Assessment Of Pelvic Organ Prolapse Research Articles

Assessment of pelvic organ prolapse with the Pelvic Inclination Correction System: defining the normal range and threshold to pathology

PurposeTo define the normal range and threshold values for pathologic prolapse on MRI using the PICS line and assess its correlation with the pubococcygeal line (PCL).MethodsThis prospective, IRB-approved study included 20 nulliparous volunteers and 18 prolapse patients (POP-Q Stage ≥ 2). Organ positions (bladder, cervix, anorectal junction) relative to PICS and PCL were measured on dynamic MRI. Differences in organ position were compared. Receiver-operating characteristic (ROC) analysis was performed to identify cutoff values for prolapse using the PICS line. The correlation between PICS and PCL measurements was tested with Spearman’s rank correlation.ResultsIn volunteers, median bladder and cervix positions measured to the PICS at rest were − 2.7 cm and − 5.3 cm compared to − 1.9 cm and − 2.7 cm in patients (p < 0.001). During straining, bladder and cervix were at − 0.9 cm and − 3.2 cm in volunteers versus + 2.5 cm and + 2.5 cm in patients (p < 0.001). Correlation was strong for PICS and PCL measurements for all three compartments (δ = 0.883–0.970, p ≤ 0.001). AUCs of PICS for the anterior and middle compartment were 0.98 (95% confidence interval [CI] 0.96–1.00, p < 0.001) and 0.96 (95% CI 0.89–1.00, p < 0.001) for differentiating patients from healthy volunteers. AUC for the posterior compartment was 0.76 (95% CI 0.57–0.96, p = 0.034).ConclusionPICS measurements reliably differentiate patients from volunteers in the anterior and middle compartment. Future studies need to identify a reliable threshold for the posterior compartment. PICS and PCL measurements are strongly correlated.Graphical abstract

Preoperative, Intraoperative and Postoperative Assessment of Pelvic Organ Prolapse by Pelvic Organ Prolapse Quantification System and Surgical Outcome

Background: Pelvic organ prolapse (POP) is a common disease of middle aged and elderly women with an incidence of 7-10% and life time risk for surgery 11 to 20%. Assessing pelvic organ prolapsed in an objective, reproducible and applicable method is essential to have successful surgical outcome. Aim of the study was preoperative, intraoperative pre and postsurgical as well as postoperative assessment of pelvic organ prolapse by POP- Q system in patients undergoing reconstructive surgery and measure optimum surgical outcome stage 0 (Q&lt;-1), Tvl &gt; 4 cm and Genital hiatus (3 to 3.4cm) to prevent recurrence (POP-Q stage &gt; -1) and dyspareunia (Pb d”3 cm). Methods : This was hospital based Prospective study done with 250 patient diagnosed as pelvic organ prolapse at OPD. Excluding 14 patients 236 had surgery in Chattagram Metropolitan Hospital during January 2010 to December 2019. POP-Q measurement was done with Valsalva before anesthesia, intraoperative after anesthesia pre and postsurgical and postoperatively in follow up visit within three months of surgery by same surgeon. All POPQ measurement were done by same surgeon using a wooden Spatula marked in cm (POP-Q popsicle stick). All measurement were recorded in grid form and preoperative &amp; presurgical POP-Q staging was done. The result was then summarized as mean and SD for numerical variable and percentage for categorical variable. Result : A total 236 patient had surgery, 233 had vaginal hysterectomy with Apical vaginal suspension with uterosacral ligament and sacrospinous fixation was done in 3 patients with vault prolapse. Mean age was 51 ± 5SD years (51 to 60 years 51%), 84% sexually active, low socioeconomic group (68%), multiparous 100% mean parity 4 ± 2SD (e” 6 62%), 95% had vaginal delivery with history of home delivery 89%, resuming house hold work within two weeks of delivery in 97% cases. Most were postmenopausal 96%. All intraoperative presurgical measurement except Pb and Tvl showed significant higher descent as compared to preoperative finding before anesthesia, mean difference were Aa 0.7, Ba1.6, C 1.6, Ap 0.25 Bp 1.6 D1.6 Gh. 8cm with highest descent in Ba C, D Bp. Immediate postsurgical measurement all patient showed optimum anatomical outcome (stage 0). But follow up within 3 month (10 to 90 days) 13 patient showed satisfactory anatomical outcome (stage 1 Q&lt;-1)) with no recurrence (Q&gt;-1) nor dyspareunia. Total vaginal length and Pb no change in measurement before and after anesthesia but Tvl reduced by 2.3 cm and Pb increased by .3cm postsurgical. Presurgical measurementof Gh increased by. 8cm but reduced to 3.5 cm postsurgical. No significant difference in postsurgical intraoperative measurements during follow up within 3 months except Gh (3.2 cm) which is narrower even with valsalva menovure. Conclusion : POP-Q technique in assessment of Pelvic organ prolapse was anatomically site specific and is with good reproducibility and less intra and inter observer variation. Significant difference in descent alert surgeon to plan surgical technique to have optimum anatomical outcome and prevent recurrence and dysparunea. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 109-118

