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POP Overview

At a glance​

  • Assess: relate the bulge to bother and goals; document POP-Q, bladder/bowel emptying, sexual function, vaginal tissue and associated incontinence. Examine with adequate strain and consider a standing examination if symptoms and findings disagree.[4]
  • Options: observation for acceptable symptoms, pelvic floor therapy, pessary care, or surgery. Discuss uterine preservation, apical support, vaginal versus abdominal approaches, and whether future penetrative vaginal intercourse is desired.[12]
  • Reconsider the pathway: unexplained bleeding, suspected mass, substantial retention or upper-tract effects need evaluation. A continence procedure is a separate shared decision; prevention of postoperative SUI must be weighed against retention and other added harms.[4][13]
  • Follow-up: agree on pessary removal/examination and a return plan for bleeding, pain or voiding difficulty. After repair, reassess symptoms, anatomy and urinary/bowel function; recurrence on examination is different from bothersome recurrence or reoperation.[12]

Compare OPUS and the two distinct 10-year prolapse trials.

Pelvic organ prolapse (POP) is the descent of one or more pelvic organs — bladder, uterus/vaginal apex, or rectum — into or through the vaginal canal as a result of deficient pelvic floor support.[1][2] It is among the most common conditions managed by reconstructive urologists, urogynecologists, and pelvic floor surgeons, with prevalence estimates depending strongly on the population and whether prolapse is defined by symptoms or examination. While many cases are asymptomatic, symptomatic prolapse significantly impacts quality of life across urinary, bowel, and sexual function domains.[1][4]

See also: Female Pelvic Examination, The Vagina, The Uterus, The Bladder, The Female Urethra, The Anal Canal, and The Perineum.

Anatomy and Levels of Support (DeLancey)​

The three-level model of vaginal support, described by DeLancey, remains the foundational framework for understanding POP and guiding repair strategy.[2]

LevelNameStructuresFailure Leads To
IApicalUpper vagina and cervix suspended by the cardinal–uterosacral ligament (CUL) complexUterine descent, vault prolapse, enterocele
IIMid-vaginalLateral attachment to the arcus tendineus fascia pelvis (ATFP/"white line") and superior fascia of levator aniAnterior wall (cystocele), posterior wall (rectocele)
IIIDistalLower vagina fused with perineal membrane, perineal body, and urethraDistal anterior wall descent, perineal deficiency

Assess the apex when evaluating anterior or posterior prolapse: compartments interact, and an isolated wall repair may leave a clinically important apical defect unaddressed.[4][12]

Classification by Compartment​

These are descriptive patterns, not a reliable bedside test of each fascial attachment. Clinical assignment of a central versus paravaginal defect has limited reproducibility; document the measured compartments and plan repair in their overall context.[4]

CompartmentTypeDefect / EtiologyTypical Repair
AnteriorCystocele — centralLoss of central pubocervical fasciaAnterior colporrhaphy
AnteriorCystocele — lateral (paravaginal)Detachment from ATFP (white line)Paravaginal repair (vaginal or abdominal)
AnteriorCystocele — transverseApical detachment of pubocervical fasciaApical suspension + anterior repair
PosteriorRectoceleRectovaginal fascia defect with rectal protrusionPosterior colporrhaphy
PosteriorEnteroceleSmall bowel herniation into rectovaginal spaceEnterocele repair (peritoneal closure)
PosteriorSigmoidoceleSigmoid colon descent into rectovaginal spaceEnterocele/sigmoidocele repair
ApicalUterine descentUterosacral/cardinal ligament attenuationHysterectomy + apical suspension OR uterine-sparing suspension
ApicalVault prolapseLoss of apical support post-hysterectomySacrocolpopexy, USL suspension, SSLF

Pathophysiology and Risk Factors​

POP results from the interaction of anatomical, obstetric, constitutional, and environmental factors leading to failure of the fascial, muscular, and connective tissue support structures of the pelvic floor.[2][3]

