Anterior Vaginal Wall Prolapse Research Articles

Urinary Tract Infection After Hysterectomy for Benign Gynecologic Conditions or Pelvic Reconstructive Surgery.

To report rates and identify risk factors for urinary tract infection (UTI) after hysterectomy for benign conditions or combined with pelvic reconstructive surgery. This is a cohort study that included women who underwent hysterectomy either for benign gynecologic conditions or hysterectomy combined with pelvic reconstructive surgery from January 1, 2012, through June 30, 2014, at a single institution. The primary outcome was UTI within 8 weeks of surgery. Logistic regression modeling was used to develop a model for predicting UTI after surgery. Of 1,156 women included in the study, 136 (11.8%, 95% CI 10.0-13.8) developed UTI within 8 weeks. Women who underwent hysterectomy for a benign gynecologic condition that was not combined with pelvic reconstructive surgery had an overall UTI rate of 7.3% (95% CI 5.6-9.3) vs 21.7% (95% CI 17.6-26.4) after hysterectomy combined with pelvic reconstructive surgery. After adjusting for hormone therapy use, the following were independent variables associated with postoperative UTI: premenopausal status with an adjusted odds ratio (OR) of 1.80 (95% CI 1.11-2.99), anterior vaginal wall prolapse with an adjusted OR of 4.39 (95% CI 2.77-6.97), and postvoid residual greater than 150 mL with an adjusted OR of 2.38 (95% CI 1.12-4.36). Using this model, postoperative UTI rates ranged from 4.3% to 59.4% with high postvoid residual and presence of anterior prolapse having the strongest association. There are wide variations in the rate of UTI after hysterectomy for begin disease including pelvic reconstructive surgery. These variations can be explained with a model based on available preoperative data.

Treatment of Anterior Vaginal Wall Prolapse Using Transvaginal Anterior Mesh With Apical Fixation: A Prospective Multicenter Study With up to 2 Years of Follow-up.

PurposeTo evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach.MethodsThis was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months.ResultsNinety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P<0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%–90% for every time point (P<0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%).ConclusionsThis midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications.

Sacrocolpopexy with Subtotal Hysterectomy for Recurrent Genital Prolapse After Laparoscopic Repair of Anterior Vaginal Wall and Uterine Prolapse by Lateral Suspension with Mesh

<span style=font-size:11.0pt;font-family: times= new= roman,serif=>1. <span style=font-size:11.0pt;font-family: times= new= roman,serif=>Abstract Sacrocolpopexy was the first laparoscopic technique used to treat POP. It may be associated with life threatening vascular injuries at the level of the promontory. Lateral suspension with mesh represents an alternative which avoids dissection of the promontory. However, the risk of recurrence exists after each technique of POP reconstructive surgery. This case report and video shows that sacrocolpopexy is feasible in case of recurrent POP after previous hysteropexy by lateral suspension with mesh. 2. <span style=font-size:11.0pt;font-family: times= new= roman,serif=>Keywords: <span style=font-size:11.0pt; font-family: times= new= roman,serif;mso-bidi-font-weight:bold=> Laparoscopic Surgery; Mesh; Pelvic Organ Prolapse; Recurrent Prolapse; Sacrocolpopexy 3. <span style=font-size:11.0pt;font-family: times= new= roman,serif=>Abbreviations POP : Pelvic Organ Prolapse <span style=font-size: 10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:cambria;= mso-fareast-theme-font:minor-latin;mso-fareast-language:en-us=> <span lang=FR-CH style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:cambria;mso-fareast-theme-font:= minor-latin;mso-ansi-language:fr-ch;mso-fareast-language:en-us=>POP-Q : Pelvic Organ Prolapse Quantification System

Medium-term follow-up after supervised pelvic floor muscle training for patients with anterior vaginal wall prolapse

