Recommandations pour la pratique clinique : Synthèse des recommandations pour le traitement chirurgical du prolapsus génital non récidivé de la femme par l'AFU, le CNGOF, la SIFUD-PP, la SNFCP, et la SCGP.

Develop guidelines for surgery for primary pelvic organ prolapse (POP).

Literature review, establishment of levels of evidence, external review, and grading of recommendations by 5 French academic societies: Association française d'urologie, Collège national des gynécologues et obstétriciens français, Société interdisciplinaire d'urodynamique et de pelvi-périnéologie, Société nationale française de colo-proctologie, and Société de chirurgie gynécologique et pelvienne.

It is useful to assess woman's symptoms and expectations and to describe the prolapse and its effects before any surgery (Grade C). Without spontaneous or occult urinary signs, no evidence supports performance of a urodynamic assessment (Grade C). When sacropexy is indicated, laparoscopy is recommended (Grade B). Bowel preparation before vaginal (Grade B) or abdominal (grade C) surgery is not recommended. No evidence supports the routine use of rectovaginal mesh to prevent rectocele (Grade C). Vaginal placement of vesicovaginal mesh should be discussed in view of its uncertain long-term benefit-risk ratio (Grade B). Levator myorraphy does not appear to be recommended for first-line treatment of rectocele (Grade C). Similarly, vaginal mesh for first-line treatment of rectocele is not indicated (Grade C). There is no reason for routine hysterectomy during surgery for POP (Grade C). It is not necessary to treat stress incontinence at the same time, as long as the woman is warned that subsequent surgery may be necessary (Grade C).

Journal of gynecology obstetrics and human reproduction. 2017 May 12 [Epub ahead of print]

Loïc Le Normand, Michel Cosson, Florence Cour, Xavier Deffieux, Laurence Donon, Philippe Ferry, Brigitte Fatton, Jean-François Hermieu, Henri Marret, Guillaume Meurette, Ariane Cortesse, Laurent Wagner, Xavier Fritel

CHU de Nantes, Nantes., CHRU de Lille, Lille., Hôpital Foch, Suresnes., Hôpital Antoine Béclère, Clamart., Polyclinique Côte Basque Sud, Saint-Jean-de-Luz., CH de La Rochelle, La Rochelle., CHU Carémeau, Nîmes., Hôpital Bichat, Paris., CHU de Tours, Tours., Hôpital Saint-Louis, Paris., CHU de Poitiers, Poitiers. Electronic address: .

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