A Review of Surgical Treatment for Pelvic Organ Prolapse

Abstract

Pelvic organ prolapse (POP) is common in women and may impair quality of life. Although vaginal pessary can relieve the symptoms and improve quality of life, women may opt for surgical treatment. This paper reviews some common surgical options for POP and their outcome. Anterior colporrhaphy is commonly performed for anterior compartment prolapse but the reported recurrence rate was high. Reinforcement with mesh can reduce the recurrence and reoperation rate; but there are higher intra-operative and long term complications. It should be performed in well-selected cases and by experienced surgeons. There is insufficient evidence to support mesh repair for posterior compartment prolapse. Vaginal hysterectomy is a commonly performed for uterine prolapse; followed by McCall culdoplasty or sacrospinous ligament fixation (SSLF) to suspend the vaginal vault and prevent the recurrence of vaginal vault prolapse.
In women with vaginal vault prolapse, abdominal sacrocolpopexy was shown to have a lower recurrence of vaginal vault prolapse when compared with SSLF although there was no difference in the re-operation rate. Laparoscopic sacrocolpopexy can be a more minimally invasive surgery but it has a longer learning curve. Uterus-preserving POP
repair is increasingly popular. Women prefer to preserve their uterus for various reasons. Manchester operation or sacrospinous hysteropexy can be the choices for women who have further fertility wish. Sacrohysteropexy can be the option if women have no fertility wish as there is limited information on pregnancy outcome. Finally, colpoclesis, an
obliterative procedure, can be an option for women who are no longer sexually active.