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