Degree Of Pelvic Organ Prolapse Research Articles

Универсальный гинекологический инструмент для трансобтураторного проведения лигатур и лентовидных имплантатов у пациенток с пролапсом тазовых органов

Objective. To study the efficacy and safety of the original surgical instrument for trans-obturator insertion of ligatures and tapelike implants in patients with pelvic organ prolapse (POP) and stress urinary incontinence (SIU). Patients and methods. This study included 164 patients with POP and urethral hypermobility aged 34–79 years. The original threecomponent surgical instrument for trans-obturator insertion of ligatures and tape-like implants (Patent No. 217079, 2022) was used during surgery. Four developed surgical programs using titanium mesh implants and non-absorbable ligatures were implemented. Results. Patient questionnaire showed satisfaction with the results of surgical treatment in all cases, which had a positive effect on the quality of life, mood and contributed to an increase in social activity. Patients of reproductive age and in perimenopause reported an improved quality of sexual life. The recurrence of first-degree POP in the late postoperative period was diagnosed after 12–36 months in 5 patients (4.8%), but it did not require surgical re-intervention. Conclusion. Clinical approbation of the developed three-component instrument for trans-obturator insertion of ligatures and tape-like implants in patients with different degrees of POP and SIU confirmed its effectiveness and safety. The undoubted advantages of this instrument include convenient assembly, simple postoperative processing and sterilization, as well as the possibility of multiple use and, therefore, economic benefit, which, together with other useful parameters, makes this instrument universal for this type of surgery. Key words: gynecological surgical instrument, trans-obturator insertion of ligatures, tape-like implants

Clinical application of a fixed reference line in the ultrasound quantitative diagnosis of female pelvic organ prolapse

ObjectiveThis study explored using an improved ultrasound (US) for quantitative evaluation of the degree of pelvic organ prolapse(POP).DesignA transluminal probe was used to standardize ultrasound imaging of pelvic floor organ displacements. A US reference line was fixed between the lower edge of the pubic symphysis and the central axis of the pubic symphysis at a 30°counterclockwise angle.MethodPoints Aa, Ba, C and Bp on pelvic organ prolapse quantification (POP-Q) were then compared with the points on pelvic floor ultrasound (PFUS).ResultsOne hundred thirteen patients were included in the analysis of the standard US plane. Correlations were good in the anterior and middle compartments (PBN:Aa, ICC = 0.922; PBB:Ba, ICC = 0.923; and PC:C, ICC = 0.925), and Bland-Altman statistical maps corresponding to the average difference around the 30°horizontal line were close to 0. Correlations were poor in the posterior compartment (PRA:Bp, ICC = 0.444). However, eight (7.1%) cases of intestinal hernia and 21 (18.6%) cases of rectocele were diagnosed.ConclusionsIntroital PFUS using an intracavitary probe, which is gently placed at the introitus of the urethra and the vagina, may be accurately used to evaluate organ displacement. The application of a 30°horizontal line may improve the repeatability of the US diagnosis of POP.

Analysis of clinical correlation between pelvic organ prolapse and HR-HPV infection

ObjectiveTo explore the influence of pelvic organ prolapse (POP) on the risk of high-risk human papilloma virus (HR-HPV) infection. Materials and methodsRetrospective analysis of the HR-HPV infection results of 1183 patients with POP who were treated at the First Affiliated Hospital of Chongqing Medical University, Liangping District People's Hospital affiliated to Chongqing Medical University, and the 13th People's Hospital of Chongqing between October 2018 and October 2021. Patients without POP who underwent HR-HPV examination at the same time were selected as the control group, and the HR-PV infection rate was compared between the two groups. Patients diagnosed with POP were stratified to analyse whether age, menopausal status, degree of POP, location of POP and duration of POP were associated with HR-HPV infection. ResultsThe rate of HR-HPV infection was lower for patients with POP compared with patients without POP over the same time period. The highest rate of infection was seen in patients aged 60–69 years (14.7%) and the lowest rate (7.5%) was seen in patients aged 50–59 years; differences between age groups were significant. The rate of HR-HPV infection in postmenopausal patients with POP was slightly higher than that in non-menopausal patients with POP, but the difference was not significant. No significant differences in the rate of HR-HPV infection were associated with location of POP, duration of POP or degree of POP. ConclusionPOP does not increase the risk of HR-HPV infection.