Pelvic organ movements in asymptomatic nulliparous and symptomatic premenopausal women with pelvic organ prolapse in dynamic MRI: a feasibility study comparing midsagittal single-slice with multi-slice sequences

PurposeTo compare multi-slice (MS) MRI sequences of the pelvis acquired at rest and straining to dynamic midsagittal single-slice (SS) sequences for the assessment of pelvic organ prolapse (POP).MethodsThis IRB-approved prospective single-center feasibility study included 23 premenopausal symptomatic patients with POP and 22 asymptomatic nulliparous volunteers. MRI of the pelvis at rest and straining was performed with midsagittal SS and MS sequences. Straining effort, visibility of organs and POP grade were scored on both. Organ points (bladder, cervix, anorectum) were measured. Differences between SS and MS sequences were compared with Wilcoxon test.ResultsStraining effort was good in 84.4% on SS and in 64.4% on MS sequences (p = 0.003). Organ points were always visible on MS sequences, whereas the cervix was not fully visible in 31.1–33.3% on SS sequences. At rest, there were no statistically significant differences of organ point measurements between SS and MS sequences in symptomatic patients. At straining, positions of bladder, cervix, and anorectum were + 1.1 cm (± 1.8 cm), − 0.7 cm (± 2.9 cm), and + 0.7 cm (± 1.3 cm) on SS and + 0.4 mm (± 1.7 cm), − 1.4 cm (± 2.6 cm), and + 0.4 cm (± 1.3 cm) on MS sequences (p < 0.05). Only 2 cases of higher-grade POP were missed on MS sequences (both with poor straining effort).ConclusionMS sequences increase the visibility of organ points compared to SS sequences. Dynamic MS sequences can depict POP if images are acquired with sufficient straining effort. Further work is needed to optimize the depiction of the maximum straining effort with MS sequences.Graphical abstract

Non-invasive biomechanical assessment of the prolapsed vaginal wall: an explorative pilot study on cutometry and indentometry

The clinical assessment of pelvic organ prolapse (POP) and associated treatment strategies is currently limited to anatomical and subjective outcome measures, which have limited reproducibility and do not include functional properties of vaginal tissue. The objective of our study was to evaluate the feasibility of using cutometry and indentometry for non-invasive biomechanical assessment of the vaginal wall in women with POP. Both techniques were applied on the vaginal wall of 20 women indicated for surgical correction of POP stage two or higher. The primary outcome was the measurement success rate. Measurements were considered successful if biomechanical parameters were generated after a maximum of three attempts. Secondary outcomes included acquisition time, number of attempts to obtain a successful measurement, and biomechanical parameters. Measurements were successfully performed on the anterior vaginal wall of 12 women with cystocele and the posterior vaginal wall of eight women with rectocele. The success rate was 100% for both techniques and acquisition time was under 1 minute for all 20 measurements. Tissue fast elasticity of the posterior vaginal wall (rectocele) was significantly higher than that of the anterior vaginal wall (cystocele) and negatively correlated with age (r = − 0.57, P < 0.05). In women with POP, measuring the biomechanical properties of the vaginal wall using cutometry and indentometry is technically feasible. Objective evaluation of biomechanical properties may help to understand the pathophysiology behind surgical outcomes, providing an opportunity for the identification of patients at risk for (recurrent) prolapse, and individualized treatment decisions.

