Prolapse surgery: which technique and when?

PURPOSE OF REVIEW

More answers are nowadays available about certain aspects of pelvic organ prolapse (POP) treatment. In this overview some of those aspects are addressed that were considered important and published in 2010.

RECENT FINDINGS

When stress urinary incontinence (SUI) is present concomitant with POP the strategy is still to perform an additional procedure for SUI. If there is no SUI the tendency is only to correct the POP. With masked SUI no firm conclusions can be drawn.The studies that look at mesh for POP provide some careful conclusions. Absorbable biomeshes do not have many benefits over repairs without mesh in the long term. Nonresorbable mesh tends to give better results but also higher complication rates and should be applied with care.A last item is how to perform a sacrocolpopexy. Laparoscopic sacrocolpopexy is a well tolerated but time-consuming and difficult procedure to treat prolapse. Comparison with other conventional techniques is lacking. Robotic surgery has the potential of enhancing the widespread introduction of laparoscopic procedures.

SUMMARY

With these findings a better evidence-based choice for surgical technique can be made with regards to POP with or without SUI, the kind of mesh to use and which sacrocolpopexy technique should be chosen.