How is Subjective Surgical Success Defined Using the Pelvic Floor Distress Inventory (PFDI-20) After Primary Uterovaginal Prolapse Repair? A Systematic Review and Consensus Statements from the U-POP & LUTD 2026 Global Consensus Conference.

INTRODUCTION AND HYPOTHESIS: Anatomic success after pelvic organ prolapse (POP) surgery correlates poorly with symptom relief, prompting reliance on patient-reported outcomes (PROs). The Pelvic Floor Distress Inventory (PFDI-20) is widely used, yet how it is applied to define subjective surgical success is unclear. We aimed to evaluate how subjective success is defined using the PFDI-20 and its components after primary uterovaginal prolapse repair.

METHODS

As part of the U-POP & LUTD 2026 Global Consensus Conference, a systematic review (PRISMA; PROSPERO CRD420251171050) of MEDLINE, EMBASE, and ClinicalTrials.gov was conducted from inception to 8 December 2025. English-language studies of women undergoing primary uterovaginal prolapse repair that reported a PFDI-20- or POPDI-6-based definition of success were included. Screening and extraction were performed in duplicate, and the certainty of evidence was assessed using GRADE. Findings informed expert consensus statements.

RESULTS

Of 5379 records, 28 studies (4196 women) were included. Surgical success was most commonly defined as the absence of a vaginal bulge symptom-a negative response to question 3 of the PFDI-20-in 21 of 28 studies. Other definitions combined question 3 with additional items, required a negative POPDI-6 subscale, or used a statistically significant change in total PFDI-20 score. Only one study applied a minimal clinically important difference (MCID), and none applied a patient acceptable symptom state (PASS).

CONCLUSIONS

Subjective success after primary uterovaginal prolapse repair is most often defined by a single PFDI-20 item, with MCID and PASS thresholds rarely applied. Consistent, validated definitions are needed to improve comparability across trials.