Pelvic Organ Prolapse
Publication Date: November 1, 2019
Last Updated: March 14, 2022
Recommendations
Uterosacral and sacrospinous ligament suspension for apical POP with native tissue are equally effective surgical treatments of POP, with comparable anatomic, functional, and adverse outcomes. (A)
574
The use of synthetic mesh or biologic grafts in transvaginal repair of posterior vaginal wall prolapse does not improve outcomes. (A)
574
Compared with native tissue anterior repair, polypropylene mesh augmentation of anterior vaginal wall prolapse repair improves anatomic and some subjective outcomes but is associated with increased morbidity. (A)
574
Many women with POP on physical examination do not report symptoms of POP. Treatment is indicated only if prolapse is causing bothersome bulge and pressure symptoms, sexual dysfunction, lower urinary tract dysfunction, or defecatory dysfunction. (B)
574
Women considering treatment of POP should be offered a vaginal pessary as an alternative to surgery. (B)
574
Vaginal apex suspension should be performed at the time of hysterectomy for uterine prolapse to reduce the risk of recurrent POP. (B)
574
Abdominal sacrocolpopexy with synthetic mesh has a lower risk of recurrent POP but is associated with more complications than vaginal apex repair with native tissue. (B)
574
Obliterative procedures––which narrow, shorten, or completely close the vagina––are effective for the treatment of POP and should be considered a firstline surgical treatment for women with significant medical comorbidities who do not desire future vaginal intercourse or vaginal preservation. (B)
574
The use of synthetic mesh or biologic grafts in POP surgery is associated with unique complications not seen in POP repair with native tissue. (B)
574
Hysteropexy is a viable alternative to hysterectomy in women with uterine prolapse, although there is less available evidence on safety and efficacy compared with hysterectomy. (B)
574
A POP-Q examination is recommended before treatment for the objective evaluation and documentation of the extent of prolapse. (C)
574
A pessary should be considered for a woman with symptomatic POP who wishes to become pregnant in the future. (C)
574
Pelvic organ prolapse vaginal mesh repair should be limited to high-risk individuals in whom the benefit of mesh placement may justify the risk, such as individuals with recurrent prolapse (particularly of the anterior or apical compartments) or with medical comorbidities that preclude more invasive and lengthier open and endoscopic procedures. Before placement of synthetic mesh grafts in the anterior vaginal wall, patients should provide their informed consent after reviewing the benefits and risks of the procedure and discussing alternative repairs. (C)
574
Surgeons who perform POP surgery with biologic grafts or synthetic mesh grafts should have training specifically for these procedures and should be able to counsel patients regarding the risk–benefit ratio for the use of mesh compared with native tissue repair. (C)
574
Routine intraoperative cystoscopy during POP surgery is recommended when the surgical procedure performed is associated with a significant risk of injury to the bladder or ureter. These procedures include suspension of the vaginal apex to the uterosacral ligaments, sacrocolpopexy, and anterior colporrhaphy and the placement of mesh in the anterior and apical compartments. (C)
574
All women with significant apical prolapse, anterior prolapse, or both should have a preoperative evaluation for occult stress urinary incontinence, with cough stress testing or urodynamic testing with the prolapse reduced. (C)
574
Patients with POP but without stress urinary incontinence who are undergoing either abdominal or vaginal prolapse repair should be counseled that postoperative stress urinary incontinence is more likely without a concomitant continence procedure but that the risk of adverse effects is increased with an additional procedure. (C)
574
Recommendation Grading
Overview
Title
Pelvic Organ Prolapse
Authoring Organization
American College of Obstetricians and Gynecologists
Publication Month/Year
November 1, 2019
Last Updated Month/Year
June 9, 2022
Document Type
Consensus
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Physician, nurse nurse midwife, nurse certified nurse midwife, nurse, nurse practitioner, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D059952 - Pelvic Floor Disorders, D056887 - Pelvic Organ Prolapse
Keywords
pelvic organ prolapse, POP