U-POP and LUTD care refined in international consensus report
The 2026 conference developed 101 consensus statements to guide care.
The global consensus conference on uterine pelvic organ prolapse (U-POP) and lower urinary tract dysfunction (LUTD) conducted 29 systematic review searches, screened over 51,143 abstracts and reviewed 3,869 full-texts to develop 101 consensus statements.
One subgroup of the committee was assigned to assess the need for urologic testing prior to surgical therapy for primary uterovaginal prolapse.
There were 0 studies assessing the use of preoperative cystoscopy. However, the AUA guidelines recommend it for individuals with moderate- or high-risk microhematuria, recurrent urinary tract infections or anatomical concerns such as strictures.
“This led us to the consensus statement that clinicians should not perform office cystoscopy in patients undergoing primary uterovaginal prolapse repair without hematuria or urinary conditions mandating investigation,” said Emily Snethkamp, NP, University of Michigan Health Medical Center.
Five studies examined retention and found that patients with higher preoperative post-void residuals tended to have higher postoperative residuals. However, the urodynamics data were mixed. Based on this, the consensus reached is that clinicians may perform office post-void residual measurements in patients undergoing primary uterovaginal prolapse repair, especially those with lower urinary tract symptoms.
The group also examined stress urinary incontinence (SUI) and overactive bladder as postoperative outcomes.
“We concluded that clinicians should not perform urodynamics in patients undergoing primary uterovaginal prolapse repair to diagnose SUI since a reduced full bladder stress test provides immediate information and there are no urodynamic parameters that predict postoperative overactive bladder or voiding dysfunction. We also concluded that clinicians should perform an office full bladder stress test with the prolapse reduced in all patients undergoing primary uterovaginal prolapse care, even if they don't have urinary incontinence,” said Anne Pelletier Cameron, MD, a clinical professor at the University of Michigan Health Medical Center.
The consensus committee also looked at the risk factors for failure among women undergoing U-POP surgery.
“Previous studies have shown that age was a risk factor for failure, but when we looked at it in U-POP, we saw no association between age and failure. The next thing we looked at was body mass index, and we found an increased risk, though it was not very dramatic. The big risk factors we identified were advanced-stage prolapse, particularly stage four, which is at a much higher risk of recurrence,” said Catherine Matthews, MD, professor at Wake Forest University School of Medicine.
Additionally, based on Delphi consensus, clinicians should be aware that levator avulsion, enlarged genital hiatus and connective tissue disorders are risk factors for surgical recurrence.
When selecting a hysterectomy method, patients who are willing to accept a higher risk of mesh exposure and small-bowel injury tend to have a lower chance of failure if they opt for hysterectomy with sacrocolpopexy.
