Skip to main content
SpringerLink
Log in

Pelvic Organ Prolapse in Older Adults

  • Chapter
  • First Online:
Geriatric Urology

Abstract

This chapter will focus on the highly prevalent condition of pelvic organ prolapse (POP). POP is a leading cause of morbidity in aging female adults and has a variety of clinical presentations. Unfortunately, there is a lack of uniformity in the approaches to POP and there is much misinformation among patients and in the lay media. Recent concerns about some of the surgical treatments of POP with synthetic mesh have heightened awareness and drawn attention to this condition. This chapter will look at the epidemiology of POP and associated risk factors. The etiology of these conditions and diagnostic criteria will also be explored. Finally, the clinical evaluation will be outlined followed by a thorough analysis of both conservative therapies and surgical options in older women.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Swift S, Tate S, Nicholas J. Correlation of symptoms with degree of prolapse organ support in a general population of women: what is pelvic organ prolapse? Am J Obstet Gynecol. 2003;189(2):372–7.

    PubMed  Google Scholar 

  2. Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004;104(3):489–97.

    PubMed  Google Scholar 

  3. Olsen A, Smith V, Bergstrom J, Colling J, Clark A. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.

    CAS  PubMed  Google Scholar 

  4. Nations U. World population ageing. 2009. http://www.un.org/esa/population/publications/WPA2009. Accessed 5 Dec 2011.

  5. Luber K, Boero S, Choe J. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol. 2001;184: 1496–501.

    CAS  PubMed  Google Scholar 

  6. Hendrix S, Clark A, Nygaard I, Aragaki A, Barnabei V, et al. Pelvic organ prolapse in the women’s health initiative: gravity and gravidity. Am J Obstet Gynecol. 2002;186(6):1160–6.

    PubMed  Google Scholar 

  7. PMIS Group. Risk factors for genital prolapse in non-hysterectomized women around menopause. Results from a large cross-sectional study in menopausal clinics in Italy. Eur J Obstet Gynecol Reprod Biol. 2000;93:135–40.

    Google Scholar 

  8. Swift S, Woodman P, O’Boyle A, 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.

    PubMed  Google Scholar 

  9. Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association study. Br J Obstet Gynaecol. 1997;104(5):579–85.

    CAS  PubMed  Google Scholar 

  10. Rortveit G, Brown J, Thom D, et al. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population based, racially diverse cohort. Obstet Gynecol. 2007;109(4):848–54.

    Google Scholar 

  11. Bradley C, Zimmerman M, Qi Y, Nygaard I. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109(6):1396–403.

    Google Scholar 

  12. Kudish B, Iglesia C, Sokol R, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009;113(1):81–8.

    PubMed Central  PubMed  Google Scholar 

  13. Spence-Jones C, Kamm M, Henry M, et al. Bowel dysfunction: a pathogenic factor in uterovaginal prolapse and urinary stress incontinence. Br J Obstet Gynaecol. 1994;101:147–52.

    CAS  PubMed  Google Scholar 

  14. Blandon R, Bharucha A, Melton 3rd LJ, et al. Risk factors for pelvic floor repair after hysterectomy. Obstet Gynecol. 2009;113(3):601–8.

    PubMed Central  PubMed  Google Scholar 

  15. Swift S, Pound T, Dias J. Case–control study of etiologic factors in the development of severe pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):187–92.

    CAS  PubMed  Google Scholar 

  16. Woodman P, Swift S, O’Boyle A, et al. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):340–5.

    PubMed  Google Scholar 

  17. Chiaffarino F, Chatenoud L, Dindelli M, et al. Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol. 1999;82(1):63–7.

    CAS  PubMed  Google Scholar 

  18. Richardson A, Lyon J, Williams N. A new look at pelvic relaxation. Am J Obstet Gynecol. 1976; 126(50):568–73.

    CAS  PubMed  Google Scholar 

  19. DeLancey J, Morgan D, Fenner D, Kearney R, Guire K, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109:295–302.

    PubMed  Google Scholar 

  20. Chapple C, Milsom I. Urinary incontinence and pelvic prolapse: epidemiology and pathophyisiology. In: Wein A, editor. Campbell-walsh urology. 10th ed. Philadelphia, PA: WB Saunders; 2011. p. 1871–95.

