UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

PELVIC ORGAN PROLAPSE REPAIR

Emre Yalçın

Çukurova University, Faculty of Medicine, Department of Gynecology and Obstetrics, Adana, Türkiye

Yalçın E. Pelvic Organ Prolapse Repair. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.233-242.

ABSTRACT

Pelvic Organ Prolapse (POP) is the herniation of the anterior or posterior vaginal wall, vaginal apex or uterus from the pelvis through the urogenital hiatus. POP is divided into three main classes: anterior, apical and posterior compartment defects. POP is a common condition and is associated with factors such as age, vaginal delivery, parity, obesity, menopause and chronic constipation. Symptomatic patients have a 12% lifetime risk of surgical repair. Methods such as pelvic examination, POP-Q grading system, stress test and voiding test are used for diagnosis. Treatment options include conservative methods (pessary use, Kegel exercises, topical estrogen) and surgical interventions. Surgical treatments are divided into two groups: reconstructive (vaginal and abdominal repair) and obliterative. Treatment of symptomatic POP is only possible through surgery. The rate of surgery for POP and the symptoms it causes is reported to be 11% in the female population. One-third of these patients are candidates for reoperation.The goals of reconstructive surgery in vaginal vault or uterine prolapse are to relieve symptoms, restore anatomy, preserve vaginal capacity for sexual function, and prevent recurrence of prolapse.Numerous surgical procedures involving both vaginal and abdominal approaches have been described for the treatment of vaginal vault and uterine prolapse. Consequently, no ideal method with high success and low complication rates has been established in uterovaginal prolapse surgery. Women who choose surgery as their treatment option or who have symptomatic prolapse and are unable to control their symptoms with conservative measures may be candidates for surgery. Making the right surgical treatment choice is the initial stage in preparing. The patient’s symptoms and anatomical features should guide the surgical approach selection. Prior to surgery, an informed consent form ought to be acquired. This document should include a detailed description of the risks of bowel and bladder injury, recurrence, and changes in voiding and feces functions.Follow-up is important for patients after POP repair and should include monitoring for hydronephrosis, de novo stress urinary incontinence and material complications. Surgeons use various surgical management strategies to repair pelvic organ prolapse (POP). Surgical management of POP includes natural tissue repair, mesh augmentation and minimally invasive surgeries. Currently, laparoscopic or robotic techniques for POP repair are growing in popularity and continue to evolve.

Keywords: Cystocele; Rectocele; Desensus; Colporhaphy anterior; Colporhaphy posterior; Sacrospinous ligament fixation

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