Skip to main content

Advertisement

Log in

Update on Surgical Treatments for Pelvic Organ Prolapse

  • Urogynecology (S Pulliam and N Kohli, Section Editors)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose of Review

The purpose of this review is to update readers on recent controversies and current evidence regarding surgical procedures for the treatment of female pelvic organ prolapse.

Recent Findings

Topics discussed include the role of patient selection and individualized care that involves the patient in surgical decision-making. Perioperative decisions reflect rapidly advancing technology, innovations in surgical technique, surgical training, and surgeon’s own unique preferences, all of which provide an opportunity for improved outcomes and also require deliberate attention to unanticipated patient safety concerns.

Summary

Pelvic reconstructive surgery for pelvic organ prolapse requires an appreciation for complex pelvic anatomy and advanced surgical training. In a field focused on patient-centered quality of life outcomes, it is imperative to involve the patient in the decision-making process while also balancing differences in surgeons’ skills, biases, and available technology. These topics are explored in detail and offered a thoughtful approach to surgical management.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

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

  1. Wu JM, Matthews CA, Conover MM, Pate V, Jonsson FM. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol. 2014;123(6):1201–6. doi:10.1097/AOG.0000000000000286.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Food and Drug Administration. Update on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse. 2011. http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm262435.htm.

  3. Barbalat Y, Tunuguntla HS. Surgery for pelvic organ prolapse: a historical perspective. Curr Urol Rep. 2012;13(3):256–61. doi:10.1007/s11934-012-0249-x.

    Article  PubMed  Google Scholar 

  4. •• Fairchild PS, Kamdar NS, Berger MB, Morgan DM. Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse. Am J Obstet Gynecol. 2016;214(2):262 e1–7. doi:10.1016/j.ajog.2015.08.053. This timely study sheds light on current practice patterns in the surgical treatment of prolapse using recently approved quality measures.

    Article  Google Scholar 

  5. 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. doi:10.1016/S0029-7844(97)00058-6.

    Article  CAS  PubMed  Google Scholar 

  6. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    Article  CAS  PubMed  Google Scholar 

  7. Baden WF, Walker TA. Genesis of the vaginal profile: a correlated classification of vaginal relaxation. Clin Obstet Gynecol. 1972;15(4):1048–54.

    Article  CAS  PubMed  Google Scholar 

  8. • Krissi H, Eitan R, Ram E, Peled Y. How accurate is preoperative evaluation of pelvic organ prolapse in women undergoing vaginal reconstruction surgery? PLoS One. 2012;7(10):e47027. doi:10.1371/journal.pone.0047027. This study highlights the importance of a very thorough and accurate pre-operative assessment of prolapse, especially in patients for whom a suspension procedure could indicate a concomitant hysterectomy.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Swenson CW, Smith TM, Luo J, Kolenic GE, Ashton-Miller JA, DeLancey JO. Intraoperative cervix location and apical support stiffness in women with and without pelvic organ prolapse. Am J Obstet Gynecol. 2017;216(2):155.e1–8. doi:10.1016/j.ajog.2016.09.074.

    Article  Google Scholar 

  10. McPencow AM, Erekson EA, Guess MK, Martin DK, Patel DA, Xu X. Cost-effectiveness of endometrial evaluation prior to morcellation in surgical procedures for prolapse. Am J Obstet Gynecol. 2013;209(1):22.e1–9. doi:10.1016/j.ajog.2013.03.033.

    Article  Google Scholar 

  11. Crisp CC, Book NM, Smith AL, Cunkelman JA, Mishan V, Treszezamsky AD, et al. Body image, regret, and satisfaction following colpocleisis. Am J Obstet Gynecol. 2013;209(5):473 e1–7. doi:10.1016/j.ajog.2013.05.019.

    Article  Google Scholar 

  12. Society CoPBGatAU. Practice bulletin no. 176: pelvic organ prolapse. Obstet Gynecol. 2017;129(4):e56–72. doi:10.1097/AOG.0000000000002016.

    Article  Google Scholar 

  13. Chen L, Ashton-Miller JA, Hsu Y, DeLancey JO. Interaction among apical support, levator ani impairment, and anterior vaginal wall prolapse. Obstet Gynecol. 2006;108(2):324–32. doi:10.1097/01.AOG.0000227786.69257.a8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Summers A, Winkel LA, Hussain HK, DeLancey JO. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006;194(5):1438–43. doi:10.1016/j.ajog.2006.01.057.

