A Global Consensus Conference on Surgical Management of Primary Uterovaginal Prolapse and Lower Urinary Tract Dysfunction: Combining Evidence with Expert Opinion

Introduction and Hypothesis: This global consensus conference was designed to define best practice for the controversial aspects of primary surgical management of uterovaginal pelvic organ prolapse (U-POP), to identify unanswered clinical questions, and to educate junior researchers on systematic review and meta-analysis methodology. Methods: Eleven committees were created with geographically diverse representation and tasked with answering pragmatic questions specific to U-POP surgical decision making. A systematic search of MEDLINE, Embase, and ClinicalTrials.gov from 2000 through December 2025 was performed with specific search terms for each committee. Relevant abstracts and full texts were doubly screened and included articles were doubly extracted. Guided by literature, consensus statements were created and assigned high, moderate, and low levels of evidence. Statements with low levels of evidence were presented and voted upon in-person at a consensus conference, hosted by the Department of Urology at Wake Forest University School of Medicine in Winston Salem, NC, USA. Results: Contributions from 154 participants (including 33 junior researchers) from 19 countries led to 29 systematic searches, screening of 51,143 abstracts and 3,869 full-text manuscripts. There were 133 consensus statements presented at the conference; 6 were supported by high-quality, 28 by moderate-quality, and 99 by low-quality or no evidence respectively, and required Delphi process consensus. Among expert opinion statements, 58 were accepted, 32 were rejected, and 9 were eligible for revision. Conclusions: A total of 92 statements are presented here to guide clinical decision making and best practices in surgical management of primary U-POP.