Pelvic organ prolapse: Which operation for which patient?

OBG Management PubMed

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May 2006 · Vol. 18, No. 5

SURGICAL TECHNIQUES

CONTROVERSIES IN PELVIC SURGERY

Pelvic organ prolapse: Which operation for which patient?

The stream of new technologies seems never-ending. That’s part of the problem.

Fast Track

“My foremost aim is to determine what the woman is most bothered by” —Mickey Karram, MD

“I probably perform 98% of reconstructive cases transvaginally” —Bob L. Shull, MD

“If you get the apex up solidly, you’re usually home free” —Linda Brubaker, MD

“Any operation that alters the vaginal axis will seriously weaken the vagina opposite the distorted axis” —Mickey Karram, MD

“Until trials are done, we won’t really know how the kits with synthetic mesh compare with conventional repairs” —Mickey Karram, MD

IN THIS ARTICLE

What is the best operation for advanced prolapse?
Are unaugmented repairs doomed to fail?
Are kits the new standard?
The Golden Rule of surgery

The more numerous the choices of surgical techniques for pelvic organ prolapse, the less agreement there is on which operation is best. Further complicating the picture is the industry’s push to consider augmentation with synthetic or biologic materials on an almost routine basis.

Few scientific comparisons of the various approaches have been performed, however. To help shed some light on surgical decision-making, we convened an expert panel to review published data and explore our experience with selected procedures.

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