Controversies and uncertainties: abdominal versus vaginal surgery for pelvic organ prolapse.

Reconstructive pelvic surgery is a common phenomenon in American women. The efficacy and durability of current procedures are often extrapolated from clinical case series and may be fraught with bias. Although the route of reconstructive pelvic surgery is debated with little evidence to support expert opinion, several recent clinical trials have provided a modest amount of data that can assist surgeons in counseling women who are facing prolapse repairs. An individual woman's tolerance for certain symptoms and risks can be matched with the scientifically based evidence for certain procedures. It is clear that the route of surgery must vary with individual surgeons and individual patients. The challenge is to test current surgical habits using modern clinical trials to obtain the necessary information to optimize each and every woman's restorative surgery.