Can Vaginal Hysterectomy be Left for the Treatment of Advanced Stage of Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) is the downward shift of pelvic organs, resulting in protrusion of the vagina, uterus or both. POP is a problem usually seen in older women and affects quality of life significantly. According to the classification system of pelvic organ prolapse developed by International Continence Society, patients are classificated in 4 stages- without pelvic organ prolapse- stage 0, the most distal portion has descended 1 cm above the hymen- stage 1, the most distal portion has descended 1 cm below or above the hymenstage 2, the most distal portion has descended more than 1 cm below the hymen- stage 3, all the lower urogenital system is outside- stage 4 [1]. Today, stage 1 and 2 cases are common, stage 3 is rarely seen, and stage 4 cases are very uncommon [2]. A population-based study of 1004 female patients revealed that 24% of cases were in Phase 0, 38% in Phase 1, 35% in Phase 2 and 2% were in Phase POP [3]. POP surgery aims to reconstruct the anatomic damage and repair bladder, bowel and sexual function. Moreover, the object of POP surgery is also to raise patients’ satisfaction and life standard and prevent possible complications. A variety of abdominal and vaginal approach procedures were defined in POP surgery. Mesh is applied in some approaches, whilst natural tissue is used in others. We have purposed to present a stage 4 POP case, who had applied to various centers, and whose treatment was delayed because of an inability to treat. This case study also addressed that the use of vaginal hysterectomy, in some cases, may be more advantageous then vaginal mesh. It also pointed out that applying a mesh procedure is not a purely harmless approach, and may cause a variety of severe complications.