Interpreting risk factors​

The 2022 Schulten review combined 27 studies involving 47,429 women. It evaluated anatomic prolapse, including anatomic recurrence after native-tissue repair. Vaginal birth/parity, older age, higher BMI, birthweight and levator defects were associated with primary prolapse; higher preoperative stage and younger age were associated with recurrence after native-tissue surgery. These associations do not select an operation or predict an individual woman's need for reoperation.[3]

The IUC pathophysiology review also supports contributions from childbirth, age and inherited susceptibility. Genetic associations remain background biology; they do not provide a routine genetic test or a gene-specific treatment pathway.[2]

Discuss weight management, constipation/straining and activities that provoke symptoms. The association between smoking and lower prolapse odds in some observational datasets is not a prevention strategy; continue ordinary smoking-cessation care. Obstetric delivery decisions should not be made from these pooled prolapse associations alone.[3][12]

Clinical Presentation​

The bulge sensation (feeling or seeing a bulge at the vaginal opening) is the most consistent and specific symptom of prolapse. Symptoms are more likely near or beyond the hymen, but there is no single distance at which all patients become symptomatic.[4]

Symptom CategorySpecific SymptomsNotes
Bulge / PelvicVaginal bulge, heaviness, pelvic pressureMost specific for POP; worsens with prolonged standing or activity
UrinaryStress urinary incontinence (SUI)May be masked by outlet obstruction from urethral kinking
Urgency / frequency / urgency incontinenceMay coexist with POP; other causes of OAB remain possible
Obstructive voiding (hesitancy, weak stream)Urethral kinking in anterior prolapse; may require manual reduction
Incomplete bladder emptyingMeasure PVR when clinically indicated; prolapse is not the only possible cause
BowelConstipation, strainingMay accompany posterior prolapse; assess stool consistency and functional defecatory disorders
Incomplete evacuation, feeling of rectal blockagePosterior compartment defect
Splinting (manual pressure to vagina or perineum to defecate)Suggests an evacuation problem; does not establish rectocele as the sole cause
Fecal incontinencePerineal body deficiency; concomitant anal sphincter injury
SexualDyspareuniaAssess pain and other contributors separately from prolapse stage
Coital incontinenceAssess the associated urinary problem; the symptom alone does not identify a compartment defect
Body image concerns, sexual avoidancePatient-centered impact; assess with validated questionnaires

Staging​

POP-Q (Pelvic Organ Prolapse Quantification System)​

Use POP-Q for reproducible description and staging; simplified POP-Q is an accepted alternative when appropriate. The hymen serves as the reference plane (0).[1][4][7]

Six measurement points relative to the hymen (negative = above, positive = below):

PointLocation
AaAnterior wall, 3 cm proximal to urethral meatus
BaMost distal point of the upper anterior vaginal wall segment
CCervix or vaginal cuff
DPosterior fornix (omit when the cervix is absent)
ApPosterior wall, 3 cm proximal to hymen
BpMost distal point of the upper posterior vaginal wall segment

Additional measurements: gh (genital hiatus), pb (perineal body), tvl (total vaginal length).

POP-Q landmarks and sign conventionOriginal schematic · v2026-09-11 · Clinical review pending

The six POP-Q points on a schematic midsagittal view, with measured positions in centimeters relative to the hymen: negative above, zero at, positive below. Aa is a defined point 3 cm proximal to the external urethral meatus; Ap is 3 cm proximal to the hymen on the posterior wall. Their measured positions change with prolapse. Ba/Bp are the most dependent points of the upper walls, C is cervix/cuff, and D is the posterior fornix (omitted when the cervix is absent). Stage II spans −1 to +1 cm; stage III/IV extends more than 1 cm beyond the hymen, with their distinction depending on TVL − 2 cm. Stage 0 requires all normal points. Measure on maximal strain except TVL, which is measured with prolapse reduced. Not to scale. (Original WARWIKI schematic; based on standardized POP-Q terminology.)[7]

POP-Q Stages:

StageDefinition
0No prolapse; all points at normal positions
ILeading edge >1 cm above hymen
IILeading edge between −1 cm and +1 cm of hymen
IIILeading edge >+1 cm but <(TVL − 2 cm)
IVComplete eversion; leading edge ≥ (TVL − 2 cm)

Record symptom bother separately from stage; neither a stage label nor a normal-looking examination fully describes bladder, bowel or sexual function.