ObjectiveThe objective of this study was to determine changes in quality of life, urogenital symptoms, and adherence to pelvic floor muscle training (PFMT) for pelvic organ prolapse (POP) in the medium term. Study designThe present study conducted a pretest-posttest quasi-experimental study design. Of 29 participants in 4-month supervised PFMT, 27 completed all assessments in a follow-up study. Twenty subjects were included in final analysis except 7 participants who underwent surgery during follow-up. To evaluate urogenital symptoms, they completed a prolapse-quality of life (P-QOL) questionnaire and POP-specific QOL. A urologist evaluated the prolapse status of all participants with POP-Q. In addition, the participants were asked about their adherence to PFMT, PFMT obstacles, and where PFMT was performed. All outcome measures were assessed at the following three time points: before PFMT, immediately after PFMT with one-on-one session, and at follow-up via a phone call. Values of p < 0.05 were considered significant. ResultsOf the 29 participants in the 4-month supervised PFMT, 27 completed all assessments in a follow-up study (response rate: 93.1%). The percentages of patients who continued PFMT at least 4 times declined substantially in non-operated at follow-up compared with supervised PFMT period. POP-specific QOL such as general health, prolapse impact, and role limitation were significantly worse at follow-up compared with immediately after PFMT despite initial improvement in the short term (p < 0.05). ConclusionPOP-specific QOL gradually worsened compared with patients immediately after supervised PFMT in mild to moderate POP women who were followed up without surgery at a 2-year follow-up. Adherence to home-based PFMT might decline without further supervision. It might indicate that to PFMT would be required to maintain symptoms and QOL in medium term. Further study will be needed to clarify if PFMT is effective to improve urogenital symptoms and QOL in long term among the patients with POP.

Prolapse reduction deteriorates the urethral closure mechanism.

Pelvic organ prolapse (POP) reduction is often performed in the preoperative assessment of women before POP surgery. Using urethral pressure reflectometry (UPR), we sought to investigate how POP reduction affects the urethral closure mechanism. Women with anterior or posterior vaginal wall prolapse stage ≥II with and without POP reduction were examined with a speculum. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest and during squeezing, and standardized stress tests with 300ml saline. All examinations were repeated after insertion of a speculum. We included 38 women: 22 with anterior and 16 with posterior vaginal wall prolapse POP-Q stage ≥II. During POP reduction, resting and squeezing urethral pressures decreased by 2.5 cmH2O (p = 0.007) and 5.1 cmH2O (p < 0.0001), respectively, in all women. During POP reduction, the number of positive stress tests increased from four (18%) to eight (36%) in women with anterior vaginal wall prolapse and from one (6%) to nine (56%) in women with posterior vaginal wall prolapse. POP reduction decreases urethral pressure, especially during squeezing, and consequently increases the number of positive stress tests. The test itself artificially deteriorates the urethral closure mechanism.

Improvement of overactive bladder symptoms: Is correction of the paravaginal defect in anterior vaginal wall prolapse necessary?

BackgroundTo explore the relationship between overactive bladder (OAB) symptoms and paravaginal defects (PVDs), and to identify the necessity of PVD repair by transvaginal mesh (TVM) for the treatment of OAB symptoms. MethodsA retrospective clinical study of 30 women with advanced cystocele with limited apical and posterior vaginal wall prolapse was conducted to identify any changes in OAB symptoms following a single Perigee procedure. Prolapse was assessed using the pelvic organ prolapse quantification (POP-Q) system, and paravaginal defects were identified by sonography. Complete urodynamic examination was performed prior to and one year after operation. All patients completed the overactive bladder questionnaire pre- and postoperatively for a quantitative assessment of OAB symptoms. ResultsAll patients showed a significant improvement at points Aa and Ba in the POP-Q system. The results of the administered questionnaire revealed statistically significant improvement postoperatively. The difference of OAB symptoms between the group with PVDs and that with central defects was not statistically significant (p = 0.67). Moreover, no statistically significant improvement of OAB symptoms in the group with repaired PVDs was observed postoperatively (p = 0.42). ConclusionStatistical improvements of symptoms exist after Aa and Ba points recovery as evaluated by POP-Q system regardless of PVD existence identified by sonography. Repairing PVD did not show significantly improve the severity of OAB symptoms in objective urodynamic data or subjective questionnaire data. The superiority of TVM in PVD repair to manage OAB symptoms seems not manifest.

