Multicompartment pelvic floor prolapse: advances in diagnosis and surgical management

Multicompartment pelvic organ prolapse, including concurrent rectal and vaginal prolapse, is increasingly recognized in aging populations. This review summarizes recent advances in diagnostic imaging, multidisciplinary evaluation, and surgical techniques for combined repair.

Multicompartment prolapse is increasingly prevalent and often underrecognized without coordinated evaluation. Dynamic defecography, particularly upright or MRI-based, improves detection of multicompartment descent. Minimally invasive combined sacrocolpopexy (SCP) and ventral mesh rectopexy (VMR) is increasingly used with favorable outcomes. Surgical series report low complication rates and suggest a potential reduction in prolapse recurrence with combined repair. Robotic platforms, including newer systems, enhance precision, and visualization. Emerging techniques include laparoscopic resection rectopexy with SCP and selective use of biologic mesh. Multidisciplinary care improves coordination and recurrence prevention.

Contemporary management of multicompartment prolapse requires a collaborative, patient-centered approach. Advances in imaging and minimally invasive surgery, particularly robotic SCP and VMR, have improved outcomes. Future research should focus on standardizing techniques, optimizing mesh configurations, and long-term functional results.