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Epidemiology and outcome assessment of pelvic organ prolapse

International Urogynecology Journal volume 24, pages 1783–1790 (2013)Cite this article

Abstract

Introduction and hypothesis

The aim was to determine the incidence and prevalence of pelvic organ prolapse surgery and describe how outcomes are reported.

Methods

Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews, level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 (case reports). The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. A grade A recommendation usually depends on consistent level 1 evidence. A grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs. A grade C recommendation usually depends on level 4 studies or “majority evidence” from level 2/3 studies or Delphi processed expert opinion. A grade D “no recommendation possible” would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi .

Results

Pelvic organ prolapse (POP) when defined by symptoms has a prevalence of 3–6 % and up to 50 % when based upon vaginal examination. Surgery for prolapse is performed twice as commonly as continence surgery and prevalence varies widely from 6 to 18%. The incidence of POP surgery ranges from 1.5 to 1.8 per 1,000 women years and peaks in women aged 60–69. When reporting outcomes of the surgical management of prolapse, authors should include a variety of standardised anatomical and functional outcomes. Anatomical outcomes reported should include all POP-Q points and staging, utilising a traditional definition of success with the hymen as the threshold for success. Assessment should be prospective and assessors blinded as to the surgical intervention performed if possible and without any conflict of interest related to the assessment undertaken (grade C). Subjective success postoperatively should be defined as the absence of a vaginal bulge (grade C). Functional outcomes are best reported using valid, reliable and responsive symptom questionnaires and condition-specific HRQOL instruments (grade C). Sexual function is best reported utilising validated condition-specific HRQOL that assess sexual function or validated sexual function questionnaires such as the Pelvic Organ Prolapse/Incontinence Sexual Questionnaire (PISQ) or the Female Sexual Function Index (FSFI). The sexual activity status of all study participants should be reported pre- and postoperatively under the following categories: sexually active without pain, sexually active with pain or not sexually active (grade C). Prolapse surgery should be defined as primary surgery, and repeat surgery sub-classified as primary surgery different site, repeat surgery, complications related to surgery and surgery for non-prolapse-related conditions (grade C).

Conclusion

Significant variation exists in the prevalence and incidence of pelvic organ prolapse surgery and how the outcomes are reported. Much of the variation may be improved by standardisation of definitions and outcomes of reporting on pelvic organ prolapse surgery.

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References

  1. Maher C, Baessler K, Barber M et al (2013) Surgical management of pelvic organ prolapse. In: Abrams C, Khoury W (eds) 5th International Consultation on Incontinence. Health Publication Ltd, Paris

    Google Scholar 

  2. Nygaard I, Barber MD, Burgio KL et al (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316

    Article  PubMed  CAS  Google Scholar 

  3. Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180(2 Pt 1):299–305

    Article  PubMed  CAS  Google Scholar 

  4. Swift SE, Tate SB, Nicholas J (2003) Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol 189(2):372–377, discussion 7–9

    Article  PubMed  Google Scholar 

  5. Neuman M, Lavy Y (2007) Conservation of the prolapsed uterus is a valid option: medium term results of a prospective comparative study with the posterior intravaginal slingoplasty operation. Int Urogynecol J Pelvic Floor Dysfunct 18(8):889–893

    Google Scholar 

  6. Inoue H, Sekiguchi Y, Kohata Y et al (2009) Tissue fixation system (TFS) to repair uterovaginal prolapse with uterine preservation: a preliminary report on perioperative complications and safety. J Obstet Gynaecol Res 35(2):346–353

    Article  PubMed  Google Scholar 

  7. Aigmueller T, Dungl A, Hinterholzer S, Geiss I, Riss P (2010) An estimation of the frequency of surgery for posthysterectomy vault prolapsed. Int Urogynecol J 21:299–302

    Article  PubMed  Google Scholar 

  8. Bai SW, Kim EH, Shin JS, Kim SK, Park KH, Lee DH (2005) A comparison of different pelvic reconstruction surgeries using mesh for pelvic organ prolapse patients. Yonsei Med J 46(1):112–118

