Pelvic organ prolapse

Abstract

Pelvic organ prolapse is a very common condition affecting about 20% of all parous women. It can be quite bothersome and adversely affects the quality of life; hence, prolapse accounts for approximately 20% of elective major gynaecological surgery and up to 59% of operations in older women. This chapter provides detailed information on the pathophysiology of pelvic organ prolapse, risk factors, clinical assessment of patients including the pelvic organ prolapse quantification system, the diagnosis and treatment of the condition. The chapter expatiates on managing pelvic organ prolapse initially by inexpensive measures as lifestyle modifications, pelvic floor exercises, use of vaginal pessaries, while preserving surgery for severely symptomatic ladies or where primary intervention has failed. It describes the details of anterior and posterior repairs, vaginal hysterectomy and vaginal vault suspension techniques. It also discusses the place of vaginal meshes in developing countries which should be used cautiously and only in centres with the ability of looking after their complications. It concludes by recommending investment and continued education in this area in order to continue to build the capacity that will be needed as improving life expectancy in the developing world will keep increasing the workload in this area.