الفهرس 
PELVIC FLOOR ANATOMYOnly 14 pages are availabe for public view
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Abstract
Surgical candidates for pelvic organ prolapse (POP) repair are women with symptomatic prolapse who decline or fail conservative therapy (eg, vaginal pessaries). ●There is no indication for repair of asymptomatic POP as an isolated procedure. We also suggest NOT performing prolapse repair for most asymptomatic women who are undergoing other pelvic floor procedures (eg, stress urinary incontinence [SUI] surgery) (Grade 2C). Prolapse repair at the time of other pelvic surgery is a reasonable option in women with risk factors for developing prolapse progression (eg, concomitant hysterectomy, premenopausal status, obesity). ●Women who are elderly, unable to tolerate extensive surgery, and do not plan future vaginal intercourse are candidates for obliterative POP surgery. ●For women undergoing apical prolapse repair, we suggest performing concomitant hysterectomy rather than uterine preservation (Grade 2B). A uterine sparing procedure performed by a surgeon familiar with the necessary techniques is a reasonable alternative for women who strongly prefer to preserve their uterus and are aware of the potential risk of recurrent prolapse and the uncertainty regarding obstetric outcomes. ●For women who are undergoing an abdominal apical suspension procedure who require repair of anterior and/or posterior vaginal wall prolapsed. ● For women with anterior vaginal wall prolapse, we suggest apical suspension alone rather than combined with abdominal paravaginal repair (Grade 2C). ● For most women with posterior vaginal wall prolapse, we suggest extending the vaginal mesh from the apical suspension down the posterior vaginal wall to the lower half of the vagina (Grade 2C). When symptoms are bothersome and/or the prolapse of the posterior wall extends to or beyond the hymen, we suggest performing a posterior colporrhaphy (Grade 2C). ●For women who are undergoing a transvaginal apical suspension procedure who require repair of anterior and/or posterior vaginal wall prolapse, we suggest concomitant anterior and/or posterior colporrhaphy (Grade 2C). ●POP often coexists with SUI. Some women with advanced POP remain continent despite loss of anterior vaginal and bladder/urethral support. These women may develop symptoms of SUI after surgical correction of the prolapse. ●All women planning repair of apical prolapse should have a preoperative evaluation for SUI with clinical or urodynamic urinary stress testing with and without reduction of prolapse. However, preoperative prolapse reduction testing does not accurately predict postoperative stress incontinence (approximately 40 percent of women with negative testing will develop postoperative SUI). This testing may impact surgical decision making, particularly for women undergoing transvaginal apical prolapse repair.●Women with symptomatic apical POP and no SUI symptoms may have occult SUI and may benefit from a prophylactic continence procedure at the time of POP repair. (See ’Urinary incontinence’ above and ”Pelvic organ prolapse and stress urinary incontinence in women: Combined surgical treatment”, section on ’POP with no symptoms of SUI’.) ●Use of surgical mesh for transvaginal POP repair has potentially higher anatomic success rates than repair without mesh, but also appears to result in similar subjective success rates and a higher complication rate than traditional vaginal surgery.