Mini-review: Modern Concept of Pelvic Organ Prolapse

Authors

  • Botagoz Aitbayeva Department of Obstetrics and Gynecology №2, NJSC “Astana Medical University”, Nur-Sultan, Kazakhstan https://orcid.org/0000-0001-6773-3936
  • Serik Iskakov Department of Obstetrics and Gynecology №2, NJSC “Astana Medical University”, Nur-Sultan, Kazakhstan
  • Lazat Smailova Department of Obstetrics and Gynecology №2, NJSC “Astana Medical University”, Nur-Sultan, Kazakhstan

DOI:

https://doi.org/10.3889/oamjms.2022.8804

Keywords:

Pelvic organ prolapse, Surgical treatment approaches, Pelvic floor reconstruction, Conservative treatment options, Modern concept

Abstract

Symptomatic pelvic organ prolapse (POP) has been increasing in recent years for both developed and developing countries. By 2050, as the adult population grows, the number of women with symptomatic POP will increase by 46%. Due to the increasing number of complications after surgery among women with POP, the current understanding of treatment has become extremely important for researchers and practitioners. There are many novel conservative and surgical treatment approaches under investigation. However, some primary surgical treatments show an approximate 30–50% risk of repeated pelvic floor reconstruction. Therefore, the review aims to summarize several conservative treatment options and identify critical areas of need for future research.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

DeLancey JO. The anatomy of the pelvic floor. Curr Opin Obstet Gynecol. 1994;6(4):313-6. PMid:7742491

Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21(1):5-26. https://doi.org/10.1007/s00192-009-0976-9 PMid:19937315

Doaee M, Moradi-Lakeh M, Nourmohammadi A, Razavi-Ratki SK, Nojomi M. Management of pelvic organ prolapse and quality of life: A systematic review and meta-analysis. Int Urogynecol J. 2014;25(2):153-63. https://doi.org/10.1007/s00192-013-2141-8 PMid:23783578

Bradley CS, Zimmerman MB, Qi Y, Nygaard IE. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109(4):848-54. https://doi.org/10.1097/01.AOG.0000255977.91296.5d PMid:17400845

Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol. 2014;123(1):141-8. https://doi.org/10.1097/AOG.0000000000000057 PMid:24463674

Wilkins MF, Wu JM. Epidemiology of pelvic organ prolapse. Curr Obstet Gynecol Rep. 2016;5:119-23.

Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: The OPTIMAL randomized trial. JAMA. 2014;311(10):1023-34. https://doi.org/10.1001/jama.2014.1719 PMid:24618964

Dällenbach P. To mesh or not to mesh: A review of pelvic organ reconstructive surgery. Int J Womens Health. 2015;7:331-43. https://doi.org/10.2147/IJWH.S71236 PMid:25848324

Wu JM, Hundley AF, Fulton RG, Myers ER. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol. 2009;114(6):1278-83. https://doi.org/10.1097/AOG.0b013e3181c2ce96 PMid:19935030

Reimers C, Siafarikas F, Stær-Jensen J, Småstuen MC, Bø K, Engh ME. Risk factors for anatomic pelvic organ prolapse at 6 weeks postpartum: A prospective observational study. Int Urogynecol J. 2019;30(3):477-82. https://doi.org/10.1007/s00192-018-3650-2 PMid:29656330

Madhu C, Swift S, Moloney-Geany S, Drake MJ. How to use the pelvic organ prolapse quantification (POP‐Q) system? Neurourol Urodyn. 2018;37(S6):S39-43. https://doi.org/10.1002/nau.23740 PMid:30614056

Ramage L, Simillis C, Yen C, Lutterodt C, Qiu S, Tan E, et al. Magnetic resonance defecography versus clinical examination and fluoroscopy: A systematic review and meta-analysis. Tech Coloproctol. 2017;21(12):915-27. https://doi.org/10.1007/s10151-017-1704-y PMid:29094218

Lince SL, van Kempen LC, Vierhout ME, Kluivers KB. A systematic review of clinical studies on hereditary factors in pelvic organ prolapse. Int Urogynecol J. 2012;23(10):1327-36. https://doi.org/10.1007/s00192-012-1704-4 PMid:22422218

Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB. Risk factors for pelvic organ prolapse and its recurrence: A systematic review. Int Urogynecol J. 2015;26(11):1559-73. https://doi.org/10.1007/s00192-015-2695-8 PMid:25966804

Abhyankar P, Uny I, Semple K, Wane S, Hagen S, Wilkinson J, et al. Women’s experiences of receiving care for pelvic organ prolapse: A qualitative study. BMC Womens Health. 2019;19(1):45. https://doi.org/10.1186/s12905-019-0741-2 PMid:30876415

DeLancey JO, Morgan DM, Fenner DE, Kearney R, Guire K, Miller JM, et al. Comparison of levator ani muscle defects and function in women with and without pelvic organ prolapse. Obstet Gynecol. 2007;109(2):295-302. https://doi.org/10.1097/01.AOG.0000250901.57095.ba PMid:17267827

Lan CW, Tavrow P. Composite measures of women’s empowerment and their association with maternal mortality in low-income countries. BMC Pregnancy Childbirth. 2017;17 Suppl 2:337. https://doi.org/10.1186/s12884-017-1492-4 PMid:29143614

van Bavel J, Hukkelhoven CW, de Vries C, Papatsonis DN, de Vogel J, Roovers JW, et al. The effectiveness of mediolateral episiotomy in preventing obstetric anal sphincter injuries during operative vaginal delivery: A ten-year analysis of a national registry. Int Urogynecol J. 2018;29(3):407-13. https://doi.org/10.1007/s00192-017-3422-4 PMid:2872148

Olafsdottir T, Thorleifsson G, Sulem P, Stefansson OA, Medek H, Olafsson K, et al. Genome-wide association identifies seven loci for pelvic organ prolapse in Iceland and the UK biobank. Commun Biol. 2020;3(1):129. https://doi.org/10.1038/s42003-020-0857-9 PMid:32184442

Feiner B, Fares F, Azam N, Auslender R, David M, Abramov Y. Does COLIA1 SP1-binding site polymorphism predispose women to pelvic organ prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(9):1061-5. https://doi.org/10.1007/s00192-009-0895-9 PMid:19655227

Ermakova EI, Balan VE, Krasnopol’skaya IV. Optimization of management tactics of patients with mixed urinary incontinence. Rossiyskiy Vestnik Akushera-Ginekol. 2014;2:67-70.

Radzinskii VE, Khanzadyan ML, Demura TA. Matrix metalloproteinases and their inhibitors in the pathogenesis of pelvic organ prolapse. Doktor Ru. 2014;1(5):7-10.

Veit-Rubin N, Cartwright R, Singh AU, Digesu GA, Fernando R, Khullar V. Association between joint hypermobility and pelvic organ prolapse in women: A systematic review and metaanalysis. Int Urogynecol J. 2016;27(10):1469-78. https://doi.org/10.1007/s00192-015-2896-1 PMid:26658756

Digesu GA, Chaliha C, Salvatore S. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG. 2005;112(7):971-6. https://doi.org/10.1111/j.1471-0528.2005.00568.x PMid:15958002

Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: What is pelvic organ prolapse? Am J Obstet Gynecol. 2003;189(2):372-7; discussion 377-9. https://doi.org/10.1067/s0002-9378(03)00698-7 PMid:14520198

Kishwara S, Tamira S, Omar E, Begum K. Genital prolapse in women of reproductive age group in a rural community of Bangladesh. J Dhaka Med Coll. 2010;19(2):118-21.

Ballard K, Ayenachew F, Wright J, Atnafu H. Prevalence of obstetric fistula and symptomatic pelvic organ prolapse in rural Ethiopia. Int Urogynecol J. 2016;27(7):1063-7. https://doi.org/10.1007/s00192-015-2933-0 PMid:26755052

Garland BH, Khatri G, Ram R, Hull TL, Kocjancic E, Quiroz LH, et al. Consensus definitions and interpretation templates for magnetic resonance imaging of defecatory pelvic floor disorders. Dis Colon Rectum. 2021;64(10):1184-97 https://doi.org/10.1097/DCR.0000000000002155

