Pelvic Prolapse

  • Rashel M. Haverkorn
  • Philippe E. Zimmern
Part of the Springer Specialist Surgery Series book series (SPECIALIST)


Pelvic organ prolapse is a condition in which the pelvic organs are displaced and they protrude by varying degrees into the vaginal canal (ACOG). Affected organs can include the urethra, bladder, rectum, small bowel, uterus, or more commonly, a combination of these pelvic organs. Approximately, 300,000 prolapse surgeries are performed annually in the United States, with an estimated cost of over $1 billion.1 Several series have estimated that approximately 30–40% of women develop pelvic organ prolapse,2-4 and the lifetime estimate of surgical risk reaches 11–12% by 80 years of age.5,6


Pelvic Organ Prolapse Pelvic Organ Stress Incontinence Pelvic Organ Prolapse Quantification Anterior Vaginal Wall 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Subak L, Waetjen L, Eeden Svd, Thom D, Vittinghoff E, Brown J. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001;98:646-651PubMedCrossRefGoogle Scholar
  2. 2.
    Bradley C, Zimmerman M, Qi Y, Nygaard I. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109(4):848-854PubMedCrossRefGoogle Scholar
  3. 3.
    Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol. 2004;104(3):489-497PubMedCrossRefGoogle Scholar
  4. 4.
    Handa V, Garrett E, Hendrix S, Gold E, Robbins J. Progression and remission of pelvic organ prolapse: a longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190:27-32PubMedCrossRefGoogle Scholar
  5. 5.
    Olsen A, Smith V, Bergstrom J, Colling J, Clark A. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89(4):501-506PubMedCrossRefGoogle Scholar
  6. 6.
    Fialkow M, Newton K, Lentz G, Weiss N. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J. 2008;19:437-440CrossRefGoogle Scholar
  7. 7.
    Bump RA, Norton PA. Epidemiology and natural history of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 1998;25(4):723-746PubMedCrossRefGoogle Scholar
  8. 8.
    Rortveit G, Brown J, Thom D, Eeden SVD, Creasman J, Subak L. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007;109(6):1396-1403PubMedCrossRefGoogle Scholar
  9. 9.
    Hendrix S, Clark A, Nygaard I, Aragaki A, Barnabei V, McTiernan A. Pelvic organ prolapse in the Women’s Health Inititative: gravity and gravidity. Am J Obstet Gynecol. 2002;186:1160-1166PubMedCrossRefGoogle Scholar
  10. 10.
    Sewell C, Chang E, Sultana C. Prevalence of genital prolapse in 3 ethnic groups. J Reprod Med. 2007;52(9):769-773PubMedGoogle Scholar
  11. 11.
    Kudish B, Iglesia C, Sokol R, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol. 2009;113(1):81-88PubMedGoogle Scholar
  12. 12.
    McLennan M, Harris J, Kariuki B, Meyer S. Family history as a risk factor for pelvic organ prolapse. Int Urogynecol J. 2008;19:1063-1069CrossRefGoogle Scholar
  13. 13.
    Altman D, Frosman M, Falconer C, Lichtenstein P. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol. 2008;54:918-923PubMedCrossRefGoogle Scholar
  14. 14.
    Woodman P, Swift S, O’Boyle A, et al. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multi-center cross-sectional study. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(4):340-345PubMedCrossRefGoogle Scholar
  15. 15.
    Swift S. The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000;183(2):277-285PubMedCrossRefGoogle Scholar
  16. 16.
    Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the oxford family planning association study. Br J Obstet Gynaecol. 1997;104:579-585PubMedCrossRefGoogle Scholar
  17. 17.
    Lukacz E, Lawrence J, Contreras R, Nager C, Luber K. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol. 2006;107(6):1253-1260PubMedCrossRefGoogle Scholar
  18. 18.