The Urogynecology Section of the Polish Society of Gynecologists and Obstetricians Guidelines for the diagnostic assessment of pelvic organ prolapse.

The aim of the team appointed by the Board of the Urogynecology Section of the Polish Society of Gynecologists and Obstetricians (PSGO) was to develop this interdisciplinary Guideline for the diagnostic assessment of pelvic organ prolapse (POP) in women, based on the available literature, expert knowledge and opinion, as well as everyday practice. A review of the literature, including current international guidelines and earlier PSGO recommendations (2010-2020) about POP, was conducted. The steps of the diagnostic assessment for patients with POP, subdivided into initial and specialized diagnostics, have been presented. Indications for specialized diagnostic assessment have also been listed. In case of surgical treatment, the patient may be referred solely based on the initial diagnostics or after certain elements of the specialized diagnostics have been completed. Due to inconclusive data, the scope of the diagnostic process for POP is individualized for each patient and depends on patient-reported symptoms, initial diagnostic findings, surgical history, management plan, availability of the equipment, and cost.

Postpartum pelvic organ prolapse assessment via adversarial feature complementation in heterogeneous data

Postpartum pelvic organ prolapse assessment via adversarial feature complementation in heterogeneous data

Vaginal cysts: An important differential diagnosis in the anterior compartment

IntroductionBenign anterior-vaginal-wall cysts (0.5–1% prevalence) often mimic other structures (e.g. cystoceles). No algorithm for their diagnosis, treatment, recurrence or complication prediction can be derived from existing data. Careful preoperative diagnosis can minimize intraoperative surprises and complications due to differences in cyst origin. MethodsThis retrospective study was performed with data from consecutive patients with anterior vaginal cysts who underwent surgery at the Pelvic Floor Centre, University Women’s Hospital of Jena, within a period of 7 years. Data on patient age, symptoms, history of previous surgery, lesion characteristics, preoperative imaging findings, surgeries, postoperative stays, complications and histological and microbiological findings were collected. ResultsOut of 797 consecutive anterior vaginal prolapse repairs 19 (2.4%) anterior vaginal cystic lesions were found, mean age 47 [standard deviation (SD) 14, range 22–72] years. Symptoms reported were pressure (58%), voiding dysfunction (26%), dyspareunia (5%) and inflammation signs (37%); 26% of cases were asymptomatic. Two patients had received prolapse pessary treatment before. Two patients had history of previous vaginal surgery. Five cases were diagnosed preoperatively by ultrasound. Cysts were located on the medial anterior vaginal wall (42%), suburethral (42%) and the vaginal apex (16%). The mean lesion size was 2.6 (SD 0.9) cm. Eleven percent of cases showed microbiological positivity. Most (89%) vaginal cysts were excised; 11% were fenestrated, biopsied and drained. Twenty-six percent of patients underwent outpatient procedures; for inpatient procedures, the median stay was 2.7 days. Postoperative hemorrhage with no transfusion requirement occurred in one patient. All lesions were benign. ConclusionsAnterior-compartment vaginal cysts can be found incidentally during pelvic organ prolapse assessment and surgery, as they can mimic anterior-vaginal-wall prolapse. In this cohort, all excised lesions were benign.

Correlation of preoperative and intraoperative assessment of pelvic organ prolapse by pelvic organ prolapse quantification system.