Effects of Extracorporeal Magnetic Wave Pelvic Floor Therapy Combined with PFMT on Pelvic Floor Muscle Strength and Pelvic Organ Prolapse in Patients with Postpartum Pelvic Floor Dysfunction: A Prospective Randomized Trial

Background: To investigate the effect of extracorporeal magnetic wave pelvic floor therapy combined with pelvic floor muscle training (PFMT) on pelvic floor muscle strength and the degree of pelvic organ prolapse in patients with postpartum pelvic floor dysfunction. Methods: A total of 100 patients with postpartum pelvic floor dysfunction (PFD) who were treated in Lishui People’s Hospital from January 2020 to May 2022 were selected as the research objects. According to the random number table method, they were divided into a control group of 50 cases and an observation group of 50 cases. The control group received pelvic floor muscle training, and the observation group received extracorporeal magnetic wave pelvic floor therapy combined with PFMT on its basis, and the two groups received continuous treatment for 8 weeks. The clinical efficacy; Pelvic floor muscle strength classification; Pelvic organ prolapse quantitative scale (POP-Q) score Ap and C index points; Pelvic floor dysfunction questionnaire (PFDI-20) and Pelvic floor dysfunction questionnaire (PFIQ-7) score were compared between the two groups. Results: Compared with the control group (70.00%), the total clinical effective rate (96.00%) of the observation group was significantly increased (p < 0.05); compared with before treatment, the proportion of pelvic floor muscle strength of grade 0 in the observation group was significantly decreased, and the proportion of grade Ⅳ was significantly increased after treatment, and the proportion of pelvic floor muscle strength of grade 0 in the observation group was significantly lower than that in the control group, and the proportion of grade Ⅳ was significantly higher than that in the control group (p < 0.05); Compared with before treatment, the POP-Q scores Ap and C index points in the two groups were significantly decreased after treatment, and the POP-Q scores Ap and C index points in the observation group were significantly lower than those in the control group (p < 0.05); Compared with before treatment, the PFDI-20 scores and PFIQ-7 scores in the two groups after treatment were significantly decreased, and the PFDI-20 scores and PFIQ-7 scores in the observation group were significantly lower than those in the control group (p < 0.05). Conclusions: Extracorporeal magnetic wave pelvic floor therapy combined with PFMT can effectively improve the clinical efficacy of PFD patients, improve pelvic floor muscle strength, reduce the degree of pelvic organ prolapse, and improve the quality of life of patients, which has a high clinical reference value. Clinical Trial Registration: The study was registered at https://www.chictr.org.cn (registration number ChiCTR1900024783).

Laparoscopic correction of combined forms of genital prolapse

BACKGROUND: The significance of pelvic organ prolapse is determined by the absence of a downward trend in its frequency and severity and by the steadily high number of recurrences in every third woman who underwent surgery. According to most authors, surgical correction is the primary treatment for genital prolapse. Therefore, the search for an effective and safe surgical treatment of this pathology is important. Currently, various minimally invasive surgical interventions have been performed via laparoscopic access, which reduces the risk of tissue or adjacent organ damage, possible intraoperative bleeding, and potential complications.
 AIM: This study aimed to assess the efficiency and safety of laparoscopic techniques for the correction of genital prolapse.
 MATERIALS AND METHODS: The study included 12 patients with pelvic organ prolapse quantification system grades IIIV who underwent surgical correction using a combined laparoscopic approach. The inclusion criterion was the presence of prolapse, including recurrent forms. At the outpatient stage, the patients medical history was collected, and complaints, and degree of pelvic organ prolapse were assessed. Genital prolapse was diagnosed based on medical history, clinical data, and additional methods of examination.
 RESULTS: With this surgical intervention technique, intraoperative bleeding was avoided, the number of possible postoperative complications was reduced, and disease recurrence was prevented. The criteria for assessing the surgical intervention included improvement of the pelvic floor anatomy, elimination of symptoms, patients satisfaction with treatment results and quality of life, and reduced risk of recurrence of complications. Mesh-associated complications were excluded by avoiding contact of the synthetic implanted material with the vaginal mucosa.
 CONCLUSIONS: Through laparoscopic access, the length of hospital stay was reduced, and compared with abdominal access, a better cosmetic effect was achieved. A comprehensive system considering the assessment of the anatomical outcome, functional status of the pelvic floor, and patients quality of life may become the most objective tool to evaluate the success of surgical treatment of genital prolapse.

