Systematic review of definitions for success in pelvic organ prolapse surgery

Kowalski, Joseph T.; Mehr, Allen; Cohen, Evan; Bradley, Catherine S.

doi:10.1007/s00192-018-3755-7

Cited by 34Pelvic floor disorders treatmentsUterine Myomas and TreatmentsSexual function and dysfunction studies

Systematic review of definitions for success in pelvic organ prolapse surgery

Kowalski, Joseph T., Mehr, Allen, Cohen, Evan, Bradley, Catherine S.·2018·International Urogynecology Journal

DOI 10.1007/s00192-018-3755-7

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Abstract

Introduction and hypothesis The current literature on pelvic organ prolapse (POP) employs wildly varying definitions of surgical success. Understanding which definitions of success have been used and how these may impact reported outcomes is critical. Therefore, we performed a systematic review to identify and summarize these definitions and how they have changed over time.Materials and methods A PubMed search was performed for studies reporting POP surgical outcomes (1996 and later). Inclusion criteria were: original research, English, adult women with POP, nonobliterative surgical treatment, comparison group, reported prolapse-specific outcomes, and clear definition of treatment success. This definition was categorized according to presence of anatomic, subjective, retreatment, or other components and whether these components were evaluated individually or in a composite definition (in which all components must be present for success).Results One-hundred forty articles were included. The number of included studies increased over time (r = 0.90, p < 0.00001). Ninety-five studies (67.9%) reported an anatomic-only definition of success, 43 (30.7%) included a subjective component to their definition of success, and 23 (16.4%) reported a composite definition of success, including 11 (7.9%) containing anatomic, symptomatic, and retreatment components. The most common definition of anatomic success was Pelvic Organ Prolapse Quantification (POP-Q) stage ≤ 1. The report of a significant difference between treatment groups (positive study) was most common in studies using an anatomic-only definition of success (p = 0.037).Conclusion The number of comparative studies evaluating POP surgical outcomes has increased from 1996 to 2016. Most use definitions of success based solely on anatomic criteria despite increasing awareness of the importance of reporting subjective outcomes and retreatment rates.

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Bump, R. C., Mattiasson, A., Bø, K., Brubaker, L. P., DeLancey, J. O. L., Klarskov, P., Shull, B. L., & Smith, A. R. B. (1996) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(96)70243-0 · Cited by 4,275 · see citing works
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Colombo, M., Vitobello, D., Proietti, F., & Milani, R. (2000) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2000.tb13276.x · Cited by 147 · see citing works
An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse
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Vaginal Descent and Pelvic Floor Symptoms in Postmenopausal Women
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Levy, G., Beck, A., From, A., & Krissi, H. (2019) · Gynecology & Reproductive Health · doi:10.33425/2639-9342.1093 · Cited by 1 · see citing works
Preoperative assessment and prediction of pelvic prolapse surgery outcome
Egorov, V. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-85161-9.00011-7
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Noor, S., Shahnaj, S., Sultana, A., Jamal, M., Farjana, S., & Jabin, T. (2023) · Bangladesh Journal of Obstetrics & Gynaecology · doi:10.3329/bjog.v37i2.68797
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Success and failure are dynamic, recurrent event states after surgical treatment for pelvic organ prolapse
Jelovsek, J. E., Gantz, M. G., Lukacz, E., Sridhar, A., Zyczynski, H., Harvie, H. S., Dunivan, G., Schaffer, J., Sung, V., Varner, R. E., et al. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2020.10.009 · Cited by 28 · see citing works
Defining Success After Surgery for Pelvic Organ Prolapse
Barber, M. D., Brubaker, L., Nygaard, I., Wheeler, T. L., Schaffer, J., Chen, Z., & Spino, C. (2009) · Obstetrics & Gynecology · doi:10.1097/aog.0b013e3181b2b1ae · Cited by 515 · see citing works
International urogynecological consultation chapter 4.1: definition of outcomes for pelvic organ prolapse surgery
Kowalski, J. T., Barber, M. D., Klerkx, W. M., Grzybowska, M. E., Toozs-Hobson, P. M., Rogers, R. G., & Milani, A. L. (2023) · International Urogynecology Journal · doi:10.1007/s00192-023-05660-9 · Cited by 29 · see citing works
Self-citation
How is Subjective Surgical Success Defined Using the Pelvic Floor Distress Inventory (PFDI-20) After Primary Uterovaginal Prolapse Repair? A Systematic Review and Consensus Statements from the U-POP & LUTD 2026 Global Consensus Conference
Ruffolo, A. F., Duong, M., Cheng, L., Serati, M., Dieter, A. A., & Haraki, A. S. E. (2026) · International Urogynecology Journal · doi:10.1007/s00192-026-06896-x
Epidemiology and outcome assessment of pelvic organ prolapse
Barber, M. D., & Maher, C. (2013) · International Urogynecology Journal · doi:10.1007/s00192-013-2169-9 · Cited by 767 · see citing works

Authors: Kowalski, J. T., Mehr, A., Cohen, E., & Bradley, C. S.
Affiliations: University of Iowa Hospitals and Clinics (US)
University of Iowa (US)
Corresponding author: Kowalski, Joseph T.
ORCID: Kowalski, Joseph T.
Mehr, Allen
Bradley, Catherine S.
Venue: International Urogynecology Journal
Publisher: Springer Science and Business Media LLC
Published: 2018-08-24
Volume: 29
Issue: 11
Pages: 1697-1704
ISSN: 0937-3462 (ISSN-L)
1433-3023
DOI: 10.1007/s00192-018-3755-7
OpenAlex: W2888500589
Cited by: 31
References: 14
Citations by year: 2026: 2 · 2025: 5 · 2024: 4 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 3 · 2019: 3 · 2016: 1
FWCI: 0.46
Type: journal article
Language: en
Open access: closed
Licence: www.springer.com/tdm (tdm)
Locations: International Urogynecology Journal (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
Keywords: pelvic organ prolapse, anatomical success, subjective outcomes, retreatment, POP-Q staging, surgical outcomes reporting
MeSH terms: Female, Humans, Gynecologic Surgical Procedures, Treatment Outcome, Outcome Assessment, Health Care, Pelvic Organ Prolapse

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Systematic review of definitions for success in pelvic organ prolapse surgery

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