To correlate the measurements of pelvic organ quantification (POP-Q) score obtained preoperatively with Valsalva maneuver with POP-Q score obtained intraoperatively under anesthesia in the assessment of pelvic organ prolapse. A prospective observational study included 25 women attending gynecology outpatient department with symptomatic pelvic organ prolapse in Midnapore Medical College, India and planned for vaginal operative treatment between March 2019 and February 2020. The preoperative examination was performed in the outpatient department using the POP-Q system with Valsalva maneuver and final examination was performed under spinal anesthesia with mechanical traction. The correlation was performed using the preoperative and intraoperative measurements. All intraoperative POP-Q measurements showed a significantly higher descent compared with preoperative measurements (mean difference Aa 0.72cm, Ba 1.08cm, C 1.66cm, Ap 0.26cm, Bp 1.6cm, D 1.6cm, Gh 0.6cm,) except for Pb and Tvl. Among all nine measurements, the greatest difference between the preoperative and intraoperative values was observed for points C, D, and Bp. Preoperative POP-Q scores significantly differed when assessed intraoperatively under spinal anesthesia with traction. The patient should be informed that the surgical plan may change depending on the intraoperative findings. Our study is an alert for both surgeons and patients.

Translabial Ultrasound for Assessment of Synthetic Midurethral Sling Complications.

Translabial ultrasound (TLUS) is an inexpensive, noninvasive imaging modality traditionally used for assessment of pelvic organ prolapse. The utility of TLUS has recently been expanded to the evaluation of synthetic midurethral slings (MUS) surgically implanted for management of stress urinary incontinence. The purpose of this article is to familiarize radiologists with translabial ultrasound technique and provide a technical protocol for TLUS execution because it can be optimized for imaging and assessment of MUS, including identification of MUS configuration and recognition of common complications. This article provides example images of transobturator and retropubic slings and their associated complications, as visualized on TLUS. Accurate imaging and assessment of MUS is helpful in the evaluation of the patient presenting with symptoms suspicious for sling-related complications and in the planning of surgical revision.

Three-Dimensional Pelvic Floor Ultrasound Assessment of Pelvic Organ Prolapse: Minimal Levator Hiatus and Levator Ani Deficiency Score.

Purpose The purpose of this study was to determine whether levator ani deficiency (LAD) scores and minimal levator hiatus (MLH) areas affect Pelvic Organ Prolapse Quantification (POP-Q) stage.Methods This study was a retrospective chart review of patients with pelvic organ prolapse (POP) at Seoul Songdo Hospital between August 2019 and August 2020. Three-dimensional (3D) pelvic floor ultrasound, preoperative anal manometry, and other physiological tests were performed in 78 patients with POP symptoms. We divided the patients into mild prolapse and severe prolapse groups based on the POP-Q. We examined the LAD and MLH areas. LAD scores were categorized as mild, moderate, or severe.Results There were 32 patients (41.0%) in the mild prolapse group (POP-Q stage I and II) and 46 (59.0%) in the severe prolapse group (POP-Q stage III and IV). The mean LAD score was significantly higher in severe prolapse group (13.33±2.49 vs. 8.19±2.92, P<0.001), and the rate of severe deficiency was also significantly higher in the severe prolapse group (29 [63.0%] vs. 2 [6.3%], P<0.001). The mean MLH was also significantly larger in the severe prolapse group (17.91±2.74 cm2 vs. 14.95±2.60 cm2, P<0.001). In addition, both MLH and LAD scores tended to increase at each stage.Conclusion There is a strong positive correlation between the POP-Q stage and the MLH and LAD scores that can be seen on 3D pelvic floor ultrasound. The findings of this study, by objectively demonstrating LAD and MLH in women with POP, are an important contribution to POP.

