Development of a personalized algorithm for managing women with pelvic organ prolapse and associated gynecologic conditions
DOI:
https://doi.org/10.37800/RM.4.2025.599Keywords:
pelvic organ prolapse (POP), laparoscopic-assisted vaginal hysterectomy, quality of life (QoL), individualized approach, recurrence, gynecologic pathology, women’s healthAbstract
Relevance: Pelvic organ prolapse (POP) is one of the most frequent pelvic floor disorders among peri- and postmenopausal women, leading to progressive descent of pelvic structures, discomfort, urinary and sexual dysfunction, and a decline in overall quality of life (QoL). POP remains a major cause of morbidity in this population. The previous study compared the outcomes of various surgical methods for prolapse correction in middle-aged and older women for developing a personalized algorithm. This paper extends the research by focusing on the development and validation of a personalized clinical algorithm designed to optimize surgical decision-making and improve long-term outcomes.
This study aimed to design and validate a clinical algorithm for personalized management of women with pelvic organ prolapse and concomitant gynecologic pathology to reduce recurrence and improve the outcomes and quality of life.
Materials and Methods: This retrospective-prospective observational study included 195 women aged 45-70 years with POP who underwent a clinical examination, POP-Q staging, ultrasound, MRI, and laboratory tests. The main group (n = 137) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and the control group (n = 58) received conventional vaginal hysterectomy (VH). Surgical correction was combined with the removal of associated gynecologic conditions and pelvic floor reconstruction. QoL was assessed using the P-QOL and ICIQ-VS questionnaires. Statistical analysis was performed using IBM SPSS Statistics v25.
Results: Surgical management significantly improved both anatomical and functional outcomes. Six months after surgery, complete pelvic floor restoration was achieved in 96.35% of LAVH and 89.66% of VH patients (p = 0.064). Excellent self-assessed results were reported by 53.5% of LAVH and 28.9% of VH patients. The recurrence rate was 0.73% and 5.17%, respectively.
Conclusion: Introduction of a personalized surgical approach integrating laparoscopic-assisted methods with structured quality-of-life assessment enhances treatment effectiveness, minimizes recurrence, and promotes physical and psychosocial recovery in women with POP.
References
1. Robinson D, Prodigalidad LT, Chan S, Serati M, Lozo S, Lowder J, Ghetti C, Hullfish K, Hagen S, Dumoulin C. Patients’ perception of disease burden of pelvic organ prolapse. Int Urogynecol J. 2022;33(2):189–210.
https://doi.org/10.1007/s00192-021-04997-3
2. Harvey M-A, Chih H-J, Geoffrion R, Amir B, Bhide A, Miotla P, Rosier P-F-W-M, Offiah I, Pal M, Alas A-N. Relationship of pelvic organ prolapse to associated pelvic floor dysfunction symptoms. Int Urogynecol J. 2021;32(10):2575–2594.
https://doi.org/10.1007/s00192-021-04941-5
3. Deffieux X, Perrouin-Verbe MA, Campagne-Loiseau S, Donon L, Levesque A, Rigaud J, Stivalet N, Venara A, Thubert T, Vidart A, Bosset PO, Revel-Delhom C, Lucot JP, Hermieu JF. Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice. Eur J Obstet Gynecol Reprod Biol. 2024 Mar; 294:170-179.
https://doi.org/10.1016/j.ejogrb.2024.01.015
4. Barbier H, Carberry CL, Karjalainen PK, Mahoney CK, Galán VM, Rosamilia A, Ruess E, Shaker D, Thariani K. International Urogynecology consultation chapter 2 committee 3: the clinical evaluation of pelvic organ prolapse including investigations into associated morbidity/pelvic floor dysfunction. Int Urogynecol J. 2023 Nov;34(11):2657-2688.
https://doi.org/10.1007/s00192-023-05629-8
5. Bø K, Anglès-Acedo S, Batra A, Brækken IH, Chan YL, Jorge CH, Kruger J, Yadav M, Dumoulin C. International Urogynecology Consultation chapter 3 committee 2; conservative treatment of patients with pelvic organ prolapse: Pelvic floor muscle training. Int Urogynecol J. 2022 Oct;33(10):2633-2667.
https://doi.org/10.1007/s00192-022-05324-0
6. Simoncini T, Panattoni A, Cadenbach-Blome T, Caiazzo N, García MC, Caretto M, Chun F, Francescangeli E, Gaia G, Giannini A, Hegenscheid L, Luisi S, Mannella P, Mereu L, Montt-Guevara MM, Ñiguez I, Ritter R, Russo E, Ferrer MLS, Tammaa A, Uhl B, Wiedemann B, Wilczak M, Pauli F, Dubuisson J. Role of lateral suspension for the treatment of pelvic organ prolapse: a Delphi survey of expert panel. Surg Endosc. 2024 Aug;38(8):4344-4352.