Adaptation of Pelvic Organ Prolapse Guideline in Iranian Adult Women

Pelvic organ prolapse (POP) is a common disease which present as symptomatic descent of the anterior or posterior vaginal wall prolapse, uterus or apical prolapse subsequent to hysterectomy, and entrocele. Since, social and cultural factors have impact on interval between symptoms incidence and seek for medical care, diagnosis method and treatment process, it was important to prepare a guideline for management of the Iranian women with POP.

Stress Urinary Incontinence and Pelvic Organ Prolapse Correction by Single Incision and Using Monoprosthesis: Three-year Follow-up.

Background:The aim was to study the effectiveness and safety of a modified technique that employs a four-arm polypropylene (PP) mesh (NAZCA-TC) to treat pelvic organ prolapse (POP) and concurrent stress urinary incontinence (SUI) simultaneously.Materials and Methods:This prospective follow-up study was conducted on fifty SUI women with concurrent high-grade (greater than Stage 2) anterior vaginal wall and/or uterine prolapse who were referred to Al-Zahra and Noor Hospitals in Isfahan and underwent surgery using the NAZCA-TC, Promedon, Argantina kit. The POP-Quantification system was employed for staging POP before and after surgery. To evaluate lower urinary tract symptoms (LUTS) and patients’ quality of life, a stress test and the short form of International Consultation on Incontinence Questionnaire of Female Lower Urinary Tract Symptom were used. Patients were followed up and assessed at 6 weeks, 6 months, and 1, 2, and 3 years after surgery.Results:The mean age of patients was 58.2 ± 10.2 years. There was a great reduction (88.6%) in POP staging after surgery. The success rate of SUI treatment was significantly high (83.5%). During 3 years of postoperative follow-up, mesh erosion occurred in 18%, 5 patients (10%) presented with mesh erosion in the first years after operation, 16% reported significant groin or pelvic pain, and 10% required sling release.Conclusion:A single vaginal incision and using two less percutaneous access sites with the PP meshes were effective for treating patients with concurrent POP and SUI but have a high rate of postsurgery erosion rate.

Effect of Pelvic Floor Muscle Rehabilitation in Preventing Recurrent Vulvovaginal Candidiasis and Recurrent Bacterial Vaginosis

Objective To investigate the effect of pelvic floor muscle rehabilitation on recurrent vulvovaginal candidiasis (RVVC) and recurrent bacterial vaginosis (RBV). Methods Between January 2014 and July 2015, 121 cases of RVVC and RBV were selected, and the patients were randomly divided into control group and experimental group. For the control group of RVVC: miconazole suppository and vaginal delivery were utilized in every patient, 1 piece per night, the period of treatment was 7 to 14 days; oral intake of fluconazole was used again after 72 hours. Clotrimazole suppository or fluconazole was still chosen for the maintenance treatment: (1) 1 piece per week and lasted 6 months for every case; (2) 400 mg of itraconazole was used, 1 time every month or 100 mg was used once a week, the period of treatment lasted for 6 months. RBV: oralintake of metronidazole or clindamycin was chosen. One piece of metronidazole suppository by vaginal utilization was still needed per night, or 2% clindamycin ointment was used by inunction for 7 days. Experimental group: pelvic floor muscle rehabilitation. Results Before rehabilitation treatment, there were 4 cases with level 4 or 5 of type I muscle strength and 8 cases level 4 or 5 of type II muscle strength. After the treatment, there were 59 cases with level 4 or 5 of type I muscle, and 60 cases with level 4 or 5 of type II muscle (P＜0.001). There were no statistical differences on the treatment of anterior vaginal wall prolapse. Before the treatment, the number of anterior vaginal wall prolapse was 53 cases, the number was 49 cases after treatment (P=0.328). Before treatment, the number of posterior vaginal wall prolapse was 25 cases, the number was11 cases after treatment (P=0.005). The number of Uterine prolapse was 14 cases, the number was 2 cases after treatment (P=0.002). Compared with the group with drug treatment, the rate of relapse in vaginitis was decreased significantly after pelvic floor rehabilitation within 1 year, 61 patients with vaginitis, there were only 2 cases of recurrences were observed after treatment (P＜0.05). Conclusion Pelvic floor rehabilitation treatment could improve the pelvic floor function significantly, and also get significant recovery of sagging and prolapse in vagina which was injured by pregnancy and childbirth. Compared with the drug treatment group, the rate of relapse in RVVC and RBV was decreased significantly after pelvic floor muscle rehabilitation.

