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Pelvic organ prolapse
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of pelvic organ prolapse are prepared by our editorial team based on guidelines from the European Association of Urology (EAU/EAUN 2025), the American College of Radiology (ACR 2021), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2021,2019,2017), the American College of Obstetricians and Gynecologists (ACOG 2019), the American Urogynecologic Society ...
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Classification and risk stratification
Diagnostic investigations
History and physical examination: as per EAU/EAUN 2025 guidelines, perform POP reduction test to identify patients with occult stress urinary incontinence.
A
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Urodynamic studies
Diagnostic imaging
Medical management
Nonpharmacologic interventions
Pelvic floor muscle training
As per EAU/EAUN 2025 guidelines:
Inform patients with POP not needing a vaginal pessary or surgical intervention about the potential relief from LUTS from pelvic floor muscle training.
A
Do not offer preoperative pelvic floor muscle training to improve lower urinary tract symptom outcomes if pessary therapy or surgical intervention is indicated for POP.
D
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Vaginal pessary
Perioperative care
Preoperative evaluation for urinary incontinence
As per ACOG 2019 guidelines:
Obtain a preoperative evaluation for occult stress urinary incontinence, with cough stress testing or urodynamic testing with the prolapse reduced, in all patients with significant apical prolapse, anterior prolapse, or both.
B
Counsel patients with POP but without stress urinary incontinence undergoing either abdominal or vaginal prolapse repair that postoperative stress urinary incontinence is more likely without a concomitant continence procedure but that the risk of adverse effects is increased with an additional procedure.
B
Surgical interventions
Indications for surgery: as per AUGS 2017 guidelines, offer surgery based on medical history and treatment goals in asymptomatic patients.
E
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Pelvic reconstructive surgery
Considerations for mesh use
Intraoperative cystoscopy
Obliterative surgery
Management of stress urinary incontinence
Patient education
General counseling: as per EAU/EAUN 2025 guidelines, counsel patients with POP and stress urinary incontinence about the pros and cons of additional anti-incontinence surgery at the time of POP surgery. Inform patients of the increased risk of adverse events with combined prolapse and anti-incontinence surgery compared to prolapse surgery alone.
A
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Preventative measures
Follow-up and surveillance
Assessment of treatment response
As per BSUG/RCOG 2015 guidelines:
Use patient-reported outcomes, including patient-reported success rates and relief of presenting symptoms, as the primary assessment outcomes.
B
Recognize that objective cure is important as it correlates to symptoms of vaginal bulge, and a POP-Q stage of I or O in the apical compartment seems to be acceptable and widely used as the optimum postoperative result.
B
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Management of recurrent POP