvic Organ Prolapse Quantification staging system. Descriptive statistics and logistic regression analyses were employed. The median age of participants was 35.0 years. Thirty-one women reported urinary incontinence (7.8%), 25 (6.3%) symptomatic pelvic organ prolapse and 2 (0.5%) faecal incontinence. Anatomical pelvic organ prolapse stage II-IV was detected in 162 (55.1%) of women who underwent pelvic examination. The questionnaire for prolapse assessment had poor validity (38.3% sensitivity and 95.4% specificity) even in cases of clinically relevant prolapse (stage III or IV). After adjustment, carrying heavy objects for 5 or more hours a day, history of prolonged labour and highland rural residence were associated with anatomical pelvic organ prolapse. Self-reported incontinence seems low in northwest Ethiopia. The prevalence of symptomatic prolapse was low despite a high prevalence of prolapse signs. Notably, heavy carrying and prolonged labour increased the risk of anatomical prolapse stage II-IV. The methods of assessing pelvic floor disorders in a low-income context need further development.

Prolapse and sexual function 8 years after neovagina according to Shears: a study of 43 cases with Mayer–von Rokitansky–Küster–Hauser syndrome

To investigate sexual and anatomical outcome after Shears neovagina in patients with Mayer-von Rokitansky-Kuster-Hauser syndrome (MRKH). Forty-three consecutive patients with MRKH syndrome underwent surgery creating a neovagina according to Shears. Follow-up was 8 years. Sexual function was assessed using the Female Sexual Function Index (FSFI) as patient reported outcome; anatomical results were assessed measuring anterior, posterior and apical prolapse using the ICS Pelvic Organ Prolapse Score (ICS-POP Score). Pelvic floor contraction was measured applying the Oxford grading system. Thirty-seven of the patients were regularly sexually active and filled in the FSFI; mean total FSFI was 27.2 (range 24-28). No significant prolapse of the neovagina was noted, 11 patients had a grade I cystocele, rectocele or apical descent that was asymptomatic. Oxford grading of the pelvic floor contraction was 4 in median (range 2-5). The neovagina according to Shears is a valuable surgical option with good sexual and anatomical outcome 8 years after therapy.

The 6th Russian School of Colorectal Surgery meeting

The capital of Russia these days is a metropolis with 12 million people. Two million people daily enter and leave Moscow! The last time we participated in this meeting was 3 years ago. Our first impression this time was that the meeting had tripled in size under the leadership of Prof. V.P. Tsarkov. He and his team spread their arms and gave a warm welcome to more than 1,500 participants. In the early spring of this year,for the sixth time, the Russian School of Colorectal Surgery offered a very interesting and busy program. The conference was divided into 2 days and two important and fascinating topics. The first day was dedicated to benign pathology of the rectum and pelvic floor. Hemorrhoidal disease was a popular topic for live surgery and problem solving. G. Millito, M. Janic, and S. Regadas demonstrated hemorrhoidectomy with Ligasure, hemorrhoidectomy with monopolar electrocautery, and stapled hemorrhoidopexy. It was concluded that surgical hemorrhoidectomy should be reserved for patients who do not respond to outpatient treatment and those who have large external hemorrhoids, or combined internal and external hemorrhoids with significant prolapse (grades III–IV). E. Rullier performed laparoscopic ventral rectosacropexy for descending perineum syndrome with new mesh and a new method for securing it. This session was chaired by M. Pescatori and moderated by V.P. Tsarkov, I. Nechai, D. Khubezov, and V. Egiev, all of whom stimulated the discussion with their comments. The following session consisted of lectures on another interesting topic: diagnosis and treatment of pelvic floor dysfunctions. With his fascinating presentation, M. Pescatori opened another perspective on this problem and spoke about the iceberg syndrome and treatment solutions. S. Regadas gave a masterly lecture based on several years of experience with a novel 3-D dynamic anorectal ultrasoound technique for the assessment of perineal descent. A.A. Popov made an important contribution with his talk on pelvic floor descent from a gynecologist’s point of view. The session closed with an interesting lecture by J. Korcek on transvaginal procedures in the treatment of rectocele and pelvic floor syndrome. The next day in the Congress Hall of the Hotel Radisson Slavyanskaya, the seats were rapidly taken and even standing room was at a premium as the hall filled with curious surgeons. Live surgery began in two operating theatres simultaneously. R. Bergamaschi, A. Parvajz, and V.P. Tsarkov masterfully demonstrated their techniques in laparoscopic and open colectomy. The next session was devoted to new perspectives in the treatment of colon cancer. The series of lectures began with R. Bergamaschi examining the issue of laparoscopic colon cancer surgery as a new standard of care, followed by E. Rullier speaking about issues in laparoscopic treatment of colon cancer and then E. Tiret, who covered the current standards of care. C.G. Fu presented an impressive case series of hand-assisted laparoscopic surgery. The session closed with a very interesting lecture by K. Maeda on the pros and cons of lymph node dissection in colon cancer. The last session was dedicated to various themes: from a surgical view of colon cancer metastases, presented by V.P. Tzarkov, through questions about when and how to treat dehiscence of colonic anastomoses, discussed by Y. Panis. A. Zakharenko described some very complicated cases of colon cancer. A. Parvajz stressed the importance of a training program for surgeons in the colorectal field. A young yet very experienced hepaticobiliary surgeon from Liverpool, S. Fenwick, gave an exciting talk on new hope for the treatment of liver metastatic colorectal cancer. An impressive master class on the first day was given by S. Regadas, with a helping hand from the staff of the Department of Colorectal and Pelvic Floor Surgery of the Russian National Center of Surgery. This very successful meeting wound to an end on the evening of the second day, as the Moscow river flowed into the night, quietly singing “Kalinka”.

