Physiological Reconstruction for Moderate-Severe Pelvic Organ Prolapse: A Multicenter Retrospective Self-Controlled Study.

Objective: This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.

Methods: From December 2014 to August 2021, 517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions. We enrolled 364 women with POP-Q stage ≥ 3. The degree of POP was quantified via a POP-Q system. The surgical purpose of physiological reconstruction is to repair the vagina, levator ani muscle, perineum, and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology. All 330 evaluable participants were followed for 2 years. The evaluation indices included the PFDI-20, PGI-I, PFIQ-7, PISQ-12, PGI-I, and PGI-S. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and International Continence Society (ICS).

Results: Compared with the preoperative POP-Q scores, statistically significant improvements were observed at the 6-month, 1-year and 2-year time points (P < 0.001). Statistically significant improvements in quality of life were observed across all time points.

Conclusions: Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape, which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch. This surgical method is safe, feasible, and effective in patients with severe prolapse.