Complex pelvic organ prolapse: decision-making algorithm
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.
KeywordsPelvic floor Complex prolapse Rectal prolapse Rectocele Hysterocele Cystocele
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.
- 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. https://doi.org/10.1177/1553350610395035 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.ciresp.2009.02.014 CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1111/j.1463-1318.2007.01259.x CrossRefGoogle Scholar
- 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. https://doi.org/10.1007/s00192-015-2859-6 CrossRefGoogle Scholar
- 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. https://doi.org/10.1016/j.amjsurg.2008.11.040 CrossRefPubMedGoogle Scholar