Care Pathway for the Management of Pelvic Organ Prolapse (POP)
SPECIALIST MANAGEMENT
This may include care by gynaecologists, urogynaecologists, urologists and
colorectal surgeons with a special interest in pelvic floor



No treatment
Non-surgical treatments
Patient assessed as requiring operative management

POP Surgical Pathway
POP Surgery
Consider:
- Bladder function
- Bowel function
- Risk of recurrent prolapse
- Bowel symptoms that warrant colonoscopy
Reconstructive surgery involves
repair of apical (upper prolapse),
anterior (bladder) and/or posterior (bowel)
repair of apical (upper prolapse),
anterior (bladder) and/or posterior (bowel)
Obliterative surgery: usually
performed with the elderly, medically compromised and not sexually active
performed with the elderly, medically compromised and not sexually active
Apical support
Cystocele (bladder)
Rectocele (bowel)
Vault
prolapse
prolapse
Uterine
prolapse
prolapse
Graft repair (synthetic mesh)
Suture repair ± fascial sling support (native tissue)
Suture repair
(native tissue)
(native tissue)
Suture repair
(native tissue)
(native tissue)
Hysterectomy ± bilateral salpingo-oophorectomy
Hysteropexy
Vaginal
hysterectomy
hysterectomy
Sub-total hysterectomy abdominal sacral colpopexy (ASC)
Hysterectomy + ASC
Vaginal
sacrospinous
hysteropexy
sacrospinous
hysteropexy
Sacral hysteropexy
Laparoscopic
sacral colpopexy ± repair
sacral colpopexy ± repair
Sacrospinous
colpopexy (vaginal)
colpopexy (vaginal)
Uterosacral
colpopexy
colpopexy
Patients should be offered the opportunity for a minimum period of six months follow-up after surgery.

Preferred options for treatment – use of mesh for these procedures is supported by evidence.

Possible pathway – these procedures are supported by evidence, but more data is needed

Not recommended
Reconstructive surgery involves
repair of apical (upper prolapse),
anterior (bladder) and/or posterior (bowel)
repair of apical (upper prolapse),
anterior (bladder) and/or posterior (bowel)
Apical support
Vault prolapse
Laparoscopic sacral colpopexy ± repair
Sacrospinous colpopexy (vaginal)
Uterine prolapse
Hysterectomy ± bilateral
salpingo-oophorectomy
salpingo-oophorectomy
Vaginal hysterectomy
Sacrospinous colpopexy (vaginal)
Uterosacral colpopexy
Sub-total hysterectomy abdominal sacral colpopexy (ASC)
Hysterectomy + ASC
Hysteropexy
Vaginal sacrospinous hysteropexy
Sacral hysteropexy
Cystocele (bladder)
Graft repair (synthetic mesh)
Suture repair ± fascial sling support (native tissue)
Suture repair
(native tissue)
(native tissue)
Rectocele (bowel)
Suture repair
(native tissue)
(native tissue)
Obliterative surgery: usually
performed with the elderly, medically compromised and not sexually active
performed with the elderly, medically compromised and not sexually active
Patients should be offered the opportunity for a minimum period of six months
follow-up after surgery.

Preferred options for treatment – use of mesh for these procedures is
supported by evidence.
supported by evidence.

Possible pathway – these procedures are supported by evidence, but more
data is needed
data is needed

Not recommended