    Article  PubMed  PubMed Central  Google Scholar 

  15. • Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195(6):1837–40. doi:10.1016/j.ajog.2006.06.065. The authors identify one of the main factors associated with surgical failure of anterior vaginal prolapse repairs, that is, inadequate apical support.

    Article  PubMed  Google Scholar 

  16. •• Chen L, Lisse S, Larson K, Berger MB, Ashton-Miller JA, DeLancey JO. Structural failure sites in anterior vaginal wall prolapse: identification of a collinear triad. Obstet Gynecol. 2016;128(4):853–62. doi:10.1097/AOG.0000000000001652. This innovative study provides some evidence to explain the tissue effects of biomechanical forces and correlation to anatomic findings.

    Article  PubMed  PubMed Central  Google Scholar 

  17. • Geynisman-Tan J, Kenton K. Surgical updates in the treatment of pelvic organ prolapse. Rambam Maimonides Med J. 2017;8(2). doi:10.5041/RMMJ.10294. This manuscript provides a thorough review of evidence supporting the variety of surgical procedures available for treating pelvic organ prolapse.

  18. Kearney R, DeLancey JO. Selecting suspension points and excising the vagina during Michigan four-wall sacrospinous suspension. Obstet Gynecol. 2003;101(2):325–30.

    CAS  PubMed  Google Scholar 

  19. Shull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183(6):1365–1373; discussion 73-4. doi:10.1067/mob.2000.110910.

    Article  CAS  PubMed  Google Scholar 

  20. Larson KA, Smith T, Berger MB, Abernethy M, Mead S, Fenner DE, et al. Long-term patient satisfaction with Michigan four-wall sacrospinous ligament suspension for prolapse. Obstet Gynecol. 2013;122(5):967–75. doi:10.1097/AOG.0b013e3182a7f0d5.

    Article  PubMed  Google Scholar 

  21. Maher CF, Murray CJ, Carey MP, Dwyer PL, Ugoni AM. Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol. 2001;98(1):40–4.

    CAS  PubMed  Google Scholar 

  22. Bradley MS, Bickhaus JA, Amundsen CL, Newcomb LK, Truong T, Weidner AC, et al. Vaginal uterosacral ligament suspension: a retrospective cohort of absorbable and permanent suture groups. Female Pelvic Med Reconstr Surg. 2017; doi:10.1097/spv.0000000000000451.

  23. Chung CP, Miskimins R, Kuehl TJ, Yandell PM, Shull BL. Permanent suture used in uterosacral ligament suspension offers better anatomical support than delayed absorbable suture. Int Urogynecol J. 2012;23(2):223–7. doi:10.1007/s00192-011-1556-3.

    Article  PubMed  Google Scholar 

  24. Kasturi S, Bentley-Taylor M, Woodman PJ, Terry CL, Hale DS. High uterosacral ligament vaginal vault suspension: comparison of absorbable vs. permanent suture for apical fixation. Int Urogynecol J. 2012;23(7):941–5. doi:10.1007/s00192-012-1708-0.

    Article  PubMed  Google Scholar 

  25. Rardin CR, Erekson EA, Sung VW, Ward RM, Myers DL. Uterosacral colpopexy at the time of vaginal hysterectomy: comparison of laparoscopic and vaginal approaches. J Reprod Med. 2009;54(5):273–80.

    PubMed  PubMed Central  Google Scholar 

  26. Turner LC, Lavelle ES, Shepherd JP. Comparison of complications and prolapse recurrence between laparoscopic and vaginal uterosacral ligament suspension for the treatment of vaginal prolapse. Int Urogynecol J. 2016;27(5):797–803. doi:10.1007/s00192-015-2897-0.

    Article  PubMed  Google Scholar 

  27. Barber MD. Pelvic organ prolapse. BMJ. 2016;354:i3853.

    Article  PubMed  Google Scholar 

  28. Arenholt LTS, Pedersen BG, Glavind K, Glavind-Kristensen M, DeLancey JOL. Paravaginal defect: anatomy, clinical findings, and imaging. Int Urogynecol J. 2017;28(5):661–73. doi:10.1007/s00192-016-3096-3.

    Article  PubMed  Google Scholar 

  29. Maher C, Baessler K, Glazener CM, Adams EJ, Hagen S. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn. 2008;27(1):3–12. doi:10.1002/nau.20542.

    Article  CAS  PubMed  Google Scholar 

  30. Darzi S, Urbankova I, Su K, White J, Lo C, Alexander D, et al. Tissue response to collagen containing polypropylene meshes in an ovine vaginal repair model. Acta Biomater. 2016;39:114–23. doi:10.1016/j.actbio.2016.05.010.