EP22.06: The feasibility of translabial ultrasound assessment of pelvic organ prolapse based on preset reference lines in the pelvic MR imaging

EP22.06: The feasibility of translabial ultrasound assessment of pelvic organ prolapse based on preset reference lines in the pelvic MR imaging

Agreement of Ultrasound Measures with POP-Q in Patients with Pelvic Organ Prolapse

Background: Ultrasound has emerged as a valuable complimentary tool for assessment of pelvic organ prolapse (POP). Objectives: The present study aimed to evaluate the correlation between ultrasound measures and clinical staging in patients with suspected POP. Patients and Methods: Forty women with clinical suspicion of POP were enrolled in this cross-sectional study between November 2011 and April 2012. Pelvic organ prolapse quantification (POP-Q) system was used for clinical staging. Perineal ultrasound was performed both at rest and during Valsalva maneuver after proper preparation. On mid sagittal view, two reference lines were drawn; midpelvic line (MPL) was defined as the inferior horizontal tangent of symphysis pubis and H line was drawn from the most inferior part of symphysis pubis to the anorectal junction. Spearman’s correlation coefficient and Kappa coefficient of agreements were used for statistical analysis. Results: Forty women with the mean age of 49.9 ± 10.07 years were enrolled. Excellent correlation was seen between MPL and H line (rho = 0.91, 0.93 and 0.88 in anterior, apical and posterior compartments, respectively). POP-Q had good-to-excellent correlation with ultrasound (rho = 0.84, 0.78 and 0.63 for H line and rho = 0.89, 0.82, 0.71 for MPL in anterior, apical and posterior compartments respectively). In anterior and apical compartments, high agreement was seen between clinical and ultrasound staging methods when grouping patients to no prolapse/mild vs. moderate/severe. In the posterior compartment, this agreement was significant when grouping was done based on the presence or absence of POP. Conclusion: Ultrasound has high correlation with POP-Q staging in all compartments for staging of pelvic organ prolapse. Ultrasound might be useful in the diagnosis of pop in those with negative clinical examination.

Impact of surgical training on the performance of proposed quality measures for hysterectomy for pelvic organ prolapse

Recent healthcare reform has led to increased emphasis on standardized provision of quality care. Use of government- and organization-approved quality measures is 1 way to document quality care. Quality measures, to improve care and aid in reimbursement, are being proposed and vetted in many areas of medicine. We aimed to assess performance of proposed quality measures that pertain to hysterectomy for pelvic organ prolapse stratified by surgical training. The 4 quality measures that we assessed were (1) the documentation of offering conservative treatment of pelvic organ prolapse, (2) the quantitative assessment of pelvic organ prolapse (Pelvic Organ Prolapse-Quantification or Baden-Walker), (3) the performance of an apical support procedure, and (4) the performance of cystoscopy at time of hysterectomy. Patients who underwent hysterectomy for pelvic organ prolapse from January 1 to December 31, 2008, within a large healthcare maintenance organization were identified by diagnostic and procedural codes within the electronic medical record. Medical records were reviewed extensively for demographic and clinical data that included the performance of the 4 proposed quality measures and the training background of the primary surgeon (gynecologic generalist, fellowship-trained surgeon in Female Pelvic Medicine and Reconstructive Surgery, and "grandfathered" Female Pelvic Medicine and Reconstructive Surgery). Data were analyzed with the use of descriptive statistics. Inferential statistics with chi-squared tests were used to compare performance rates of quality measures that were stratified by surgical training. Probability values <.05 were considered statistically significant. Six hundred thirty patients who underwent hysterectomy for pelvic organ prolapse in 2008 had complete records available for analysis. Fellowship-trained surgeons performed 302 hysterectomies for pelvic organ prolapse; grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed 98 hysterectomies, and gynecologic generalist surgeons performed 230 hysterectomies. Fellowship-trained surgeons had the highest performance rates for individual quality measures (91.4-98.7%) and cumulative performance of all measures (80.8% of cases). Grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed significantly fewer measures (80.6-95.9% performance rate for individual measures; 65.3% cumulatively for all measures) than fellowship-trained surgeons and more than gynecologic generalists (64.3-70% for individual measures; 29.1% cumulatively for all measures). There was an association between surgeon training background and number of hysterectomies performed for pelvic organ prolapse, with specialist surgeons performing more hysterectomies. When quality measure performance was stratified by surgeon volume, similar significant associations were found, with high-volume surgeons performing more quality measures than low-volume surgeons. Within a large healthcare maintenance organization, fellowship-trained Female Pelvic Medicine and Reconstructive Surgery surgeons were more likely to perform proposed quality measures in women who underwent hysterectomy for pelvic organ prolapse compared with those surgeons without such training. Grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed measures more frequently than gynecologic generalists but less than fellowship-trained surgeons. Further study is indicated to correlate the proposed quality measures with clinical outcomes.

