Women with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva maneuvers. These factors, combined with pelvic floor weakness, may increase the risk of pelvic organ prolapse (POP). This study aimed to assess the prevalence of POP in women with spina bifida, identify associated risk factors, and evaluate outcomes of surgical management.

We retrospectively analyzed a prospectively maintained database of women with spina bifida seen at a French referral center from 2007 to 2024. Age under eighteen and congenital perineal abnormality were exclusion criteria. Primary outcome was the presence of POP grade 2 or higher (Baden-Walker classification). Secondary outcomes included symptomatic POP requiring surgery, recurrence after surgery, use of vaginal pessaries, and related symptoms.

POP grade ≥2 was present in 14.8% of patients. Women with POP were older (median 44 vs. 31 years; p<0.0001) and more frequently parous (58.5% vs. 18.3%; p<0.0001), although 41.5% of POP cases occurred in nulliparous women. Apical prolapse was predominant (64.3%). Among 11 patients who underwent POP surgery, 54.5% experienced recurrence. Multivariate analysis identified parity (OR 5.33; p=0.005) and lower maximum urethral closure pressure (OR 0.97; p=0.02) as independent risk factors.

Parity and low maximum urethral closure pressure, likely reflecting underlying pelvic floor weakness, may explain the particular vulnerability of this population to POP. The association between low MUCP and POP supports the hypothesis that a flaccid perineum plays a central role in the pathophysiology of prolapse in neurogenic patients, beyond the classical obstetric risk factors. The elevated recurrence rate after surgical repair could be explain by the persistence of structural risk factors such as Valsalva voiding and intrinsic pelvic floor dysfunction, which are inherently difficult to fully correct in this context. Although the potential role of ileal conduit as an additional risk factor could not be formally assessed due to limited statistical power, this association warrants further investigation. Altogether, these observations suggest that preoperative optimization of bladder and bowel management, as well as careful counseling regarding childbirth, deserve particular attention in the care of women with spina bifida.

POP is highly prevalent in young adult women with spina bifida, including many nulliparous patients. The parity status and a low maximum urethral closure pressure could be associated with an increased risk of POP in this population. High recurrence after surgery highlights the need for information, routine screening and tailored management in this population.