El Sayed RF, Alt CD, Maccioni F, Meissnitzer M, Masselli G, Manganaro L, et al. Magnetic resonance imaging of pelvic floor dysfunction-joint recommendations of the ESUR and ESGAR pelvic floor working group. Eur Radiol. 2017;27(5):2067-85. https://doi.org/10.1007/s00330-016-4471-7 PMid:27488850

Dietz HP. Ultrasound in the assessment of pelvic organ prolapse. Best Pract Res Clin Obstet Gynaecol. 2019;54:12-30. https://doi.org/10.1016/j.bpobgyn.2018.06.006 PMid:30082146

Lalwani N, Khatri G, El Sayed RF, Ram R, Jambhekar K, Chernyak V, et al. MR defecography technique: Recommendations of the society of abdominal radiology’s disease-focused panel on pelvic floor imaging. Abdom Radiol (NY). 2021;46(4):1351-61. https://doi.org/10.1007/s00261-019-02160-7 PMid:31385010

Iacobellis F, Brillantino A, Renzi A, Monaco L, Serra N, Feragalli B, et al. MR Imaging in diagnosis of pelvic floor descent: Supine versus sitting position. Gastroenterol Res Pract. 2016;2016:6594152. https://doi.org/10.1155/2016/6594152 PMid:26880893

Poncelet E, Rock A, Quinton JF, Cosson M, Ramdane N, Nicolas L, et al. Dynamic MR defecography of the posterior compartment: Comparison with conventional X-ray defecography. Diagn Interv Imaging. 2017;98(4):327-32. https://doi.org/10.1016/j.diii.2016.03.018 PMid:28089181

Kumar NM, Khatri G, Christie AL, Sims R, Pedrosa I, Zimmern PE. Supine magnetic resonance defecography for evaluation of anterior compartment prolapse: Comparison with upright voiding cystourethrogram. Eur J Radiol. 2019;117:95-101. https://doi.org/10.1016/j.ejrad.2019.05.018 PMid:31307659

Maccioni F, Al Ansari N, Buonocore V, Mazzamurro F, Indinnimeo M, Mongardini M, et al. Prospective comparison between two different magnetic resonance defecography techniques for evaluating pelvic floor disorders: Air-balloon versus gel for rectal filling. Eur Radiol. 2016;26(6):1783-91. https://doi.org/10.1007/s00330-015-4016-5 PMid:26443600

Kieserman-Shmokler C, Pandit A, Zawistowski M, Swenson CW. Genome wide assocation study (GWAS) of pelvic organ prolapse using an institutional genomics initiative. Female Pelvic Med Reconstr Surg. 2019;25 Suppl 5:S143.

Dos Santos RG, Pepicelli FC, Batista NC, de Carvalho CV, Bortolini MA, Castro RA. Collagen XVIII and LOXL-4 polymorphisms in women with and without advanced pelvic organ prolapse. Int Urogynecol J. 2018;29(6):893-8. https://doi.org/10.1007/s00192-018-3597-3 PMid:29532123

Li L, Sun Z, Chen J, Zhang Y, Shi H, Zhu L. Genetic polymorphisms in collagen-related genes are associated with pelvic organ prolapse. Menopause. 2020;27(2):223-9. https://doi.org/10.1097/GME.0000000000001448 PMid:31663982

NICE guidance-urinary incontinence and pelvic organ prolapse in women: Management: NICE (2019) urinary incontinence and pelvic organ prolapse in women: Management. BJU Int. 2019;123(5):777-803. https://doi.org/10.1111/bju.14763 PMid:31008559

American College of Obstetricians and Gynecologists and the American Urogynecologic Society, Interim Update: This Practice Bulletin is Updated as Highlighted to Reflect the US Food and Drug Administration Order to Stop the Sale of Transvaginal Synthetic Mesh Products for the Repair of Pelvic Organ Prolapse. Pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2019;25(6):397-408. https://doi.org/10.1097/SPV.0000000000000794 PMid:31663890

Kashyap R, Jain V, Singh A. Comparative effect of 2 packages of pelvic floor muscle training on the clinical course of stage I-III pelvic organ prolapse. Int J Gynaecol Obstet. 2013;121(1):69-73. https://doi.org/10.1016/j.ijgo.2012.11.012 PMid:23332657

Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: A systematic review and meta-analysis of observational studies. Am J Obstet Gynecol. 2017;217(1):11-26.e3. https://doi.org/10.1016/j.ajog.2017.01.039 PMid:28188775

Hagen S, Glazener C, McClurg D, Macarthur C, Elders A, Herbison P, et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): A multicentre randomised controlled trial. Lancet. 2017;389(10067):393-402. https://doi.org/10.1016/S0140-6736(16)32109-2 PMid:28010994

Lamers BH, Broekman BM, Milani AL. Pessary treatment for pelvic organ prolapse and health-related quality of life; a review. Int Urogynecol J. 2011;6:637-44. https://doi.org/10.1007/s00192-011-1390-7 PMid:21472447

Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011;(12):CD003882. https://doi.org/10.1002/14651858 PMid:22161382

Coolen AW, Troost S, Mol BW, Roovers JP, Bongers MY. Primary treatment of pelvic organ prolapse: Pessary use versus prolapse surgery. Int Urogynecol J. 2018;29(1):99-107. https://doi.org/10.1007/s00192-017-3372-x PMid:28600758

de Boer TA, Milani AL, Kluivers KB, Withagen MI, Vierhout ME. The effectiveness of surgical correction of uterine prolapse: Cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(11):1313-9. https://doi.org/10.1007/s00192-009-0945-3 PMid:19669686

Tadir Y, Iglesia C, Alexiades M, Davila GW, Guerette N, Gaspar A. Energy-based treatment for gynecologic conditions including genitourinary syndrome of menopause: Consensus, controversies, recommendations, and FDA clearance. Lasers Surg Med. 2019;51(4):315-7. https://doi.org/10.1002/lsm.23031 PMid:30408203

Detollenaere RJ, den Boon J, Stekelenburg J, IntHout J, Vierhout ME, Kluivers KB, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: Multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717. https://doi.org/10.1136/bmj.h3717 PMid:26206451

Mowat A, Maher D, Baessler K, Christmann-Schmid C, Haya N, Maher C. Surgery for women with posterior compartment prolapse. Cochrane Database Syst Rev. 2018;3(3):CD012975. https://doi.org/10.1002/14651858.CD012975 PMid:29502352

Jefferis H, Jackson SR, Price N. Management of uterine prolapse: Is hysterectomy necessary? Obstet Gynaecol. 2016;18:17-23.

Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10(10):CD012376. https://doi.org/10.1002/14651858.CD012376 PMid:27696355

Gutman RE, Rardin CR, Sokol ER, Matthews C, Park AJ, Iglesia CB, et al. Vaginal and laparoscopic mesh hysteropexy for uterovaginal prolapse: A parallel cohort study. Am J Obstet Gynecol. 2017;216(1):38.e1-11. https://doi.org/10.1016/j.ajog.2016.08.035 PMid:27596620

Favre-Inhofer A, Carbonnel M, Murtada R, Revaux A, Asmar J, Ayoubi JM. Sacrospinous ligament fixation: Medium and longterm anatomical results, functional and quality of life results. BMC Womens Health. 2021;21(1):66. https://doi.org/10.1186/s12905-021-01195-7 PMid:33579252

Linder BJ, Gebhart JB, Occhino JA. Total colpocleisis: Technical considerations. Int Urogynecol J. 2016;27:1767-9. https://doi.org/10.1007/s00192-016-3034-4 PMid:27179809

Catanzarite T, Rambachan A, Mueller M. Risk factors for perioperative complications after le fort colpocleisis. JMIG. 2014;21(S34):poster44.