Baden-Walker Halfway System​

The Baden-Walker system is a historical descriptive scale. Use POP-Q or simplified POP-Q for reproducible documentation and comparison; the IUC found insufficient reproducibility to recommend Baden-Walker for this purpose.[4]

Evaluation​

Core assessment​

Tailor the evaluation to symptoms, examination and the contemplated treatment:

  1. History: Obstetric, gynecologic, medical, and surgical history; onset and progression of symptoms; degree of bother; impact on physical and sexual function; desire for future vaginal intercourse; future pregnancy plans[1][4]
  2. Symptom assessment: SUI, urgency incontinence, bladder emptying symptoms, bowel symptoms (straining, laxatives, fecal incontinence, incomplete emptying), dyspareunia
  3. Physical examination:
    • Abdominal exam (rule out pelvic mass)
    • External genitalia (atrophy, irritation, ulceration from chronic prolapse exposure)
    • Split speculum exam with Valsalva and cough, with an empty bladder for prolapse staging; repeat upright if the examination does not reproduce the reported bulge
  4. POP-Q staging: Document the compartments and apical support; simplified POP-Q is an alternative where appropriate[1][4]
  5. Post-void residual (PVR): Obtain for voiding symptoms, recurrent UTI or concern about incomplete emptying; PVR >100 mL is a commonly used research threshold, not a universal diagnostic cutoff; interpret repeated measurements with symptoms and voided volume
  6. Urinalysis: Indicated if urgency or LUTS present

Continence planning: when testing for SUI before repair, reduce the prolapse and use adequate bladder filling (the IUC describes at least 200 mL). This is separate from staging the prolapse with an empty bladder. A positive reduction test increases concern for postoperative SUI but does not mean it is inevitable; a negative test lowers risk without eliminating it. Invasive urodynamics is selective, particularly when incontinence and voiding dysfunction coexist.[4]

Optional / Selective Testing​

TestIndication
Urodynamics (UDS)Uncertainty about SUI diagnosis; voiding dysfunction; prior failed surgery
CystoscopySuspected bladder/urethral pathology or mesh-related complication; distinguish this from intraoperative cystoscopy
Defecography / MRI defecographyComplex posterior compartment symptoms; recurrent posterior repair
Pelvic MRI (levator morphology)Selected complex questions or research; not routine prolapse staging
Validated questionnaires (PFDI-20, PFIQ-7)Quantify symptom bother; assess response to treatment

A demonstrable prolapse does not routinely require imaging, cystoscopy or urodynamics before nonsurgical treatment. Investigate unexplained bleeding, a mass, retention or other concerning findings on their own merits.[1][4]

Nonsurgical Management​

Indications​

  • Asymptomatic prolapse: reassurance and education; observation appropriate
  • Symptomatic prolapse: first-line or preferred by patient; mandatory discussion for women desiring future pregnancy

Lifestyle measures and pelvic floor muscle training​

Address constipation and consider weight reduction when BMI exceeds 30; discuss reducing heavy lifting that aggravates symptoms. For symptomatic stage I–II prolapse, NICE recommends a supervised pelvic floor muscle training program for at least 16 weeks, continued if helpful. Training aims to improve symptoms and function; it is not a promise of anatomic reversal.[12]

Offer referral to pelvic floor physical therapy. Biofeedback/electrical stimulation is not required for every program. An August 2026 trial randomized 220 primiparous women with early postpartum prolapse; all had stage II prolapse at baseline, and 183 completed 24-month follow-up. Adding electrical stimulation/biofeedback did not establish better anatomic improvement or quality of life than supervised training alone, although muscle strength improved. Its postpartum population should not be generalized to postmenopausal surgical candidates.[6][8]