Diagnostic and therapeutic recommendations for patients with nocturia.

IntroductionNocturia is defined as the urge to urinate at night when the micturition was directly preceded and followed by sleep. Due to its negative impact on the quality of life of patients, an effective treatment for this disease has become a significant therapeutic challenge. The aim of this article was to explain the main risk factors for the occurrence of nocturia and to present diagnostic and therapeutic schemes in the case of nocturnal polyuria (idiopathic night time polyuria).Material and methodsA review of the literature was carried out and the available guidelines of international science societies, which provided the basis for the above recommendations, were analyzed.ResultsDetailed medical history should include information concerning: lower urinary tract symptoms (including nocturia), underlying illnesses, urogenital disorders, previous surgeries and medications administered. Keeping a bladder diary is recommended. The physical examination, depending on the patient's gender, should include gynecological examination with pelvic organ prolapse assessment or prostate evaluation. In laboratory tests, a urinalysis may be used, in particular cases a cytological analysis of urine sediment may be carried out. In addition, a possible ultrasound and/or cystoscopy may be conducted. Nocturia therapy should begin with modifying dietary habits, including compliance with the fluid regimen, avoiding alcohol, coffee and tea. Moderate physical exercise is also recommended. The pharmacological treatment of nocturia caused by nocturnal polyuria is based on the use of desmopressin at a daily single dose of 25 µg for women and 50 µg for men. The use of desmopressin allows for the reduction in the number of nocturia episodes, as well as improves the overall quality of life and sleep. Treatment with desmopressin can also be considered as a form of therapy added in people with an overactive bladder or benign prostatic hyperplasia, in which nocturia is a significant clinical problem.ConclusionsDesmopressin is an effective and safe first-line treatment option in pharmacological therapy of nocturia caused by nocturnal polyuria.

Characterizing Pelvic Organ Prolapse in Adult Spina Bifida Patients

To report the distribution of pelvic organ prolapse (POP) stages in adult spina bifida (SB) patients. The severity of POP in the SB population has not been previously reported. Retrospective review of SB patients ≥18 years with a documented POP quantification examination between 2006 and 2014 were included. Patient demographics, gestation, parity, POP quantification examinations and prolapse symptoms were obtained. Thirty-three SB patients were identified with a mean age of 33.2 years. Five patients (15.2%) had stage 0 prolapse, 12 (36.4%) had stage 1, 12 (36.4%) had stage 2, 3 (9.1%) had stage 3, and 1 (3.0%) had stage 4. Of the 16 patients with advanced POP (stage 2 prolapse or greater), only 6 patients (37.5%) reported symptoms related to POP. All 6 symptomatic patients endorsed sensation of a vaginal bulge. Two of the 6 patients also reported dyspareunia. Additionally, 1 patient with advanced POP presented with vaginal bulge, noted by a caregiver, and cervical bleeding, but was otherwise asymptomatic. Twenty-four patients (72.7%) were nulliparous, and 12 of the 24 nulliparous patients (50%) demonstrated prolapse. Despite young age and frequent nulliparity, patients with SB are more likely to have POP than the general population. Additionally, the majority of SB patients with prolapse are asymptomatic. Assessment of pelvic organ prolapse should be included in the evaluation of adult SB females due to the low rate of symptoms even in the setting of advanced stage prolapse and potential impact on both urinary and bowel function.