Szcześniewska A, Szpakowski M, Władziński J, Wilczyński JR. (Un)Forgotten neugebauer-le fort operation. Paramedian closure of the vagina-safe and effective surgical procedure for treating of pelvic organ prolapse in older women. Ginekol Pol. 2015;86(3):198-202. https://doi.org/10.17772/gp/2063 PMid:25920310

Jones KA, Zhuo Y, Solak S, Harmanli O. Hysterectomy at the time of colpocleisis: A decision analysis. Int Urogynecol J. 2016;27(5):805-10. https://doi.org/10.1007/s00192-015-2903-6 PMid:26658894

Caliskan A, Ozeren M, Goeschen K. Modified posterior intravaginal slingplasty: Does the additional bilateral tape attachment to the sacrospinous ligament improve the results? Cent European J Urol. 2018;71(3):326-33. https://doi.org/10.5173/ceju.2018.1685 PMid:30386655

Rogowski A, Kluz T, Szafarowska M, Mierzejewski P, Sienkiewicz-Jarosz H, Samochowiec J, et al. Efficacy and safety of the Calistar and Elevate anterior vaginal mesh procedures. Eur J Obstet Gynecol Reprod Biol. 2019;239:30-34. https://doi.org/10.1016/j.ejogrb.2019.05.033 PMid:31163354

Campbell P, Jha S and Cutner A. Vaginal mesh in prolapse surgery. Obstet Gynaecol. 2018;20:49-56.

Funk MJ, Edenfield AL, Pate V, Visco AG, Weidner AC, Wu JM. Trends in use of surgical mesh for pelvic organ prolapse. Am J Obstet Gynecol. 2013;208(1):79.e1-7. https://doi.org/10.1016/j.ajog.2012.11.008 PMid:23159692

Bugge C, Adams EJ, Gopinath D, Stewart F, Dembinsky M, Sobiesuo P, et al. Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database Syst Rev. 2020;11(11):CD004010. https://doi.org/10.1002/14651858.CD004010.pub4 PMid:33207004

Lo TS, Ng KL, Huang TX, Chen YP, Lin YH, Hsieh WC. Anteriorapical transvaginal mesh (surelift) for advanced urogenital prolapse: Surgical and functional outcomes at 1 year. J Minim Invasive Gynecol. 2021;28(1):107-16. https://doi.org/10.1016/j.jmig.2020.05.002 PMid:32416263

Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Marjoribanks J. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev. 2016;2(2):CD012079. https://doi.org/10.1002/14651858.CD012079 PMid:26858090

Glazener C, Breeman S, Elders A, Hemming C, Cooper K, Freeman R, et al. Clinical effectiveness and cost-effectiveness of surgical options for the management of anterior and/or posterior vaginal wall prolapse: Two randomised controlled trials within a comprehensive cohort study-results from the PROSPECT Study. Health Technol Assess. 2016;20(95):1-452. https://doi.org/10.3310/hta20950 PMid:28052810

Bø K, Hilde G, Stær-Jensen J, Siafarikas F, Tennfjord MK, Engh ME. Postpartum pelvic floor muscle training and pelvic organ prolapse-a randomized trial of primiparous women. Am J Obstet Gynecol. 2015;212(1):38.e1-7. https://doi.org/10.1016/j.ajog.2014.06.049 PMid:24983687

Matsuzaki S, Bonnin M, Fournet-Fayard A, Bazin JE, Botchorishvili R. Effects of low intraperitoneal pressure on quality of postoperative recovery after laparoscopic Surgery for genital prolapse in elderly patients aged 75 years or older. J Minim Invasive Gynecol. 2021;28(5):1072-8.e3. https://doi.org/10.1016/j.jmig.2020.09.017 PMid:32979535

Shkarupa DD, Kubin ND, Popov EN, Shapovalova ЕА, Kovalev GV, Pisarev АV. Vaginal apical and anterior reconstruction using ultralight weight mesh: Two-year follow-up. J Obstet Womens Dis. 2018;67(3):55-63.

Kubin ND, Shkarupa DD, Shapovalova EA, Zaytseva AO. Hybrid technique of pelvic floor reconstruction based on apical sling. Urol Vedomosti. 2017;7(C):62-3.

Downloads

Published

2022-03-10

How to Cite

1.
Aitbayeva B, Iskakov S, Smailova L. Mini-review: Modern Concept of Pelvic Organ Prolapse. Open Access Maced J Med Sci [Internet]. 2022 Mar. 10 [cited 2026 Oct. 19];10(F):201-7. Available from: https://oamjms.eu/index.php/mjms/article/view/8804

Issue

Section

Narrative Review Article

Categories