Clinical characteristics of different prolapse phenotypes in severe pelvic organ prolapse: a single-centre retrospective study

Background Severe pelvic organ prolapse (POP) shows heterogeneous patterns of compartment involvement. We compared three major severe POP phenotypes and explored the adjusted association between manual labour and total pelvic organ prolapse (TPOP).Methods This retrospective study included 417 women with POP-Q stage III–IV POP treated between 1 June 2022 and 30 June 2025. The main comparison included isolated anterior compartment prolapse (n = 128), anterior and apical compartment prolapse (n = 162), and TPOP (n = 67); the remaining 60 cases were used only to describe overall phenotype distribution. Demographic characteristics, obstetric history, pelvic floor anatomical parameters and related clinical indicators were compared. Exploratory multivariable binary logistic regression was performed in the full cohort, with TPOP as the outcome and all other severe POP phenotypes as the reference category; manual labour was the exposure of interest, with adjustment for age, BMI, number of vaginal deliveries, and place of first delivery.Results The three major phenotypes accounted for 85.61% of severe POP cases. After Holm adjustment, anterior and apical compartment prolapse had a higher genital hiatus (gh) value than isolated anterior compartment prolapse (adjusted p = 0.017), while TPOP had a larger uterine volume (adjusted p = 0.043). Observed differences in total vaginal length and place of first delivery did not remain statistically significant after multiplicity adjustment. Perineal body length did not differ significantly among groups. Manual labour was associated with higher odds of TPOP after adjustment (aOR = 2.80, 95% CI 1.22–6.41; p = 0.015).Conclusion Severe POP is phenotypically heterogeneous. TPOP represents concurrent involvement of the anterior, apical, and posterior compartments. Assessment of affected compartments, delivery history and pelvic floor parameters may support preoperative stratification and individualised management.