Vaginal Pessaries​

Pessaries are the principal nonsurgical intervention for symptomatic POP. They should be offered to all women as an alternative to surgery, including women who wish to defer surgery for future pregnancy; acceptance is a patient choice.[12]

Fitting and follow-up: more than one size or type may be needed. Choose a device that provides symptom relief, stays in position, permits voiding and fits the patient's sexual and self-care goals; stage alone does not determine fitting success. Discuss discharge, bleeding, expulsion and removal needs. Teach self-management when feasible and arrange clinic care when it is not.[12]

NICE advises removal at least every six months and six-monthly pessary-clinic review for women at increased risk because they cannot manage their own care; an earlier or more frequent review may be appropriate after fitting or with symptoms. Bleeding, pain, ulceration or difficulty voiding should prompt assessment rather than waiting for a scheduled review.[12]

Consider vaginal estrogen for associated GSM. In a 2025 placebo-controlled trial of 420 postmenopausal ring-pessary users, estrogen did not improve 12-month continuation with satisfaction (87.0% vs 86.7% among 411 analyzed); erosion/ulcer, bleeding and discharge were less frequent secondary outcomes. Estrogen is not required for every pessary user.[15]

PEOPLE trial (JAMA 2022): 440 women with symptomatic stage II or greater prolapse were randomized after a successful initial pessary fitting; one ineligible participant was excluded. At 24 months, improvement was reported by 132/173 (76.3%) assigned initially to pessary treatment and 132/162 (81.5%) assigned to surgery. Pessary treatment did not meet the prespecified 10-percentage-point noninferiority margin (one-sided lower confidence bound −12.7%; P=.16 for noninferiority). This result alone does not establish surgical superiority.[5]

118/218 (54.1%) assigned to pessary treatment crossed to surgery. The percentages therefore compare initial treatment strategies, not the success of continuing a pessary alone. Loss to follow-up and crossover limit interpretation; patients with previous prolapse/incontinence surgery or pessary use were excluded, and surgery did not include a concomitant SUI procedure. Discuss an initial pessary trial and the possibility of later surgery according to the patient's preferences.[5]

Surgical Management​

For step-by-step operative technique and comparative outcomes for each repair below, see the Prolapse Repair atlas.

General Indications and Principles​

Surgery is indicated when:

  • The patient is bothered by prolapse symptoms AND
  • Nonsurgical management has failed or has been declined

Pre-surgical planning must account for: compartments involved, severity of prolapse, patient comorbidities, desire for future vaginal intercourse, durability requirements vs. risk profile, prior repairs, and surgeon expertise.

Discuss outcomes using a defined procedure, endpoint and follow-up interval. Anatomic recurrence, recurrent bothersome bulge and repeat surgery are different outcomes.

Perioperative vaginal estrogen — EVA 2026​

EVA randomized 311 postmenopausal women scheduled for primary native-tissue prolapse repair; 293 underwent surgery and started the study cream. The 12-month primary patient-reported outcome was available for 210 women: improvement occurred in 97/106 (91.5%) with estriol versus 83/104 (79.8%) with placebo. Although statistically significant, the 11.7-percentage-point difference was below the trial's prespecified 15-point threshold for clinical relevance. Anatomy, composite success and reintervention did not differ significantly. Discuss a possible symptom benefit with the missing-outcome limitation; these findings do not establish a more durable repair. See the perioperative hormone evidence.[18]