Interobserver agreement of multicompartment ultrasound in the assessment of pelvic floor anatomy.

To assess the interobserver agreement of pelvic floor anatomical measurements using multicompartment pelvic floor ultrasound. Females were recruited from the urogynaecology/gynaecology clinics between July and October 2009 and underwent multicompartment pelvic floor ultrasonography (PFUS) using two-dimensional (2D) transperineal ultrasound (TPUS), high-frequency 2D/three-dimensional (3D) endovaginal ultrasound (EVUS) using a biplane probe with linear and transverse arrays and a 360° rotational 3D-EVUS. PFUS measurements were independently analysed by two clinicians. 158 females had PFUS assessment. Good-to-excellent interobserver agreement was observed for bladder-symphysis distance at rest and valsalva, urethral thickness, urethral length, urethral volume, levator hiatus area and width, anteroposterior diameter and anorectal angle. Lins Correlation was used to calculate the interobserver agreement and Bland-Altman plots were created to demonstrate the agreement between the researchers. There was also a good-to-excellent agreement between the two clinicians for the assessment of pelvic organ prolapse (POP) in the anterior, middle and posterior compartment. Multicompartment PFUS is a reliable tool in the anatomical assessment of pelvic floor measurements and POP. We found a good-to-excellent agreement between the two assessors in the assessment of pelvic floor measurements for all three pelvic floor compartments and suggest that multicompartment PFUS could be considered as a systematic integrated approach to assess the pelvic floor.

Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence: a randomized controlled trial with 14-year follow-up

ObjectiveTo compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases. Study designLong-term follow-up of a randomized clinical trial of subtotal vs. total abdominal hysterectomy with objective outcomes. All randomized women still alive and living in Denmark (n=304) were invited to answer a questionnaire and come for clinical examination consisting of 20-min pad weighing test, urinary flow, measurement of residual urine, POP-Q measurement for pelvic organ prolapse, 3 day voiding diary and also filled out the pelvic floor distress inventory (PFDI-20) questionnaire. ResultsWe included 100/304 (32.9%) women (subtotal hysterectomy: 53, total hysterectomy: 47) in the clinical examinations. The study questionnaire was answered by 197 (64.8%) (subtotal: 97, total: 100), the PFDI-20 questionnaire was answered by 140 (46.1%) (subtotal: 68, total: 72). We found no difference between subtotal and total abdominal hysterectomy in the PFDI-20 scores or regarding objectively assessed urinary incontinence or pelvic organ prolapse. In the subtotal hysterectomy group, 31 (59.6%) women had objective stage 2 pelvic organ prolapse compared with 33 (70.2%) in the total hysterectomy group (P=0.27); however, only 6/31 and 9/33 had symptoms (P=0.45). There were more anterior pelvic organ prolapses in the total hysterectomy group (N=10) than in the subtotal hysterectomy group (N=4) (P=0.048). We found a higher mean maximum flow rate (Qmax) in the subtotal hysterectomy group (34.78ml/s) than in the total hysterectomy group (27.08ml/s) (P=0.042) as well as a higher mean functional capacity in the subtotal hysterectomy group (526ml) than in the total hysterectomy group (443ml) (P=0.0147) according to the voiding diary. ConclusionSubtotal and total abdominal hysterectomy are comparable regarding long-term objective pelvic organ prolapse and urinary incontinence. The subtotal hysterectomy group had a higher Qmax and voided volume.

Use of Ultrasound Imaging in Pelvic Organ Prolapse: an Overview

Pelvic floor ultrasonography has emerged as a procedure that is accurate, easy to perform, cost-effective, and widely available. Numerous studies have been published that demonstrate its potential applications in the assessment of pelvic organ prolapse (POP). Despite the current lack of standardization of techniques and validation studies, use of ultrasound holds promise for aiding the clinician in making surgical decisions and understanding causes of operative failures in POP. Three-dimensional and four-dimensional transperineal and endovaginal ultrasound (3D/4D-TPUS and EVUS) can provide detailed visualization of pelvic floor muscles and soft tissues. Real-time imaging capabilities also allow functional pelvic floor assessment during dynamic maneuvers such as Valsalva or muscle contraction. We provide in this report up-to-date information on the use of ultrasound imaging in POP. Special attention is given to the study of levator ani muscle (LAM) morphology and functionality, which is believed to play an essential role in pelvic organ support.

