Recommendations of The Polish Society of Obsterics and Gynaecology regarding prevention and treatment of pelvic organ prolapse and urinary incotinence in patients qualified to hysterectomy

Abstract

Abstract To develop guidelines regarding prevention and treatment of pelvic organ prolapse and stress urinary incontinence in patients qualified to hysterectomy. The Polish Gynecological Society formed a work group to develop guidelines. The work group formulated the following guidelines: 1. Since the hysterectomy per se is a risk factor for pelvic organ prolapse, more conservative procedures to hysterectomy should be considered and applied, whenever it is possible. 2. Pelvic organ prolapse is not the indication for hysterectomy. 3. Not all lesions of the uterine cervix without concomitant pathological changes of the uterine corpus are indications for hysterectomy. 4. During both abdominal and laparoscopic hysterectomy the fixation of vaginal vault to sacro-uterine and round ligaments, McCall procedure, Burch procedure and paravaginal defect repair should be done as a prevention or treatment of pelvic organ prolapse. 5. During vaginal hysterectomy, sacrospinal colpopexy or McCall procedure is recommended. 6. In cases of hysterectomy performed due to oncological indications, prophylactic fixation of the vaginal vault to sacro-uterine and round ligaments is recommended. In these cases, the repair of the defects of DeLancey second and third level are not recommended because of postradiotherapy vaginal vault shortening and stenosis. In most of oncological indications for hysterectomies, the surgical treatment of stress urinary incontinence should be postponed until the radiotherapy has been completed.