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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

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No treatment
Non-surgical treatments
Patient assessed as requiring operative management
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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)
Obliterative surgery: usually
performed with the elderly, medically compromised and not sexually active
 
 
 
Apical support
Cystocele (bladder)
Rectocele (bowel)
 
 
 
 
 
 
Vault
prolapse
Uterine
prolapse
Graft repair (synthetic mesh)
Suture repair ± fascial sling support (native tissue)
Suture repair
(native tissue)
Suture repair
(native tissue)
 
 
 
 
 
Hysterectomy ± bilateral salpingo-oophorectomy
Hysteropexy
 
 
 
 
 
 
 
Vaginal
hysterectomy
Sub-total hysterectomy abdominal sacral colpopexy (ASC)
Hysterectomy + ASC
Vaginal
sacrospinous
hysteropexy
Sacral hysteropexy
 
 
 
Laparoscopic
sacral colpopexy ± repair
Sacrospinous
colpopexy (vaginal)
Uterosacral
colpopexy

Patients should be offered the opportunity for a minimum period of six months follow-up after surgery.

Green arrow
Preferred options for treatment – use of mesh for these procedures is supported by evidence.
Orange arrow
Possible pathway – these procedures are supported by evidence, but more data is needed
Red arrow
Not recommended

 
Reconstructive surgery involves
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
 
 
 
 
 
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)
 
 
Rectocele (bowel)
 
 
 
Suture repair
(native tissue)
 
Obliterative surgery: usually
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.

Green arrow
Preferred options for treatment – use of mesh for these procedures is
supported by evidence.
Orange arrow
Possible pathway – these procedures are supported by evidence, but more
data is needed
Red arrow
Not recommended
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