Long-term pelvic floor symptoms and urogenital prolapse after hysterectomy

BackgroundThe aim of this study was to describe the natural course of pelvic floor symptoms and pelvic floor anatomy for women long-term after hysterectomy.MethodsWomen who underwent hysterectomy between 1996–2004 carried out the PFDI-20 questionnaire and POP-Q examination. We collected data on the presence and type of pelvic floor symptoms and its relation to the degree of pelvic organ prolapse (POP) per compartment (≥ stage 2).ResultsWe obtained data from 247 women on average sixteen years after hysterectomy, with no prolapse (n = 94), anterior prolapse (n = 76), posterior prolapse (n = 38), both anterior- and posterior prolapse (n = 20), and a prolapse involving the vaginal vault (n = 19). Of all 153 women with ≥ stage 2 prolapse, 80 (52%) experienced moderate and/or severe symptoms of the PFDI-20. Most frequently reported symptoms by women with POP were uncontrollable flatus, urinary frequency and urge incontinence. Bulging was associated with a prolapse beyond the hymen. 39% Of women without prolapse experienced bothersome pelvic floor symptoms as well. Most often these were stress incontinence, straining to pass stool and incomplete bowel emptying. Women with a history of hysterectomy for prolapse have more pelvic floor symptoms than women who underwent hysterectomy for other indications, regardless of the current presence of POP (57% versus 40%, p = 0.009).ConclusionIn a group of post-hysterectomy women who did not actively seek help, 47% experienced problematic pelvic floor symptoms, independent of the presence or absence of an anatomic POP. Creating more knowledge and awareness of the impact of hysterectomy on the pelvic floor can help women in the future.Trial registrationThe study was registered in the Dutch Trial Registry; Trial NL5967 (NTR6333, 2017–02-01) and approved by the Medical Research Ethics Committee of the Máxima Medical Center (NL60096.015.16, 2017–02-24).

7709 Tips and Tricks for Vaginal Hysterectomy

<h3>Study Objective</h3> The objective of this video is to review surgical techniques and tips for vaginal hysterectomy to improve provider confidence and serve as an educational tool. <h3>Design</h3> Audio narration, still images, and surgical footage will be used to review difficult scenarios and present an evidence-based approach to troubleshoot common issues. <h3>Setting</h3> Video footage was filmed with patients in dorsal lithotomy positioning in the operating room. <h3>Patients or Participants</h3> Patients with varying degrees of pelvic organ prolapse, ranging from stage 0-IV on POP-Q (Pelvic Organ Prolapse Quantification), were filmed during vaginal hysterectomy for heavy menstrual bleeding or prolapse repair. <h3>Interventions</h3> This video will review four common difficulties faced during vaginal hysterectomy: patient selection, the colpotomy, vaginal salpingectomy, and laparoscopically assisted vaginal hysterectomy. <h3>Measurements and Main Results</h3> This video discusses how to select candidates for vaginal hysterectomy including commonly misquoted contraindications. An approach, using the physical exam as guidance, is given for the anterior and posterior colpotomy and video footage is used to review how to troubleshoot the anterior entry. Steps to improve visualization for vaginal salpingectomy are discussed. Finally, laparoscopically assisted vaginal hysterectomy and how to divide the case between laparoscopic and vaginal approaches is reviewed to optimize success in the operating room. <h3>Conclusion</h3> This video reviews important steps of vaginal hysterectomy and provides tips to improve surgeon confidence. It can serve as an educational resource for trainees and early-career surgeons to improve their knowledge and confidence in performing vaginal hysterectomy. These types of resources are important to counter declining rates of vaginal hysterectomy and decreasing provider comfort in performing this operation.