    Article  CAS  PubMed  Google Scholar 

  31. •• 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. doi:10.1002/14651858.CD012079. This comprehensive review provides a rare, balanced evidence regarding the role of mesh-augmented prolapse repairs.

    PubMed  Google Scholar 

  32. Costantini E, Brubaker L, Cervigni M, Matthews CA, O'Reilly BA, Rizk D, et al. Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations. Eur J Obstet Gynecol Reprod Biol. 2016;205:60–5. doi:10.1016/j.ejogrb.2016.07.503.

    Article  PubMed  Google Scholar 

  33. Nosti PA, Carter CM, Sokol AI, Tefera E, Iglesia CB, Park AJ, et al. Transvaginal versus transabdominal placement of synthetic mesh at time of sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22(3):151–5. doi:10.1097/spv.0000000000000222.

    Article  PubMed  Google Scholar 

  34. Cundiff GW, Varner E, Visco AG, Zyczynski HM, Nager CW, Norton PA, et al. Risk factors for mesh/suture erosion following sacral colpopexy. Am J Obstet Gynecol. 2008;199(6):688.e1–5. doi:10.1016/j.ajog.2008.07.029.

    Article  Google Scholar 

  35. McDermott CD, Hale DS. Abdominal, laparoscopic, and robotic surgery for pelvic organ prolapse. Obstet Gynecol Clin N Am. 2009;36(3):585–614. doi:10.1016/j.ogc.2009.09.004.

    Article  Google Scholar 

  36. Siddiqui NY, Grimes CL, Casiano ER, Abed HT, Jeppson PC, Olivera CK, et al. Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol. 2015;125(1):44–55. doi:10.1097/AOG.0000000000000570.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Detollenaere RJ, den Boon J, Stekelenburg J, IntHout J, Vierhout ME, Kluivers KB, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Brubaker L, Cundiff GW, Fine P, Nygaard I, Richter HE, Visco AG, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–66. doi:10.1056/NEJMoa054208.

    Article  CAS  PubMed  Google Scholar 

  39. Wei JT, Nygaard I, Richter HE, Nager CW, Barber MD, Kenton K, et al. A midurethral sling to reduce incontinence after vaginal prolapse repair. N Engl J Med. 2012;366(25):2358–67. doi:10.1056/NEJMoa1111967.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol. 1992;166(6 Pt 1):1717–24. discussion 24-8

    Article  CAS  PubMed  Google Scholar 

  41. • Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for postoperative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS®) society recommendations—part II. Gynecol Oncol. 2016;140(2):323–32. doi:10.1016/j.ygyno.2015.12.019. References 41 and 42 are paired guidelines which summarize the benefits of adopting an Enhanced Recovery After Surgery approach for patients undergoing gynecologic surgery.

    Article  CAS  PubMed  Google Scholar 

  42. • Nelson G, Altman AD, Nick A, Meyer LA, Ramirez PT, Achtari C, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: enhanced recovery after surgery (ERAS®) society recommendations—part I. Gynecol Oncol. 2016;140(2):313–22. doi:10.1016/j.ygyno.2015.11.015. References 41 and 42 are paired guidelines which summarize the benefits of adopting an Enhanced Recovery After Surgery approach for patients undergoing gynecologic surgery.

    Article  CAS  PubMed  Google Scholar 

  43. Elkadry EA, Kenton KS, FitzGerald MP, Shott S, Brubaker L. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol. 2003;189(6):1551–7. discussion 7-8

    Article  PubMed  Google Scholar 

  44. Hullfish KL, Bovbjerg VE, Steers WD. Patient-centered goals for pelvic floor dysfunction surgery: long-term follow-up. Am J Obstet Gynecol. 2004;191(1):201–5. doi:10.1016/j.ajog.2004.03.086.

    Article  PubMed  Google Scholar 

  45. Komesu YM, Rogers RG, Rode MA, Craig EC, Schrader RM, Gallegos KA, et al. Patient-selected goal attainment for pessary wearers: what is the clinical relevance? Am J Obstet Gynecol. 2008;198(5):577 e1–5. doi:10.1016/j.ajog.2007.12.033.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Emily E. Weber LeBrun.

Ethics declarations

Conflict of Interest

The author declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Disclosure

The author has no financial or other disclosures.

Additional information

This article is part of the Topical Collection on Urogynecology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weber LeBrun, E.E. Update on Surgical Treatments for Pelvic Organ Prolapse. Curr Obstet Gynecol Rep 6, 249–256 (2017). https://doi.org/10.1007/s13669-017-0221-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13669-017-0221-3

Keywords

Navigation