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Pelvic organ prolapse

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Updated 2024 EAU guidelines for the diagnosis and management of pelvic organ prolapse.


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 2024), 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

Classification: as per BSUG/RCOG 2015 guidelines, use standardized classification systems for the assessment and documentation of POP, including vault prolapse.
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Diagnostic investigations

History and physical examination: as per EAU/EAUN 2024 guidelines, perform POP reduction test to identify patients with occult stress urinary incontinence.

More topics in this section

  • Urodynamic studies

  • Diagnostic imaging

Medical management

Expectant management: as per AUGS 2017 guidelines, consider offering expectant management in asymptomatic patients without evidence of urinary retention.

Nonpharmacologic interventions

Pelvic floor muscle training
As per EAU/EAUN 2024 guidelines:
Inform patients with POP not needing a vaginal pessary or surgical intervention about the potential relief from LUTS from pelvic floor muscle training.
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.

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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.
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.

Surgical interventions

Indications for surgery: as per AUGS 2017 guidelines, offer surgery based on medical history and treatment goals in asymptomatic patients.

More topics in this section

  • Pelvic reconstructive surgery

  • Considerations for mesh use

  • Intraoperative cystoscopy

  • Obliterative surgery

  • Management of stress urinary incontinence

Patient education

General counseling: as per EAU/EAUN 2024 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.
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Preventative measures

Prevention of post-hysterectomy POP: as per ACOG 2019 guidelines, perform vaginal apex suspension at the time of hysterectomy for uterine prolapse to reduce the risk of recurrent POP.

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.
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.

More topics in this section

  • Management of recurrent POP