# Pelvic organ prolapse is highly prevalent in women with spina bifida

## TL;DR

Women with spina bifida have a high rate of pelvic organ prolapse, even in those who have never given birth, and surgery often leads to recurrence.

## Contribution

This study is the first to report a high prevalence of pelvic organ prolapse in young women with spina bifida, including nulliparous individuals.

## Key findings

- Pelvic organ prolapse grade ≥2 was present in 14.8% of women with spina bifida.
- Parity and lower maximum urethral closure pressure were identified as independent risk factors for pelvic organ prolapse.
- Surgical management of pelvic organ prolapse had a 54.5% recurrence rate in this population.

## Abstract

Women with spina bifida often experience neurological impairments leading to pelvic organ dysfunction, including difficulties with bladder and bowel emptying that necessitate frequent Valsalva manoeuvres. 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 analysed a prospectively maintained database of women with spina bifida seen at a French referral centre from 2007 to 2024. Age under 18 and congenital perineal abnormality were exclusion criteria. The 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.

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.