ACOG and AUGS have updated the Pelvic Organ Prolapse (POP) recommendations. Guidelines now address the FDA order for manufacturers to discontinue sale and distribution of mesh for treatment of POP in the US. The FDA order applies only to mesh placed vaginally for POP and does not apply to (1) transvaginal mesh for SUI or (2) sacrocolpopexy (abdominal placement). POP is considered ‘benign’, but symptoms can seriously impact quality of life, affecting defecatory, voiding and sexual function.
Pelvic organ prolapse only should be considered a problem if it is causing prolapse symptoms (ie, pressure with or without a bulge) or sexual dysfunction or if it is disrupting normal lower urinary tract or bowel function
See below in ‘Learn More – Primary Sources’ for link to AUGS POP-Q tool
Increasing parity | Vaginal delivery | Age | Menopausal status | Obesity | Connective tissue disorders | Chronic constipation
Surgical Therapy for Failed/Declined Nonsurgical Treatment
Additional Notes on Surgical Treatment
Sacral colpopexy is associated with lower risk of awareness of prolapse, recurrent prolapse on examination, repeat surgery for prolapse, postoperative SUI and dyspareunia than a variety of vaginal interventions
Vaginal Prolapse Repair
Posterior Wall Prolapse
Anterior Wall Prolapse
It is imperative that local hospitals and health systems establish and strictly enforce robust processes to both/credential and audit surgeons with specific expertise, experience, training and skill to perform these procedures. AUGS has developed, and published credentialing guidelines for transvaginal mesh surgery for pelvic organ prolapse and sacrocolpopexy for the treatment of pelvic organ prolapse.
ACOG Practice Bulletin 214: Pelvic organ prolapse
ACOG Committee Opinion 694: Management of Mesh and Graft Complications in Gynecologic Surgery
AUGS: Update on FDA Announcement on Transvaginal Mesh for Prolapse
FDA takes action to protect women’s health, orders manufacturers of surgical mesh intended for transvaginal repair of pelvic organ prolapse to stop selling all devices
Cochrane Review: Surgery for women with anterior compartment prolapse. Cochrane Database of Systematic Reviews
Incidence and Management of graft erosion, wound granulation, and dyspareunia following vaginal prolapse repair with graft materials: a systemic review. Systematic Review Group of the Society of Gynecologic Surgeons.
AUGS Position Statement on Restriction of Surgical Options for Pelvic Floor Disorders, March 26, 2013
FIGO review of statements on use of synthetic mesh
AUGS-SUFU_Joint Position Statement on Midurethral Slings for Stress Urinary Incontinence
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