    Delancey JO et al. Anatomic aspects of vaginal eversion. Am J Obstet Gynecol. 1992;166(6 pt 1):1717-1724PubMedGoogle Scholar
  19. 19.
    Badiou W, Granier G, Bousquet P, Monrozies X, Mares P, Tayrac RD. Comparative histological analysis of anterior vaginal wall in women with pelvic organ prolapse or control subjects: a pilot study. Int Urogynecol J. 2008;19:723-729CrossRefGoogle Scholar
  20. 20.
    Jackson S, Avery N, Tartlton V, Eckford S, Abrams P, Bailey A. Changes in metabolism of collagen in genitourinary prolapse. Lancet. 1996;347(9016):1658-1661PubMedCrossRefGoogle Scholar
  21. 21.
    Moalli P, Talarico L, Sung V, et al. Impact of menopause on collagen subtypes in the arcus tenineous fasciae pelvis. Am J Obstet Gynecol. 2004;190:620-627PubMedCrossRefGoogle Scholar
  22. 22.
    Klutke J, Ji Q, Campeau J, et al. Decreased endopelvic fascia elastin content in uterine prolapse. Acta Obstet Gynecol. 2008;87:111-115CrossRefGoogle Scholar
  23. 23.
    Karam J, Vazquez D, Lin V, Zimmern P. Elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and without prolapse. BJU. 2007;100:346-350CrossRefGoogle Scholar
  24. 24.
    Goh JT. Biomechanical properties of prolapsed vaginal tissue in pre- and postmenopausal women. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(2):76-79; discussion 79PubMedCrossRefGoogle Scholar
  25. 25.
    Cosson M, Lambaudie E, Boukerrou M, Lobry P, Crepin G, Ego A. A biomechanical study of the strength of vaginal tissues. Results on 16 post-menopausal patients presenting with genital prolapse. Eur J Obstet Gynecol Reprod Biol. 2004;112(2):201-205PubMedCrossRefGoogle Scholar
  26. 26.
    Zimmern PE, Eberhart RC, Bhatt A. Methodology for biomechanical testing of fresh anterior wall vaginal samples from postmenopausal women undergoing cystocele repair. Neurourol Urodyn. 2009;28(4):325-329PubMedCrossRefGoogle Scholar
  27. 27.
    Gutman R, Ford D, Quiroz L, Shippey S, Handa V. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol. 2008;6:683.e681-683.e687Google Scholar
  28. 28.
    Bump RC, Mattiasson A, Bo K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175(1):10-17PubMedCrossRefGoogle Scholar
  29. 29.
    Lowenstein L, Kenton K, Peirce K, FitzGerald M, Mueller E, Brubaker L. Patients’ pelvic goals change after initial urogynecologic consultation. Am J Obstet Gynecol. 2007;197:640.e641-640.e643CrossRefGoogle Scholar
  30. 30.
    Jelovsek J, Barber M. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol. 2006;194:1455-1461PubMedCrossRefGoogle Scholar
  31. 31.
    Dmochowski RR, Sanders SW, Appell RA, Nitti VW, Davila GW. Bladder-health diaries: an assessment of 3-day vs 7-day entries. BJU Int. 2005;96(7):1049-1054PubMedCrossRefGoogle Scholar
  32. 32.
    Showalter P, Zimmern P, Roehrborn C, Lemack G. Standing cystourethrogram: an outcome measure after anti-incontinence procedures and cystocele repair in women. Urology. 2001;58:33-37PubMedCrossRefGoogle Scholar
  33. 33.
    Groenendijk A, Hulst Vvd, Birnie E, Bonsel G. Correlation between posterior vaginal wall defects assessed by clinical examination and by defecography. Int Urogynecol J. 2008;19:1291-1297CrossRefGoogle Scholar
  34. 34.
    Finco C, Savastano S, Luongo B, et al. Colpocystodefecography in obstructed defecation: is it really useful to the surgeon? Correlating clinical and radiological findings in surgery for obstructed defecation. Colorectal Dis. 2007;10:446-452PubMedCrossRefGoogle Scholar
  35. 35.
    Grody M. Urinary incontinence and concomitant prolapse. Clin Obstet Gynecol. 1998;41:777-785PubMedCrossRefGoogle Scholar
  36. 36.
    Long C, Hsu S, Wu T, Sun D, Su J, Tsai E. Urodynamic comparison of continent and incontinent women with severe urogenital prolapse. J Reprod Med. 2004;49(1):33-37PubMedGoogle Scholar