Summary of Surgical Options​

ApproachProcedureIndicationKey Points
Vaginal — Native TissueAnterior colporrhaphyCentral cystocelePlication of pubocervical fascia; low morbidity
Paravaginal repairLateral (ATFP) cystoceleCan be performed vaginally or abdominally
Posterior colporrhaphy + perineorrhaphyRectocele, perineal deficiencyRisk of dyspareunia with over-plication
Enterocele repairEnterocele / sigmoidocelePeritoneal purse-string closure
Uterosacral ligament (USL) suspensionApical prolapseIncorporates Level I support; ureteral injury risk
Sacrospinous ligament fixation (SSLF)Apical prolapseVaginal apex attached to the sacrospinous ligament; counsel on buttock pain and neurovascular risk
Abdominal / RoboticSacrocolpopexySelected symptomatic apical prolapseAbdominal mesh attachment; open, laparoscopic or robotic
ObliterativeLeFort colpocleisis (partial)Advanced prolapse when future penetrative vaginal intercourse is not desiredDiscuss the permanent loss of vaginal penetrative function
Total colpocleisisVault prolapse when vaginal penetration is no longer desiredObliterative repair; discuss permanence and urinary function

Vaginal Native Tissue Repair​

Native-tissue repairs avoid an implanted mesh or graft. The appropriate vaginal suspension depends on the defect, risks and the patient's goals; absence of mesh does not mean absence of complications.

In E-OPTIMAL, five-year estimated composite failure was 61.5% after uterosacral suspension versus 70.3% after sacrospinous fixation (adjusted difference −8.8 percentage points; 95% CI −24.2 to 6.6). The original trial enrolled women with SUI and planned retropubic midurethral sling placement; 285 of 374 randomized women entered the extension, and 244 completed it. No significant difference between suspensions was detected, and symptoms remained improved despite many women meeting the trial's strict first-failure definition. This is not evidence that two thirds required reoperation or that the procedures are equivalent in all respects.[19]

When hysterectomy is performed for uterine prolapse, document how apical support will be restored; see the prolapse-repair principles and vaginal hysterectomy pages.

Abdominal Sacrocolpopexy​

Sacrocolpopexy attaches the vaginal apex to the anterior longitudinal ligament over the sacrum using mesh. It can be performed open, laparoscopically or robotically. See Sacrocolpopexy for operative principles, the ASPIRe trial and the limitations of platform comparisons.

Choosing sacrocolpopexy: discuss it alongside vaginal native-tissue suspension using the patient's compartment defects, prior repairs, sexual goals, comorbidities and preferences. Age, BMI or a prior failed repair alone do not mandate mesh. For post-hysterectomy vault prolapse, the 2023 Cochrane review found less prolapse awareness, recurrence and repeat surgery after sacral colpopexy than vaginal procedures. Evidence for superiority across all uterine-preserving comparisons was inconclusive.[12][16]

Counsel about mesh exposure, bowel and vascular complications, and operative burden. Follow the procedure-specific perioperative protocol; routine bowel preparation should not be inferred from the choice of sacrocolpopexy alone.

Colpocleisis (Obliterative Procedures)​

Colpocleisis closes the vaginal canal and is an effective option for selected patients who do not want future vaginal penetration, especially when comorbidity increases the burden of reconstructive surgery. It should not be presented as universally superior to every reconstructive operation.[12]

  • LeFort colpocleisis (partial): appropriate for women with uterus in situ
  • Total colpocleisis: performed in post-hysterectomy vault prolapse

Selection and counseling:

  • Advanced-stage prolapse (Stage III–IV)
  • No desire for future vaginal intercourse (must be confirmed and documented)
  • Significant comorbidities that make longer procedures higher risk

Preoperative counseling must explicitly address the permanent loss of vaginal penetrative function. Explore expectations, decisional certainty and possible future changes in sexual goals; age alone is not the indication.

Mesh and Grafts​

Abdominal Polypropylene Mesh (Sacrocolpopexy)​

  • Established role in apical repair, with mesh-specific risks requiring explicit counseling
  • Macroporous, monofilament type 1 polypropylene is the standard
  • Comparative benefit is clearest for post-hysterectomy vault prolapse; do not apply it to every uterine-preserving comparison
  • Exposure risk depends on mesh, concomitant hysterectomy and follow-up. A longitudinal total-hysterectomy/sacrocolpopexy cohort reported cumulative mesh exposure of 18/182 (9.9%) at a mean 5.3 years, including prior events; only 82 of the original 200 participants entered the second extension, and 56 had an examination. This is not a universal rate for every sacrocolpopexy.[17]