Prolapse of the apical compartment. Surgical techniques that preserve the uterus. The benefits of the Saba Nahedd technique

The prolapse of the apical compartment is defined as the herniation of the vaginal apex below the plane of the hymen and it is most often associated with an anterior and/or posterior vaginal wall prolapse. The vaginal apex is formed by the uterus or cervix and/or the vaginal cuff in women who received a subtotal or total hysterectomy respectively. The etiology of the apical prolapse is connected to the integrity of the connective tissue which is contained in the uterosacral, cardinal ligaments and the endopelvic fascia. The changes in the life style and beliefs, the current tendency towards a less invasive surgery which involves reduced surgical risk and lower costs have determined more women with genital prolapse to opt for surgical methods that preserve the uterus. These methods include abdominal, vaginal or laparoscopic routes, the chose depending on the local situation and the experience of the surgeon. One of the vaginal techniques which have showed very good results in terms of postoperative morbidity, rate of recurrence and life quality is the “Saba Nahedd” procedure which uses a special kit consisting of an isthmic and a suburethral strip and special clamps for the suspension of the uterus. The aim of this paper is to present the current data on the surgical options that preserve the uterus in women with uterine prolapse, especially, grade II and III with focus on the transvaginal approach using the S.N. method compared with other transvaginal techniques that preserve the uterus.

The urethral closure mechanism is deteriorated after anterior colporrhaphy.

Urethral pressure reflectometry (UPR) has proven highly reproducible in women with pelvic organ prolapse. We hypothesized that urethral parameters would decrease after anterior colporrhaphy. A prospective, observational study where women with anterior vaginal wall prolapse ≥stage II were assessed before and after anterior colporrhaphy. Assessments consisted of prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining (at a standardized abdominal pressure of 50 cmH2O, PO-Abd 50), standardized stress tests with 300ml saline, and answering the International Consultation on Incontinence - Urinary incontinence short form. Stress urinary incontinence (SUI) was defined as a positive stress test and a questionnaire with symptoms of SUI and a bother score>1. Sample size was 30, power was 100% and the level of significance was 5%. We analyzed data with paired t-tests or non-parametric Wilcoxon signed rank tests; p-values <0.05 were considered statistically significant. Twenty-eight women who underwent anterior colporrhaphy completed the study. PO-Abd 50 decreased 12 cmH2O after surgery (p<0.0001). Five women developed postoperative SUI and one had persistent SUI; the six women's preoperative PO-Abd 50 was lower than the rest (p<0.01). If preoperative PO-Abd 50 was ≤65 cmH2O, the positive predictive value for postoperative SUI was 50%, and if PO-Abd 50 was ≥85 cmH2O, the negative predictive value was 100%. The urethral closure mechanism deteriorates after anterior colporrhaphy. Using UPR, we can calculate a woman's risk of SUI after anterior colporrhaphy.

300 - Laparoscopic Excision of Anterior Vaginal Wall Prolapse Mesh Kit

This video presents the technique of laparoscopic excision of an anterior vaginal wall prolapse mesh kit. A 67-year-old female underwent repair of anterior compartment defect using transvaginal synthetic mesh in 2009. She complained of persistent vaginal pain and dyspareunia. We removed the central portion of the mesh vaginally, followed by laparoscopic excision of remaining 4 arms of the mesh. This video will demonstrate the anatomical relations of the mesh and the key surgical principles followed during mesh dissection from the underlying tissue. Mesh was extracted successfully from both sides and resulted in resolution of patient's symptoms on the follow up.

Anterior compartment prolapse: what's new?

