How can I effectively counsel patients about the potential risks and benefits of surgical versus non-surgical management for pelvic organ prolapse?

When counseling patients about surgical versus non-surgical management for pelvic organ prolapse, explain that:

• There is evidence of benefit for all procedures, but limited long-term data on effectiveness and adverse effects, especially with mesh procedures, and the true prevalence of long-term complications is unknown ¹.
• Surgical options are offered when symptoms have not improved with or have been declined after non-surgical treatments ¹.
• Use a decision aid to promote informed preference and shared decision making, discussing the different treatment options, benefits, and risks, including potential changes in urinary, bowel, and sexual function, risk of recurrence, and uncertainties about long-term adverse effects, particularly with mesh procedures ¹.
• Discuss the differences in procedures regarding anesthesia, hospital stay, incisions, and recovery period ¹.
• Explain that non-surgical options include lifestyle modifications, pelvic floor muscle training, pessaries, and topical oestrogen, which can improve symptoms and are less invasive ¹.
• Highlight that non-surgical management is generally preferred initially, with surgery reserved for persistent or severe symptoms, and that surgery carries risks such as complications and uncertain long-term outcomes ¹.

Ensure the patient understands that the choice depends on their preferences, symptom severity, and individual circumstances, and that ongoing follow-up is essential regardless of the management approach ¹.