    Google Scholar 

  21. Delancey J, Hurd W. Size of the urogenital hiatus in the levator ani muscles in normal women and women with pelvic organ prolapse. Obstet Gynecol. 1998;91:364–8.

    CAS  PubMed  Google Scholar 

  22. Busacchi P, Perri R, Paradisi C, Oliverio D, Santini S, et al. Abnormalities of somatic peptide-containing nerves supplying the pelvic floor of women with genitourinary prolapse and stress urinary incontinence. Urology. 2004;63(3):591–5.

    CAS  PubMed  Google Scholar 

  23. Smith A, Hosker G, Warrell D. The role of partial denervation of the pelvic floor in the etiology of genitourinary prolapse and stress urinary incontinence of urine. A neurophysiological study. Br J Obstet Gynaecol. 1989;96(1):24–8.

    CAS  PubMed  Google Scholar 

  24. Rinne K, Kirkinen P. What predisposes young women to genital prolapse? Eur J Obstet Gynecol Reprod Biol. 1999;84:23.

    CAS  PubMed  Google Scholar 

  25. Tinelli A, Malvasi A, Rahimi S, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause. 2010;17: 201–12.

    Google Scholar 

  26. Goh J. Biomechanical and biochemical assessments for pelvic organ prolapse. Curr Opin Obstet Gynecol. 2003;15(5):391–4.

    PubMed  Google Scholar 

  27. Jackson S, Avery N, Tarlton J, Eckford S, Abrams P, Bailey A. Changes in metabolism of collagen in genitourinary prolapse. Lancet. 1996;15(347):1658–61.

    Google Scholar 

  28. Takano C, Girao M, Sartori M, Castro R, Arruda R, et al. Analysis of collagen in parametrium and vaginal apex of women with and without uterine prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(6):342–5.

    CAS  PubMed  Google Scholar 

  29. Maolli P, Shand S, Zyczynski H, Gordy S, Meyn L. Remodeling of vaginal connective tissue in patients with prolapse. Obstet Gynecol. 2005;106:952–63.

    Google Scholar 

  30. Gabriel B, Denschlag D, Gobel H, et al. Uterosacral ligament in postmenopausal women with or without pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:475–9.

    PubMed  Google Scholar 

  31. Carley M, Schaffer J. Urinary incontinence and pelvic organ prolapse in women with Marfan’s or Ehlers Danlos syndrome. Am J Obstet Gynecol. 2000;182: 1021–3.

    CAS  PubMed  Google Scholar 

  32. McIntosh L, Mallett V, Frahm J, Richardson D, Evans M. Gynecologic disorders in women with Ehlers–Danlos syndrome. J Soc Gynecol Investig. 1995;2(3):559–64.

    CAS  PubMed  Google Scholar 

  33. Bailey A, Paul R, Knott L. Mechanisms of maturation and ageing of collagen. Mech Ageing Dev. 1998;106:1–56.

    CAS  PubMed  Google Scholar 

  34. Boreham M, Wai C, Miller R, et al. Morphometric analysis of smooth muscle in the anterior vaginal wall of women with pelvic organ prolapse. Am J Obstet Gynecol. 2002;187:56–63.

    PubMed  Google Scholar 

  35. Reisenauer C, Shiozawa T, Oppitz M, et al. The role of smooth muscle in the pathogenesis of pelvic organ prolapse. An immunohistochemical and morphometric analysis of the cervical third of the uterosacral ligament. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:383–9.

    PubMed  Google Scholar 

  36. Ellerkmann R, Cundiff G, Melick C, et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185:1332–8.

    CAS  PubMed  Google Scholar 

  37. Tan J, Lukacz E, Menefee S, et al. Predictive value of prolapse symptoms: a large database study. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16:203–9.

    PubMed  Google Scholar 

  38. Burrows L, Meyn L, Walters M, Weber A. Pelvic symptoms in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;104:982–8.

    Google Scholar 

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

    CAS  PubMed  Google Scholar 

  40. Bump R, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10–7.

    CAS  PubMed  Google Scholar 

  41. Rogers R, Coates K, Kammerer-Doak D, et al. A short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12). Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:164–8.