Native-tissue uterine preservation: 10-year SAVE-U update​

The August 2026 follow-up found apical surgical failure in 3/44 women after sacrospinous hysteropexy versus 7/49 after vaginal hysterectomy with uterosacral suspension (difference −6.6 percentage points; 95% CI −19.9 to 6.7). Only 93 of the original 208 randomized women contributed that primary endpoint. The small retained sample limits precision: a nonsignificant difference is not proof of equivalent long-term results. This is native-tissue evidence and must be kept separate from the mesh-assisted SUPeR comparison below.[14]

Transvaginal Mesh — FDA Actions and Current Status​

YearFDA Action
2008Public health notification — serious complications reported with transvaginal mesh for POP
2011Safety communication emphasizing serious complications
2016Transvaginal POP mesh reclassified as Class III
2019Ordered halt of sales of transvaginal mesh products for POP in the United States

Transvaginal POP mesh has a different benefit–harm profile and regulatory status from abdominal sacrocolpopexy mesh. Historical trial results do not establish a currently available US treatment option.[11]

US regulatory distinction: the 2019 order stopped sales and distribution of mesh products intended for transvaginal POP repair. It does not apply to abdominal sacrocolpopexy mesh or SUI slings. Historical or international uses should not be presented as routine currently available US treatment options.[11]

Ten-year SUPeR results (published online June 24, 2026). Vaginal mesh sacrospinous hysteropexy had fewer composite failures than vaginal hysterectomy with uterosacral suspension: 40% versus 53% among 175 analyzed participants (adjusted HR 0.64, 95% CI 0.41–1.00). Only 64% entered extended follow-up; patient-reported outcomes did not differ, and the durability advantage did not increase in years 6–10. This is evidence about the studied vaginal mesh procedure, not native-tissue hysteropexy or abdominal sacrohysteropexy. It does not reverse US restrictions on transvaginal mesh for POP.[10]

Biologic Grafts​

A biologic graft is not an automatic solution to infection risk or poor tissue quality. Evidence depends on the graft, compartment and operation; discuss native-tissue repair and other established alternatives rather than treating all grafts as interchangeable. NICE recommends anterior and posterior vaginal repairs without mesh and restricts transvaginal mesh repair to research in its guidance.[12]

Concomitant Anti-Incontinence Surgery​

2026 Cochrane update: 22 RCTs involving 3,095 women support discussing a concomitant midurethral sling for symptomatic or occult SUI; it probably reduces postoperative SUI, while adverse-effect estimates remain uncertain. A staged continence procedure is also reasonable. Evidence in women with neither overt nor occult SUI is less certain, so this is not a mandate for prophylactic slings.[9]

Before prolapse surgery, assess baseline continence and discuss de novo SUI. A prolapse-reduction stress test may help counselling; routine invasive urodynamics is not required solely because prolapse is present.[4][12] See Stress Urinary Incontinence (Female), Mixed Urinary Incontinence, and the Female SUI treatment database for procedure selection.

Decision Framework:

Pre-op SUI StatusRecommendation
Overt SUI (present with prolapse unreduced)Discuss concomitant anti-incontinence procedure (midurethral sling); counsel on added risks vs. persistent SUI
Occult SUI (present only with prolapse reduced)Discuss the increased risk of postoperative SUI, benefits/harms of a concomitant procedure and a staged option
No SUI (overt or occult)Counsel that de novo SUI may develop post-repair; concomitant procedure not routinely recommended but may be discussed

In OPUS, adding a retropubic midurethral sling to vaginal prolapse repair increased bladder perforation, UTI and incomplete-emptying events while reducing postoperative incontinence. These findings apply to the studied procedure and population; other continence operations have different harms. Discuss simultaneous versus staged treatment using baseline symptoms, testing, patient preference and the operation planned.[13]

Outcomes and Complications​

Recurrence and retreatment​

Record both symptoms and examination findings after treatment. A recurrent stage II finding does not necessarily require another operation. Duration of follow-up, the compartments repaired and the trial's failure definition explain much of the variation between published rates.[14][19]

