Approach to Pelvic Organ Prolapse: A Urological Perspective

Pelvic organ prolapse (POP) has an estimated global prevalence of 28.8% [1], defined as the descent of one or more of the anterior vaginal wall, the posterior vaginal wall, the uterus (cervix), or the apex of the vagina (vaginal vault or cuff scar after hysterectomy) [2]. As the population ages, we will face an increasing prevalence of women with symptomatic POP [3] and those who may need to undergo surgical repair [4]. Presentation can be quite variable and does not always involve a bulging sensation. Many women can develop lower urinary tract symptoms, urinary incontinence, defecatory issues, and sexual dysfunction, primarily caused by their POP. Urinary tract symptoms can range from increased urinary frequency, urinary urgency, voiding dysfunction, incomplete bladder emptying, and recurrent urinary tract infection. Therefore, POP treatment in several women can lead to improvements in these issues, whether through conservative management with pelvic floor physiotherapy, pessary use, or surgical repair.

As urologists, we have the privilege of treating both men and women for a vast range of urological conditions. No matter our subspecialisation or expertise, we will be diagnosing and managing various urological issues in women, some of us more than others. Urinary tract conditions cannot be managed in a silo without considering the contribution of pelvic floor support or lack thereof. POP diagnosis and consideration in management decisions are critical to obtaining results of higher efficacy and durability. Early interventions and recognition of risk factors can help delay the onset and progression of POP, enhance women’s well-being, and reduce the burden on healthcare systems.

This issue brings together the collective expertise of distinguished contributors reviewing the clinical evidence of several aspects of POP from a urological perspective. The articles of this issue will highlight important aspects of the etiology, epidemiology, and evaluation of POP [5]. The authors discuss the implications of POP in terms of sexual dysfunction [6] and stress urinary incontinence management [7]. We provide an overview of the conservative and surgical management of POP and present in more detail the role of mesh use in POP surgical repair [8], the implications of a hysterectomy, and the surgical management of high-grade POP (procidentia) [9].

The insights presented within this collection of articles will inspire further research, facilitate clinical decision-making, and ultimately improve the lives of women suffering from POP. Evidence-based guidelines supported by multi-institutional randomized clinical trials must be encouraged and fostered to provide strong recommendations in POP management amongst different clinical communities actively involved in the care of women such as urologists, urogynecologists, and colorectal surgeons.