    PubMed  Google Scholar 

  42. Barber M, Kuchibhatla M, Pieper C, Bump R. Psychometric evaluation of 2 comprehensive condition-specific quality of life instruments for women with pelvic floor disorders. Am J Obstet Gynecol. 2001;185:1388–95.

    CAS  PubMed  Google Scholar 

  43. Boyadzhyan L, Raman S, Raz S. Role of static and dynamic MR imaging in surgical pelvic floor dysfunction. Radiographics. 2008;28(4):949–67.

    PubMed  Google Scholar 

  44. Maubon A, Aubard Y, Berkane V, et al. Magnetic resonance imaging of the pelvic floor. Abdom Imaging. 2003;28:217–25.

    CAS  PubMed  Google Scholar 

  45. Comiter C, Vasavada S, Barbaric Z, et al. Grading pelvic floor prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology. 1999;54:454–7.

    CAS  PubMed  Google Scholar 

  46. Cortes E, Reid W, Singh K, et al. Clinical examination and dynamic magnetic resonance imaging in vaginal vault prolapse. Obstet Gynecol. 2004;103: 42–6.

    Google Scholar 

  47. Gousse A, Barbaric Z, Safir M, et al. Dynamic half Fourier acquisition, single shot turbo spin-echo magnetic resonance imaging for evaluating the female pelvis. J Urol. 2000;164(5):1606–13.

    CAS  PubMed  Google Scholar 

  48. Bai S, Jeon M, Kim J, et al. Relationship between stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13:256–60.

    CAS  PubMed  Google Scholar 

  49. Romanzi L, Chaikin D, Blaivas J. The effect of genital prolapse on voiding. J Urol. 1999;161:581–6.

    CAS  PubMed  Google Scholar 

  50. Bergman A, Koonings P, Ballard D. Predicting post-operative urinary incontinence development in women undergoing operation for genitourinary prolapse. Am J Obstet Gynecol. 1988;158:1171–5.

    CAS  PubMed  Google Scholar 

  51. Chaikin D, Groutz A, Blaivas J. Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol. 2000;163:531–4.

    CAS  PubMed  Google Scholar 

  52. Richardson D, Bent A, Ostergard D. The effect of uterovaginal prolapse on urethrovesical pressure dynamics. Am J Obstet Gynecol. 1983;15:901–5.

    Google Scholar 

  53. Stanton S, Hilton P, Norton C, et al. Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with and without incontinence. Br J Obstet Gynaecol. 1982;89: 459–63.

    CAS  PubMed  Google Scholar 

  54. Borstad E, Rud T. The risk of developing urinary stress incontinence after vaginal repair in continent women: a clinical and urodynamic follow up study. Acta Obstet Gynecol Scand. 1989;68:545–9.

    CAS  PubMed  Google Scholar 

  55. Ballert K, Biggs G, Isenalumhe AJ, et al. Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol. 2009;181(2): 679–84.

    PubMed  Google Scholar 

  56. Elser D, Moen M, Stanford E, et al. Abdominal sacrocolpopexy and urinary incontinence: surgical planning based on urodynamics. Am J Obstet Gynecol. 2010;202(4):375.e1–5.

    Google Scholar 

  57. Brubaker L, Cundiff G, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557–66.

    CAS  PubMed  Google Scholar 

  58. Visco A, Brubaker L, Nygaard I, Network PFD, et al. The role of preoperative urodynamic testing in stress-continent women undergoing sacrocolpopexy: the colpopexy and urinary reduction efforts (CARE) randomized surgical trial. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):607–14.

    PubMed Central  PubMed  Google Scholar 

  59. Roovers J, van Laar J, Loffeld C, et al. Does urodynamic investigation improve outcome in patients undergoing prolpase surgery? Neurourol Urodyn. 2007;26:170–5.

    CAS  PubMed  Google Scholar 

  60. Kobashi K. Evaluation of patients with urinary incontinence and pelvic prolapse. In: Wein A, editor. Campbell-Walsh urology. 10th ed. Philadelphia, PA: WB Saunders; 2011. p. 1896–908.

