Surgery for pelvic organ prolapse: current status and future perspectives

The aim of this article is to highlight the latest developments and future perspectives of the surgical treatment of pelvic organ prolapse.

The review of the relevant literature was performed through a complex search strategy including both free text and medical subject heading (MeSH) protocols. The search was limited to records written in English, concerning humans, and published in 2004. In addition, the Cochrane Database of Systematic Reviews was browsed for records regarding surgical treatment of pelvic organ prolapse. The selected papers were ranked according to the grade of evidence provided. Eight hundred and fifteen records were selected from a Medline search. We reviewed the abstracts of the records and selected 61 papers concerning the topic of the review. There was only one meta-analysis and four randomized clinical trials. All the other chosen studies were retrospective. The quality of the evidence found was poor. The evidence supported the use of mesh in anterior vaginal wall prolapse surgery and the indications both for abdominal sacrocolpopexy in case of vaginal vault prolapse and posterior colporrhaphy in case of rectocele. However, the data regarding lower urinary tract, bowel, sexual functions, generic quality of life issues, and long-term outcome were insufficient.

Well designed, adequately powered, multicenter prospective randomized studies should be planned, including appropriate standardizations of methodology of pelvic organ prolapse staging (such as POP-Q system) and indications for treatment. Moreover, validated questionnaires should be used to assess the impact of surgery on functional and quality of life issues at adequate follow-up.