Critical Assessment of Pelvic Floor Surgical Reconstruction Outcome Giacomo Novara a , Antonio Galfano a , Mariangela Mancini a , Vincenzo Ficarra b , Walter Artibani a, * a Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua, Italy b Department of Urology, University of Verona, Verona, Italy 1. Introduction Pelvic organ prolapse (POP) is a major healthcare problem. It was reported as present in 50% of parous women [1], with aggregated rates of prolapse surgery which were estimated at between 15 and 49 per 10,000 women/years [2]. A landmark study from North America showed that the lifetime risk of surgery for prolapse or stress urinary incontinence (SUI) was 11%, with 29% of the patients experiencing eau-ebu update series 4 (2006) 202–213 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Keywords: Anterior vaginal wall prolapse Posterior vaginal wall prolapse Uterine prolapse Rectal prolapse Pelvic organ prolapse Rectocele Cystocele ICS POP-Q Sacrocolpopexy Questionnaire Quality of life Pelvic Floor Distress Inventory PFDI Pelvic Floor Impact Questionnaire PFIQ Urogenital Distress Inventory UDI Abstract Purpose: To summarize the most important evidence available in the field of pelvic floor reconstruction surgery, as well as at indicating the proper methodology for studies in the field. Methods: A non systematic review of the literature was performed by means of MEDLINE search. Results: The available evidence supported the use of mesh in anterior vaginal wall prolapse surgery, the indications both for abdominal sacro- colpopexy in case of vaginal vault prolapse and posterior colporrhaphy in case of rectocele. In patients with vaginal vault prolapse, two recently published RCTs recommended the use of polypropylene mesh during sacrocolpopexy, as well as the use of a prophylactic concomitant anti- incontinence procedure, such as Burch colposuspension. However, the data regarding lower urinary tract, bowel, sexual functions, generic quality of life issues, and long-term outcome were insufficient. Conclusions: Few high-quality RCTs are available in the field of pelvic floor reconstruction. Further RCTs with long-term follow-up and atten- tion to the assessment of functional outcomes by means of validated questionnaires and re-evaluation at longer follow-up of most of the currently available trials are strongly desired to improve evidence-based management in urogynecology. # 2006 European Association of Urology and European Board of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Via Giustiniani 2 - 35128 Padua, Italy. Tel. +39 049 8212720; Fax: +39 049 8218757. E-mail address: walterartibani@libero.it, walter.artibani@unipd.it (W. Artibani). 1871-2592/$ – see front matter # 2006 European Association of Urology and European Board of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eeus.2006.07.003