    Google Scholar 

  61. Chen C, Walters M. Pelvic organ prolapse: clinical diagnosis and presentation. In: Raz S, Rodriguez LV, editors. Female urology. 3rd ed. Philadelphia, PA: WB Saunders; 2008. p. 556–3.

    Google Scholar 

  62. Sieber F, Pauldine R. Miller’s anesthesia. 7th ed. Philadelphia, PA: Churchill Livingston; 2009.

    Google Scholar 

  63. John A, Sieber F. Age associated issues: geriatrics. Anesthesiol Clin North Am. 2004;22:45–58.

    CAS  Google Scholar 

  64. Dzankic S, Pastor D, Gonzalez C, et al. The prevalence and predictive value of abnormal laboratory test in elderly surgical patients. Anesth Analg. 2001;93:301–8.

    CAS  PubMed  Google Scholar 

  65. Fischer S, Bader A, Sweitzer B. Preoperative evaluation. In: Miller R, editor. Miller’s anesthesia. 7th ed. Philadelphia, PA: Churchill Livingston; 2009. p. 1001–66.

    Google Scholar 

  66. Tait A, Parr H, Tremper K. Evaluation of the efficacy of routine preoperative electrocardiogram. J Cardiothorac Vasc Anesth. 1997;11:752–5.

    CAS  PubMed  Google Scholar 

  67. Liu L, Dzankic S, Leung J. Preoperative electrocardiogram abnormalities do not predict postoperative cardiac complications in geriatric surgical patients. J Am Geriatr Soc. 2002;50:1186–91.

    PubMed  Google Scholar 

  68. Fleisher L, Beckman J, Brown K, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care noncardiac surgery: executive summary: a report of the American College of Cardiology/American heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Preoperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation. 2007;116:1971–96.

    PubMed  Google Scholar 

  69. Smith F, Holman D, Moorin R, Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.

    PubMed  Google Scholar 

  70. Fialkow M, Newton K, Lentz G. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:437–40.

    CAS  PubMed  Google Scholar 

  71. Novara G, Artibani W. Surgery for pelvic organ prolapse: current status and future perspectives. Curr Opin Urol. 2005;15:256–62.

    PubMed  Google Scholar 

  72. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;12.

    Google Scholar 

  73. Braekken I, Majida M, Engh M, Bø K. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol. 2010;203(2):170.e1–7.

    Google Scholar 

  74. Goldstein S, Neven P, Zhou L, Taylor Y, Ciaccia A. Raloxifene effect on frequency of surgery for pelvic floor relaxation. Obstet Gynecol. 2001;98: 91–6.

    CAS  PubMed  Google Scholar 

  75. Ismail S, Bain C, Hagen S. Oestrogens for treatment or prevention of pelvic organ prolapse in postmenopausal women. Cochrane Database Syst Rev. 2010;9.

    Google Scholar 

  76. Sarma S, Ying T, Moore K. Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG. 2009;116:1715–21.

    CAS  PubMed  Google Scholar 

  77. Lone F, Thakar R, Sultan A, Karamalis G. A 5-year prospective study of vaginal pessary use for pelvic organ prolapse. Int J Gynaecol Obstet. 2011;114(1): 56–9.

    PubMed  Google Scholar 

  78. Friedman S, Sandhu K, Wang C, Mikhail M, Banks E. Factors influencing long-term pessary use. Int Urogynecol J. 2010;21:673–8.

    PubMed  Google Scholar 

  79. Maher C, Baessler K. Surgical management of anterior vaginal wall prolapse: an evidence based literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:195–201.

    PubMed  Google Scholar 

  80. Uebersax JS, Wyman J, Shumaker SA, McClish DK, Fantl JA, & the Continence Program for Women Research Group. Short forms to assess life quality and symptom distress for urinary incontinence in women: the Incontinence Impact Questionnaire and the Urogenital Distress Inventory. Neurology and 1995;14(2):131–9.

    Google Scholar 

  81. Barber MD, Walters MD, Bump RC. Short forms of two condition-specific quality of life questionnaires for women with pelvic floor disorder (PFDI-20 and PFIQ-7). Am J Ob Gyn. 2005;193:103–113.

