Questions to Ask Before Prolapse or Incontinence Surgery

Questions about your diagnosis

Start with what is actually prolapsing. Ask which compartments are involved: the bladder (cystocele), the rectum (rectocele), the uterus or the vaginal vault. Many women have more than one, and an operation that fixes one compartment can leave another untreated. Ask what stage the prolapse is and how it was measured. The POP-Q examination is the staging system the NICE guideline asks specialists to use and record, and the stage should be written in your notes.

Ask whether your bladder and bowel function were assessed, and whether you also have stress incontinence or urgency. Ask what non-surgical options were considered first. NICE lists pelvic floor muscle training and a vaginal pessary as options before surgery for many women. A clear answer names the compartments, gives a stage, and explains why surgery is being suggested for you rather than a pessary or exercises.

Questions about the operation

Ask for the exact name of the operation and what it does for each compartment. Ask what is done for apical support, meaning the support of the uterus or the vaginal vault, because a repair of the front or back wall alone can fail if the apex is not supported. If you have a uterus, ask whether it will be kept or removed and why. The uterine prolapse options guide on this site explains the choices.

Ask whether the operation is done through the vagina or through the abdomen, how long it takes, and what type of anesthesia is planned. Ask who will perform each part of the operation. A clear answer gives you a procedure name you can look up, the approach, the anesthesia type, and the surgeon's name.

Bladder prolapse surgery: mesh or your own tissue

Ask every surgeon whether any synthetic mesh or graft will be placed, and if so where and what type. Ask what the alternative is with your own tissue, and why the surgeon prefers one over the other for your case.

In April 2019 the US FDA ordered manufacturers to stop selling surgical mesh for transvaginal repair of pelvic organ prolapse. The 2024 Cochrane review of prolapse repair records the same timeline. Mesh placed through the abdomen for apical prolapse (sacrocolpopexy) remains available, and mid-urethral slings for stress incontinence remain available in the US. Native-tissue repairs stitch your own tissue, and ligament-based repairs re-anchor the supporting ligaments. The cystocele mesh guide on this site covers the regulatory history in more detail. A clear answer tells you plainly whether mesh is involved, names the material, and explains the trade-off without pressure.

Questions about the surgeon

Ask what the surgeon's specialty is and where the training in pelvic floor surgery came from. Ask how often this exact operation is performed and by whom. Ask how the surgeon tracks results, whether patients are followed for years rather than weeks, and whether complications are reviewed.

A clear answer gives a number or a range for case volume, names the specialty and board certification, and describes a follow-up system that exists for every patient rather than on request.

Questions about recovery and risks

Ask how many nights you will stay, whether a catheter is used and for how long, and what the pain plan is. Ask when you can walk, shower, drive, lift, return to work and have sex. Ask what restrictions apply in the first six weeks and why.

Ask about the specific risks of the operation chosen for you. NICE asks surgeons to discuss the benefits and risks of each procedure, including changes in urinary, bowel and sexual function, the risk of the prolapse recurring, and the uncertainty about long-term effects, especially for procedures that implant mesh. The trials summarized in the 2024 Cochrane review of prolapse repair tracked bladder injury, new stress incontinence, pain during sex, mesh exposure and repeat surgery as outcomes. As with any operation, bleeding and infection are also possible. Ask how often each has happened in this surgeon's practice and what is done when it does. The recovery guides on this site describe the usual milestones; use them to check whether the answers you receive are realistic. Results and recovery vary from person to person.

Questions about recurrence and follow-up

Ask how the surgeon defines success. Some count anatomy on examination, others count symptoms, and the two do not always agree. Ask what the recurrence rate is for this operation in this surgeon's hands, and over what period it was measured. Ask what the follow-up schedule looks like at two weeks, six weeks, one year and after.

Ask what happens if the prolapse comes back. Who examines you, who operates again, and what you would be charged. Ask for the answer in writing before you book. A clear answer separates anatomy from symptoms, gives a time frame for the recurrence figure, and states the redo policy without you having to ask twice.

Questions if you also have incontinence

Many women with prolapse also leak urine, and some develop leaking only after the prolapse is corrected. Ask which type of incontinence you have. Stress incontinence is leaking with coughing, sneezing or exercise. Urgency is a sudden need to go. Sling and suspension operations treat stress incontinence. Urgency is treated differently, usually with medicines or bladder injections rather than this kind of surgery. Ask whether urodynamic testing was done or is needed. NICE recommends urodynamic testing before stress incontinence surgery when anterior or apical prolapse is also present.

