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Polyetiological pathogenesis of pelvic organ prolapse in women. Current understanding of the problem

This review presents the analysis of literature which reveals the role of various factors contributing to the development of pelvic organ prolapse in women. The role and significance of factors leading to elevated intra-abdominal pressure, including obesity, are discussed. The effect of natural childbirth on the structure and function of pelvic floor is assessed. A current perspective on the influence of estrogen levels on the structure and properties of pelvic connective tissue in women is presented. The issue of metabolic and structural disorders of collagen in the development of pelvic organ prolapse as well as the role and significance of hereditary connective tissue disorders in the genesis of this disease are considered separately. The connection between pelvic surgeries such as hysterectomy and the subsequent development of pelvic organ prolapse is traced and analyzed. Particular attention is paid to the analysis of the effectiveness of surgical treatment for pelvic organ prolapse, also data on the use of mesh materials is provided, and the possibility of increasing the efficacy of surgical treatment by improving surgical techniques and using promising synthetic materials with stem cells is discussed. Key words: pelvic organ prolapse, hereditary connective tissue disorders, recurrence, pelvic floor, birth-related perineal trauma, risk factors for pelvic organ prolapse, surgical correction