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Review
. 2020 Jan/Feb;26(1):30-36.
doi: 10.1097/SPV.0000000000000591.

Summary: 2017 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse

Christopher F Maher  1 , Kaven K Baessler  2 , Matthew D Barber  3 , Cecilia Cheon  4 , Esther C J Consten  5 , Kevin G Cooper  6 , Xavier Deffieux  7 , Viviane Dietz  8 , Robert E Gutman  9 , Jan J van Iersel  10 , Charles W Nager  11 , Vivian W Sung  12 , Renaud de Tayrac  13
Affiliations
Review

Summary: 2017 International Consultation on Incontinence Evidence-Based Surgical Pathway for Pelvic Organ Prolapse

Christopher F Maher et al. Female Pelvic Med Reconstr Surg. 2020 Jan/Feb.

Abstract

Objective: The aim of this article is to summarize the relevant findings that inform the 2017 International Consultation on Incontinence pathway for surgical treatment of pelvic organ prolapse (POP).

Methods: We conducted an evidence-based review of the English-language peer-reviewed literature relating to POP surgery published prior to December 2016. Level 1 evidence (randomized controlled trials [RCTs] or systematic reviews of RCTs) was preferred; however, level 2 (poor-quality RCT, prospective cohort studies) or 3 evidence (case series or retrospective studies) has been included if level 1 data were lacking. The committee evaluated the literature and made recommendations based on the Oxford grading system summarized as follows: grade A recommendation usually depends on consistent level 1 evidence; grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs; grade C recommendation usually depends on level 3 studies or "majority evidence" from level 2/3 studies or Delphi-processed expert opinion; grade D, "no recommendation possible," would be used where the evidence is inadequate or conflicting.

Results: The recommendations from each chapter of the review are presented and serve to inform an evidence-based pathway for the surgical treatment of prolapse. A Web-based interactive application of the pathway is presented.

Conclusions: The 2017 International Consultation on Incontinence pathway on surgery for POP is designed as an adjunct to transparent consultation and consent relating to POP surgery. The final decision regarding surgical intervention can be made only after a shared decision-making process between the patient and the clinician that will evaluate a variety of individual factors that cannot be assessed in the pathway.

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References

    1. Maher C, Baessler K, Cheong C, et al. Surgical management of pelvic organ prolapse. In: Abrams P, Cardozo L, Wagg A, et al. ed. International Consulatation on Incontinence. 6th ed. Bristol, UK: ICUD ICS 2017:1855–1992.
    1. Luber KM, Boero S, Choe JY. The demographics of pelvic floor disorders: current observations and future projections. Am J Obstet Gynecol 2001;184(7):1496–1501, discussion 501–503.
    1. Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. women. Obstet Gynecol 2014;123(1):141–148.
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