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Surgery for Pelvic Organ Prolapse

Brubaker, Linda MD, MS*; Maher, Chris MD; Jacquetin, Bernard MD; Rajamaheswari, Natarajan MD, DGO, MCh§; von Theobald, Peter MD, PhD; Norton, Peggy MD

Female Pelvic Medicine & Reconstructive Surgery: January-February 2010 - Volume 16 - Issue 1 - p 9-19
doi: 10.1097/SPV.0b013e3181ce959c
Original Articles

Objectives: Surgery for pelvic organ prolapse (POP) is common with increasing high-quality evidence to guide surgical practice. Yet many important basic questions remain, including the optimal timing for POP surgery, the optimal preoperative evaluation of urinary tract function, and the postoperative outcome assessment. This manuscript reviews traditional surgical approaches for POP.

Methods: Formal and hand-searching of prolapse literature was conducted by the committee on Pelvic Organ Prolapse Surgery for the most recent International Consultation on Incontinence. The committee (authors) was composed of prolapse specialists from around the world. Consensus recommendations were made following literature abstraction.

Results: Surgical correction of POP can be divided into 2 main categories as follows: reconstructive procedures to correct anterior and posterior wall defects and resuspend the vaginal apex or obliterative procedures to close off the vagina. Reconstructive surgery may use the vaginal route or the abdominal route.

Conclusions: In addition to recommendations within the report, the committee reaffirms that in planning surgery, the individual patient's risk for surgery, risk of recurrence, previous treatments, and surgical goals are all considered in deciding on obliterative versus reconstructive procedures, and in deciding whether the vaginal or the abdominal approach will be used for reconstructive repairs.

There are varying levels of evidence to support many traditional techniques for surgical treatment of pelvic organ prolapse. This article summarizes available evidence based on the consensus opinion of prolapse experts who formed the International Committee on Incontinence Committee on Prolapse Surgery. This well-referenced article provides summary tables that may be useful for clinicians and researchers in this field.

From the *Loyola University Medical Center, Maywood, IL; †Wesley Urogynaecology Unit, Queensland, Australia; ‡Department of Gynecology and Obstetrics, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France; §Govt Kasturba Gandhi Hospital and Madras Medical College, Chennai, India; ¶Department of Gynecology Obstetrics and Reproductive Medicine, University Hospital of Caen, Caen Cedex, France; and ∥University of Utah School of Medicine, Salk Lake City, UT.

Dr. Brubaker receives research funding from Pfizer and Allergan and is a consultant for Pfizer.

Reprints: Linda Brubaker, MD, Loyola University Medical Center, 2160 S. First Avenue, Building 103–Suite 1004, Maywood, IL 60153. E-mail:

© 2010 by Wolters Kluwer Health | Lippincott Williams & Wilkins