Apical Prolapse: A Review of Treatments and Patient Outcomes

This literature review evaluated the efficacy of surgical treatments for apical pelvic organ prolapse (POP), focusing on recurrence rates and compartment-specific outcomes. Eligible studies included women aged 18 years or older with Stage II-IV POP, with data published between 2000 and 2024 from the United States. Seven studies met the inclusion criteria, comprising three randomized controlled trials (RCTs), three retrospective cohort studies, and one prospective cohort study. The review assessed outcomes such as anatomical success, symptom relief, recurrence rates, adverse events, and patient-reported measures. The findings highlighted significant differences in recurrence rates among surgical techniques. Specifically, Sacrocolpopexy (SCP) consistently demonstrated superior outcomes, particularly for Stage III prolapse, compared to uterosacral ligament suspension (USLS) and sacrospinous ligament fixation (SSLF). For Stage II prolapse, SCP and USLS showed comparable recurrence rates, suggesting SCP’s advantages are more pronounced in advanced cases. Minimally invasive SCP (MISC) provided better anterior compartment outcomes than vaginal USLS (vUSLS), while both techniques showed similar improvements in overall prolapse severity. By contrast, SSLF and USLS had higher recurrence and surgical failure rates over time, with anterior and posterior compartment failures being most common. Despite SCP’s effectiveness, its use of mesh introduces risks of complications, highlighting the need for continued evaluation of mesh-based repairs. The review also identified disparities in long-term outcomes, emphasizing the importance of individualized treatment plans that consider prolapse stage, patient preferences, and recovery expectations. This review underscores the complexity of surgical decision-making in apical POP management. SCP offers durable outcomes for advanced prolapse, while less invasive techniques like USLS and vUSLS remain viable options for moderate cases or patients unable to undergo mesh-based procedures. These findings emphasize the need for long-term follow-up, robust comparisons across surgical approaches, and greater focus on patient-centered outcomes. The public health relevance of this review lies in its potential to improve the management of pelvic organ prolapse through evidence based treatment decisions, ultimately enhancing the well-being of affected women and advancing healthcare equity.