  37. 37.
    Brubaker L, Cundiff G, Fine P, et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence. N Engl J Med. 2006;354(15):1557-1566PubMedCrossRefGoogle Scholar
  38. 38.
    Gilleran J, Lemack G, Zimmern P. Reduction of moderate to large cystocele during urodynamic evaluation using a vaginal gauze pack: 8-year experience. Br J Urol. 2005;97:292-295Google Scholar
  39. 39.
    Glazener C, Lapitan M. Urodynamic investigations for management of urinary incontinence in children and adults. Cochrane Database Syst Rev. 2002; Issue 3, Art. No. CD003195. doi:  10.1002/14651858.CD003195
  40. 40.
    Maher C, Baessler K, Glazener C, Adams E, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2007; Issue 3, Art. No. CD004014. doi:  10.1002/
  41. 41.
    Ballert K, Biggs G, Isenalumhe A, Rosenblum N, Nitti V. Managing the urethra at transvaginal pelvic organ prolapse repair: a urodynamic approach. J Urol. 2009;181:679-684PubMedCrossRefGoogle Scholar
  42. 42.
    Bradley C, Kenton K, Gao X, Zyczynski H, Weber A, Nygaard I. Obestiy and outcomes after sacrocolpopexy. Am J Obstet Gynecol. 2008;199(6):690.e691-690.e698CrossRefGoogle Scholar
  43. 43.
    Clemons J, Aguilar V, Tillinghast T, Jackson N, Myers D. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190:1025-1029PubMedCrossRefGoogle Scholar
  44. 44.
    Maito J, Quam Z, Craig E, Danner K, Rogers R. Predictors of successful pessary fitting and continued use in a nurse-midwifery pessary clinic. J Midwifery Womens Health. 2006;51:78-84PubMedCrossRefGoogle Scholar
  45. 45.
    Fernando R, Thakar R, Sultan A, Shah S, Jones P. Effect of vaginal pessaries on symptoms associated with pelvic organ prolapse. Obstet Gynecol. 2006;108(1):93-99PubMedCrossRefGoogle Scholar
  46. 46.
    Clemons J, Aguilar V, Tillinghast T, Jackson N, Myers D. Risk factors associated with an unsuccessful pessary fitting trial in women with pelvic organ prolapse. Am J Obstet Gynecol. 2004;190:345-350PubMedCrossRefGoogle Scholar
  47. 47.
    Barber M, Walters M, Cundiff G. Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal urgery and pessary treatment for pelvic organ prolapse. Am J Obstet Gynecol. 2006;194:1492-1498PubMedCrossRefGoogle Scholar
  48. 48.
    Piva-Anant M, Therasakvichya S, Leelaphatanadit C, Techantrisak K. Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assoc Thai. 2003;86(6):509-515Google Scholar
  49. 49.
    Simonds R, Holmberg S, Hurwitz R, et al. Transmission of human immunodeficiency virus type 1 from a seronegative organ and tissue donor. N Engl J Med. 1992;326(11):726-732PubMedCrossRefGoogle Scholar
  50. 50.
    Riccetto C, Miyaoka R, DeFraga R, et al. Impact of the structure of polypropylene meshes in local tissue reaction: in vivo stereological study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(8):1117-1123PubMedCrossRefGoogle Scholar
  51. 51.
    Huebner M, Hsu Y, Fenner D. The use of graft materials in vaginal pelvic floor surgery. Int J Gynecol Obstet. 2006;92:279-288CrossRefGoogle Scholar
  52. 52.
    Diwadkar G, Barber M, Feiner J, Maher C, Jelovsek J. Complication and reoperation rates after apical vaginal prolapse surgical repair: a systematic review. Obstet Gynecol. 2009;113(2):367-373PubMedGoogle Scholar
  53. 53.
    Nichols D, Randall C. Vaginal Surgery. 4th ed. Baltimore, MD: Williams & Wilkins; 1996Google Scholar

Copyright information

© Springer London 2011

Authors and Affiliations

  • Rashel M. Haverkorn
    • 1
  • Philippe E. Zimmern
    • 2
  1. 1.Department of Urology, Female Pelvic Medicine, Reconstructive Surgery, and NeurourologyUT Southwestern Medical CenterDallasUSA
  2. 2.Department of UrologyUniversity of Texas Southwestern Medical Center at DallasDallasUSA

Personalised recommendations