    CAS  Google Scholar 

  82. Van Rooyen J, Cundiff G. Surgical management of pelvic organ prolapse. In: Cundiff G, Bent A, Ostergaard D, Swift S, editors. Ostergaard’s urogynecology and pelvic floor dysfunction. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  83. Winters J, Togami J, Chermansky C. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein AJ, editor. Campbell-walsh urology. Philadelphia, PA: Elsevier; 2011.

    Google Scholar 

  84. Morley G, DeLancey J. Sacrospinous ligament fixation for eversion of the vagina. Am J Obstet Gynecol. 1988;158:872–81.

    CAS  PubMed  Google Scholar 

  85. Maher C, Qatawneh A, Dwyer P, Carey M, Cornish A, Schluter P. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004;190:20–6.

    PubMed  Google Scholar 

  86. Benson J, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol. 1996;175:1418–22.

    CAS  PubMed  Google Scholar 

  87. Maher C, Feiner B, DeCuyper E, Nichlos C, Hickey K, O’Rourke P. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol. 2011:204:360.e1–7.

    PubMed  Google Scholar 

  88. Kenton K, Pham T, Mueller E, Brubaker L. Patient preparedness: an important predictor of surgical outcome. Am J Obstet Gynecol. 2007;197(654):e1–6.

    Google Scholar 

  89. ACOG Committee on Practice Bulletins–Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2009;113(5):1180–9.

    Google Scholar 

  90. Wolf J, Bennett C, Dmochowski R, Hollenbeck B, Pearle M, Schaeffer A, editors. Best practice policy statement on urologic surgery antimicrobial prophylaxis. Linthicum, MD: American Urological Association; 2011.

    Google Scholar 

  91. Geerts W, Pineo G, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest. 2004;126(3 Suppl):338S–400.

    CAS  PubMed  Google Scholar 

  92. Winters J, Togami J, Chermansky C. Vaginal and abdominal reconstructive surgery for pelvic organ prolapse. In: Wein A, editor. Campbell-Walsh urology, vol. 3. Philadelphia, PA: Elsevier; 2012. p. 2069–114.

    Google Scholar 

  93. Higgins E, Rao A, Baumann S, et al. Effect of estrogen replacement on the histologic response to polypropylene mesh implanted in the rabbit vagina model. Am J Obstet Gynecol. 2009;201(5):505.e1–9.

    Google Scholar 

  94. Administration FUSFaD: FDA public health notification: serious complications associated with transvaginal placement of surgical mesh in repair of pelvic organ prolapse and stress urinary incontinence. 2011. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm. Accessed 18 Dec 2011.

  95. Altman D, Väyrynen T, Engh M, Axelsen S, Falconer C, Group. NTM. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011;364(19):1826–36.

    CAS  PubMed  Google Scholar 

  96. Togami J, Krilin R, Winters J. Graft materials in prolapse surgery. AUA Update Series. 2008;27(31): 1764–71.

    Google Scholar 

  97. Choe J, Bell T. Genetic material is present in cadaveric dermis and cadaveric fascia lata. J Urol. 2001;166:122–4.

    CAS  PubMed  Google Scholar 

  98. Deprest J, Zheng F, Konstantinovic M, et al. The biology behind fascial defects and the use of implants in pelvic organ prolapse repair. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:S16–25.

    PubMed  Google Scholar 

  99. Badylak S, Kokini K, Tullius B, Simmons-Byrd A, Morff R. Morphologic study of small intestinal submucosa as a body wall repair device. J Surg Res. 2002;103:190–202.

    PubMed  Google Scholar 

  100. Cole E, Gomelsky A, Dmochowski R. Encapsulation of a porcine dermis pubovaginal sling. J Urol. 2003;170:1950.

    PubMed  Google Scholar 

  101. Taylor G, Moore R, Miklos J, Mattox T. Posterior repair with perforated porcine dermal graft. Int Braz J Urol. 2008;34:84–90.

    PubMed  Google Scholar 

  102. Medical B. 2011. http://www.bardmedical.com/PELVICOLAcellularCollagenMatrix. Accessed 18 Dec 2011.

  103. Medical C. 2011. http://www.cookmedical.com/uro/dataSheet.do?id=5165. Accessed 18 Dec 2011.

  104. Goldstein HB, Maccarone J, Naughton MJ, Aguirre OA, Patel RC. A multicenter prospective trial evaluating fetal bovine dermal graft (Xenform® Matrix) for pelvic reconstructive surgery. BMC Urol. 2010;10(21):1–5.

