[Assessment before surgical treatment for pelvic organ prolapse: Clinical practice guidelines].
BACKGROUND
The issue addressed in this chapter of recommendations is: What is the clinical and para-clinical assessment to achieve in women with genital prolapse and for whom surgical treatment has been decided. What are the clinical elements of the examination that must be taken into account as a risk factor of failure or relapse after surgery, in order to anticipate and evaluate possible surgical difficulties, and to move towards a preferred surgical technique?


METHODS
This work is based on a systematic review of the literature (PubMed, Medline, Cochrane Library, Cochrane Database of Systemactic Reviews, EMBASE) for meta-analyzes, randomized trials, registries, literature reviews, controlled studies and major not controlled studies, published on the subject. Its implementation has followed the methodology of the HAS on the recommendations for clinical practice, with a scientific argument (with the level of evidence, NP) and a recommendation grade (A, B, C, and professional agreement [AP]).


RESULTS
It suits first of all to describe prolapse, by clinical examination, helped, if needed, by a supplement of imagery if clinical examination data are insufficient or in case of discrepancy between the functional signs and clinical anomalies found, or in case of doubt in associated pathology. It suits to look relapse risk factors (high grade prolapse) and postoperative complications risk factors (risk factors for prothetic exposure, surgical approach difficulties, pelvic pain syndrome with hypersensitivity) to inform the patient and guide the therapeutic choice. Urinary functional disorders associated with prolapse (urinary incontinence, overactive bladder, dysuria, urinary tract infection, upper urinary tract impact) will be search and evaluated by interview and clinical examination and by a flowmeter with measurement of the post voiding residue, a urinalysis, and renal-bladder ultrasound. In the presence of voiding disorders, it is appropriate to do their clinical and urodynamic evaluation. In the absence of any spontaneous or hidden urinary sign, there is so far no reason to recommend systematically urodynamic assessment. Anorectal symptoms associated with prolapse (irritable bowel syndrome, obstruction of defecation, fecal incontinence) should be search and evaluated. Before prolapse surgery, it is essential not to ignore gynecologic pathology.


CONCLUSIONS
Before proposing a surgical cure of genital prolapse of women, it suits to achieve a clinical and paraclinical assessment to describe prolapse (anatomical structures involved, grade), to look for recurrence, difficulties approach and postoperative complications risk factors, and to appreciate the impact or the symptoms associated with prolapse (urinary, anorectal, gynecological, pelvic-perineal pain) to guide their evaluation and their treatment. © 2016 Published by Elsevier Masson SAS.
Polyclinique Côte Basque Sud, 7, rue Léonce-Goyetche, 64500 Saint-Jean-de-Luz, France. Electronic address: laurence-donon@hotmail.fr.
L
L
Donon
Service de gynécologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes Cedex 9, France.
S
S
Warembourg
Radiologue, 151, avenue de Saxe, 69003 Lyon, France.
J-F
JF
Lapray
Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, Paris, France.
A
A
Cortesse
Service d'urologie, hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
J-F
JF
Hermieu
Service de gynécologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes Cedex 9, France.
B
B
Fatton
Service de gynécologie obstétrique, CHU Montpellier, hôpital Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France.
M
M
Cayrac
Service de gynécologie obstétrique, hôpital Antoine-Beclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
X
X
Deffieux
Polyclinique Saint-Côme, 9, rue Jean-Jacques-Bernard, 60200 Compiègne, France.
M
M
Geraud
Service urologie, CHU Nantes, place Alexis-Ricordeau, 44093 Nantes, Cedex 1, France.
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L
Le Normand
D005260:Female; D006801:Humans; D056887:Pelvic Organ Prolapse / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011300:Preoperative Care / Q000592:standards*; D014563:Urodynamics
Bilan clinique; Bilan gynécologique; Clinical evaluation; Genital prolapse; Gynecological checkup; Imagerie; Imaging; MOTS-CLÉS; Prolapsus génital; Recommandations pour la pratique clinique; Recommendations for clinical practice; Urodynamics; Urodynamique