Photo Credit: Lars Neumann

The following is a summary of “Recurrent pelvic prolapse after pelvic organ prolapse suspension (POPS): Analysis and treatment of an emerging clinical issue,” published in the August 2024 issue of Obstetrics and Gynecology by Campagna et al.

This study investigates the outcomes of a novel laparoscopic technique called Pelvic Organ Prolapse Suspension (POPS) for treating multicompartmental pelvic organ prolapse (POP) and rectal prolapse, focusing on recurrent prolapse following POPS. The study also aims to assess treatment strategies for recurrent POP, evaluating anatomical, subjective, and functional results following revision surgery. Researchers prospectively analyzed patients with symptomatic prolapse relapse after POPS at a single tertiary care institution, offering each patient comprehensive multidisciplinary clinical and radiological evaluations before revision surgery. 

The cohort included 25 women with a median age of 59 years (interquartile range [IQR] 49–73), 88% of whom were menopausal. All participants presented with high-grade (Pelvic Organ Prolapse Quantification System stage >2) recurrent posterior vaginal wall-predominant prolapse following POPS, with 64% also exhibiting multicompartmental prolapse. The majority of patients reported vaginal bulging accompanied by obstructed defecation syndrome (ODS) symptoms. Surgical intervention for these cases consisted of laparoscopic ventral rectopexy (VR) in all patients, with 64% also undergoing concomitant sacral colpopexy (SCP) and previous mesh removal. 

No anatomical recurrences were noted after a median follow-up period of 12 months (IQR 3–18), and all patients demonstrated significant subjective improvement, as measured by a Patient Global Improvement Index score of ≤2. The findings suggest that recurrent POP following POPS primarily involves the posterior vaginal wall and is often associated with ODS symptoms. A multidisciplinary approach is recommended for managing these patients, with minimally invasive VR, either alone or combined with SCP, proving to be an effective treatment strategy.

Source: sciencedirect.com/science/article/abs/pii/S0301211524004652