The prevalence of detrusor overactivity amongst patients with symptoms of overactive bladder: a retrospective cohort study

Overactive bladder (OAB) is a symptom-based condition consisting of urgency, with or without incontinence, usually with frequency and nocturia. There are many potential causes of OAB, yet many patients are prescribed anticholinergic medications empirically. This study aimed to determine what proportion of patients presenting for urogynecologic assessment with symptoms of OAB had urodynamic detrusor overactivity (DO). Retrospective chart review was performed for 220 consecutive patient referrals. Demographic data, physical exam information, and urodynamic results were collected. The t test and Fisher's exact test were used for statistical analyses. The prevalence of DO was 11.8 % in this population. Urogenital atrophy and incomplete emptying were more common. Patients with DO were older and more often menopausal than those without DO. Significant prolapse was a common finding amongst patients with OAB symptoms. Patients with symptoms of OAB should undergo pelvic examination and assessment of post-void residuals before being initiated on anticholinergic medication.

Overview of pelvic floor failure and associated problems

Pelvic organ prolapse POP, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of women worldwide. The aim of this review is to highlight the clinical importance of prolapse, its pathophysiology, and different modalities for diagnosis and treatment. POP includes a range of disorders, from asymptomatic disturbed vaginal anatomy to complete vaginal eversion associated with considerable degrees of urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial however genetically susceptible women are more exposed to life events that result in the development of clinically significant prolapse. The evaluation of women with prolapse requires a comprehensive approach, with focusing on the function in all pelvic compartments based on a detailed patient history, physical examination, and investigations. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often a challenge for the clinician to determine which symptoms are prolapse-specific and will therefore improve or resolve after prolapse treatment. Prolapse treatment is based on specific symptoms moreover its management options fall into two broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive or obliterative. Associated symptoms require additional management. All women with prolapse can be treated and their symptoms improved, even if not completely resolved.

Avulsion injury and levator hiatal ballooning: two independent risk factors for prolapse? An observational study

To study whether avulsion and ballooning are independent risk factors for symptoms and/or signs of pelvic organ prolapse. Retrospective analysis of data obtained in clinical practice. Tertiary urogynecology unit. Seven hundred and sixty-one consecutive women with symptoms of pelvic floor dysfunction. Evaluation included history, vaginal examination and four-dimensional translabial ultrasound. Ultrasound analysis was performed off-line, blinded against clinical data. Hiatal dimensions were measured at the plane of minimal hiatal dimensions. Puborectalis avulsion was identified using tomographic imaging. Symptoms and objective signs of prolapse (ICS POP-Q stage 2+). Owing to previous surgery 156 women were excluded, leaving 605, of whom 258 (43%) had prolapse symptoms. Significant prolapse (International Continence Society Prolapse Quantification System grade 2+) was identified as follows: cystocele in 222 (37%) women, rectocele in 159 (27%) and apical in 40 (8%), while 110 (18%) had an avulsion. There was a strong association between avulsion, hiatal ballooning and symptoms/signs of prolapse (p < 0.001). On multivariable backwards stepwise logistic regression, puborectalis avulsion was associated with an increased risk of symptoms and signs of prolapse, even after allowing for the degree of levator ballooning. The presence of avulsion did not modify the relation between hiatal area and symptoms of prolapse. Puborectalis avulsion injury and levator hiatal ballooning are independent risk factors for symptoms and signs of prolapse. The role of avulsion in the pathogenesis of prolapse is not fully explained by its effect on hiatal dimensions. It is likely that avulsion implies not only muscular trauma but also damage to structures impossible to assess clinically or by imaging, i.e. myofascial and connective tissue.

