Surgical Management of Pelvic Organ Prolapsein Women : How to Choose Tee Best Approach

Abstract

Although benign, pelvic organ prolapse is a real public health problem, affecting mostly women above sixty-five. Eighty-year-old women have an 11.1% lifetime risk of undergoing surgery for prolapse or stress urinary incontinence and 29% will need a second procedure. Surgical approach may be abdominal (sacrocolpopexy by laparotomy, laparoscopy or robot-assisted) or vaginal (autologous, or prosthetic reinforcement). In addition to anatomical correction, surgical objectives include: improvement of the patient's quality of life, prolapse symptoms relief, normal urinary, digestive and sexual functions and especially, avoiding iatrogenic sequelae. Thus, the choice of the surgical approach does not only depend upon the site and the severity of the prolapse. Urogynecological surgeons should take into consideration the patient's expectations and life style, her age--a determinant factor in deciding upon the best approach -, and her relapse risk factors. They should master both approaches, and the management of surgical complications. Therefore, an apprenticeship in a reference pelviperineology center is a must. In addition, surgeons should be aware of and consider contraindications to each procedure, for instance contraindications to transvaginal prosthesis reinforcement like risk factors of bad healing or infection. Urogynecology specialists have to take into consideration known anatomical and functional results of each technique as cited in the medical literature and act in accordance with international recommendations. The surgery's main objective is to ameliorate the patient's discomfort and her quality of life without causing iatrogenic dysfunctional symptoms (urinary, digestive, sexual). The pelvic organ prolapse being a benign pathology, the patient's satisfaction is the main marker of the procedure success. In short, regarding the surgical management of pelvic organ prolapse in women the answer to the question How to choose the best approach? is not binary. It depends on several factors, and regardless of the choice, it must

Quality of Life Following Pelvic Organ Prolapse Treatments in Women: A Systematic Review and Meta-Analysis

“…Laparoscopic sacrocolpopexy and sacrohysteropexy have been demonstrated to be effective and safe with faster recovery time, shorter operating time, lower blood loss, lower scar tissue, lower pain, and minimally invasive nature compared to the abdominal approaches [ 94 ]. However, these procedures have been associated with some complications, such as stress urinary incontinence [ 95 ], defecation problems [ 96 ], and injuries of the presacral venous plexus [ 97 ]. On the other hand, robotic surgeries have recently been introduced with good results and improvement in QoL.…”

Treatment results of female pelvic organ prolapse by surgical placement of synthetic vaginal mesh: a prospective study at An Giang Obstetrics and Pediatrics Hospital

“…When surgeons are proficient with the new method, the surgical time will gradually shorten as this is a minimally invasive and not overly complex surgery. [8][9][10][11]…”