Evidence of Pelvic Organ Prolapse and its Treatment

Abstract

Pelvic organ prolapse (POP) is a very common condition in elderly women in which pelvic organs descend or prolapse, impairing quality of life (QOL). In this article, I describe the concept of POP, and review papers published after the emergence of vault suspension procedures, with a focus on surgical treatments. There are differences in the context of POP operations between foreign countries and Japan, such as a ban of tension-free vaginal mesh (TVM) in western countries ; therefore, I picked papers written on subjects that seemed important in Japan. As for native tissue repair (NTR), procedures such as hysterectomy combined with vaginal vault suspension have been performed ; however, the relatively high recurrence rate has been a problem. As for TVM, mesh-related complications, such as mesh extrusion or chronic persistent pain, have been reported, resulting in many western countries banning TVM using a polypropylene mesh. In Japan, a PTFE mesh is now available for TVM, but there is still little evidence surrounding its use. There are two types of laparoscopic sacrocolpopexy (LSC), a US style and a French style, with the latter more popular in Japan. On the whole, a lack of evidence remains a key issue for the Japanese in POP surgery.