    Article  PubMed  Google Scholar 

  9. Morley GW, DeLancey JO (1988) Sacrospinous ligament fixation for eversion of the vagina. Am J Obstet Gynecol 158(4):872–881

    Article  PubMed  CAS  Google Scholar 

  10. Bradley CS, Nygaard IE, Brown MB et al (2007) Bowel symptoms in women 1 year after sacrocolpopexy. Am J Obstet Gynecol 197(6):642e1–648e8

    Article  Google Scholar 

  11. Luber KM, Boero S, Choe JY (2001) The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 184(7):1496–1501; discussion 1501–1503

    Article  PubMed  CAS  Google Scholar 

  12. Wu JM, Hundley AF, Fulton RG, Myers ER (2009) Forecasting the prevalence of pelvic floor disorders in US women: 2010 to 2050. Obstet Gynecol 114(6):1278–1283

    Article  PubMed  Google Scholar 

  13. Sung VW, Hampton BS (2009) Epidemiology of pelvic floor dysfunction. Obstet Gynecol Clin North Am 36(3):421–443

    Article  PubMed  Google Scholar 

  14. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506

    Article  PubMed  CAS  Google Scholar 

  15. Clark AL, Gregory T, Smith VJ, Edwards R (2003) Epidemiologic evaluation of reoperation for surgically treated pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 189(5):1261–1267

    Article  PubMed  Google Scholar 

  16. Boyles SH, Weber AM, Meyn L (2003) Procedures for pelvic organ prolapse in the United States, 1979–1997. Am J Obstet Gynecol 188(1):108–115

    Article  PubMed  Google Scholar 

  17. Shah AD, Kohli N, Rajan SS, Hoyte L (2008) The age distribution, rates, and types of surgery for pelvic organ prolapse in the USA. Int Urogynecol J Pelvic Floor Dysfunct 19(3):421–428

    Article  PubMed  Google Scholar 

  18. Smith FJ, Holman CD, Moorin RE, Tsokos N (2010) Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 116(5):1096–1100

    Article  PubMed  Google Scholar 

  19. Brown JS, Waetjen LE, Subak LL, Thom DH, Van den Eeden S, Vittinghoff E (2002) Pelvic organ prolapse surgery in the United States, 1997. Am J Obstet Gynecol 186(4):712–716

    Article  PubMed  Google Scholar 

  20. Silva WA, Pauls RN, Segal JL, Rooney CM, Kleeman SD, Karram MM (2006) Uterosacral ligament vault suspension: five-year outcomes. Obstet Gynecol 108(2):255–263

    Article  PubMed  Google Scholar 

  21. Mant J, Painter R, Vessey M (1997) Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol 104(5):579–585

    Article  PubMed  CAS  Google Scholar 

  22. Barber MD, Brubaker L, Nygaard I et al (2009) Defining success after surgery for pelvic organ prolapse. Obstet Gynecol 114(3):600–609

    Article  PubMed  Google Scholar 

  23. Barber MD, Kuchibhatla MN, Pieper CF, Bump RC (2001) Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol 185(6):1388–1395

    Article  PubMed  CAS  Google Scholar 

  24. Barber MD, Walters MD, Bump RC (2005) Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7). Am J Obstet Gynecol 193(1):103–113

    Article  PubMed  CAS  Google Scholar 

  25. Bump RC, Mattiasson A, Bo K et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Article  PubMed  CAS  Google Scholar 

  26. Digesu GA, Khullar V, Cardozo L, Robinson D, Salvatore S (2005) P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 16(3):176–181; discussion 81

    Article  PubMed  Google Scholar 

  27. Price N, Jackson SR, Avery K, Brookes ST, Abrams P (2006) Development and psychometric evaluation of the ICIQ Vaginal Symptoms Questionnaire: the ICIQ-VS. BJOG 113(6):700–712

    Article  PubMed  CAS  Google Scholar 

  28. Baessler K, O’Neill SM, Maher CF, Battistutta D (2010) A validated self-administered female pelvic floor questionnaire. Int Urogynecol J 21(2):163–172

