Apical prolapse in routine clinical practice: a review

Apical prolapse of the pelvic organs represents a significant concern in modern gynecology, primarily due to its high prevalence, considerable adverse effects on the quality of life of affected women, and a consistent rise in incidence corresponding with the global population aging. This review aims to analyze the prevalence of apical prolapse and its impact on patients' quality of life, based on a comprehensive review of scientific literature. Relevant publications were sourced and evaluated from databases such as PubMed, UpToDate, Cochrane Library, Scopus, Web of Science, and Google Scholar, focusing on studies published in the last five years; foundational research papers on pathogenesis and epidemiology from prior periods were also included. Findings indicate that the prevalence of apical prolapse within the broader category of pelvic organ prolapse is approximately 49.8%; furthermore, 85% of cases are associated with cystocele or rectocele, while isolated cases occur in only 4.4%. Identified risk factors include genetic predisposition, impaired collagen metabolism, vaginal delivery with obstetric trauma, hysterectomy, age-related changes, menopausal estrogen deficiency, and metabolic syndrome. Apical prolapse markedly diminishes the quality of life, leading to physical and psycho-emotional discomfort, sexual dysfunction, and social maladjustment, yet patients still rarely seek help. Non-surgical treatment options include pessaries, pelvic floor muscle exercises, and behavioral interventions; however, in cases of severe prolapse, surgical intervention is essential. Reconstructive surgical techniques, both abdominal and vaginal, are advocated for sexually active women, whereas obliterative surgery is recommended for elderly patients. The selection of treatment approach requires individualization, taking into account the patient's age, comorbidities, reproductive intentions, and sexual activity. The true prevalence of apical prolapse remains undetermined; data on risk factors and underlying pathogenesis have yet to be systematically organized, and the choice of a universal surgical approach that yields consistent results without relapses remains an unsolved problem.