Conference Coverage

Pelvic organ prolapse surgery isn’t as ‘simple’ as you think


 

EXPERT ANALYSIS FROM PAGS 2019

– Surgical repair of pelvic organ prolapse often may seem like an uncomplicated procedure. But many factors play roles into decisions, and surgeons around the world vary widely in how they handle the operations, Mark D. Walters, MD, told colleagues at the Pelvic Anatomy and Gynecologic Surgery Symposium.

Dr. Mark D. Walters, professor and vice-chair of gynecology at the Cleveland Clinic

Dr. Mark D. Walters

“These prolapse repairs seem relatively simple at first, but they’re not simple at all,” he said. “Experts can have completely different and sometimes almost opposite opinions” on how to perform pelvic organ prolapse repairs.

Questions to ask prior to surgery

It’s important to first answer a number of questions, said Dr. Walters, professor and vice-chair of gynecology at the Cleveland Clinic. “When you see a patient like this, you may not realize how many decisions you’re making.”

These questions include:

  • Is the patient sexually active or planning to be?
  • Has she had a hysterectomy, and or is one necessary? If so, how should it be done? What does the patient think about a hysterectomy?
  • Should the prolapse procedure be performed vaginally, open, laparoscopically, or robotically?
  • Is adding a graft advisable? What kind?
  • Should there be a sling to prevent stress urinary incontinence?”

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