Clinical Efficacy of LSC and TVT-O for Stress Urinary Incontinence Complicated with Pelvic Organ Prolapse and Factors Influencing Postoperative Urinary Function Recovery.

Pelvic organ prolapse is caused by various causes, which leads to the weakness of the tissue supporting the pelvic floor and then causes the downward displacement of female reproductive organs and adjacent organs. Clinical studies have shown that pop is often associated with stress urinary incontinence. This research project aimed to clarify the clinical effect of laparoscopic sacrocolpopexy (LSC) and tension-free vaginal tape obturator (TVT-O) for stress urinary incontinence (SUI) complicated with pelvic organ prolapse (POP) and the influencing factors of postoperative urinary function (UF) recovery. The clinical data of 125 patients with SUI complicated with POP treated in Wenzhou Central Hospital and Beidahuang Industry Group General Hospital between March 2018 and December 2019 were retrospectively analyzed. Patients were assigned to the following two arms based on different treatment methods: the combination group (n = 65, treated with LSC plus TVT-O) and the control group (n = 60, treated with LSC). The alterations of perioperative clinical and urodynamic indexes were analyzed. The objective and subjective response rates were observed and compared. The degree of POP before and after surgery was evaluated. According to the urinary function recovery time, the patients were divided into the fast and non-fast recovery groups, and then, the factors influencing postoperative UF recovery were analyzed between groups. The combination group showed statistically longer operation time (OT) and postoperative indwelling catheter and higher intraoperative blood loss (IBL) than the control group (all P < 0.05), but the anal exhaust time and postoperative length of stay (LOS) differed insignificantly between the two arms. The combination group outperformed the control group in the objective response rate, as well as the scores of illness, quality of life (QOL), and sexual life (all P < 0.05). Menopause, maximum flow rate (MFR), and preoperative residual urine volume were identified as the influencing factors for normal urination. For patients with SUI complicated with POP, the efficacy of laparoscopic sacrocolpopexy was limited, while combining with TVT-O would obtain more significant short-term and long-term efficacy, which can significantly improve patients' urination and long-term quality of life, with higher safety and clinical promotion value.

Pelvic organ prolapse surgery and overactive bladder symptoms\u2014a population-based cohort (FINPOP)

Introduction and hypothesisIt is unclear how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after POP surgery. We hypothesized that anterior and apical prolapse are more strongly associated with OAB symptoms than posterior compartment prolapse.MethodsA total of 2933 POP surgeries from a prospective population-based cohort were divided into two groups: (1) anterior and/or apical compartment surgery (± posterior repair), N = 2091; (2) posterior repair only, N = 478. Urinary frequency and urgency urinary incontinence (UUI) were evaluated using PFDI-20 (bothersome symptom: score 3–4) at baseline, 6, and 24 months. Association between degree of POP in specific compartments and symptoms at baseline was estimated with generalized linear models and between compartment of surgery and symptom improvement with generalized estimating equations.ResultsAt least one bothersome symptom was reported by 40% at baseline, 14% at 6, and 19% at 24 months. At baseline, urinary frequency was associated with degree of anterior and apical and UUI with anterior compartment prolapse. Women undergoing surgery for anterior/apical compartment started with worse symptoms and experienced greater improvement than women undergoing posterior compartment surgery. Bothersome frequency resolved in 82% after anterior/apical and in 63% after posterior compartment surgery. Bothersome UUI resolved in 75% after anterior/apical and in 61% after posterior compartment surgery. After surgery, symptom severity was comparable between groups. Bothersome de novo symptoms occurred in 1–3%.ConclusionsOAB symptoms are more strongly related to anterior and apical than to posterior compartment prolapse, but improvement is seen after surgery for any vaginal compartment.