    Article  PubMed  Google Scholar 

  29. Toozs-Hobson P, Freeman R, Barber M et al (2012) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J 23(5):527–535

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  31. Chmielewski L, Walters MD, Weber AM, Barber MD (2011) Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol 205:69e1–69e8

    Article  Google Scholar 

  32. Culligan PJ, Blackwell L, Goldsmith LJ, Graham CA, Rogers A, Heit MH (2005) A randomized controlled trial comparing fascia lata and synthetic mesh for sacral colpopexy. Obstet Gynecol 106(1):29–37

    Article  PubMed  Google Scholar 

  33. Zyczynski HM, Carey MP, Smith AR et al. (2010) One-year clinical outcomes after prolapse surgery with nonanchored mesh and vaginal support device. Am J Obstet Gynecol 203(6):587e1–587e8

    Article  Google Scholar 

  34. Sayer T, Lim J, Gauld JM et al. (2012) Medium-term clinical outcomes following surgical repair for vaginal prolapse with tension-free mesh and vaginal support device. Int Urogynecol J 23(4):487–493

    Article  PubMed  CAS  Google Scholar 

  35. Macer GA (1978) Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach. Am J Obstet Gynecol 131(2):203–207

    PubMed  CAS  Google Scholar 

  36. Porges RF, Smilen SW (1994) Long-term analysis of the surgical management of pelvic support defects. Am J Obstet Gynecol 1994(171):1518–1528

    Article  Google Scholar 

  37. Stanton SL, Hilton P, Norton C, Cardozo L (1982) Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with and without incontinence. Br J Obstet Gynaecol 89(6):459–463

    Article  PubMed  CAS  Google Scholar 

  38. Walter S, Olesen KP, Hald T, Jensen HK, Pedersen PH (1982) Urodynamic evaluation after vaginal repair and colposuspension. Br J Urol 54(4):377–380

    Article  PubMed  CAS  Google Scholar 

  39. Sand PK, Koduri S, Lobel RW et al (2001) Prospective randomized trial of polyglactin 910 mesh to prevent recurrence of cystoceles and rectoceles. Am J Obstet Gynecol 184(7):1357–1362

    Article  PubMed  CAS  Google Scholar 

  40. Weber AM, Walters MD, Piedmonte MR, Ballard LA (2001) Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 185(6):1299–1304

    Article  PubMed  CAS  Google Scholar 

  41. Antosh DD, Iglesia CB, Vora S, Sokol AI (2011) Outcome assessment with blinded versus unblinded POP-Q exams. Am J Obstet Gynecol 205(5):489e1–489e4

    Article  Google Scholar 

  42. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE (2001) Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol 185(6):1332–1337; discussion 7–8

    Article  PubMed  CAS  Google Scholar 

  43. Bradley CS, Nygaard IE (2005) Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol 106(4):759–766

    Article  PubMed  Google Scholar 

  44. Tan JS, Lukacz ES, Menefee SA, Powell CR, Nager CW (2005) Predictive value of prolapse symptoms: a large database study. Int Urogynecol J Pelvic Floor Dysfunct 16(3):203–209; discussion 9

    Article  PubMed  Google Scholar 

  45. Barber MD (2005) Symptoms and outcome measures of pelvic organ prolapse. Clin Obstet Gynecol 48(3):648–661

    Article  PubMed  Google Scholar 

  46. Jelovsek JE, Barber MD (2006) Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol 194(5):1455–1461

    Article  PubMed  Google Scholar 

  47. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ (2004) Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol 190(1):20–26

    Article  PubMed  Google Scholar 

  48. Brubaker L, Cundiff GW, Fine P et al (2006) Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med 354(15):1557–1566

    Article  PubMed  CAS  Google Scholar 

  49. Brubaker L, Nygaard I, Richter HE et al. (2008) Two-year outcomes after sacrocolpopexy with and without burch to prevent stress urinary incontinence. Obstet Gynecol 112(1):49–55

    Article  PubMed  Google Scholar 

  50. Barber MD, Amundsen CL, Paraiso MF, Weidner AC, Romero A, Walters MD (2007) Quality of life after surgery for genital prolapse in elderly women: obliterative and reconstructive surgery. Int Urogynecol J Pelvic Floor Dysfunct 18(7):799–806