Surgical Outcomes of Abdominal Versus Laparoscopic Sacral Colpopexy Related to Body Mass Index

ObjectiveObesity can predispose women to pelvic organ prolapse and can also affect the success of prolapse surgery. Sacral colpopexy is a common surgical approach used to treat significant prolapse, and may be performed by laparotomy or laparoscopy. The objective of this study was to determine whether surgical outcomes following abdominal sacral colpopexy (ASC) and laparoscopic sacral colpopexy (LSC) varied according to BMI. MethodsWe conducted a retrospective cohort study of women who had undergone ASC (n = 90) and LSC (n = 150). Preoperative, perioperative, and postoperative information was collected from patient charts and entered into a database according to BMI category (normal weight 18.5 to 24.9 kg/m2, overweight = 25 to 29.9 kg/m2, obese ≥ 30 kg/m2). Within each BMI group, outcomes were compared between ASC and LSC patients using Student t, Mann-Whitney U, and Fisher exact tests, and analyses of covariance. ResultsIn normal weight patients, postoperative apical measurements were worse in ASC patients (P = 0.01). In overweight patients, the ASC group had worse posterior measurements (P = 0.05) and fewer mesh/suture erosions (P = 0.03) but more recurrent prolapse symptoms (P = 0.007). In obese patients, the ASC group had better anterior measurements (P = 0.008). There were no differences in any BMI category for prolapse stage, surgical satisfaction, or classification of surgical success or failure (P > 0.05). ConclusionDifferences between ASC and LSC were identified when patients were categorized according to BMI. These findings may be useful in counselling patients and planning the appropriate surgical approach for sacral colpopexy based on BMI.

Sacrohysteropexy followed by successful pregnancy and eventual reoperation for prolapse

A multitude of uterine-sparing prolapse repairs exist in the literature, but little is published on subsequent pregnancy and long-term success following a repair. A 35-year-old gravida 2 para 2 underwent laparoscopic sacrohysteropexy and suburethral sling for stage III prolapse and stress urinary incontinence. She conceived 6 months postprocedure. Her antepartum course was complicated by third trimester pelvic pressure--successfully managed with a pessary. She delivered via cesarean section at term. At 12 months postpartum she had no signs of prolapse. Two years postpartum, she reprolapsed and underwent robotic assisted laparoscopic supracervical hysterectomy, sacrocolpopexy, and perineorrhaphy. Two years postoperatively she remained without any prolapse symptoms. Laparoscopic sacrohysteropexy is a reasonable surgical option for patients with pelvic organ prolapse considering future pregnancies.

Can ballooning of the levator hiatus be determined clinically?

The objective of the study was to determine whether genital hiatus (gh) and perineal body (pb), measured using the pelvic organ prolapse quantification system of the International Continence Society, are predictive of an abnormally distensible levator hiatus on ultrasound and of objective prolapse and/or prolapse symptoms. The design of the study included datasets of 188 urogynecology patients assessed in a cross-sectional retrospective study. Gh and pb, as well as gh plus pb, were strongly associated with symptoms and signs of prolapse and with hiatal area on ultrasound. The sum of gh and pb was superior in predictive performance to individual measures for symptoms (P < .001) and signs of prolapse (P < .001). Gh plus pb equaled the hiatal area on ultrasound (area under the curve, 0.886; 95% confidence interval, 0.828-0.945 vs 0.867; 95% confidence interval, 0.808-0.926) for predicting objective prolapse. Optimal sensitivity (80%) and specificity (81%) was reached with a cutoff of 7 cm for gh plus pb. A cutoff of 7 cm for gh plus pb measured on Valsalva is proposed as a clinical definition of excessive levator hiatal distensibility.