The purpose of this review is to summarize the treatment options for anterior compartment prolapse, describe the role that apical suspension plays in the correction of anterior vaginal wall prolapse, and assess the risks and benefits of biologic and synthetic graft use in anterior compartment repair. In 2016, The Cochrane Review published a review of 37 trials including 4023 participants finding that compared to native tissue repair, the use of synthetic mesh resulted in reduced symptomatic prolapse recurrence, anatomic recurrence, and repeat prolapse surgery. There was insufficient evidence regarding quality of life improvement or the use of biologic grafts. Of note the differences between native tissue and mesh kit repairs were not large. A strong consideration should be on the correction of apical prolapse when present; isolated anterior wall repairs should be pursued with caution. The surgeon may consider the use of augmenting materials in their repair of anterior vaginal wall prolapse, although the available evidence is not strongly supportive of their use given potential risks.

Re: Clinical Effectiveness and Cost-Effectiveness of Surgical Options for the Management of Anterior and/or Posterior Vaginal Wall Prolapse: Two Randomised Controlled Trials within a Comprehensive Cohort Study-Results from the PROSPECT Study.

Re: Clinical Effectiveness and Cost-Effectiveness of Surgical Options for the Management of Anterior and/or Posterior Vaginal Wall Prolapse: Two Randomised Controlled Trials within a Comprehensive Cohort Study-Results from the PROSPECT Study.

Avoidance of the vaginal incision site for mesh placement in vaginal wall prolapse surgery: A prospective study

ObjectiveTo evaluate efficacy of a minimal surface area, vaginally-installed polypropylene tape (VPT), avoiding insertion on the incision line to treat an anterior, posterior or anteroposterior vaginal wall prolapse. Study designPatients with an anterior, posterior or anteroposterior vaginal wall prolapse waiting for surgical treatment were included in the study. Primary outcome was the incidence of prolapse recurrence reported with combined outcome measures and was reported with Kaplan-Meier cumulative incidence. Secondary outcomes were operative complications, adverse events, urinary, colorectal and sexual functions as well as quality of life. Participation in the study involved up to 8 visits over 5 years. At each visit, patients used a self-reported questionnaire to report symptoms related to pain, urinary, colorectal, sexual functions, and quality of life. A physical examination was also performed. Paired t-tests were used to investigate change in POP-Q and quality of life measurements since baseline. Results71 patients underwent the procedure and were followed-up for an average (standard deviation) of 32.5 (18.7) months. Only 2 (2.8%) women experienced a recurrence of their pelvic organ prolapse. Only one case of erosion and no case of persistent pain have been recorded up to 5 years post-surgery. Quality of life was improved and then sustained throughout the follow-up period (p<0.01). ConclusionThis VPT surgical procedure is safe and has a high level of efficacy to treat anterior, posterior or anteroposterior vaginal wall prolapse. It is also associated with improvements in quality of life of patients which are sustained for many years.

What are patient goals after an anterior colporrhaphy operation?

ObjectivesThe aim of this study was to describe patient-reported goals after an anterior colporrhaphy operation for anterior vaginal wall prolapse, the fulfilment of goals, and the correlation with subjective patient-reported outcomes. Study designA prospective study involving 100 women. Preoperatively, patients completed three modified questions from the International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS) named ICIQ-VS short form (ICIQ-VS SF) and stated three goals for the operation. A telephone interview was performed 3 months postoperatively. ResultsA Visual Analogue Scale (VAS) score from one to 10 estimated the extent to which goals were achieved. Goals were divided into eight groups: 1: mechanical symptoms (bulging), 2: voiding symptoms, 3: quality of life (physical), 4: quality of life (emotional), 5: avoidance of urinary tract infection, 6: cure of incontinence, 7: sexual function and 8: others. ICIQ-VS SF preoperatively was mean 13.6 and postoperatively mean 1.7 (p<0.001). A total of 276 goals were stated, 63.4% of the goals were fulfilled with a VAS score of 10. The majority of the goals (27%) were in group 1 concerning symptoms of bulging. Mean VAS score for all goals was 8.6 (SD 2.5). Group 1 concerning mechanical symptoms of bulging had most goals fulfilled with a VAS of 10 (76%), and group 6 concerning cure of incontinence had fewest goals fulfilled with a VAS of 10 (31%). Forty patients (40%) fulfilled all their goals. ConclusionsPatient-described goal achievement was high. The majority of the fulfilled goals concerned mechanical symptoms of bulging, and goals concerning incontinence were the least fulfilled.

