Urogynecologists are continually refining their approach to pelvic organ prolapse (POP), balancing surgical advancements with evolving conservative management strategies. With ongoing research addressing the complexities of POP treatment—ranging from optimizing surgical outcomes to enhancing conservative care—new insights continue to shape clinical practice. This month, we highlight recent studies in the IUJ that provide fresh perspectives on diagnosis, management, and patient outcomes, offering valuable updates for those at the forefront of prolapse care.
Recent Studies
The Interplay Between Chronic Pelvic Pain and Pelvic Organ Prolapse
This narrative review explores the relationship between chronic pelvic pain (CPP) and pelvic organ prolapse (POP), highlighting risk factors, clinical findings, and management strategies. While POP surgeries, particularly those involving uterosacral ligament repair, can alleviate CPP, untreated CPP is linked to poorer postoperative outcomes, emphasizing the need for comprehensive pain management before, during, and after surgery.
This study analyzes global trends in pelvic organ prolapse (POP) from 1990 to 2021 using GBD data, revealing a decline in age-standardized prevalence and disability rates, though the burden remains highest in low-SDI regions. With an aging population, the number of POP cases is projected to reach 156 million by 2036, underscoring the need for enhanced global surveillance, prevention, and treatment strategies.
Fistulae Secondary to Vaginal Pessary Use for Pelvic Organ Prolapse: A Systematic Review
This systematic review examines the rare occurrence of urogenital and rectovaginal fistulae in patients using pessaries for pelvic organ prolapse (POP), identifying a prevalence of up to 3% with risk factors such as Gellhorn pessaries and neglected care. While conservative management was effective in reducing or resolving 69% of cases, surgical interventions, including vaginal and abdominal fistula repairs, also showed high success rates, emphasizing the importance of proper pessary care and individualized treatment approaches.
This study evaluates the clinical utility of two MRI-based reference lines, PCLjnt and PCLcc, in diagnosing pelvic organ prolapse (POP) and pelvic floor laxity. Both lines showed strong correlations with the POP-Q system, with PCLcc exhibiting slightly higher accuracy, supporting their use in MR defecography for assessing anterior wall and uterine prolapse.
This study compares robotic-assisted sacral hysterocolpopexy (RASC) and the Uphold™ Vaginal Support System for apical prolapse repair, finding similar anatomical success rates but a higher reoperation rate for prolapse recurrence after RASC (15.3% vs. 2.8%). While both approaches significantly improved pelvic floor symptoms, Uphold™ showed greater improvement in patient-reported outcomes, suggesting it may offer superior durability for anterior vaginal wall support.
This systematic review and meta-analysis found that concomitant pelvic organ prolapse (POP) and rectal prolapse repair do not significantly increase short-term postoperative complications compared to isolated apical prolapse repair or rectopexy. The findings support the safety and feasibility of combined surgeries, offering a comprehensive treatment option for patients with multicompartmental prolapse without added operative risks.
Systematic Review of Evidence for Conservative Management of Pelvic Organ Prolapse in Younger Women
This systematic review highlights the limited research on conservative pelvic organ prolapse (POP) treatments in younger women, emphasizing the need for alternatives to surgery due to high complication and reoperation rates. Findings suggest that pelvic floor muscle training (PFMT) improves patient-reported outcomes, with biofeedback and electrical stimulation providing additional benefits, while the effectiveness of pessary use remains underexplored.
The International Urogynecology Journal (IUJ) remains at the forefront of advancing knowledge on pelvic organ prolapse, publishing cutting-edge research that informs clinical practice. These recent studies highlight the ongoing evolution of prolapse management, emphasizing the need for individualized treatment approaches and continued investigation into gaps in care, particularly for younger patients and underserved populations. We encourage researchers to contribute to this growing body of evidence by submitting their work on POP to the IUJ, helping to shape the future of urogynecologic care.