Imaging in the Diagnosis and Management of Two Failed Colpocleisis Procedures

Colpocleisis is an effective surgical procedure for the correction of advanced pelvic organ prolapse, with an overall low failure rate. This procedure is typically reserved for older patients with significant prolapse who are not suitable candidates for pelvic reconstructive surgery. This video demonstrates the imaging findings, and surgical repair, of two patients who underwent a colpocleisis procedure with subsequent post-operative recurrence of a vaginal bulge. In conclusion, post-operative recurrence of pelvic organ prolapse after a colpocleisis procedure can be effectively managed with a site-specific repair.

Anterior but not posterior compartment prolapse is associated with levator hiatus area: a three- and four-dimensional transperineal ultrasound study

many women seeking help for pelvic organ prolapse (POP) have a clinically significant descent in more than one vaginal compartment, and there is often a discrepancy between subjective symptoms and objective findings. We examined the association between the size of the levator hiatus using transperineal three-dimensional (3D) ultrasound and both the degree and anatomical site(s) of POP, and symptoms of pelvic organ dysfunction. cross-sectional study. Gynaecology Department, University Hospital. a total of 157 women with (POP) stage 0-IV with or without symptoms, recruited by community gynaecologists. all women answered the symptom questionnaire. They underwent a clinical examination with grading of the prolapse and a 3D/4D transperineal ultrasound. The ultrasound volumes were analysed offline using the software 4D View (GE, Zipf, Austria). area of the levator hiatus at rest and on Valsalva manoeuvre. clinically significant prolapse in the anterior but not in the posterior compartment was positively associated with area of the levator hiatus (P < 0.001). This was also true for women with POP in two compartments. No independent association between area of the levator hiatus and symptoms of pelvic floor dysfunction was found. our data suggest that accessing the axial plane to evaluate the size of the levator hiatus is indicated in women who have clinically significant POP including the anterior vaginal compartment. The size of the levator hiatus did not explain the discrepancy between subjective and objective findings in women with POP.

Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids

Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique used to treat symptomatic haemorrhoids. In 2005, the DGHAL proctoscope was redesigned to incorporate a window through which a recto anal repair (RAR) could be performed to improve the outcome in patients with significant prolapse symptoms. The aim of this study was to observe the outcome of a series of consecutive DGHAL-RAR procedures. Seventy-seven consecutive patients (49 male) underwent DGHAL-RAR for symptomatic haemorrhoids and were reviewed for a minimum of 6 months post-surgery. Fifty-seven (74%) of patients presented with both prolapse and bleeding symptoms. The median number of DGHALs performed was six, and the median number of RARs was two. Most (96%) patients were discharged the same day. At follow-up, 11 patients complained of recurrent symptoms, five of prolapse, four of bleeding and two of pruritus. Eight patients suffered with post-operative anal fissures. The procedure is recommended by 84.4% of patients 6 weeks post-surgery. DGHAL-RAR is safe, effective and well tolerated. It reduces the need for potentially dangerous excisional procedures. The RAR component is an effective addition to DGHAL in the short term for the treatment of prolapse, but longer follow-up will be required to demonstrate durability of the technique.

Vaginal Hysterectomy for the Prolapsed Uterus

Although most gynecologists are comfortable performing vaginal hysterectomy in the patient without significant uterovaginal prolapse, vaginal hysterectomy for the prolapsed uterus poses unique challenges and requires an increased awareness of deviations in pelvic anatomy that may result. This review article discusses the background of vaginal hysterectomy performed for uterovaginal prolapse, the pathophysiology of uterovaginal prolapse, preoperative assessment of the patient with uterovaginal prolapse, surgical technique, ureteral anatomy, techniques to avoid injury to the ureter at the time of vaginal hysterectomy for uterovaginal prolapse, and other relevant considerations.

Does avulsion of the puborectalis muscle affect bladder function?

