UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

PELVIC ORGAN PROLAPSE AND TREATMENT APPROACHES

Esra Yaprak Uçar

İzmir Tepecik Training and Research Hospital, Department of Perinatology, İzmir, Türkiye

Yaprak Uçar E. Pelvic Organ Prolapse and Treatment Approaches. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.207-217.

ABSTRACT

Pelvic organ prolapse (POP) is a condition that presents when the pelvic organs herniate through the vaginal walls. The most frequently affected organs include bladder, rectum, uterus and small intestine. It is named as anterior, posterior and apical prolapse according to the herniated compartment. The main underlying problem is weakness in the pelvic floor muscles and connective tissue that normally support the pelvic organs. Factors such as childbirth trauma, hormonal changes during menopause, aging, obesity and chronic increases in intra-abdominal pressure all contribute to this weakening process. Women experiencing POP may report a sensation of vaginal bulging, pelvic pain or pressure, urinary incontinence, difficulty emptying the bladder, bowel dysfunction and discomfort during sexual intercourse. Although POP is rarely life-threatening, it can significantly reduce quality of life by limiting physical activity and affecting physological well-being. Staging of pelvic organ prolapse is essential for determining severity and guiding treatment. The most widely used system is the Pelvic Organ Prolapse Quantification (POP-Q) system, which objectively measures the descent of pelvic structures during examination. Accurate staging helps clinicians standardize diagnosis, monitor progression and select appropriate management strategies. Treatment methods for POP vary and should be personalised for needs of each patient. But the general principle is that treatment should only be given to those who are symptomatic. In appropriate patients, a conservative approach is recommended as the first line of treatment. The main conservative treatments for patients with pelvic organ prolapse are lifestyle modifications, pelvic floor muscle exercises (PFME) and vaginal support devices (pessaries). For women with more severe or persistent symptoms, surgical intervention may be required. Surgical approaches include vaginal, abdominal or minimally invasive laparoscopic techniques, aimed at restoring normal anatomy and function.

This article includes pelvic organ prolapse and its stages, who and how conservative approaches are applied, indications, contraindications and complications. It also discusses the meshes used in the treatment of pelvic organ prolapse and their safety profile.

Keywords: Mesh; Pelvic floor muscle exercises; Pelvic organ prolapse; Pessary

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