Self-retaining support implant: an anchorless system for the treatment of pelvic organ prolapse—2-year follow-up

The search for an improved vaginal mesh prompted the development of a new anchorless implant. The objective was to report on outcome after 2years of a technique using a self-retaining support (SRS) implant. Patients with anterior vaginal wall prolapse, with/without apical prolapse, were recruited. Participants underwent surgical repair using the SRS device. Demographic data, pre-surgical Pelvic Organ Prolapse Quantification (POP-Q) scoring, quality of life (QoL) questionnaires (Pelvic Floor Distress Inventory Short Form 20 [PFDI-20], Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire 12 [PISQ-12]), and surgical data were collected. Patients were followed at 2weeks, 2, 6, 12, and 24months after surgery. Objective anatomical success was defined using the NIH criteria. Twenty women were recruited for the study with an average age of 62.1years and an average parity of 4.0 deliveries. Average BMI was 28. Pre-operative mean POP-Q measurements were Aa =1.40 (-1 to 3) cm, Ba =2.3 (-1 to 6) cm and C=0.4 (-7 to 6) cm. Surgical time averaged 31.2min. Estimated blood loss averaged 165ml. No intra-operative complications were observed. One case (5%) of frame erosion was documented 8months after surgery. At 2years' follow-up, mean POP-Q measurements were: Aa=-2.95 (-3 to -2) cm, Ba=-2.85 (-3 to -2) cm, and C point -6.90 (-10 to -3) cm. Seventeen (85%) patients had stage 0 and 3 patients (15%) had stage 1. No mesh erosions or chronic pelvic pain were documented at follow-up. The total PFDI score at follow-up was decreased by 92.8 points (p<0.0001). At 2years' follow-up, the SRS implant was found to be safe, showing no intra-operative or immediate post-operative complications. All women presented with POP-Q measurements of the anterior and apical compartment at normal value (Ba ≤ -2cm) and statistically significant subjective improvement.

Posterior colporrhaphy does not affect the urethral closure mechanism.

Studies have suggested that a posterior vaginal wall prolapse might compress the urethra and mask stress urinary incontinence (SUI), much like an anterior vaginal wall prolapse. A recent study with urethral pressure reflectometry (UPR) has shown that the urethral closure mechanism deteriorates after anterior colporrhaphy; this could explain the occurrence of postoperative de novo SUI. We hypothesized that urethral pressure would also decrease after posterior colporrhaphy. This was a prospective, observational study where women with posterior vaginal wall prolapse ≥stage II were examined before and after posterior colporrhaphy. We performed prolapse staging according to the Pelvic Organ Prolapse Quantification system, UPR measurements at rest, during squeezing and straining, and standardized stress tests with 300ml saline. The women filled out International Consultation on Incontinence-Urinary incontinence (ICIQ-UI) short forms. The sample size was 18, with a power of 99.9% and a level of significance of 5%. Parameters were compared using paired t tests or Fisher's exact test, where appropriate; p values <0.05 were considered statistically significant. Eighteen women with posterior vaginal wall prolapse ≥stage II were recruited. One woman did not undergo surgery. There were no changes in urethral pressure at rest (p=0.4), during squeezing (p=0.2) or straining (p=0.2), before and after surgery. The results of the stress tests and ICIQ-UI short forms were the same after surgery. The urethral closure mechanism is not affected by posterior colporrhaphy. Our study does not support the theory that the posterior vaginal wall prolapse compresses the urethra and masks SUI.

