How Can We Improve the Assessment and Indifferent Outcomes From Pelvic Organ Prolapse Management From Conservative and Surgical Therapies? ICI‐RS 2025

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INTRODUCTION: Pelvic organ prolapse is a common condition and many women seek surgical treatment for prolapse symptoms. However, recurrence of prolapse after surgical treatment is common. A think tank was held at ICI-RS 2025 to discuss how the assessment and indifferent results from conservative and surgical management can be improved. METHODS: Data were collected and presented on identification of women at risk of prolapse recurrence after surgery, understanding patient goals and expectations, optimising lifestyle interventions, pelvic floor muscle training, pessary management, and surgical care. Discussions identified knowledge gaps and proposed research studies that could advance knowledge to improve treatment outcomes. RESULTS: There is insufficient information to understand the assessment of prolapse treatment outcomes; examination findings do not necessarily correlate with symptoms. Further research is needed to understand if patient-reported goal attainment is superior to patient-reported outcome measures, including measures of patient satisfaction. There is insufficient information on the value of lifestyle adjustments and pelvic floor muscle training as prehabilitation to improve surgical outcomes. The place of pessary management in an optimally integrated prolapse treatment pathway is unclear and the role that pessaries may have in anatomical modelling of prolapse is not fully understood. Further research into adjuncts to improve native tissue repair as alternatives to polypropylene mesh is needed to optimise surgical outcome. CONCLUSION: Further research into understanding what represents treatment, cure, and optimising conservative and surgical treatments is of high priority to improve pelvic organ prolapse treatment outcomes. The utility of preoperative rehabilitation requires investigation. Developing an optimised pessary care pathway and continued surgical innovation are required to ensure progress in reducing prolapse symptom recurrence.

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