Surgical treatment and pessary treatment are both efficacious in reducing the presence and severity of prolapse symtoms.34 Women with symptomatic POP who decline pessary treatment or when such treatment fails, require surgical intervention.The risk for a woman to undergo surgery in her life due to a prolapse is 11-19%.24
Surgical treatment for POP can be categorised into reconstructive and obliterative procedures.
Reconstructive surgery aims to correct the prolapse while maintaining vaginal sexual function and relieving any associated pelvic symptoms.3Surgery is not 100% successful. New or recurrent prolapses will occur in a significant percentage (up to 30-35%) and these can be difficult to repair.24
Options for reconstructive surgical repair of POP can be classified by compartment and can be subdivided into abdominal and vaginal procedures.
For a prolapse of the anterior compartment the most used procedure is a colporrhaphia anterior (or possibly variants), for the posterior compartment a colporrhaphia posterior (or possibly variants). These operations, depending on the anatomical outcome measure used, give a considerable chance of recurrences, which are regularly asymptomatic.
As far as symptomatic prolapse of the middle compartment is concerned, the vaginal hysterectomy, whether or not with shortening and suturing of the sacrouterine ligaments in the vaginal top, has been the preferred treatment for some time. However, there has been increasing interest in uterine-saving surgery in recent years. This is because it is becoming clear that not the uterus itself is the cause of the prolapse but the lack of suspension: especially the suspension system of the uterus was found to be inadequate. Various old and new alternative methods receive more attention, such as the sacrospinal hysteropexy and the (modified) Manchester operation.36
Obliterative surgical procedures may be suitable for women who do not wish to preserve coital function. Colpocleisis corrects POP by moving pelvic viscera back into the pelvis and closing off the vaginal canal partly or totally. This type of surgery is associated with high cure rates (up to 95%), fast recovery times and less complications.2,3
The rationale for using implants in prolapse surgery is that an implant replaces deficient body's own material, gives reinforcement provided by increasing the support surface and induces new support tissue. Although in the short-term operations with vaginal mesh result in better anatomical and functional outcome, the risk of (long term) complications is the reason that operations with mesh are reserved for women with recurrent prolapse.