Pelvic organ prolapse

Pelvic organ prolapse (POP) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the pelvic floor collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in cystocele, rectocele or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.
Types
Anterior vaginal wall prolapse
Cystocele (bladder into vagina)
Urethrocele (urethra into vagina)
Cystourethrocele (both bladder and urethra)
Posterior vaginal wall prolapse
Enterocele (small intestine into vagina)
Rectocele (rectum into vagina)
Sigmoidocele
Apical vaginal prolapse
Uterine prolapse (uterus into vagina)
Vaginal vault prolapse (descent of the roof of vagina) – after surgical removal of the uterus hysterectomy
Grading
Pelvic organ prolapses are graded either via the Baden–Walker System, Shaw's System, or the Pelvic Organ Prolapse Quantification (POP-Q) System.
Shaw's System
Anterior wall
Upper 2/3 cystocele
Lower 1/3 urethrocele
Posterior wall
Upper 1/3 enterocele
Middle 1/3 rectocele
Lower 1/3 deficient perineum
Uterine prolapse
Grade 0 Normal position
Grade 1 descent into vagina not reaching introitus
Grade 2 descent up to the introitus
Grade 3 descent outside the introitus
Grade 4 Procidentia
Baden–Walker
POP-Q
Management
Vaginal prolapses are treated according to the severity of symptoms.
Non-surgical
With conservative measures, such as changes in diet and fitness, Kegel exercises, and pelvic floor physical therapy.
A pessary, a rubber or silicone rubber device fitted to the patient is also a non-surgical option, it is inserted into the vagina and may be retained for up to several months. Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms. Pessaries are a good choice of treatment for women who wish to maintain fertility, are poor surgical candidates, or who may not be able to attend physical therapy. Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself. Pessaries should be offered as a non-surgical alternative for women considering surgery.
Surgery
Surgery (for example native tissue repair, biological graft repair, absorbable and non-absorbable mesh repair, colpopexy, or colpocleisis) is used to treat symptoms such as bowel or urinary problems, pain, or a prolapse sensation. When operating a pelvic organ prolapse, introducing a mid-urethral sling during or after surgery seems to reduce stress urinary incontinence. Transvaginal repair seems to be more effective than transanal repair in posterior wall prolapse, but adverse effects cannot be excluded. According to the FDA, serious complications are "not rare."
Evidence does not support the use of transvaginal surgical mesh compared with native tissue repair for anterior compartment prolapse owing to increased morbidity. For posterior vaginal repair, the use of mesh or graft material does not seem to provide any benefits.
Compared to native tissue repair, transvaginal permanent mesh likely reduces both the perception of vaginal prolapse sensation, and the risk of recurrent prolapse and of having repeat surgery for prolapse. However, transvaginal mesh (TVM) has a greater risk of bladder injury and of needing repeat surgery for stress urinary incontinence or mesh exposure. Also, the use of a TVM in treating vaginal prolapses is associated with side effects including pain, infection, and organ perforation.
Safety and efficacy of many newer meshes is unknown. Thousands of class action lawsuits have been filed and settled against several manufacturers of TVM devices.
For surgical treatment of apical vaginal prolapse, going through the abdomen (sacral colpopexy) may have better outcomes than a surgical approach that goes through the vagina.
Epidemiology
Genital prolapse occurs in about 316 million women worldwide as of 2010 (9.3% of all females).
Research
To study POP, various animal models are employed: non-human primates, sheep, pigs, rats, and others.
See also
Perineometer
Pessary
References
External links
Noninflammatory disorders of female genital tract
Vagina