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Pelvic Organ Prolapse: Current Challenges and Future Perspectives
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Pelvic Organ Prolapse: Current Challenges and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 20 December 2025 | Viewed by 9014

Special Issue Editor

Dr. Marco Soligo

E-Mail Website
Guest Editor
Obstetrics and Gynecology Department, Hospital of Lodi, Via Largo Donatori del Sangue, 26900 Lodi, Italy
Interests: urogynecology; genital prolapse; urinary incontinence; urodynamics; anal incontinece; obstetric anal sphincter injuries; pelvico floor disorders

Special Issue Information

Dear Colleagues,

Pelvic organ prolapse (POP) is a quite common condition in the female population, which has a detrimental impact on quality of life (QoL), due to subjective discomfort along with a potential interference with visceral function (lower urinary tract disorders (LUTDs) and bowel disorders) and reproductive aspects of women’s life, including sexuality.

Gynecologists have always been confronted with this disorder, but traditional approaches deserve to be reassessed in the light of new scientific evidence concerning POP management.

Amongst innovative aspects are the following concepts:

  • Multidisciplinarity and multiprofessionality;
  • Improvements in classification and clinical assessment with a more patient-centered vision;
  • Risk factors and potential preventive strategies of POP;
  • Making conservative management available to a wider population;
  • Discussing a modern approach to surgical treatment based on a critical interpretation of the available literature;
  • Looking for innovation in the crucial aspects of tissue engineering and technological support to surgery;
  • Debating the actual role of hysterectomy in the treatment of POP.

In drafting this Special Issue, we aim at highlighting what is controversial in the current standards of care, and to focus on possible solutions that may be around the corner. I hope that you will join us in this effort to advance the field.

Dr. Marco Soligo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pelvic organ prolapse
  • urinary incontinence
  • lower urinary disorders
  • quality of life
  • patient-reported outcomes

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Published Papers (5 papers)

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Research

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13 pages, 830 KB  
Article
Colpocleisis—Still a Valuable Option: A Point of Technique
by Diana Hoehn, Hannes Egli, Martin Chase Marak, Gloria Ryu, Anna-Sophie Villiger, Giovanni Ruggeri, Michael David Mueller and Annette Kuhn
J. Clin. Med. 2025, 14(20), 7433; https://doi.org/10.3390/jcm14207433 - 21 Oct 2025
Viewed by 472
Abstract
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that increases with age and affects up to 40% of women. Colpocleisis is a possible native-tissue repair used in elderly persons not interested in vaginally penetrative sex to correct advanced POP. This study [...] Read more.
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that increases with age and affects up to 40% of women. Colpocleisis is a possible native-tissue repair used in elderly persons not interested in vaginally penetrative sex to correct advanced POP. This study aims to evaluate the recurrence and reoperation rate of a technique using purse-string sutures in a standardised way. Methods: This retrospective quality control study evaluated all women who underwent obliterative procedures for POP at the Department of Obstetrics and Gynaecology at the University Hospital of Bern from 2014 to 2023. Total Colpocleisis (TC) and Le-Fort Colpocleisis (LFC) were performed by a standardised technical procedure using purse-string sutures. The primary outcome was the recurrence rate measured by the POP-Q stage (stage 2 