title: Surgical management of pelvic organ prolapse in women: how to choose the best approach.
abstract: Although benign, pelvic organ prolapse is a real public health problem, affecting mostly women above sixty-five. Eighty-year-old women have an 11.1% lifetime risk of undergoing surgery for prolapse or stress urinary incontinence and 29% will need a second procedure. Surgical approach may be abdominal (sacrocolpopexy by laparotomy, laparoscopy or robot-assisted) or vaginal (autologous, or prosthetic reinforcement). In addition to anatomical correction, surgical objectives include: improvement of the patient's quality of life, prolapse symptoms relief, normal urinary, digestive and sexual functions and especially, avoiding iatrogenic sequelae. Thus, the choice of the surgical approach does not only depend upon the site and the severity of the prolapse. Urogynecological surgeons should take into consideration the patient's expectations and life style, her age--a determinant factor in deciding upon the best approach -, and her relapse risk factors. They should master both approaches, and the management of surgical complications. Therefore, an apprenticeship in a reference pelviperineology center is a must. In addition, surgeons should be aware of and consider contraindications to each procedure, for instance contraindications to transvaginal prosthesis reinforcement like risk factors of bad healing or infection. Urogynecology specialists have to take into consideration known anatomical and functional results of each technique as cited in the medical literature and act in accordance with international recommendations. The surgery's main objective is to ameliorate the patient's discomfort and her quality of life without causing iatrogenic dysfunctional symptoms (urinary, digestive, sexual). The pelvic organ prolapse being a benign pathology, the patient's satisfaction is the main marker of the procedure success. In short, regarding the surgical management of pelvic organ prolapse in women the answer to the question How to choose the best approach? is not binary. It depends on several factors, and regardless of the choice, it must
authors.affiliation: Visceral & Gynecological Surgery Dept., Groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France. nadine.kassis@gmail.com
authors.forename: Nadine
authors.initials: N
authors.lastname: El Kassis
authors.forename: David
authors.initials: D
authors.lastname: Atallah
authors.forename: Maroun
authors.initials: M
authors.lastname: Moukarzel
authors.forename: Wadih
authors.initials: W
authors.lastname: Ghaname
authors.forename: Charbel
authors.initials: C
authors.lastname: Chalouhy
authors.forename: Joseph
authors.initials: J
authors.lastname: Suidan
authors.forename: Richard
authors.initials: R
authors.lastname: Villet
authors.forename: Delphine
authors.initials: D
authors.lastname: Salet-Lizee
mesh_terms: D003657:Decision Making; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010358:Patient Participation; D056887:Pelvic Organ Prolapse / Q000601:surgery*