Complex pelvic organ prolapse: decision-making algorithm

Purpose: The pelvic floor is considered as a single anatomical and functional unit, consisting of several structures that suspend the pelvic organs maintaining their function. For this reason, a multi-compartmental prolapse is a common disease that needs a multidisciplinary pelvic floor team in order to be treated. The aim of the authors is to suggest a treatment algorithm to better approach complex pelvic organ prolapse. Methods: A multidisciplinary pelvic floor team was set up 7 years ago. Starting from the literature review integrated with a team experience, a decision-making algorithm was drawn up. It was used to guide all the shared treatment for the complex pelvic floor disorders. Results: An accurate preoperative assessment with a shared diagnosis among the specialist is the base to follow the proposed algorithm. It leads to combine different surgical procedures considering advantages and disadvantages which may have an influence on the final outcome. Conclusions: The proposed algorithm provides an integrated surgical view of complex pelvic floor disorders. It shows how is it feasible to associate surgical treatments of different compartments to obtain good pelvic floor anatomical and functional results and leading to an improvement of the patients’ quality of life.