Abstract

Pelvic organ prolapse (POP) is a common benign condition in women that can impair urinary, bowel, and sexual function and adversely affect quality of life. However, consensus on its surgical management remains limited. This structured narrative review examined literature published between 1990 and 2026. PubMed, Scopus, the Cochrane Library, official websites of professional organizations, and reference lists of relevant clinical practice guidelines were searched. Recommendations were compared across key clinical areas, including anterior, posterior, and apical prolapse, mesh use, concomitant treatment of urinary incontinence, and emerging surgical techniques.

The reviewed guidelines generally favor native-tissue vaginal repair for primary anterior and posterior prolapse. Most international organizations favor sacrocolpopexy with uterine preservation for abdominal treatment of apical prolapse. Although the US Food and Drug Administration (FDA) ordered the cessation of the sale and distribution of transvaginal mesh products for pelvic organ prolapse repair in 2019, mesh remains relevant to selected pelvic floor reconstructive procedures, particularly those involving compartments other than the posterior compartment. Uterine preservation is generally favored when clinically appropriate. However, consensus remains lacking on whether urinary incontinence should be treated concomitantly with prolapse surgery or in a staged procedure. Emerging techniques, including pectopexy, nerve-sparing surgery, and robotic surgery, show potential benefits, although further evaluation is needed.