    Google Scholar 

  105. Klinge U, Schumpelick V, Klosterhalfen B. Functional assessment and tissue response of short- and long-term absorbable surgical meshes. Biomaterials. 2001;22(11):1415–24.

    CAS  PubMed  Google Scholar 

  106. Amid P. Classification of biomaterials and their related complications in abdominal wall hernia surgery. Hernia. 1997;1:15–21.

    Google Scholar 

  107. Dietz H, Vancaillie P, Svehla M, Walsh W, Steensma A, Vancaillie T. Mechanical properties of urogynecologic implant materials. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14(4):239–43.

    CAS  PubMed  Google Scholar 

  108. Birch C. The use of prosthetics in pelvic reconstructive surgery. Best Pract Res Clin Obstet Gynaecol. 2005;19:979–91.

    PubMed  Google Scholar 

  109. Tuschy B, Berlit S, Hornemann A, Sütterlin M, Bussen S. Morbidity in elderly women undergoing gynaecological pelvic floor surgery. Arch Gynecol Obstet. 2011;285(5):1295–300.

    PubMed  Google Scholar 

  110. Ghezzi F, Uccella S, Cromi A, Bogani A. Surgical treatment for pelvic floor disorders in women 75 years or older: a single-center experience. Menopause. 2011;18(3):314–8.

    PubMed  Google Scholar 

  111. Gabriel B, Rubod C, Córdova L, Lucot J, Cosson M. Prolapse surgery in women of 80 years and older using the Prolift™ technique. Int Urogynecol J. 2010;12:1463–70.

    Google Scholar 

  112. Kelly HA. Incontinence of urine in women. Urol Cutaneous Rev. 1913;17:291–93.

    Google Scholar 

  113. Porges R, Smilen S. Long-term analysis of the surgical management of pelvic support defects. Am J Obstet Gynecol. 1994;171:1518–26.

    CAS  PubMed  Google Scholar 

  114. Weber A, Walters M, Piedmonte M, Ballard L. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol. 2001;185(6):1299–304.

    CAS  PubMed  Google Scholar 

  115. White GR. Cystocele. A radical cure by suturing lateral sulci of vagina to white line of pelvic fascia. JAMA 1909;80(21):1707–10.

    Google Scholar 

  116. Shull B, Benn S, Kuehl T. Surgical management of prolapse of the anterior vaginal segment: an analysis of support defects, operative morbidity, and anatomic outcome. Am J Obstet Gynecol. 1994;171(6): 1429–36.

    CAS  PubMed  Google Scholar 

  117. Young S, Daman J, Bony L. Vaginal paravaginal repair: one-year outcomes. Am J Obstet Gynecol. 2001;185:1360–7.

    CAS  PubMed  Google Scholar 

  118. Elkins T, et al. Transvaginal paravaginal repair: a useful adjunctive procedure in pelvic relaxation surgery. J Pelvic Surg. 2000;6:11–5.

    Google Scholar 

  119. Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique)—a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(7):743–52.

    CAS  PubMed  Google Scholar 

  120. Elmér C, Altman D, Engh M, Axelsen S, Vayrynen T, Falconer C. Trocar-guided transvaginal mesh repair of pelvic organ prolapse. Obstet Gynecol. 2009;113:117–26.

    PubMed  Google Scholar 

  121. Abdel-Fattah M, Ramsay I. Retrospective multicentre study of the new minimally invasive mesh repair devices for pelvic organ prolapse. BJOG. 2008;115: 22–30.

    CAS  PubMed  Google Scholar 

  122. Feiner B, Jelovsek J, Maher C. Efficacy and safety of transvaginal mesh kits in the treatment of prolapse of the vaginal apex: a systematic review. BJOG. 2009;116:15–24.

    CAS  PubMed  Google Scholar 

  123. Maher C, Feiner B, Baessler K, Glazener C. Surgical management of pelvic organ prolapse in women: the updated summary Cochrane review. Int Urogynecol J. 2011;22:1445–57.