NICE also advises against adding an incontinence procedure to prolapse surgery for women who do not leak, and advises that women having front-wall or apical repairs be told that leaking can appear afterwards and may need further treatment. Ask whether the incontinence can be treated in the same operation as the prolapse and what the added procedure is. Ask whether it uses a synthetic sling or your own tissue. The sling comparison on this site explains the difference. Ask about the risk of difficulty emptying the bladder after surgery, new urgency, and leaking that persists or returns. Ask what is done in each case.

What the written plan and estimate should contain

Before you book with any clinic, ask for a written plan and an itemized estimate. The plan should name the procedure for each compartment, the approach, whether mesh or a sling is used, the anesthesia type, the number of nights of stay, and the follow-up schedule. The estimate should list what is included: surgery, anesthesia, the stay, medicines, follow-up visits, and what is not included.

If you intend to claim from an insurer, ask which documents the clinic will issue. Podo prepares the documents international insurers typically require: an itemized English receipt, a medical certificate, procedure codes and a completed claim form. Whether a procedure is reimbursed depends on your policy; the clinic provides documentation, not coverage decisions. Medical records and receipts are issued in English on request. The booking page describes when the written plan is sent.

Questions for international patients, and what Podo can answer here

If you are traveling for surgery, add these questions. How many nights do I need in the city, and when is it safe to fly. Who do I call at night if something worries me. How is follow-up done once I am home, and what happens if a complication appears after I leave. Can I see a female doctor. Will the consultation be in English, and will my records be in English.

Here are the answers Podo can give on this page, limited to what the clinic has confirmed. Consultations are available in English. Two of the clinic's three OB-GYN specialists are women, and all three are board-certified specialists in obstetrics and gynecology. Dr. Mo Hyung-jin was elected a Fellow of the International College of Surgeons (Korea Section) in obstetrics and gynecology in 2016. Pelvic ligament suspension uses the patient's own ligaments and sutures, without synthetic mesh; it restores pelvic support by re-anchoring the patient's own lax pelvic ligaments and is used for stress urinary incontinence, cystocele, rectocele and uterine prolapse. Anesthesia follows a four-step protocol tailored to the procedure and the patient, a pre-operative safety check-up is completed before every surgery, and surgery is performed in the clinic's own operating room. Overnight stays are available in the clinic's recovery suites, and the stay in Seoul after incontinence or prolapse surgery is planned at 5 to 10 days. For revision surgery, bring as many records of the earlier operation as you can. The final decision rests on the in-person examination, and a revision is usually considered from 3 months after the original surgery, 2 months at the earliest. Patients have a 24-hour nurse contact line after surgery, and a video follow-up is scheduled after you return home.

Case volume and the policy if a repair needs to be redone are answered at consultation and stated in the written plan. This page is general information and is not a diagnosis; a consultation is needed to decide whether a procedure suits you.

Questions

Can you have prolapse surgery without mesh?

Yes. Native-tissue repairs use your own tissue and stitches, and ligament-based repairs re-anchor your own supporting ligaments. Ask each surgeon which repair is planned for each compartment and whether any mesh or graft is involved.

Is mesh still used in prolapse surgery?

In the US, mesh for transvaginal prolapse repair has not been sold since the FDA order of April 2019. Mesh placed through the abdomen for apical support remains available, and synthetic mid-urethral slings for stress incontinence remain available. Ask which, if any, applies to your operation.

Is pelvic prolapse surgery dangerous?

It is a common operation with known risks. NICE asks surgeons to discuss changes in urinary, bowel and sexual function and the chance of recurrence, and trials of prolapse repair track bladder injury, new stress incontinence, pain during sex and repeat surgery. Ask how often each has happened in your surgeon's practice; your own health affects the risk, so the answer should be specific to you.

Should I get more than one opinion?

It is reasonable to ask two surgeons the same questions and compare the written answers. Differences in the proposed operation, the use of mesh or the follow-up plan are worth understanding before you decide.

What if a clinic will not answer in writing?

A procedure name, the materials used, the stay, the follow-up schedule and the redo policy are facts a clinic can state in advance. If a clinic cannot state these before you book, ask why.

Sources

About the reviewer

Dr. Mo Hyung-jin, MD, PhD, board-certified OB-GYN specialist, is the medical director of Podo Women's Clinic. He developed the pelvic ligament suspension technique used at the clinic for stress urinary incontinence and pelvic organ prolapse. Profile