When should I consider referring a patient with pelvic organ prolapse for surgical intervention?

Consider referring a patient with pelvic organ prolapse (POP) for surgical intervention if:

• The woman’s symptoms have not improved with, or she has declined, non-surgical treatment options such as pelvic floor muscle training, pessaries, or lifestyle modifications.
• She has bothersome urinary symptoms for which surgery is an option.
• There are symptoms of obstructed defaecation or faecal incontinence that may require specialist assessment.
• She experiences pain or symptoms not explained by examination findings.
• The woman prefers surgical management after discussing the benefits, risks, and alternatives including no treatment.

Before surgery, use a decision aid to support informed shared decision making, discussing the risks of recurrence, possible changes in urinary, bowel, and sexual function, and uncertainties about long-term outcomes, especially with mesh procedures.

Refer to a specialist or urogynaecology service if the chosen procedure is not available locally or if pessary care is not accessible.

Do not offer surgery solely to prevent incontinence in women without incontinence undergoing prolapse surgery.

Explain the risk of postoperative urinary incontinence to women undergoing surgery for anterior or apical prolapse who do not have incontinence.

For women considering surgery for uterine prolapse, discuss options including uterus-preserving procedures and hysterectomy, and consider referral to a regional multidisciplinary team if future childbearing is desired.

Overall, referral for surgical intervention is appropriate when conservative management fails, is declined, or when symptoms significantly impact quality of life and the patient opts for surgery after informed discussion.

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