Rate of pelvic organ prolapse in Maternity Teaching Hospital in Erbil city

The present study is carried out to describe the prevalence rate of pelvic organ prolapse (POP) among women in Erbil city and to compare the outcomes between normal vaginal delivery and cesarean section. It also aims to find out the risk factors associated with POP. This study is a cross-sectional observational study carried out in Maternity Teaching Hospital in Erbil city, Kurdistan region, north of Iraq from 1 st April 2015 to 1 st April 2016. It includes all married women aged between 15-80 years both nulliparous and multiparous, excluding pregnant women and those in perpurium period in addition to those who underwent previous POP surgery. The data collected by using standardized POP-Q system and the results were analyzed using SPSS computer software version 23.0, Chi-square test; the results were considered significant at p<0.05. 510 women participated in this study aged between 15-80 years. The prevalence of POP was 90.2% in general. The POP rates for 372 cases who have delivered vaginally and 88 cases with cesarean section operation deliveries were 92.1% and 77.3%, respectively. Generally among those 90.2% of the cases who have prolapse, 32.9% have only anterior vaginal wall prolapse, 2% of them have only posterior vaginal wall prolapse, 52.9% have both anterior and posterior vaginal wall prolapse and 2.4% have all the types of prolapse at the same time (anterior, posterior and uterine). The overall distribution of POP stages were: stage zero (9.8%), 1 st stage (26.3%), 2 nd stage (39.2%), 3 rd stage (1.2%), 4 th stage (2.4%) and (21.2%) have combined stage of prolapse (1 st and 2 nd stage in those who have anterior and posterior type prolapse together at the same time). Findings of the study showed that POP is very common among women and is more so among those women who delivered vaginally than those delivered by cesarean section; those who delivered by cesarean section have a fewer degree of prolapse. The common type of prolapse was anterior vaginal prolapse and 2 nd stage prolapse was the prevailed one. The most important risk factors were age, a high number of vaginal deliveries, occupation, history of an overweight baby, short birth gap space and low social economic state.

The Importance of a Multidisciplinary Approach or Women with Pelvic Organ Prolapse and Cystocele.

Pelvic organ prolapse (POP) is a very common clinical condition affecting about 40% of women aged over 45 and 50% of parous women.1,2 It is defined as the descent of one or more of the anterior or posterior vaginal wall, the uterus (cervix), or the vaginal vault (after hysterectomy).3,4 Age, pregnancy, delivery, and previous pelvic surgery, in addition to some high-risk factors that increase intra-abdominal pressure, such as chronic pulmonary disease, obesity, and heavy manual labor, are the main causes of POP.1,2 Cystocele is the most commonly affected compartment in POP, and it is one of the most common indications for gynecologic surgery. Cystocele is the anterior vaginal wall prolapse accompanied by prolapse of the bladder wall. It is defined as the descent of the anterior vagina such that the urethro-vesical junction or any anterior point proximal to this is < 3 cm above the plane of the hymen.1,2,5 Management of POP and cystocele includes nonsurgical and surgical treatments.2 In the last few years, new surgical techniques have been developed with a reduction of postoperative pain and a shorter period of hospitalization.1,5-8 POP impairs quality of life (QoL) of women affected because of vaginal bulge symptoms and changes in sexual function.1,5,6,9 Many studies about this topic have underlined that POP can seriously compromise QoL and limit physical, psychological, and sexual function.1,4,5 Sexual wellbeing is an important aspect of women’s health, and the presence of sexual disorders can adversely affect QoL and couple relationships. POP and cystocele are frequently associated with sexual dysfunctions that usually include disorders of sexual desire, arousal, orgasm, and pain.1,5 The assessment of QoL and sexual function of women with POP and cystocele is important to choose the most suitable treatment for the patient. Indeed, in most cases, impairment of QoL is an indication for surgical treatment of POP.4 According to recent studies about this topic, surgical management of POP significantly improves QoL and sexual function in the patients, and these results remain stable in the long term with further improvement.1,5 In the light of these considerations, a multidisciplinary approach in the management of patients with POP and cystocele is strongly suggested. Specifically, it would be appropriate to evaluate the QoL and sexual dysfunctions of patients through validated questionnaires to improve the treatment decision-making process. For example, the Short Form-369 and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire10 are useful instruments to assess QoL and the effects of POP on sexual function. We recommend that the assessment of QoL and sexual dysfunction using validated questionnaires becomes an integral part of the therapeutic process of women affected from POP and cystocele.