    PubMed  Google Scholar 

  124. Nicita G. A new operation for genitourinary prolapse. J Urol. 1998;160:741–5.

    CAS  PubMed  Google Scholar 

  125. de Tayrac R, Deffieux X, Gervaise A, Chauveaud-Lambling A, Fernandez H. Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(5): 483–8.

    PubMed  Google Scholar 

  126. Hiltunen R, Nieminen K, Takala T, et al. Low-weight polypropylene mesh for anterior vaginal wall prolapse: a randomized controlled trial. Obstet Gynecol. 2007;110(2 Pt 2):455–62.

    PubMed  Google Scholar 

  127. Rzepka J, Brocker K, Alt C, Corteville C, Sohn C, Lenz F. Pelvic organ prolapse: does the postoperative course of mesh-repair surgery differ in elderly women when compared with younger patients? J Obstet Gynaecol. 2010;30(8):852–6.

    CAS  PubMed  Google Scholar 

  128. Long C, Hsu C, Wu M, Lo T, Liu C, Tsai E. Comparison of the changes in sexual function of premenopausal and postmenopausal women following transvaginal mesh surgery. J Sex Med. 2011;8(7): 2009–16.

    PubMed  Google Scholar 

  129. Gomelsky A, Rudy D, Dmchowski R. Porcine dermis interposition graft for repair of high grade anterior compartment defects with or without concomitant pelvic organ prolapse procedures. J Urol. 2004;171:1581–4.

    PubMed  Google Scholar 

  130. Meschia M, Pifarotti P, Bernasconi F, Magatti F, Riva D, Kocjancic E. Porcine skin collagen implants to prevent anterior vaginal wall prolapsed recurrence: a multicenter, randomized study. J Urol. 2007;177:192–5.

    PubMed  Google Scholar 

  131. McCall M. Posterior culdoplasty. Obstet Gynecol. 1957;10:595–602.

    CAS  PubMed  Google Scholar 

  132. Shull B, Bachofen C, Coates K, Kuehl T. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183: 1365–74.

    CAS  PubMed  Google Scholar 

  133. Lowenstein L, Fitz A, Kenton K, FitzGerald M, Mueller E, Brubaker L. Transabdominal uterosacral suspension: outcomes and complications. Am J Obstet Gynecol. 2009;200(6):656.e1–5.

    Google Scholar 

  134. Karram M, Goldwasser S, Kleeman S, Steele A, Vassallo B, Walsh P. High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse. Am J Obstet Gynecol. 2001;185(6):1339–42.

    CAS  PubMed  Google Scholar 

  135. Nichols D. Sacro-spinous fixation for massive eversion of the vagina. Am J Obstet Gynecol. 1982;142:901–4.

    CAS  PubMed  Google Scholar 

  136. Snyder T, Krantz K. Abdominal-retroperitoneal sacral colpopexy for the correction of vaginal prolapse. Obstet Gynecol. 1991;77:944–9.

    CAS  PubMed  Google Scholar 

  137. Daneshgari F, Paraiso M, et al. Robotic and laparoscopic female pelvic floor reconstruction. BJU Int. 2006;98 Suppl 1:62–8.

    PubMed  Google Scholar 

  138. Menefee S, et al. Results of abdominal sacral colpopexy using polyester mesh in the treatment of posthysterectomy vaginal vault prolapse and enterocele. Obstet Gynecol. 1999;154:563–5.

    Google Scholar 

  139. Maher C, Feiner B, Baessler K, Glazener C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2010;4.

    Google Scholar 

  140. Blanchard K, Vanlangendonck R, Winters J. Recurrent pelvic floor defects after abdominal sacral colpopexy. J Urol. 2006;175(3 Pt 1):1010–3.

    PubMed  Google Scholar 

  141. Nygaard I, McCreery R, Brubaker L, et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004;104(4):805–23.

    PubMed  Google Scholar 

  142. Murthy V, et al. Excellent outcome using selective criteria for rectocele repair. Dis Colon Rectum. 1996;39:374–8.

    CAS  PubMed  Google Scholar 

  143. Watson S, Loder P, Halligan S, et al. Transperineal repair of symptomatic rectocele with Marlex mesh: a clinical, physiological and radiologic assessment of treatment. J Am Coll Surg. 1996;183:257–61.