or higher). Reoperation rate, perioperative complications, bladder outlet disorders and incontinence symptoms were assessed as secondary outcomes. Results: We analysed eighty-eight patients who underwent obliterative surgery with TC or LFC in this study. The recurrence rate for all patients was 16%, and the reoperation rate was 9.2%. In patients without previous surgeries (52%), the recurrence rate was 7%. Thirteen patients (14.8%) had perioperative complications, mainly urinary tract infections (seven patients, 8%). Objective POP improved significantly (p < 0.001), as did the bladder voiding dysfunction in the rate of high postvoid residual volume (p < 0.05), stress urinary incontinence, overactive bladder and mixed urinary incontinence (p < 0.001). In three patients, de novo stress urinary incontinence developed postoperatively. Conclusions: Colpocleisis by the purse-string technique is an effective surgical treatment for advanced POP surgery. Recurrence and reoperation rates are similar to the previously mentioned techniques and are easy to learn due to the standardised procedure. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Challenges and Future Perspectives)
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26 pages, 1429 KB  
Article
Symptom Burden, Treatment Goals, and Information Needs of Younger Women with Pelvic Organ Prolapse: A Content Analysis of ePAQ-Pelvic Floor Free-Text Responses
by Georgina Forshall, Thomas J. Curtis, Ruth Athey, Rhys Turner-Moore, Stephen C. Radley and Georgina L. Jones
J. Clin. Med. 2025, 14(15), 5231; https://doi.org/10.3390/jcm14155231 - 24 Jul 2025
Viewed by 1001
Abstract
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of [...] Read more.
Background/Objectives: Pelvic organ prolapse (POP) is a common condition that significantly impacts quality of life. Research has focused largely on older women, while experiences of younger women remain relatively underexplored despite challenges unique to this population. Informed by the biopsychosocial model of illness, this study aims to assess the symptom burden, treatment goals, and information needs of younger women complaining of prolapse by analyzing questionnaire responses from an existing electronic Personal Assessment Questionnaire—Pelvic Floor (ePAQ-PF) dataset. Methods: Mixed-methods content analysis was conducted using free-text data from an anonymized multi-site ePAQ-PF dataset of 5717 responses collected across eight UK NHS trusts (2018–2022). A quantitative, deductive approach was first used to identify younger women (≤50 years old) with self-reported prolapse. ePAQ-PF scores for younger women with prolapse were compared with those aged >50 years, using Mann–Whitney tests. Free-text response data were analyzed inductively to qualitatively explore younger women’s symptom burden, treatment goals, and information needs. Results: Of the 1473 women with prolapse identified, 399 were aged ≤50 years. ePAQ-PF scores of the younger cohort demonstrated significantly greater symptom severity and bother than those aged >50, particularly in bowel, prolapse, vaginal, body image, and sexual health domains (p < adjusted threshold). Qualitative analysis undertaken to understand women’s concerns and priorities produced five health-related themes (physical health; functionality; psychosocial and emotional wellbeing; reproductive and sexual health; and healthcare journeys) and a sixth intersecting theme representing information needs. Conclusions: The findings highlight the substantial symptom burden of younger women with prolapse, as well as treatment goals and information needs specific to this population. The development of age-specific resources is identified as a requirement to support this group. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Challenges and Future Perspectives)
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Review