https://doi.org/10.1007/s00464-024-10917-5
7. Robinson MO, Linder BJ. Evaluation and treatment of pelvic organ prolapse. Minerva Med. 2023 Aug;114(4):516-528.
https://doi.org/10.23736/s0026-4806.22.08396-3
8. Raju R, Linder BJ. Evaluation and Management of Pelvic Organ Prolapse. Mayo Clin Proc. 2021 Dec;96(12):3122-3129.
https://doi.org/10.1016/j.mayocp.2021.09.005
9. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013 Apr 30;(4): CD004014. https://doi.org/10.1002/14651858.CD004014.pub5.
Update in: Cochrane Database Syst Rev. 2016 Nov 30;11:CD004014.
https://doi.org/10.1002/14651858.CD004014.pub6
10. Мейрманова А., Омарова Г., Бегниязова Ж., Юлдашева А., Уалиева А., Велиева А., Диамбекова Л., Хампиева Л., Нашекенова З. Индивидуальный подход в хирургическом лечении генитального пролапса у женщин: сравнительный анализ методов и результаты лечения. Репродуктивная медицина (Центральная Азия). 2024;4:122-129.
Meirmanova А, Omarova G, Begniyazova Zh, Yuldasheva А, Ualiyeva А, Veliyeva А, Diambekova L, Khampiyeva L, Nashekenova Z. Individual approach in surgical treatment of genital prolapse in women: comparative analysis of methods and treatment results. Reproductive Medicine (Central Asia). 2024;4:122-129. Russian.
https://doi.org/10.37800/RM.4.2024.432
11. Meirmanova A, Omarova G, Kurmanova A, Begniyazova Z, Yuldasheva A. Surgical management of genital prolapse and combined gynecological pathologies in women: A meta-analysis. Electron J Gen Med. 2023;20(2): em446.
https://doi.org/10.29333/ejgm/12793
12. Geoffrion R, Larouche M. Guideline No. 413: Surgical Management of Apical Pelvic Organ Prolapse in Women. J Obstet Gynaecol Can. 2021 Apr;43(4):511-523.e1. https://doi.org/10.1016/j.jogc.2021.02.001
13. Malanowska E, Soltes M, Starczewski A, Petri E, Jozwik M. Laparoscopic approach to pelvic organ prolapse - the way to go or a blind alley? Wideochir Inne Tech Maloinwazyjne. 2019 Dec;14(4):469-475.
https://doi.org/10.5114/wiitm.2019.88749
14. Pesebre AR, Nomura M, Soliza DY, Ruanphoo P, Kuriyama M, Obuchi T, Nagae M, Tokiwa S, Nishio K, Hayashi T. Various Laparoscopic Techniques in Pelvic Organ Prolapse Surgery. Gynecol Minim Invasive Ther. 2024 Jul 18;13(3):180-183.
https://doi.org/10.4103/gmit.gmit_113_23
15. Naldini G, Fabiani B, Sturiale A, Simoncini T. Complex pelvic organ prolapse: decision-making algorithm. Int J Colorectal Dis. 2019 Jan;34(1):189-192.
https://doi.org/10.1007/s00384-018-3149-9
16. Ko KJ, Lee KS. Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes. Investig Clin Urol. 2019 Nov;60(6):413-424.
https://doi.org/10.4111/icu.2019.60.6.413
17. Wang YT, Jiang JY, Han JS. A review of the pelvic organ prolapse quantification system in China. Int Urogynecol J. 2016 Feb;27(2):287-90.
https://doi.org/10.1007/s00192-015-2830-6
18. Oliveira MBM, Mendes F, Martins M, Cardoso P, Fonseca J, Mascarenhas T, Saraiva MM. The Role of Artificial Intelligence in Urogynecology: Current Applications and Future Prospects. Diagnostics (Basel). 2025 Jan 24;15(3):274.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 A.О. Мейрманова, Г.К. Омарова, Ж.О. Бузумова, Ж.С. Бегниязова, Э.А. Махмутова, Ж.У. Базарбаева
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The articles published in this Journal are licensed under the CC BY-NC-ND 4.0 (Creative Commons Attribution – Non-Commercial – No Derivatives 4.0 International) license, which provides for their non-commercial use only. Under this license, users have the right to copy and distribute the material in copyright but are not permitted to modify or use it for commercial purposes. Full details on the licensing are available at https://creativecommons.org/licenses/by-nc-nd/4.0/.
