Therapeutic Options for Advanced Pelvic Organ Prolapse

Background: Advanced pelvic organ prolapse (POP) can have a significant impact on women’s health and quality of life (QoL). Several treatments, both conservative and surgical, can be offered to patients. These include vaginal pessaries, abdominal reconstructive surgeries, vaginal reconstruction, as well as obliterative procedures. Methods: This is a narrative review of the management of advanced POP using the PubMed, Google Scholar, and Cochrane databases. Results: Gellhorn pessaries are the most used space-occupying pessaries, with good long-term success rates. The only space-occupying pessaries that allow for self-management by the patient and that could be associated with prolapse reduction are cube pessaries. Laparoscopic sacrocolpopexy (L-SCP) is the gold standard for POP surgery. Other abdominal reconstructive procedures include sacrocervicopexy (SCerP) and laparoscopic lateral suspension (LLS). The two most common vaginal reconstructive techniques are sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (USLS). Both procedures have comparable success rates. Obliterative procedures include the total, Lefort, and Labhart colpocleisis. These procedures are ideal for women who do not wish to have intercourse or who cannot tolerate extensive surgical procedures. There is a general tendency towards uterine preservation when performing these surgeries. Conclusions: Several therapeutic options exist for advanced POP, and most of them are associated with good long-term success rates. Treatment should be chosen based on patient comorbidities and in the context of shared decision-making.