Pelvic organ prolapse (POP) is a recognized complication following radical cystectomy (RC). However, there remains ongoing debate regarding its incidence and the optimal (surgical) management of post-RC POP. The aim of this systematic review was to provide a comprehensive overview of the available literature on the incidence and treatment options for POP in patients who have undergone radical cystectomy.

This systematic review was conducted in accordance with PRISMA guidelines [1]. Studies were included if they assessed the incidence or treatment options for POP in patients with radical pelvic surgery in which at least the bladder and other pelvic organs were removed, e.g. radical cystectomy and anterior exenteration. Studies exclusively reporting vaginal evisceration were excluded. Given the paucity of high-level evidence, all study designs were eligible, including case reports and case series. A systematic search of PubMed and Embase was conducted up to 22 October 2025 using the following search terms: ("Pelvic organ prolapse"[Mesh] OR prolaps*[tiab] OR POP[tiab] OR enterocele[tiab] OR rectocele[tiab] OR ("perineal"[tiab] AND "hernia*"[tiab]) OR "pelvic descent"[tiab] OR "vaginal dehiscence"[tiab]) AND ("cystectomy"[Mesh] OR "cystectom*"[tiab] OR Bricker[tiab] OR "Wallace"[tiab] OR studer[tiab] OR "cutaneous ureterostomy"[tiab] OR Nesbit[tiab] OR "ileal conduit"[tiab] OR "neobladder"[tiab] OR "pelvic exenteration"[mesh] OR "anterior exenteration"[tiab] OR "pelvic exenteration"[tiab] OR "pelvic resection"[tiab])

Titles and abstracts were assessed for eligibility in a standardized manner by 3 independent reviewers. Disagreements were resolved by the assessment of the abstract by a fourth reviewer. The search yielded 439 citations. A total of 84 full text articles were screened. A total of 31 studies met the inclusion criteria. Seven studies reported on the incidence of post-RC POP, with reported rates ranging from 0.5% to 6%. However, higher rates of POP-related findings were observed in studies assessing POP using radiological imaging (96%) or patient-reported questionnaires (11%).

23 studies (all case reports or case series) described surgical management techniques for post-RC POP, encompassing a total of 48 patients. The majority of patients (n = 39, 81%) were treated via a transvaginal approach, while 5 patients (10%) underwent laparoscopic procedures and 4 patients (8%) were treated via an open abdominal approach. Mesh was utilized in 16 patients (33%). The various surgical approaches are illustrated in Figure 1, demonstrating both vaginal and abdominal placement options. The median follow-up duration was 12 months (range 3–60 months). An overview of the surgical techniques is provided in Figure 1 and Table 1.

There is a clear lack of high-quality evidence regarding both the incidence and management of post-RC POP. Retrospective studies suggest an incidence ranging from 0.5% to 6%. A wide variety of surgical techniques has been described, with the transvaginal approach being most commonly employed; however, abdominal approaches (open or laparoscopic) also appear to be feasible. Due to the absence of high-quality comparative studies, no definitive conclusions can be drawn regarding the relative effectiveness of the different surgical techniques. Further research is warranted to determine the optimal management strategy for post-RC POP.

M.J.Page, The PRISMA 2020 statement: an updated guideline for reporting systematic reviews, BMJ 2021; 372

Continence 19S (2026) 102794
DOI: 10.1016/j.cont.2026.102794