Abstract
The objective of this review is to discuss the main goals of pelvic organ prolapse repair. Pelvic organ prolapse symptoms are variable, and prolapse degree does not necessarily correlate with perceived symptoms or other associated conditions including urinary, defecatory, and sexual dysfunction. Treatment for pelvic organ prolapse is based upon symptom bother and patient expectations. There are various surgical approaches to treat pelvic organ prolapse; however, there is no standardized definition of cure or success. Physician goals of pelvic surgery to correct prolapse include restoration of anatomy, resolution of patient symptoms, avoidance of complications and attainment of patient goals. However, patient’s expectations may differ, and discussing preoperative goals and setting realistic expectations prior to treatment may guide surgical therapy and improve patient satisfaction.
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Samuelsson EC et al. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999;180(2 Pt 1):299–305.
Olsen AL et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501–6.
Smith FJ et al. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096–100.
Subak LL et al. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001;98(4):646–51.
Rogers GR et al. Sexual function in women with and without urinary incontinence and/or pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(6):361–5.
Ozel B et al. The impact of pelvic organ prolapse on sexual function in women with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(1):14–7.
Barber MD et al. Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstet Gynecol. 2002;99(2):281–9.
Ghielmetti T et al. Gynaecological operations: do they improve sexual life? Eur J Obstet Gynecol Reprod Biol. 2006;129(2):104–10.
Clemons JL et al. Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(2):345–50.
Clemons JL et al. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(4):1025–9.
DeLancey JO, Morley GW. Total colpocleisis for vaginal eversion. Am J Obstet Gynecol. 1997;176(6):1228–32. discussion 1232-5.
Fitzgerald MP et al. Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1603–9.
Hullfish KL, Bovbjerg VE, Steers WD. Colpocleisis for pelvic organ prolapse: patient goals, quality of life, and satisfaction. Obstet Gynecol. 2007;110(2 Pt 1):341–5.
Crisp CC, et al. Body image, regret, and satisfaction following colpocleisis. American journal of obstetrics and gynecology. 2013.
Sze EH, Karram MM. Transvaginal repair of vault prolapse: a review. Obstet Gynecol. 1997;89(3):466–75.
Weber AM et al. The standardization of terminology for researchers in female pelvic floor disorders. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):178–86.
Swift S 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.
Bradley CS, Nygaard IE. Vaginal wall descensus and pelvic floor symptoms in older women. Obstet Gynecol. 2005;106(4):759–66.
Swift SE, Barber MD. Pelvic organ prolapse: defining the disease. Female Pelvic Med Reconstr Surg. 2010;16(4):201–3.
Ellerkmann RM et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185(6):1332–7. discussion 1337-8.
Burrows LJ et al. Pelvic symptoms in women with pelvic organ prolapse. Obstet Gynecol. 2004;104(5 Pt 1):982–8.
Ghetti C et al. Pelvic organ descent and symptoms of pelvic floor disorders. Am J Obstet Gynecol. 2005;193(1):53–7.
Barber MD et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114(3):600–9.
Jelovsek JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol. 2006;194(5):1455–61.
Digesu GA et al. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG: Int J Obstet Gynaecol. 2005;112(7):971–6.
Hullfish KL et al. Patient-centered goals for pelvic floor dysfunction surgery: what is success, and is it achieved? Am J Obstet Gynecol. 2002;187(1):88–92.
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.
Elkadry EA et al. Patient-selected goals: a new perspective on surgical outcome. Am J Obstet Gynecol. 2003;189(6):1551–7. discussion 1557-8.
Komesu YM et al. Patient-selected goal attainment for pessary wearers: what is the clinical relevance? Am J Obstet Gynecol. 2008;198(5):577. e1-5.
Mamik MM, et al. Goal attainment after treatment in patients with symptomatic pelvic organ prolapse. Am J Obstet Gynecol. 2013. The objective of this study was to compare the differences in goal attainment of self-described goals in patients who elected surgery vs. pessary for treatment of pelvic organ prolapse. Patients who chose surgery had better global improvement and met their goals better compared to patients who chose pessary.
Hullfish KL et al. Surgical versus nonsurgical treatment of women with pelvic floor dysfunction: patient centered goals at 1 year. J Urol. 2008;179(6):2280–5. discussion 2285.
Srikrishna S, Robinson D, Cardozo L. A longitudinal study of patient and surgeon goal achievement 2 years after surgery following pelvic floor dysfunction surgery. BJOG: Int J Obstet Gynaecol. 2010;117(12):1504–11. This study highlights the differences in goal achievement and overall satisfaction in surgeons and patients undergoing or performing prolapse and incontinence surgery.
Adams SR et al. Do patient goals vary with stage of prolapse? Am J Obstet Gynecol. 2011;205(5):502. e1-6.
Shveiky D et al. Patient goal attainment in vaginal prolapse repair with and without mesh. Int Urogynecol J. 2012;23(11):1541–6.
Paraiso MF et al. Rectocele repair: a randomized trial of three surgical techniques including graft augmentation. Am J Obstet Gynecol. 2006;195(6):1762–71.
Mahajan ST et al. Patient-centered surgical outcomes: the impact of goal achievement and urge incontinence on patient satisfaction one year after surgery. Am J Obstet Gynecol. 2006;194(3):722–8.
de Boer TA et al. Predictive factors for overactive bladder symptoms after pelvic organ prolapse surgery. Int Urogynecol J. 2010;21(9):1143–9.
Pham T et al. New pelvic symptoms are common after reconstructive pelvic surgery. Am J Obstet Gynecol. 2009;200(1):88. e1-5.
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Dr. Margarita M. Aponte and Dr. Nirit Rosenblum each declare no potential conflicts of interest relevant to this article.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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Aponte, M.M., Rosenblum, N. Repair of Pelvic Organ Prolapse: What is the Goal?. Curr Urol Rep 15, 385 (2014). https://doi.org/10.1007/s11934-013-0385-y
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DOI: https://doi.org/10.1007/s11934-013-0385-y