Skip to main content

Advertisement

SpringerLink
Log in

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

  • Stress Incontinence and Prolapse (S Reynolds, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

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.

Recent Findings

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ICS:

International Continence Society

IUGA:

International Urogynecological Association

POP:

pelvic organ prolapse

POP-Q:

Pelvic Organ Prolapse Quantification System

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Neurourol Urodyn. 2016;35(2):137–68.

    Article  Google Scholar 

  2. Winters JC, Smith AL, Krlin RM. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh urology. 11th ed. Philadelphia: Elsevier; 2016.

    Google Scholar 

  3. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.

    Article  CAS  Google Scholar 

  4. Denman MA, Gregory WT, Boyles SH, Smith V, Edwards SR, Clark AL. Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol. 2008;198(5):555 e1–5.

    Article  Google Scholar 

  5. •• Ismail S, Duckett J, Rizk D, Sorinola O, Kammerer-Doak D, Contreras-Ortiz O, et al. Recurrent pelvic organ prolapse: International Urogynecological Association Research and Development Committee opinion. Int Urogynecol J. 2016;27(11):1619–32. Recently published international committee opinion paper that sumarizes available evidence on recurrent pelvic organ prolapse and provides guidance on management.

    Article  Google Scholar 

  6. Barber MD, Brubaker L, Nygaard I, Wheeler TL 2nd, Schaffer J, Chen Z, et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114(3):600–9.

    Article  Google Scholar 

  7. Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol. 2005;192(3):795–806.

    Article  Google Scholar 

  8. Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Neurourol Urodyn. 2012;31(4):415–21.

    Article  Google Scholar 

  9. Diez-Itza I, Aizpitarte I, Becerro A. Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(11):1317–24.

    Article  CAS  Google Scholar 

  10. Salvatore S, Athanasiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M, et al. Identification of risk factors for genital prolapse recurrence. Neurourol Urodyn. 2009;28(4):301–4.

    Article  Google Scholar 

  11. Whiteside JL, Weber AM, Meyn LA, Walters MD. Risk factors for prolapse recurrence after vaginal repair. Am J Obstet Gynecol. 2004;191(5):1533–8.

    Article  Google Scholar 

  12. Clark AL, Gregory T, Smith VJ, Edwards R. Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol. 2003;189(5):1261–7.

    Article  Google Scholar 

  13. Fialkow MF, Newton KM, Lentz GM, Weiss NS. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(3):437–40.

    Article  CAS  Google Scholar 

  14. Dallenbach P, Jungo Nancoz C, Eperon I, Dubuisson JB, Boulvain M. Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse. Int Urogynecol J. 2012;23(1):35–41.

    Article  Google Scholar 

  15. Oversand SH, Staff AC, Spydslaug AE, Svenningsen R, Borstad E. Long-term follow-up after native tissue repair for pelvic organ prolapse. Int Urogynecol J. 2014;25(1):81–9.

    Article  Google Scholar 

  16. Moen M, Noone M, Vassallo B. Anterior colporrhaphy: why surgeon performance is paramount. Int Urogynecol J. 2014;25(7):857–62.

    Article  Google Scholar 

  17. Altman D, Vayrynen T, Engh ME, Axelsen S, Falconer C. Nordic transvaginal mesh G. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364(19):1826–36.

    Article  CAS  Google Scholar 

  18. Colombo M, Vitobello D, Proietti F, Milani R. Randomised comparison of Burch colposuspension versus anterior colporrhaphy in women with stress urinary incontinence and anterior vaginal wall prolapse. BJOG. 2000;107(4):544–51.

    Article  CAS  Google Scholar 

  19. Eilber KS, Alperin M, Khan A, Wu N, Pashos CL, Clemens JQ, et al. Outcomes of vaginal prolapse surgery among female Medicare beneficiaries: the role of apical support. Obstet Gynecol. 2013;122(5):981–7.

    Article  Google Scholar 

  20. Lavelle RS, Christie AL, Alhalabi F, Zimmern PE. Risk of prolapse recurrence after native tissue anterior vaginal suspension procedure with intermediate to long-term followup. J Urol. 2016;195(4 Pt 1):1014–20.

    Article  Google Scholar 

  21. • Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;11:CD004014. A cochrane database systematic review that summarizes safety and efficacy of surgical interventions for the management of anterior compartment prolapse.

    PubMed  Google Scholar 

  22. Mowat A, Maher D, Baessler K, Christmann-Schmid C, Haya N, Maher C. Surgery for women with posterior compartment prolapse. Cochrane Database Syst Rev. 2018;3:CD012975.

    PubMed  Google Scholar 

  23. • Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10:CD012376. A cochrane database systematic review that summarizes safety and efficacy of surgical interventions for the management of apical vaginal prolapse.

    PubMed  Google Scholar 

  24. Jonsson Funk M, Visco AG, Weidner AC, Pate V, Wu JM. Long-term outcomes of vaginal mesh versus native tissue repair for anterior vaginal wall prolapse. Int Urogynecol J. 2013;24(8):1279–85.

    Article  Google Scholar 

  25. Urogynecologic Surgical Mesh: Update on the Safety and Effectiveness of Vaginal Placement for Pelvic Organ Prolapse: Center for Devices and Radiological Health, Food and Drug Administration; July 2011 [Available from: http://proxy.library.upenn.edu:2157/downloads/medicaldevices/safety/alertsandnotices/UCM262760.pdf.

  26. Tate SB, Blackwell L, Lorenz DJ, Steptoe MM, Culligan PJ. Randomized trial of fascia lata and polypropylene mesh for abdominal sacrocolpopexy: 5-year follow-up. Int Urogynecol J. 2011;22(2):137–43.

    Article  Google Scholar 

  27. • Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2:CD012079. A cochrane database systematic review that summarizes safety and efficacy of transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse.

    PubMed  Google Scholar 

  28. Toh VV, Bogne V, Bako A. Management of recurrent vault prolapse. Int Urogynecol J. 2012;23(1):29–34.

    Article  CAS  Google Scholar 

  29. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet. 2007;369(9566):1027–38.

    Article  Google Scholar 

  30. Reid RI. Repair of recurrent prolapse. Best Pract Res Clin Obstet Gynaecol. 2011;25(2):175–96.

    Article  Google Scholar 

  31. Norinho de Oliveira P, Bourdel N, Rabischong B, Canis M, Botchorishvili R. What to do with recurrent prolapse after vaginal mesh failure? J Minim Invasive Gynecol. 2016;23(2):161–2.

    Article  Google Scholar 

  32. Schmid C, O'Rourke P, Maher C. Laparoscopic sacrocolpopexy for recurrent pelvic organ prolapse after failed transvaginal polypropylene mesh surgery. Int Urogynecol J. 2013;24(5):763–7.

    Article  Google Scholar 

  33. Nygaard I, Brubaker L, Zyczynski HM, Cundiff G, Richter H, Gantz M, et al. Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.

    Article  CAS  Google Scholar 

  34. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23.

    Article  Google Scholar 

  35. Linder BJ, Chow GK, Elliott DS. Long-term quality of life outcomes and retreatment rates after robotic sacrocolpopexy. Int J Urol. 2015;22(12):1155–8.

    Article  Google Scholar 

  36. Bracken JN, Tran DH, Kuehl TJ, Larsen W, Yandell PM, Shull BL. A novel transvaginal approach to correct recurrent apical prolapse after failed sacral colpopexy: case series. Int Urogynecol J. 2012;23(10):1429–33.

    Article  Google Scholar 

  37. Linder BJ, Gebhart JB, Occhino JA. Total colpocleisis: technical considerations. Int Urogynecol J. 2016;27(11):1767–9.

    Article  Google Scholar 

  38. DeLancey JO, Morley GW. Total colpocleisis for vaginal eversion. Am J Obstet Gynecol. 1997;176(6):1228–32. discussion 32-5

    Article  CAS  Google Scholar 

  39. FitzGerald MP, Richter HE, Siddique S, Thompson P, Zyczynski H. Ann Weber for the pelvic floor disorders N. Colpocleisis: a review. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):261–71.

    Article  Google Scholar 

  40. Hoskey KA, Shippey SH, Handa VL. Surgical repair of recurrent prolapse after LeFort colpocleisis. Int Urogynecol J. 2012;23(3):371–3.

    Article  Google Scholar 

  41. Curtiss N, Duckett J. A long-term cohort study of surgery for recurrent prolapse comparing mesh augmented anterior repairs to anterior colporrhaphy. Gynecol Surg. 2018;15(1):1.

    Article  Google Scholar 

  42. Dallas KB, Rogo-Gupta L, Elliott CS. What impacts the all cause risk of reoperation after pelvic organ prolapse repair? A comparison of mesh and native tissue approaches in 110,329 women. J Urol. 2018.

  43. Nussler EK, Greisen S, Kesmodel US, Lofgren M, Bek KM, Glavind-Kristensen M. Operation for recurrent cystocele with anterior colporrhaphy or non-absorbable mesh: patient reported outcomes. Int Urogynecol J. 2013;24(11):1925–31.

    Article  Google Scholar 

  44. Milani AL, Damoiseaux A, IntHout J, Kluivers KB, Withagen MIJ. Long-term outcome of vaginal mesh or native tissue in recurrent prolapse: a randomized controlled trial. Int Urogynecol J. 2018;29(6):847–58.

    Article  Google Scholar 

  45. Wu PY, Chang CH, Shen MR, Chou CY, Yang YC, Huang YF. Seeking new surgical predictors of mesh exposure after transvaginal mesh repair. Int Urogynecol J. 2016;27(10):1547–55.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Pennsylvania Health System, Philadelphia, PA, USA

    Siobhan M. Hartigan & Ariana L. Smith

Authors
  1. Siobhan M. Hartigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ariana L. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Conflict of Interest

No disclosures for any contributing author.

Additional information

This article is part of the Topical Collection on Stress Incontinence and Prolapse

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hartigan, S.M., Smith, A.L. So the First Pelvic Organ Prolapse Repair Failed…Now What?. Curr Bladder Dysfunct Rep 13, 238–243 (2018). https://doi.org/10.1007/s11884-018-0484-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-018-0484-1

Keywords

Search

Navigation