ICI 2017 Pathway prolapse surgery


 

The following pathway is meant as an evidence based guide developed by leading and internationally recognised Gynaecologist and Colorectal surgeons to offer guidance to both clinicians and patients.  The green lines demonstrate preferred options for treatment and the yellow represent reasonable options. 

You should recognise the pathway is only guidance and is no substitute for one-on-one consultation with your specialist who is best placed to individualise your care and treatment.

An interactive version can also be found HERE.

 

The chart below can be used by clicking on any of the cells, a window will display further information. To exit this window either click on the X in the top right or click anywhere outside the window.

 

   
POP Surgery
 
Bladder function
Bowel
function
Risk of
recurrent prolapse
 
     
   
 
Reconstructive surgery
     
Obliterative surgery
   
           
 
Apical support
   
Anterior
support
Posterior support
     
     
Vault
 
Uterine
 
Graft repair
Suture repair
   
       
 
Hysterectomy ±BSO
 
Hysteropexy
 
   
         
Vaginal hysterectomy
Sub-total hysterectomy ASC
ASC + hysterectomy
Vaginal SS hysteropexy
Sacral hysteropexy
 
   
LSC + repair
Sacrospinous colpopexy
Uterosacral colpopexy
     

Preferred Option
Possible Pathway
Further Data Required

Summary of pathway findings:

• Obliterative surgery is a safe and efficacious option for the elderly or medically compromised who are happy to sacrifice sexual activity.

• In reconstructive surgery consider addition of apical support to both anterior and posterior vaginal repair

• The vaginal native tissue repair (sutures) is the preferred treatment of anterior vaginal prolapse

• The vaginal native tissue repair (sutures) is the preferred treatment of posterior vaginal prolapse (rectocele)   

• In those with post-hysterectomy (vault) prolapse sacral colpopexy is the preferred apical option with vaginal based colpopexy being a reasonable alternative.

• In those with uterine prolapse hysterectomy and hysteropexy (uterine preservation) are both reasonable options however based solely on medical grounds the vaginal hysterectomy with apical support is the preferred option. 

• Bilateral salpingo-oopherectomy (BSO) should be discussed at the time of hysterectomy in post-menopausal women.

• At prolapse surgery, those with pre-operative urinary stress incontinence and occult stress urinary incontinence should consider concomitant continence surgery.