    CAS  PubMed  Google Scholar 

  144. Richardson A. The rectovaginal septum revisited: its relationship to rectocele and its importance in rectocele repair. Clin Obstet Gynecol. 1993;36:976–83.

    CAS  PubMed  Google Scholar 

  145. Khan M, Stanton S. Posterior colporrhaphy: its effects on bowel and sexual function. Br J Obstet Gynaecol. 1997;104:882–6.

    Google Scholar 

  146. Abramov Y, et al. Site-specific rectocele repair compared with standard posterior colporrhaphy. Obstet Gynecol. 2005;105:314–8.

    PubMed  Google Scholar 

  147. Paraiso M, et al. Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol. 2006;195:1762–71.

    PubMed  Google Scholar 

  148. Singh K, et al. Evaluation of the fascial technique for surgical repair of isolated posterior vaginal wall prolapse. Obstet Gynecol. 2003;101:320–4.

    CAS  PubMed  Google Scholar 

  149. Kohli N, Miklos J. Dermal graft-augmented rectocele repair. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:146–9.

    CAS  PubMed  Google Scholar 

  150. Kobashi K, Leach G, Frederick R, et al. Initial experience with rectocele repair using nonfrozen cadaveric fascia lata interposition. Urology. 2005;66:1203–8.

    PubMed  Google Scholar 

  151. de Tayrac R, Picone O, Chauveaud-Lambling A, Fernandez H. A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh. Int J Gynecol Obstet. 2006;17: 100–5.

    Google Scholar 

  152. Milani R, Salvatore S, et al. Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with Prolene mesh. Br J Obstet Gynaecol. 2005;112:107–11.

    Google Scholar 

  153. Lindau S, Schumm L, Laumann E, et al. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357:762–74.

    CAS  PubMed Central  PubMed  Google Scholar 

  154. Fitzgerald M, Richter H, Bradley C, et al. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1603–9.

    CAS  PubMed Central  PubMed  Google Scholar 

  155. Cespedes R, Winters J, Ferguson K. Colpocleisis for the treatment of vaginal vault prolapse. Tech Urol. 2001;7(2):152–60.

    CAS  PubMed  Google Scholar 

  156. Shayya R, Weinstein M, Lukacz E. Pyometra after Le Fort colpocleisis resolved with interventional radiology drainage. Obstet Gynecol. 2009;113(2 Pt 2):566–8.

    PubMed  Google Scholar 

  157. Goldman J, Ovadia J, Feldberg D. The Neugebauer-Le Fort operation: a review of 118 partial colpocleisis. Eur J Obstet Gynecol Reprod Biol. 1981;12:31–5.

    CAS  PubMed  Google Scholar 

  158. Langmade C, Oliver JJ. Partial colpocleisis. Am J Obstet Gynecol. 1986;154:1200–5.

    CAS  PubMed  Google Scholar 

  159. DeLancey J, Morley G. Total colpocleisis for vaginal eversion. Am J Obstet Gynecol. 1997;176:1228–35.

    CAS  PubMed  Google Scholar 

  160. von Pechmann W, Mutone M, Fyffe J, Hale D. Total colpocleisis with high levator plication for the treatment of advanced pelvic organ prolapse. Am J Obstet Gynecol. 2003;189:121–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Urology, The University of Chicago School of Medicine, 5841 S. Maryland Avenue, MC 6038, Chicago, IL, 60637, USA

    Gregory Bales M.D. & Doreen Chung M.D., F.R.C.S.C.

  2. Department of Surgery, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY, 40536, USA

    Katie Ballert M.D.

Authors
  1. Gregory Bales M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Doreen Chung M.D., F.R.C.S.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katie Ballert M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory Bales M.D. .

Editor information

Editors and Affiliations

  1. Department of Urology and the Landon Center on Aging, The University of Kansas, Kansas City, Kansas, USA

    Tomas Lindor Griebling

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Bales, G., Chung, D., Ballert, K. (2014). Pelvic Organ Prolapse in Older Adults. In: Griebling, T. (eds) Geriatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9047-0_13

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9047-0_13

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9046-3

  • Online ISBN: 978-1-4614-9047-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation