Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is very common in women seen for routine gynecologic care, although it may be asymptomatic and its impact on women's quality of life (QoL) markedly varies. Many women with POP experience comorbidity pelvic floor disorders, such as urinary and/or fecal problems, including incontinence which can seriously compromise QoL and limit social, psychological and sexual function. Because of importance of understanding the impact of POP and POP-associated comorbid pelvic floor disorders on QoL, there are a lot of studies available in the literature to provide meaningful suggestions both clinically and for costeffectiveness research. We are glad to learn that Dr. Huang's study published in this issue of the Journal of the Chinese Medical Association entitled “A bibliometric and social network analysis of pelvic organ prolapse during 2007e2016” attempted to use the PubMed database to emphasize the importance on this issue of POP. The authors retrospectively reviewed 3294 articles and found the publications were mainly derived from the developed countries (high-income countries) and the majority of research focused on therapy (74.4% of highly-frequent MeSH/ subheading words), suggesting that management of women with POP is frequently discussed, although the recent trend for this-type publication was declined. The number of published articles reached to the highest level (n 1⁄4 406) in 2012 and dramatically dropped to the nadir (n 1⁄4 233) in 2015 without a significant change in the next year (n 1⁄4 252 in 2016). The finding of Dr. Huang's study is interesting and worthy of a discussion. First, the close anatomical and functional relationship of the lower urinary tract, lower genital tract and anorectum means that the POP is likely to have symptoms affecting multiple compartments. With an increasing elderly population, there is greater demand on the healthcare providers with more complicated patients due to the different etiologies, different modulating factors, and the accompanied co-morbidities. Although therapy includes nonsurgical and surgical treatments, surgical approach increased significantly in the recent 10 years. New surgical techniques have been developed with a reduction of postoperative pain and a shorter period of hospitalization. Among these, the development of “mesh”, either made by natural material and/or by biosynthesis, and