Procedure-specific harms​

Counsel about infection, voiding dysfunction, new urinary or bowel symptoms, pain/dyspareunia, organ injury and repeat treatment. Uterosacral suspension carries ureteral risk; sacrospinous fixation carries buttock/nerve and vascular risks. Abdominal mesh repair adds potential mesh exposure, bowel/adhesion complications and rare sacral infection. Use the relevant technique page for the procedure's details rather than applying one complication percentage to all repairs.[12][17][19]

Arrange follow-up to assess healing, bladder emptying and symptoms. Persistent bleeding/discharge, fever, severe or new pain, or inability to void warrants assessment; delayed mesh problems may first appear years after surgery.[12][17]

Selected evidence​

OPUS · 2012[13]; SAVE-U · 10 years[14]; SUPeR · 10 years[10]. The comparison below preserves the study-specific population, denominator, endpoint and uncertainty.

Selected studies, not a systematic review. Outcomes and populations differ; percentages across studies should not be ranked as if they were directly comparable. These source checks do not record a clinician review of the full article.

Pelvic organ prolapse — key study comparisons
Study and populationComparison and resultsUse and limitations
OPUS · 2012

Women without symptomatic SUI, with anterior prolapse stage ≥2, undergoing vaginal prolapse repair.

Randomized n=337

Source and methods: OPUS · 2012
Source
Wei JT et al. A Midurethral Sling to Reduce Incontinence after Vaginal Prolapse Repair (2012). DOI: 10.1056/NEJMoa1111967
Design
Multicentre randomized sham-controlled trial
Denominators
327 (97%) completed 1-year follow-up.
Follow-up
12 months
Source access
Selected full-text methods/results and source metadata; checked 2026-09-11.
Corrections and retractions
No notice identified in the checked metadata. No linked correction/retraction notice found in the Europe PMC indexed record. This metadata check is not an exhaustive publisher review. Checked 2026-09-11.
Concomitant midurethral sling vs sham incisions

Urinary incontinence, allowing subsequent treatment · 12 months

27.3% with sling vs 43.0% without sling; number needed to treat 6.3.

Adjusted odds ratio 0.48; 95% CI 0.30–0.77.

Counsel about staged versus concomitant continence surgery using both prevention benefit and procedure-related harms.

  • Sling increased bladder perforation (6.7% vs 0%), UTI (31.0% vs 18.3%) and incomplete emptying at 6 weeks (3.7% vs 0%).
  • Vaginal-repair population; do not extrapolate directly to abdominal sacrocolpopexy.
SAVE-U · 10 years

Women with uterine descent stage ≥2; native-tissue sacrospinous hysteropexy.

Randomized n=208

Source and methods: SAVE-U · 10 years
Source
Oegema K et al. Sacrospinous Hysteropexy Versus Vaginal Hysterectomy in Women with Uterine Prolapse: 10-year Follow-up of a Randomised Controlled Trial (2026). DOI: 10.1007/s00192-026-06822-1
Design
Long-term follow-up of a randomized trial
Denominators
Primary 10-year outcome available in 93 women: 44 hysteropexy and 49 hysterectomy; 89 underwent examination. Earlier failures were incorporated.
Follow-up
10 years; published online August 13, 2026
Source access
Complete main article and tables; supplements assessed separately; checked 2026-09-12.
Corrections and retractions
No notice identified in the checked metadata. No linked correction/retraction notice found in the Europe PMC indexed record. This metadata check is not an exhaustive publisher review. Checked 2026-09-11.
Native-tissue sacrospinous hysteropexy vs vaginal hysterectomy with uterosacral suspension

Apical stage ≥2 plus bothersome bulge or repeat apical surgery · 10 years

3/44 (7%) vs 7/49 (14%).

Difference −6.6 percentage points; 95% CI −19.9 to 6.7; no statistically significant difference.

Provides native-tissue uterine-preservation counselling; do not combine its rates with the mesh-based SUPeR trial.