Analysis of Risk Factors with the Degree of Pelvic Organs Prolapse at Dr. Mohammad Hoesin General Hospital Palembang

Background. Pelvic organ prolapse (POP) is a condition in which one or more pelvic organs (consisting of the uterus, vaginal cuff, bladder, intestines, and rectum) or more are still in or out of the vagina. Risk factors that influence the incidence of POP consist of obstetric risk factors (number of parity and birth method) and non-obstetric risk factors (age, menopause, BMI, comorbid disease, and hypertension). The purpose of this study was to analyze the risk factors associated with the degree of POP.&#x0D; Methods. This study is an observational study with a cross-sectional approach to 111 patients examined at the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin general hospital Palembang on January 2017 to December 2019, who was diagnosed with pelvic organ prolapse.&#x0D; Results. The results showed the effect of variables with the degree of POP using the chi-square test, consisting of parity (p=0.007), birth method (p=&lt;0.001), age (p=0.016), menopause (p=0.001), BMI (p =0.005), indicates that there is a significant effect on the degree of POP. Meanwhile, comorbid factors (p=0.481) and hypertension (p=0.415) did not show a significant relationship with the degree of POP. The results of the binary logistic regression analysis of all risk factors, the number of parity &gt;4, overweight, and age 40 years, will have a 99.85% chance of experiencing grade 3 or 4 prolapse.&#x0D; Conclusion. Age is the most dominant risk factor affecting the degree of pelvic organ prolapse, with 19 times the chance of developing POP 3 or 4 degrees.

Analysis of Risk Factors with the Degree of Pelvic Organs Prolapse at Dr. Mohammad Hoesin General Hospital Palembang

Background. Pelvic organ prolapse (POP) is a condition in which one or more pelvic organs (consisting of the uterus, vaginal cuff, bladder, intestines, and rectum) or more are still in or out of the vagina. Risk factors that influence the incidence of POP consist of obstetric risk factors (number of parity and birth method) and non-obstetric risk factors (age, menopause, BMI, comorbid disease, and hypertension). The purpose of this study was to analyze the risk factors associated with the degree of POP.&#x0D; Methods. This study is an observational study with a cross-sectional approach to 111 patients examined at the Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin general hospital Palembang on January 2017 to December 2019, who was diagnosed with pelvic organ prolapse.&#x0D; Results. The results showed the effect of variables with the degree of POP using the chi-square test, consisting of parity (p=0.007), birth method (p=&lt;0.001), age (p=0.016), menopause (p=0.001), BMI (p =0.005), indicates that there is a significant effect on the degree of POP. Meanwhile, comorbid factors (p=0.481) and hypertension (p=0.415) did not show a significant relationship with the degree of POP. The results of the binary logistic regression analysis of all risk factors, the number of parity &gt;4, overweight, and age 40 years, will have a 99.85% chance of experiencing grade 3 or 4 prolapse.&#x0D; Conclusion. Age is the most dominant risk factor affecting the degree of pelvic organ prolapse, with 19 times the chance of developing POP 3 or 4 degrees.

Ultrasound analysis of the effect of second delivery on pelvic floor function in Chinese women

In our study, patients who had a second delivery were categorised into the following 4 groups. Pelvic floor ultrasound data were compared during the 6th week after the second delivery. The incidence of cystoceles was highest in group A and lowest in group D. In addition, groups A and B had a higher rate of rectoceles or perineum descent. Similarly, the areas of the levator hiatus were higher in Groups A and B during Valsalva manoeuvres. The area of the levator hiatus from the resting state to the Valsalva manoeuvre effect had the greatest change in Group A. A comparison of the PR thickening rates among the four groups did not reveal significant differences. All second delivery methods can cause varying degrees of pelvic organ prolapse and decreased pelvic floor function; however, vaginal delivery as the second delivery mode may have a more significant effect in Chinese women. Impact Statement What is already known on this subject? Different modes of delivery have significantly different effects on female pelvic floor function. Pregnancy beyond 35 weeks of gestation has an effect on female pelvic floor function, irrespective of the mode of delivery. What do the results of this study add? This study analysed the impact of different delivery modes on Chinese female pelvic floor function. Parous women who underwent different modes of second delivery all demonstrated different degrees of pelvic organ prolapse, as well as pelvic floor function decline. What are the implications of these findings for clinical practice and/or further research? Our study will provide basic research of Chinese female pelvic floor function after a second delivery, which will be of clinical significance around the world, as well as in China. China will keep promoting further delivery as the aging population is increasing. If the developing countries want to promote the second delivery around the women, they have basic research and data to instruct the females.

