To pull or not to pull, that is the question…how should we define prolapse?

Excerpt

Eleven per cent of women will at some stage in their lives undergo an operation for uterovaginal prolapse or incontinence [1, 2]. With an ageing population, and the desire for women to remain active and free from symptoms of prolapse, it is probable that the demand for urogynaecological surgery will increase. Over the last decade, debate has occurred about the best surgical treatment for uterovaginal prolapse, comparing alternative operations. In this debate, there is an assumption that data collected in one unit, concerning the degree of prolapse present in the women undergoing surgery, are comparable to the data acquired in another unit. What has perhaps not been discussed enough is the standardised examination of the support to the vagina, cervix, and uterus, and an agreement reached as to what constitutes symptomatic prolapse. Recent editorials have been written about how to best define pelvic organ prolapse based on symptoms, and identifying a Pelvic Organ Prolapse Quantification (POPQ) examination point beyond which subjects can be said to have symptomatic prolapse. Except for recommending the POPQ system, there has been very little mention about how to standardise the examination of the patient, and thus arrive at the POPQ values [3‐5]. …