Surgical management of pelvic organ prolapse and stress urinary incontinence.

There is no single operative approach to correct pelvic organ prolapse in conjunction with urinary and/or fecal incontinence or rectal prolapse. Each case needs to be individualized and dealt with surgically following the principles outlined in Table 1. In postmenopausal women, it is not only important to pretreat patients with estrogen prior to reconstructive pelvic surgery, but also maintain patients on long-term treatment after surgery. The genitourinary and reconstructive pelvic surgeon should have the skills to offer patients alternative approaches tailored to their individual symptomatology, and anatomic and pelvic pathology. Long-term follow-up of all patients is imperative to ascertain the clinical and cost effectiveness of these procedures.