Defining Success After Surgery for Pelvic Organ Prolapse
Open accessAbstract
OBJECTIVES: To describe pelvic organ prolapse surgical success rates using a variety of definitions with differing requirements for anatomic, symptomatic, or re-treatment outcomes. METHODS: Eighteen different surgical success definitions were evaluated in participants who underwent abdominal sacrocolpopexy within the Colpopexy and Urinary Reduction Efforts trial. The participants' assessments of overall improvement and rating of treatment success were compared between surgical success and failure for each of the definitions studied. The Wilcoxon rank sum test was used to identify significant differences in outcomes between success and failure. RESULTS: Treatment success varied widely depending on definition used (19.2-97.2%). Approximately 71% of the participants considered their surgery "very successful," and 85.2% considered themselves "much better" than before surgery. Definitions of success requiring all anatomic support to be proximal to the hymen had the lowest treatment success (19.2-57.6%). Approximately 94% achieved surgical success when it was defined as the absence of prolapse beyond the hymen. Subjective cure (absence of bulge symptoms) occurred in 92.1% while absence of re-treatment occurred in 97.2% of participants. Subjective cure was associated with significant improvements in the patient's assessment of both treatment success and overall improvement, more so than any other definition considered (P<.001 and <.001, respectively). Similarly, the greatest difference in symptom burden and health-related quality of life as measured by the Pelvic Organ Prolapse Distress Inventory and Pelvic Organ Prolapse Impact Questionnaire scores between treatment successes and failures was noted when success was defined as subjective cure (P<.001). CONCLUSION: The definition of success substantially affects treatment success rates after pelvic organ prolapse surgery. The absence of vaginal bulge symptoms postoperatively has a significant relationship with a patient's assessment of overall improvement, while anatomic success alone does not. LEVEL OF EVIDENCE: II.
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There is a consensus that the absence of vaginal bulge symptoms should be included in the definition of composite success, since this absence has a strong relationship with patients' assessment of overall improvement.
“Despite the lack of an internationally accepted definition, there is nowadays a consensus that the absence of vaginal bulge symptoms should be included in the definition of composite success, since this absence has a strong relationship with patients’ assessment of overall improvement [15].”
From The External Validation of a Multivariable Prediction Model for Recurrent Pelvic Organ Prolapse After Native Tissue Repair: A Prospective Cohort Study (2025) · cites this paper as [15]
The Results and Discussion report a strong relationship between absence of vaginal bulge symptoms and patients’ assessment of overall improvement, and recommend including symptom absence in a definition of success. The Discussion calls this an argument for a future consensus definition; it does not establish that a consensus already exists. Page numbers are not provided in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredOutcome definitions focused on apical support tend to correlate better with subjective cure.
“outcome definitions focused on apical support tend to correlate better with subjective cure.38”
From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [38]
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- Authors
- Barber, M. D., Brubaker, L., Nygaard, I., Wheeler, T. L., Schaffer, J., Chen, Z., & Spino, C.
- Affiliations
- Cleveland Clinic (US)
- Loyola University Chicago (US)
- University of Utah (US)
- University of Alabama at Birmingham (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2009-09
- Volume
- 114
- Issue
- 3
- Pages
- 600-609
- ISSN
- 0029-7844 (ISSN-L)
- PMC
- PMC2904469
- OpenAlex
- W2070502906
- Cited by
- 515
- References
- 31
- Citations by year
- 2026: 24 · 2025: 19 · 2024: 25 · 2023: 34 · 2022: 27 · 2021: 34 · 2020: 38 · 2019: 37 · 2018: 38 · 2017: 32 · 2016: 33 · 2015: 23 · 2014: 27 · 2013: 36 · 2012: 37
- FWCI
- 20.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U10 HD 54215, U10 HD54241, U10 HD41267, U10 HD41261, U10HD041268, U01-HD41249, U10 HD 54214, U10HD041261, U10HD054136, U10HD054214, U10 HD 41250, U01HD041249, U10HD054215, U10HD041263, U10 HD 54136, U10HD041267, U10HD054241, U10HD041248, U10HD041269, U10HD041250, UG1HD041267)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- pelvic organ prolapse, sacrocolpopexy, anatomical success, retreatment, patient-reported outcomes, health-related quality of life
- MeSH terms
- Adult, Female, Follow-Up Studies, Humans, Quality of Life, Surgical Mesh, Uterine Prolapse, Visceral Prolapse, Patient Satisfaction, Outcome Assessment, Health Care, Pelvic Floor, Retreatment
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