    Article  PubMed  Google Scholar 

  51. Rogers RG, Kammerer-Doak D, Villarreal A, Coates K, Qualls C (2001) A new instrument to measure sexual function in women with urinary incontinence or pelvic organ prolapse. Am J Obstet Gynecol 184(4):552–558

    Article  PubMed  CAS  Google Scholar 

  52. Rosen R, Brown C, Heiman J et al (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 26(2):191–208

    Article  PubMed  CAS  Google Scholar 

  53. Miedel A, Tegerstedt G, Morlin B, Hammarstrom M (2008) A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 19(12):1593–1601

    Article  PubMed  Google Scholar 

  54. Kapoor DS, Nemcova M, Pantazis K, Brockman P, Bombieri L, Freeman RM (2010) Reoperation rate for traditional anterior vaginal repair: analysis of 207 cases with a median 4-year follow-up. Int Urogynecol J 21(1):27–31

    Article  PubMed  Google Scholar 

  55. Diwadkar GB, Barber MD, Feiner B, Maher C, Jelovsek JE (2009) Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol 113(2 Pt 1):367–373

    PubMed  Google Scholar 

  56. Brubaker L (2005) Burch colposuspension at the time of sacrocolpopexy in stress continent women reduces bothersome stress urinary symptoms: the CARE randomized trial. J Pelvic Surg 11 [Suppl 1]:S5

    Article  Google Scholar 

  57. Paraiso MF, Ballard LA, Walters MD, Lee JC, Mitchinson AR (1996) Pelvic support defects and visceral and sexual function in women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol 175(6):1423–1430

    Article  PubMed  CAS  Google Scholar 

  58. Barber MD, Visco AG, Weidner AC, Amundsen CL, Bump RC (2000) Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol 183(6):1402–1410; discussion 10–11

    Article  PubMed  CAS  Google Scholar 

  59. Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL (2007) Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 109(6):1396–1403

    Article  PubMed  Google Scholar 

  60. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A (2002) Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 186(6):1160–1166

    Article  PubMed  Google Scholar 

  61. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J (2004) Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol 190(1):27–32

    Article  PubMed  Google Scholar 

  62. Nygaard I, Bradley C, Brandt D; Women’s Health Initiative (2004) Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol 104(3):489–497

    Article  PubMed  Google Scholar 

  63. Marchionni M, Bracco GL, Checcucci V, Carabaneanu A, Coccia EM, Mecacci F, Scarselli G (1999) True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med 44(8):679–684

    PubMed  CAS  Google Scholar 

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Acknowledgements

This publication results from the work of the Committee on Pelvic Organ Prolapse Surgery, part of the 5th International Consultation on Incontinence, held in Paris in February 2012, under the auspices of the International Consultation on Urological Diseases, and enabled by the support of the European Association of Urology.

The authors wish to acknowledge the fine work of previous consultations led by Professor Linda Brubaker.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Urogynecology and Pelvic Reconstructive Surgery, Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

    Matthew D. Barber

  2. University of Queensland, Royal Brisbane and Wesley Urogynaecology, 30 Chaseley Street, Auchenflower, 4067, Brisbane, Australia

    Christopher Maher

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  1. Matthew D. Barber
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Correspondence to Christopher Maher.

Additional information

On behalf of Committee 15 “Surgical Management of Pelvic Organ Prolapse” from the 5th International Consultation on Incontinence held in Paris, February 2012

This work has been previously published as: Maher C, Baessler K, Barber M, Cheon C, Deitz V, DeTayrac R, Gutman R, Karram M, Sentilhes L (2013) Surgical management of pelvic organ prolapse. In: Abrams, Cardozo, Khoury, Wein (eds) 5th International Consultation on Incontinence. Health Publication Ltd, Paris, Chapter 15 and modified for publication in International Urogynaecology Journal.

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Barber, M.D., Maher, C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 24, 1783–1790 (2013). https://doi.org/10.1007/s00192-013-2169-9

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Keywords

  • Pelvic organ prolapse surgery
  • Outcomes
  • Epidemiology