Ultrasonography in Gynecology

Ultrasonography is the gold standard as a simple, safe, non-invasive, cost effective, reliable method in evaluation of gynecological diseases especially in infertility assessment and management. This unique new book “Ultrasonography in Gynecology” offers extensive coverage of technique of USG and comparison with other imaging technology and operative procedures. It highlights the importance of legal counseling and all benign and malignant gynecologic conditions with wonderful pictorial comparison of sonographic findings with actual pathologies. Intelligently selected topics in each section are comprehensive and cover all clinical aspects and different approaches in the ultrasonographic evaluation—including 3D ultrasonography, 3D sonohysterography, Doppler imaging, and pelvic floor imaging. The book is easy to read and the practical emphasis is reflected in the structure of the chapters. The fifth section of this book Ultrasonography in infertility is so detailed and that is why it is a must-read book for trainees, beginners, and also for practitioners in Infertility Gynecology and Radiology. “One Stop” fertility diagnosis and management is convenient and cost effective to patients. Every detail of sonologic assessment and management of an IVF cycle is written in the last fifteen chapters of this book. It explores the application of ultrasonography for determining ovarian reserves by 2D as well as 3D ultrasound, calculating ovarian volume using Virtual Organ Computer-aided Analysis (VOCAL) to obtain automated follicular measurement using a software program while monitoring follicular growth in oocyte retrieval and transabdominal as well as transvaginal embryo transfer. By describing ultrasound-guided fallopian tube catheterization, hysteroscopic myomectomy under ultrasound guidance, MRI-guided focused ultrasound, and percutaneous ultrasound-guided radiofrequency ablation, it emphasizes the therapeutic value of ultrasound in infertility. It introduces the concept of self-operated vaginal ultrasound as the future for monitoring follicular growth. There are certain chapters which are the highlight of this book like the chapter on Pelvic floor ultrasound which recommends the use of ultrasound as the method of choice for the assessment of pelvic organ prolapse most notably in the differential diagnosis of posterior compartment prolapse. The chapter is written in a very logical format where the functional assessments of the pelvic floor musculature, the imaging of anterior and posterior compartment, and diagnosis of their defects are made easy with the help of well-labeled high-resolution images to aid visual learning. The editorial team of two eminent editors Botros Rizk and Elizabeth Puscheck along with the world-renowned international contributors have combined their expertise and clinical experience to this outstanding book which is hugely referenced, comprehensive, and written step by step from the basic to most complicated case.

Assessment of Pelvic Organ Prolapse by Pelvic Organ Prolapse Quantification Technique Among Pre-operative Patients

Aims: This was performed to examine pelvic organ prolapse using POP-Q technique and correlate pre-existing urinary symptoms with segments of pelvic organ prolapse. Methods: All patients admitted with pelvic organ prolapse were included. Patients were asked regarding any concomitant urinary symptoms and then all patients were examined by POP-Q technique and correlation of urinary symptoms was done with various segments of pelvic organ prolapse. Results: Eighty patients were studied in one year duration. Majority of patients had presented with stage 4 prolapse (58.8%). Majority of patients had urinary symptoms among which 87.5% had increased urinary frequency, 88.8% had dysuria, 65% had stress urinary incontinence (SUI), 72.5% had incomplete evacuation. Dysuria and SUI was found to have significant correlation with anterior segment prolapse (p&lt;0.05%). Conclusions: Site specific measurements by POP-Q system showed anterior segment prolapse to be more and were significantly associated with various urinary symptoms.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 26-29 DOI: http://dx.doi.org/10.3126/njog.v8i2.9765