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2017 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse

Maher, Christopher F., MD, PhD*; Baessler, Kaven K., MD, PhD; Barber, Matthew D., MD, MHS; Cheon, Cecilia, MD§; Consten, Esther C.J., MD, PhD; Cooper, Kevin G., MSc, MD; Deffieux, Xavier, MD, PhD**; Dietz, Viviane, MD, PhD††; Gutman, Robert E., MD‡‡; van Iersel, Jan J., MD, PhD§§; Nager, Charles W., MD∥∥; Sung, Vivian W., MD, MPH¶¶; de Tayrac, Renaud, MD, PhD***

Female Pelvic Medicine & Reconstructive Surgery: April 28, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000591
Original Article: PDF Only

Objective The aim of this article is to summarize the relevant findings that inform the 2017 International Consultation on Incontinence pathway for surgical treatment of pelvic organ prolapse (POP).

Methods We conducted an evidence-based review of the English-language peer-reviewed literature relating to POP surgery published prior to December 2016. Level 1 evidence (randomized controlled trials [RCTs] or systematic reviews of RCTs) was preferred; however, level 2 (poor-quality RCT, prospective cohort studies) or 3 evidence (case series or retrospective studies) has been included if level 1 data were lacking. The committee evaluated the literature and made recommendations based on the Oxford grading system summarized as follows: grade A recommendation usually depends on consistent level 1 evidence; grade B recommendation usually depends on consistent level 2 and/or 3 studies, or “majority evidence” from RCTs; grade C recommendation usually depends on level 3 studies or “majority evidence” from level 2/3 studies or Delphi-processed expert opinion; grade D, “no recommendation possible,” would be used where the evidence is inadequate or conflicting.

Results The recommendations from each chapter of the review are presented and serve to inform an evidence-based pathway for the surgical treatment of prolapse. A Web-based interactive application of the pathway is presented.

Conclusions The 2017 International Consultation on Incontinence pathway on surgery for POP is designed as an adjunct to transparent consultation and consent relating to POP surgery. The final decision regarding surgical intervention can be made only after a shared decision-making process between the patient and the clinician that will evaluate a variety of individual factors that cannot be assessed in the pathway.

From the *University Queensland, Brisbane, Australia; †Franziskus and St Joseph Hospitals, Berlin, Germany; ‡Duke University, Durham, NC; §Queen Elizabeth Hospital, Hong Kong; ∥Meander Medical Centre, Department of Surgery, Amersfoort, the Netherlands; ¶Aberdeen Royal Infirmary, Aberdeen, United Kingdom; **University Paris South, Antoine Beclere Hospital, Clamart, France; ††Catharina Medical Center, Michelangelolaan, Eindhoven, the Netherlands; ‡‡MedStar Washington Hospital Center, Georgetown University, Washington, DC; §§Twente University, Institute of Technical Medicine, Enschede, the Netherlands; ∥∥UC San Diego Health, San Diego, CA; ¶¶The Warren Alpert Medical School of Brown University, Providence, RI; and ***Caremeau University Hospital, Nimes, France.

Correspondence: Christopher F. Maher, MD, PhD, 86/30 Chasley St, Auchenflower 4066, Queensland, Australia. E-mail:

Full manuscript: Maher C, Baessler K, Cheong C, et al. Surgical management of pelvic organ prolapse. In: Abrams P, Cardozo L, Wagg A, et al, eds. International Consultation on Incontinence. 6th ed. ICUD ICS; 2017:1855–1992.

The lead author (C.F.M.) received financial support for travel and accommodation to present this work at the 6th International Consultation on Incontinence, Tokyo, Japan, September 2016. X.D. was a consultant to Allergan, UrgoTech, and Astellas. The other authors have declared they have no conflicts of interest.

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