  • Fewer than half of the original randomized participants contributed the 10-year primary endpoint; wide intervals do not establish equivalence.
  • Published main text and all three tables read; the actual flow-diagram image and supplemental document remain unavailable for this check.
SUPeR · 10 years

Postmenopausal women with symptomatic uterovaginal prolapse at 9 US centres.

Randomized n=183

Source and methods: SUPeR · 10 years
Source
Nager CW et al. Sacrospinous Hysteropexy With Mesh vs Vaginal Hysterectomy for Treatment of Uterovaginal Prolapse: 10-Year Results of a Randomized Clinical Trial (2026). DOI: 10.1001/jamasurg.2026.2263
Design
Extended follow-up of a randomized trial
Denominators
175 eligible for intention-to-treat analysis (88 vs 87); 112 (64%) entered years 6–10 follow-up.
Follow-up
10 years; first online June 24, 2026 (August issue date)
Source access
Published abstract and source metadata; checked 2026-09-11.
Corrections and retractions
No notice identified in the checked metadata. No linked correction/retraction notice found in the Europe PMC indexed record. This metadata check is not an exhaustive publisher review. Checked 2026-09-11.
Sacrospinous hysteropexy with vaginal mesh vs vaginal hysterectomy with uterosacral suspension

Composite prolapse beyond hymen, symptoms or retreatment · Through 10 years

Failure 40% (35/88) vs 53% (46/87).

Adjusted hazard ratio 0.64; 95% CI 0.41–1.00; P=.05.

Historical mesh-assisted comparison; not evidence for native-tissue hysteropexy or a recommendation to use unavailable vaginal mesh.

  • Substantial attrition and loss of masking in years 6–10; no patient-reported outcome difference.
  • The vaginal mesh product is not currently marketed in the US.

See Also​

Videos​

Surgical Treatment of Pelvic Organ Prolapse
UAB Medicine
Native Tissue Approaches for Pelvic Organ Prolapse
Grand Rounds in Urology (2024)

References​

1. "Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214." Obstet Gynecol. 2019;134(5):e126-e142. doi:10.1097/AOG.0000000000003519

2. Deprest JA, Cartwright R, Dietz HP, et al. "International Urogynecological Consultation (IUC): Pathophysiology of POP." Int Urogynecol J. 2022;33(7):1699-1710. doi:10.1007/s00192-022-05081-0

3. Schulten SFM, Claas-Quax MJ, Weemhoff M, et al. "Risk Factors for Primary POP and Prolapse Recurrence." Am J Obstet Gynecol. 2022;227(2):192-208. doi:10.1016/j.ajog.2022.04.046

4. Barbier H, Carberry CL, Karjalainen PK, et al. "IUC Chapter 2 Committee 3: Clinical Evaluation of POP." Int Urogynecol J. 2023;34(11):2657-2688. doi:10.1007/s00192-023-05629-8

5. van der Vaart LR, Vollebregt A, Milani AL, et al. "Effect of Pessary vs Surgery on Patient-Reported Improvement: PEOPLE Trial." JAMA. 2022;328(23):2312-2323. doi:10.1001/jama.2022.22385

6. Sung VW, Jeppson P, Madsen A. "Nonoperative Management of POP." Obstet Gynecol. 2023;141(4):724-736. doi:10.1097/AOG.0000000000005121

7. 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):10-17. PMID:8694033

8. Li M, Lyu Y, Li P, et al. "Long-Term Effects of Pelvic Floor Muscle Training Combined With Electrical Stimulation Biofeedback Among Women With Symptomatic Pelvic Organ Prolapse: A Randomised Controlled Trial." BJOG. Published online August 12, 2026. doi:10.1111/1471-0528.70313

9. Baessler K, Christmann-Schmid C, Haya N, et al. "Surgery for women with pelvic organ prolapse with or without stress urinary incontinence." Cochrane Database Syst Rev. 2026;2:CD013108. doi:10.1002/14651858.CD013108.pub2

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