BERKELEY, CA (UroToday.com) - Approximately 50% of parous women lose pelvic floor support[1,2] and it has been estimated that 11% of women will have a surgical procedure for management of pelvic organ prolapse (POP) or urinary incontinence by age 80.
For apical prolapse, the abdominal sacrocolpopexy has been shown to have high long-term success and patient satisfaction with open, laparoscopic, and robotic options available. These minimally invasive approaches offer improved cosmesis, decreased blood loss, and decreased length of hospital stay, but are associated with an increased cost. With similar success rates and similar complication rates among the various approaches, the decision to proceed with one option over another depends on the surgeon’s preference, patient’s preference, laparoscopic experience of the surgeon, and access to equipment. A patient’s preferences should also play a role in the decision-making process, along with evaluation of concomitant voiding dysfunction and other medical comorbidities. A patient’s preference particularly plays a large role in deciding whether uterine preservation would be an option for management of POP. Hysteropexy may play a role in younger women with symptoms of POP who have a desire to maintain their fertility status or avoid the potential complications of a hysterectomy. A minimally invasive treatment option, whether it is standard laparoscopy or a robotic approach, may come at an increased cost but with the added benefits of improved cosmesis, decreased length of stay, and decreased blood loss.
Patients should be provided with good preoperative counseling so that they have appropriate expectations, which can help reduce postoperative dissatisfaction. Variations of the current treatment options may continue to be developed, as there are reports of single-port laparoscopic sacrocolpopexy.
- Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapsed and urinary incontinence. Obstet Gynecol 1997;89:501.
- Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapsed in women. Cochrane Database Syst Rev 2010;4:CD004014.
Daniel S. Elliott, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Department of Urology
Section of Female Urology and Voiding Dysfunction
Rochester, MN USA