Recent Updates in Management of Pelvic Organ Prolapse

Abstract

●Surgical candidates for pelvic organ prolapse (POP) repair are women with symptomatic prolapse who decline or fail conservative therapy (eg, vaginal pessaries).

●There is no indication for repair of asymptomatic POP as an isolated procedure. We also suggest NOT performing prolapse repair for most asymptomatic women who are undergoing other pelvic floor procedures (eg, stress urinary incontinence [SUI] surgery) (Grade 2C). Prolapse repair at the time of other pelvic surgery is a reasonable option in women with risk factors for developing prolapse progression (eg, concomitant hysterectomy, premenopausal status, obesity).

●Women who are elderly, unable to tolerate extensive surgery, and do not plan future vaginal intercourse are candidates for obliterative POP surgery.

●For women undergoing apical prolapse repair, we suggest

performing concomitant hysterectomy rather than uterine

preservation (Grade 2B). A uterine sparing procedure performed by a surgeon familiar with the necessary techniques is a reasonable alternative for women who strongly prefer to preserve their uterus and are aware of the potential risk of recurrent prolapse and the uncertainty regarding obstetric outcomes.