Urinary, Bowel and Sexual Symptoms After Surgery for Pelvic Organ Prolapse

The aim of this chapter is to provide evidence-based summary on the effect of surgical management of pelvic organ prolapse on urinary, bowel and sexual symptoms. Available literature is reviewed and analysed. Prolapse repair does not increase the risk of de novo stress urinary incontinence, which has the highest probability after surgery for apical compartment prolapse. For patients with coexistent prolapse and stress incontinence, there is no difference in postoperative outcome between combined or interval surgery, bearing in mind the higher morbidity of the combined approach. Preoperative overactive bladder and voiding symptoms usually improve after prolapse repair. Bowel symptoms tend to improve, especially if posterior repair is performed, though this carries a risk of de novo constipation. Whilst sexual function tends to improve after abdominal or laparoscopic repair of apical compartment prolapse, available evidence in relation to transvaginal mesh repair is conflicting. Patient-centred management and adequate pre-operative counselling are essential to ensure that patients’ expectations are realistic and improve their satisfaction.