SURGICAL MANAGEMENT OF PELVIC ORGAN PROLAPSE

Abstract

Pelvic organ prolapse (POP) is a common condition that affects the quality of life of affected women. A prevalence of 12% has been reported in Ghana with the condition affecting mainly the emotional wellbeing, sexual life and women’s relationship with their partners. This review discusses the adequacy of the available surgical options for managing POP and provide our expert opinion and recommendations based on our experience. Surgical management of POP is undertaken through 2 main approaches i.e., obliterative and reconstructive. Obliterative procedures should only be considered for women who are not sexually active and have no desire for future sex as it closes the vagina. Because of the significant contribution of the apex to vaginal support, inadequate apical support during prolapse repair may lead to a vault prolapse or failure of anterior and posterior vaginal wall repairs. Vaginal mesh is not recommended for the repair of POP. We advise the performance of concurrent anti-incontinent procedure for women with symptomatic and occult stress incontinence at the time of prolapse repair. We do not however advocate the performance of prophylactic anti-incontinent procedure (i.e., anti-incontinent procedure for continent women with POP) at the time of prolapse repair. Surgical repair of POP is expected to achieve good anatomical and functional outcome. It is therefore important that surgeons equip themselves with the skills and knowledge necessary to address all the problems confronting the patient.