A novel two-stage approach for the management of massive pelvic organ prolapse

A new two-stage surgical procedure to treat massive pelvic organ prolapse in elderly women is described. Four women in whom previous pessary treatment had failed (two of these had also tried and failed the double ring pessary) or was not possible due to poor pelvic muscle tone or enlarged vaginal introitus underwent manual reduction of prolapse, colpoperineorrhaphy and ring pessary insertion in the first stage followed by a vaginal hysterectomy with or without sacrospinous fixation 6 weeks later. All patients had a favourable outcome in terms of improvement of symptoms and satisfaction with the treatment.