The levator ani muscle is generally thought to play a role in urinary continence, with incontinence assumed to be due to abnormal muscle function or morphology. This study examined whether avulsion of the puborectalis muscle is associated with symptoms or signs of bladder dysfunction. In a retrospective observational study, we reviewed the records of 425 women who had attended a urogynecological unit for independent flowmetry, multichannel urodynamic testing, and 4D pelvic floor ultrasound. Mean age was 55 years (range, 17-87 years). Of 420 women with complete datasets, 104 (25%) were diagnosed with a puborectalis muscle avulsion. These women were less likely to suffer from stress urinary incontinence (SUI; P < 0.001) and urodynamic stress incontinence (USI; P = 0.065) and more likely to present with symptoms of prolapse (P < 0.001) and show signs of voiding dysfunction (P = 0.005). The negative association between avulsion and SUI persisted in multivariate models. Puborectalis muscle trauma is not associated with an increased risk of SUI or USI in a urogynecological population, even when controlling for symptoms or signs of prolapse and previous surgery.

Pelvic organ prolapse in rural Ghana

Objective To determine the prevalence of pelvic organ prolapse (POP) and its impact on the lives of women in Sekyidumasi, a rural Ghanaian community. Methods A cross-sectional study of 200 women was performed using a questionnaire and pelvic examination to detect symptoms and signs of prolapse. Main outcome measures were the presence of POP and its impact on quality of life. Results Out of 174 women included in the study, 21 women (12.07%) had POP. Seventeen of these women (81%) were symptomatic, of which only 6 women (35.3%) had sought treatment because of financial constraints. The odds of prolapse increased with increasing parity ( P = 0.02) and age ( P < 0.01). The main impacts of prolapse were on emotional well-being (52.4%), the women's relationship with their partner (46.2%), and sex life (25%). Conclusion Only about one-third of women with symptomatic prolapse sought treatment because the cost of medical care outweighed the impact of the condition on their lives.

Levator trauma is associated with pelvic organ prolapse

To estimate the risk of prolapse associated with levator avulsion injury among a urogynaecological clinic population. Retrospective observational study. Tertiary urogynaecological unit. A total of 934 women seen for interview, examination using the pelvic organ prolapse quantification (POP-Q) staging system and imaging of the levator ani muscle by four-dimensional translabial ultrasound. Retrospective review of charts and stored imaging data. Pelvic organ prolapse stage II and higher and presence of defects of the levator ani muscle. After exclusion of 137 women with a history of anti-incontinence or prolapse surgery, and a further exclusion of 16 women in whom either examination or imaging was impossible, we compared prolapse and imaging data in 781 women. Mean age was 53 years (range 15-89 years), and median parity was 2 (range 0-12). Women reported stress incontinence (76%), urge incontinence (69%), frequency (47%), nocturia (49%) and symptoms of prolapse (38%). Significant prolapse (stage II or higher) was diagnosed in 415 (53%) women, and 181 (23%) women were found to have levator avulsion defects. Prolapse was seen in 150/181 (83%) women with avulsion and in 265/600 (44%) women without avulsion, giving a relative risk (RR) of 1.9 (95% CI 1.7-2.1). The association was strongest for cystocele (RR 2.3, 95% CI 2.0-2.7) and uterine prolapse (RR 4.0, 95% CI 2.5-6.5). Women with levator avulsion defects were about twice as likely to show pelvic organ prolapse of stage II or higher than those without. This effect is mainly due to an increased risk of cystocele and uterine prolapse.

Ballooning of the levator hiatus

The levator hiatus defines the 'hernial portal' through which female pelvic organ prolapse develops. Hiatal area may therefore be an independent etiological factor for this condition. In this retrospective study we defined 'normality' for hiatal area by assessing its relationship with symptoms and clinical signs of prolapse. Datasets of 544 women seen in a tertiary urogynecological unit were assessed. Patients had undergone an interview, clinical examination and three-/four-dimensional (3D/4D) pelvic floor ultrasound imaging. All analysis was performed off-line, blinded against clinical data. Information on prolapse symptoms was available for 538 women and 171 (32%) of these complained of such symptoms. There was a strong statistical relationship between hiatal dimensions, both at rest and on Valsalva maneuver, and prolapse symptoms (all P < 0.001). Receiver-operating characteristics (ROC) curve analysis yielded an area under the curve of 0.65 (95% CI, 0.60-0.70) for hiatal area at rest and 0.71 (95% CI, 0.66-0.76) for hiatal area on Valsalva. Cut-offs of 25 and 30 cm(2) on Valsalva gave sensitivities of 0.55 and 0.34 and specificities of 0.77 and 0.86, respectively, for detecting symptomatic prolapse. Similar values were obtained when significant prolapse (Grade 2 or higher) was used as the state variable. Levator hiatal area as measured by 3D translabial pelvic floor ultrasound examination is strongly associated with symptoms and clinical signs of prolapse. Based on the ROC curves that we obtained, we suggest that a hiatal area of > 25 cm(2) on Valsalva be defined as abnormal distensibility or 'ballooning' of the levator hiatus.

