Mini-review: Modern Concept of Pelvic Organ Prolapse

Botagoz Aitbayeva; Serik Iskakov; Lazat Smailova

doi:10.3889/oamjms.2022.8804

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 DOI: https://doi.org/10.1097/00001703-199408000-00003

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 DOI: https://doi.org/10.1007/s00192-009-0976-9

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 DOI: https://doi.org/10.1007/s00192-013-2141-8

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 DOI: https://doi.org/10.1097/01.AOG.0000255977.91296.5d

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 DOI: https://doi.org/10.1097/AOG.0000000000000057

Wilkins MF, Wu JM. Epidemiology of pelvic organ prolapse. Curr Obstet Gynecol Rep. 2016;5:119-23. DOI: https://doi.org/10.1007/s13669-016-0149-z

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 DOI: https://doi.org/10.1001/jama.2014.1719

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 DOI: https://doi.org/10.2147/IJWH.S71236

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 DOI: https://doi.org/10.1097/AOG.0b013e3181c2ce96

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 DOI: https://doi.org/10.1007/s00192-018-3650-2

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 DOI: https://doi.org/10.1002/nau.23740

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 DOI: https://doi.org/10.1007/s10151-017-1704-y

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 DOI: https://doi.org/10.1007/s00192-012-1704-4

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 DOI: https://doi.org/10.1007/s00192-015-2695-8

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 DOI: https://doi.org/10.1186/s12905-019-0741-2

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 DOI: https://doi.org/10.1097/01.AOG.0000250901.57095.ba

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 DOI: https://doi.org/10.1186/s12884-017-1492-4

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 DOI: https://doi.org/10.1007/s00192-017-3422-4

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 DOI: https://doi.org/10.1038/s42003-020-0857-9

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 DOI: https://doi.org/10.1007/s00192-009-0895-9

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 DOI: https://doi.org/10.1007/s00192-015-2896-1

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 DOI: https://doi.org/10.1111/j.1471-0528.2005.00568.x

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 DOI: https://doi.org/10.1067/S0002-9378(03)00698-7

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. DOI: https://doi.org/10.3329/jdmc.v19i2.7082

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 DOI: https://doi.org/10.1007/s00192-015-2933-0

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 DOI: 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 DOI: https://doi.org/10.1007/s00330-016-4471-7

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 DOI: https://doi.org/10.1016/j.bpobgyn.2018.06.006

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 DOI: https://doi.org/10.1007/s00261-019-02160-7

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 DOI: https://doi.org/10.1155/2016/6594152

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 DOI: https://doi.org/10.1016/j.diii.2016.03.018

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 DOI: https://doi.org/10.1016/j.ejrad.2019.05.018

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 DOI: https://doi.org/10.1007/s00330-015-4016-5

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 DOI: https://doi.org/10.1007/s00192-018-3597-3

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 DOI: https://doi.org/10.1097/GME.0000000000001448

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 DOI: https://doi.org/10.1111/bju.14763

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 DOI: https://doi.org/10.1097/SPV.0000000000000794

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 DOI: https://doi.org/10.1016/j.ijgo.2012.11.012

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 DOI: https://doi.org/10.1016/j.ajog.2017.01.039

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 DOI: https://doi.org/10.1016/S0140-6736(16)32109-2

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 DOI: https://doi.org/10.1007/s00192-011-1390-7

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 DOI: https://doi.org/10.1002/14651858.CD003882.pub4

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 DOI: https://doi.org/10.1007/s00192-017-3372-x

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 DOI: https://doi.org/10.1007/s00192-009-0945-3

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 DOI: https://doi.org/10.1002/lsm.23031

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 DOI: https://doi.org/10.1136/bmj.h3717

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 DOI: https://doi.org/10.1002/14651858.CD012975

Jefferis H, Jackson SR, Price N. Management of uterine prolapse: Is hysterectomy necessary? Obstet Gynaecol. 2016;18:17-23. DOI: https://doi.org/10.1111/tog.12220

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 DOI: https://doi.org/10.1002/14651858.CD012376

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 DOI: https://doi.org/10.1016/j.ajog.2016.08.035

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 DOI: https://doi.org/10.1186/s12905-021-01195-7

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 DOI: https://doi.org/10.1007/s00192-016-3034-4

Catanzarite T, Rambachan A, Mueller M. Risk factors for perioperative complications after le fort colpocleisis. JMIG. 2014;21(S34):poster44. DOI: https://doi.org/10.1016/j.jmig.2013.12.050

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 DOI: https://doi.org/10.17772/gp/2063

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 DOI: https://doi.org/10.1007/s00192-015-2903-6

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 DOI: https://doi.org/10.5173/ceju.2018.1685

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 DOI: https://doi.org/10.1016/j.ejogrb.2019.05.033

Campbell P, Jha S and Cutner A. Vaginal mesh in prolapse surgery. Obstet Gynaecol. 2018;20:49-56. DOI: https://doi.org/10.1111/tog.12454

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 DOI: https://doi.org/10.1016/j.ajog.2012.11.008

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 DOI: https://doi.org/10.1002/14651858.CD004010.pub4

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 DOI: https://doi.org/10.1016/j.jmig.2020.05.002

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 DOI: https://doi.org/10.1002/14651858.CD012079

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 DOI: https://doi.org/10.3310/hta20950

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 DOI: https://doi.org/10.1016/j.ajog.2014.06.049

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 DOI: https://doi.org/10.1016/j.jmig.2020.09.017

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. DOI: https://doi.org/10.17816/JOWD67355-63

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.