2026 Urogynecology for the Advanced Practice Provider-Prepping for Prolapse Surgery

Video Transcription

Video Summary

Dr. Mary Duarte-Tubo discussed how to prepare patients for prolapse surgery. She reviewed when surgery is indicated: symptomatic prolapse or end-organ issues like hydronephrosis, while asymptomatic patients usually do not need referral. She outlined a practical decision pathway based on sexual activity, uterine status, prolapse compartment, and cervical elongation. Options included obliterative procedures such as colpocleisis/LeFort, reconstructive repairs with native tissue or mesh, hysteropexy, apical suspensions, and procedures for cervical elongation like Manchester-Fothergill.  <br /><br />She also emphasized preoperative optimization using risk tools like ASA class, NSQIP calculators, cardiac risk assessment, functional capacity, and frailty evaluation. Key modifiable factors included smoking cessation, marijuana avoidance before surgery, and diabetes control. ERAS principles were reviewed, including fasting guidance, antibiotics, skin prep, multimodal pain control, and bladder drainage. Finally, she noted that strict postoperative activity restrictions have limited evidence, and liberal activity appears safe.

Asset Subtitle

This lecture equips Urogynecology APPs with a comprehensive framework for preoperative evaluation of patients with pelvic organ prolapse. Topics include indications for surgery, reconstructive options, preoperative optimization, and postoperative recovery expectations.

Learning Objectives:

Outline the key components of the initial evaluation for pelvic organ prolapse.
Identify clinical indications for surgical management of pelvic organ prolapse.
Understand a structured approach for selecting the appropriate reconstructive surgical options.
Counsel patients on preoperative optimization of medical comorbidities.
Prepare patients for expected postoperative recovery and functional outcomes.

Speaker: Mary Duarte Thibault, MD

Keywords

prolapse surgery

preoperative optimization

pelvic organ prolapse

colpocleisis

hysteropexy

ERAS protocol