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17 pages, 554 KB  
Review
Pelvic Organ Prolapse: Current Challenges and Future Perspectives
by Anna Padoa, Andrea Braga, Sharon Brecher, Tal Fligelman, Giada Mesiano and Maurizio Serati
J. Clin. Med. 2025, 14(20), 7313; https://doi.org/10.3390/jcm14207313 - 16 Oct 2025
Cited by 1 | Viewed by 2079
Abstract
Pelvic organ prolapse (POP) affects millions of women around the world, with age-standardized prevalence rates of 2769 per 100,000 women in 2021. Although it greatly affects quality of life (QoL), only 18–50% of women experiencing this issue seek medical attention, largely due to [...] Read more.
Pelvic organ prolapse (POP) affects millions of women around the world, with age-standardized prevalence rates of 2769 per 100,000 women in 2021. Although it greatly affects quality of life (QoL), only 18–50% of women experiencing this issue seek medical attention, largely due to a lack of knowledge, misunderstandings about the condition, and obstacles to accessing healthcare. This narrative review explores the progression of POP management towards a focus on patient-centered care, highlighting the importance of personalized treatment strategies that prioritize patient-reported outcomes (PROs) over solely anatomical factors. The approach to treatment has transitioned from being centered on anatomy to focusing on the patient, emphasizing the relief of symptoms and enhancement in QoL. Existing research indicates that monitoring without intervention is advisable for asymptomatic patients, as long-term studies have revealed that up to 40% of women experience stable or improved prolapse over a period up to 60 months. Pessary treatment has a fitting success rate above 90% and a treatment persistence rate of 60%, providing an effective non-surgical option for management. The approach to selecting surgical treatments has progressed to prioritize sufficient apical support as a key factor for achieving lasting results. For primary POP, native tissue repair (NTR) is now recommended as the first-line surgical option. Mesh-augmented repairs are used only in certain high-risk situations, whereas sacrocolpopexy offers the best anatomical stability for particular cases, such as those involving post-hysterectomy prolapse and recurrences. Contemporary POP management involves personalized, patient-focused decision-making that emphasizes addressing symptom severity and functional objectives rather than solely aiming for anatomical precision. The evidence suggests that NTR should be the primary surgical approach, while other procedures should be reserved for specially chosen patients. Success should primarily be evaluated based on PROs instead of anatomical factors, ensuring that treatments align with each patient’s preferences and expectations while reducing complications. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Challenges and Future Perspectives)
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12 pages, 254 KB  
Review
Is There a Role for Urodynamic Investigation in the Management of Pelvic Organ Prolapse?
by Eleonora Rosato, Lorenzo Vacca, Andrea Lombisani, Giuseppe Campagna, Luca Orecchia, Daniele Bianchi, Yuri Cavaleri, Maurizio Serati and Enrico Finazzi Agrò
J. Clin. Med. 2025, 14(4), 1163; https://doi.org/10.3390/jcm14041163 - 11 Feb 2025
Cited by 1 | Viewed by 1970
Abstract
Background/Objectives: The role of urodynamic study (UDS) in women with pelvic organ prolapse (POP) and concurrent lower urinary tract symptoms (LUTS) remains controversial. Although LUTS alone often fail to yield an accurate diagnosis, routine UDS is debated due to its invasiveness, cost, [...] Read more.
Background/Objectives: The role of urodynamic study (UDS) in women with pelvic organ prolapse (POP) and concurrent lower urinary tract symptoms (LUTS) remains controversial. Although LUTS alone often fail to yield an accurate diagnosis, routine UDS is debated due to its invasiveness, cost, patient discomfort, and risk of urinary tract infections. The aim of this narrative review is to summarise the utility of UDS in the pre- and postoperative management of POP, focusing on its role in diagnosing and predicting outcomes for detrusor overactivity (DO), bladder outlet obstruction (BOO), detrusor underactivity (DU), and SUI. Methods: An extensive search of the available medical literature was conducted using PubMed, Scopus, and Embase to identify relevant studies published up to December 2024. The search combined keywords and MeSH terms related to pelvic organ prolapse (POP), urodynamic studies (UDS), overactive bladder, detrusor overactivity, stress urinary incontinence (SUI), female bladder outlet obstruction (BOO), detrusor underactivity (DU), preoperative assessment, and postoperative outcomes. Results: Occult stress urinary incontinence (SUI) detection with UDS can aid in planning concurrent anti-incontinence procedures, while preoperative assessment of DO or DU helps predict postoperative complications like urinary retention or overactive bladder symptoms. Conclusions: Despite its diagnostic advantages, evidence on UDS parameters and surgical outcomes remains inconsistent. The most important societies’ guidelines promote the use of UDS in selected cases, highlighting the need for individualised assessments to optimise patient counselling and management strategies. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Challenges and Future Perspectives)
11 pages, 928 KB  
Review
Laparoscopic Hysteropexy: How, When and for Whom Is It an Alternative Option? A Narrative Review of the Literature
by Anna Pitsillidi and Günter Karl Noé
J. Clin. Med. 2025, 14(4), 1080; https://doi.org/10.3390/jcm14041080 - 8 Feb 2025
Cited by 2 | Viewed by 2557
Abstract
Background/Objectives: Surgical repair of apical prolapse most commonly includes hysterectomy. However, nowadays, the number of women who seek uterine preserving surgical treatment is increasing. Our objective is to review the current evidence on laparoscopic hysteropexy techniques, outcomes and appropriate patient selection. Methods [...] Read more.
Background/Objectives: Surgical repair of apical prolapse most commonly includes hysterectomy. However, nowadays, the number of women who seek uterine preserving surgical treatment is increasing. Our objective is to review the current evidence on laparoscopic hysteropexy techniques, outcomes and appropriate patient selection. Methods: A literature search was carried out in MEDLINE/PubMed and ClinicalTrials.gov databases. The search was restricted to humans, female patients and currently used surgical procedures. Results: Laparoscopic hysteropexy was found to be associated with good anatomic outcomes, symptom improvement and low complication or reoperation rates. Conclusions: Laparoscopic hysteropexy appears to be a good alternative option for women who undergo surgical treatment for apical prolapse and desire preservation of the uterus. However, further prospective comparative studies, as well as longer follow-up periods, are necessary for evaluating long-term safety and efficacy outcomes of the method. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Challenges and Future Perspectives)
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