Poly(Propylene Fumarate) Scaffolds With Surface Porosity for Space Maintenance of Mandibular Defects

When reconstruction of a bony defect is delayed or staged, significant prolapse of the surrounding soft tissues into the wound requires a secondary dissection for placement of bone grafting materials. Although attempts have been made to preserve space with alloplastic materials such as poly(methyl methacrylate) (PMMA), intra-oral soft tissue healing over PMMA implants is unpredictable, leading to dehiscence of the wound and subsequent infection of the surgical site.

Ultrasound assessment of pelvic organ prolapse: the relationship between prolapse severity and symptoms

At present little information is available to help define whether a certain degree of pelvic organ prolapse is clinically relevant. We performed a retrospective study to define cut-offs for significant pelvic organ descent on the basis of prolapse symptoms. At a tertiary urogynecological center, 735 women with symptoms of lower urinary tract dysfunction and prolapse were seen for interview, clinical examination, multi-channel urodynamics and ultrasound imaging, while supine and after voiding, for prolapse quantification. Women with multi-compartment prolapse, i.e. those in whom no compartment was clearly dominant were excluded. Receiver-operator statistics were used to test pelvic organ descent as a predictor of prolapse symptoms. Mean age was 55.1 years, mean parity 2.8 (range, 0-12). Symptoms of prolapse were reported by 188 women (25.6%). Seventy-four showed a symptomatic multi-compartment prolapse and were excluded, 56 symptomatic women had cystoceles and 48 had rectoceles. Symptomatic cystoceles descended on average to 23.8 mm below the symphysis pubis and symptomatic rectoceles to 21.4 mm below the symphysis pubis. Descent was strongly associated with symptoms of prolapse (both, P < 0.001). Receiver-operating characteristics (ROC) statistics suggested a cut-off of 10 mm below the symphysis pubis for cystocele, and 15 mm below the symphysis pubis for rectocele. ROC curves were similar for both compartments (area under the curve, 0.857 and 0.821, respectively). Descent of the bladder to > or = 10 mm and of the rectum to > or = 15 mm below the symphysis pubis are strongly associated with symptoms, and these values are proposed as cut-offs for the diagnosis of significant prolapse on the basis of ROC statistics.

Recurrent Pelvic Floor Defects After Abdominal Sacral Colpopexy

The incidence of site specific pelvic organ prolapse defects following sacral colpopexy is not clearly reported. We evaluated site specific pelvic organ defects after colpopexy and determined its impact on patient satisfaction. A total of 40 women with vault prolapse underwent abdominal sacral colpopexy, culdeplasty and paravaginal repair. Followup consisted of pelvic examination and satisfaction assessment every 6 months. The Baden-Walker classification was used and prolapse halfway to the introitus (grade II) or greater was considered significant prolapse. Surgical failure was identified as grade III prolapse or greater. Satisfaction was assessed on a scale of 1 to 3 with 3 being highly satisfied and according to whether patients perceived a successful outcome. A total of 40 patients with an average age of 66.5 years (range 48 to 81) had an average followup of 25.5 months (range 18 to 42). Of the 40 patients 22 (55%) did not have significant prolapse, including 14 with no prolapse, and 8 with grade I cystocele and/or rectocele. Of the 40 patients 18 (45%) had recurrent significant prolapse, including cystocele in 8 (grades II and III in 4 each), rectocele in 6 (grades II and III in 2 and 4, respectively), and grade II cystocele and rectocele in 3. There was 1 case of recurrent vault prolapse. Eight of 40 cases (20%) were considered surgical failures. Patients without prolapse were highly satisfied (average score 2.95) and 100% considered surgery to have been successful. The recurrent prolapse group was less satisfied (mean score 2.5) and 66.7% considered the surgery successful. Recurrent pelvic organ prolapse is not an uncommon finding after colpopexy and it may adversely affect patient satisfaction.