International Journal of Colorectal Disease

, Volume 34, Issue 1, pp 189–192 | Cite as

Complex pelvic organ prolapse: decision-making algorithm

  • Gabriele Naldini
  • Bernardina FabianiEmail author
  • Alessandro Sturiale
  • Tommaso Simoncini
Short Communication



The pelvic floor is considered as a single anatomical and functional unit, consisting of several structures that suspend the pelvic organs maintaining their function. For this reason, a multi-compartmental prolapse is a common disease that needs a multidisciplinary pelvic floor team in order to be treated. The aim of the authors is to suggest a treatment algorithm to better approach complex pelvic organ prolapse.


A multidisciplinary pelvic floor team was set up 7 years ago. Starting from the literature review integrated with a team experience, a decision-making algorithm was drawn up. It was used to guide all the shared treatment for the complex pelvic floor disorders.


An accurate preoperative assessment with a shared diagnosis among the specialist is the base to follow the proposed algorithm. It leads to combine different surgical procedures considering advantages and disadvantages which may have an influence on the final outcome.


The proposed algorithm provides an integrated surgical view of complex pelvic floor disorders. It shows how is it feasible to associate surgical treatments of different compartments to obtain good pelvic floor anatomical and functional results and leading to an improvement of the patients’ quality of life.


Pelvic floor Complex prolapse Rectal prolapse Rectocele Hysterocele Cystocele 


Authors’ contribution

Gabriele Naldini, Bernardina Fabiani, and Tommaso Simoncini contribute to the conception and design of the study. Gabriele Naldini, Bernardina Fabiani, and Alessandro Sturiale contribute to the acquisition of literature data and revision, and to the final approval to the version to be published.


  1. 1.
    Santoro GA (2017) Imaging the pelvic floor. Tech Coloproctol 21(7):497–499. CrossRefPubMedGoogle Scholar
  2. 2.
    Wei JT, De Lancey JO (2004) Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol 47(1):3–17CrossRefPubMedGoogle Scholar
  3. 3.
    Liu W, Sturiale A, Fabiani B, Giani I, Menconi C, Naldini G (2017) Internal Delorme’s procedure for treating ods associated with impaired anal continence. Surg Innov 24(6):566–573. CrossRefPubMedGoogle Scholar
  4. 4.
    Mercer-Jones MA, D’Hoore A, Dixon AR, Lehur P, Lindsey I, Mellgren A, Stevenson AR (2014) Consensus on ventral rectopexy: report of a panel of experts. Color Dis 16:82–88. CrossRefGoogle Scholar
  5. 5.
    Stuto A, Renzi A, Carriero A, Gabrielli F, Gianfreda V, Villani RD, Pietrantoni C, Seria G, Capomagi A, Talento P (2011) Stapled trans-anal rectal resection (STARR) in the surgical treatment of the obstructed defecation syndrome: results of STARR Italian registry. Surg Innov 18(3):248–253. CrossRefPubMedGoogle Scholar
  6. 6.
    Enríquez-Navascués JM, Elósegui JL, Apeztegui FJ, Placer C, Borda N, Irazusta M, Múgica JA, Murgoitio J (2009) Ventral rectal sacropexy (colpo-perineal) in the treatment of rectal and rectogenital prolapse. Cir Esp 86(5):283–289. CrossRefPubMedGoogle Scholar
  7. 7.
    Slawik S, Soulsby R, Carter H, Payne H, Dixon AR (2008) Laparoscopic ventral rectopexy, posterior colporrhaphy and vaginal sacrocolpopexy for the treatment of recto-genital prolapse and mechanical outlet obstruction. Color Dis 10:138–143. CrossRefGoogle Scholar
  8. 8.
    Karram M, Maher C (2013) Surgery for posterior vaginal wall prolapse. Int Urogynecol J 24(11):1835–1841. CrossRefPubMedGoogle Scholar
  9. 9.
    Veit-Rubin N, Dubuisson JB, Lange S, Eperon I, Dubuisson J (2016) Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse: a patient-centred outcome report and video of a continuous series of 245 patients. Int Urogynecol J 27(3):491–493. CrossRefGoogle Scholar
  10. 10.
    Boccasanta P, Venturi M, Spennacchio M, Buonaguidi A, Airoldi A, Roviaro G (2010) Prospective clinical and functional results of combined rectal and urogynecologic surgery in complex pelvic floor disorders. Am J Surg 199(2):144–153. CrossRefPubMedGoogle Scholar
  11. 11.
    Hoel AT, Skarstein A, Ovrebo KK (2009) Prolapse of the rectum, long-term results of surgical treatment. Int J Color Dis 24(2):201–207. CrossRefGoogle Scholar
  12. 12.
    Kim M, Reibetanz J, Boenicke L, Germer CT, Jayne D, Isbert C (2012) Quality of life after laparoscopic resection rectopexy. Int J Color Dis 27(4):489–495. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Proctological and Perineal Surgical UnitCisanello University HospitalPisaItaly
  2. 2.Department of Experimental and Clinical Medicine, Division of Obstetrics and GynecologyUniversity HospitalPisaItaly

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