Patient Satisfaction and Symptoms Improvement in Women Using a Vginal Pessary for The Treatment of Pelvic Organ Prolapse.

Pelvic organ prolapse is a common complaint among older women. Vaginal pessary insertion is an appropriate treatment as a non-surgical method with few complications. This paper is a prospective observational study of 68 patients with pelvic organ prolapse that was carried out at the Imam Khomeini Hospital’s Pelvic Floor clinic. The degree of pelvic organ prolapse was graded according to the Pelvic Organ Prolapse Quantification (POP-Q) System. For all patients, the Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire was completed before vaginal pessary insertion, and after approximately 6 months of treatment. After 6-8 months, we found out that vaginal discharge was significantly increased and the feeling of fullness in the vagina was significantly decreased. However, sexual dissatisfaction, the feeling of incomplete evacuation, fecal and urinary incontinence, frequent urination, and pain or discomfort in the genital region were not significantly different after using a pessary. Approximately half a year later, 96.7% of the women with a successful pessary fitting trial were satisfied and reported a significant improvement in symptoms. Further studies with larger sample size, a different type of pessary, and a longer follow-up duration are recommended to evaluate all the symptoms associated with pelvic organ prolapse and its treatment.

To mesh or not to mesh: a review of pelvic organ reconstructive surgery.

Pelvic organ prolapse (POP) is a major health issue with a lifetime risk of undergoing at least one surgical intervention estimated at close to 10%. In the 1990s, the risk of reoperation after primary standard vaginal procedure was estimated to be as high as 30% to 50%. In order to reduce the risk of relapse, gynecological surgeons started to use mesh implants in pelvic organ reconstructive surgery with the emergence of new complications. Recent studies have nevertheless shown that the risk of POP recurrence requiring reoperation is lower than previously estimated, being closer to 10% rather than 30%. The development of mesh surgery – actively promoted by the marketing industry – was tremendous during the past decade, and preceded any studies supporting its benefit for our patients. Randomized trials comparing the use of mesh to native tissue repair in POP surgery have now shown better anatomical but similar functional outcomes, and meshes are associated with more complications, in particular for transvaginal mesh implants. POP is not a life-threatening condition, but a functional problem that impairs quality of life for women. The old adage “primum non nocere” is particularly appropriate when dealing with this condition which requires no treatment when asymptomatic. It is currently admitted that a certain degree of POP is physiological with aging when situated above the landmark of the hymen. Treatment should be individualized and the use of mesh needs to be selective and appropriate. Mesh implants are probably an important tool in pelvic reconstructive surgery, but the ideal implant has yet to be found. The indications for its use still require caution and discernment. This review explores the reasons behind the introduction of mesh augmentation in POP surgery, and aims to clarify the risks, benefits, and the recognized indications for its use.

High-resolution anorectal manometry and dynamic pelvic magnetic resonance imaging are complementary technologies

Dynamic pelvic magnetic resonance imaging (DP-MRI) offers a comprehensive evaluation of pelvic organ structure in addition to functional information regarding evacuation. Opportunity to apply this technology can be limited due to regional lack of availability. Ideally, clues from standard anorectal testing could predict abnormalities on DP-MRI, leading to its efficient use. The aim of this study is to determine whether high-resolution anorectal manometry (HR-ARM) correlates with findings on DP-MRI. This is a retrospective study of HR-ARM performed on patients with constipation who also underwent DP-MRI. Studies were reviewed for significant findings including posterior pelvic organ prolapse, rectocele > 3 cm, rectal intussusception, and anorectal angle. Statistical analysis was performed using Pearson's correlation coefficient, Student's t-test, and Fisher's exact test. Twenty-three patients undergoing HR-ARM (age range 25-78) also underwent DP-MRI. All were female; 76% were Caucasian. Twenty had significant structural findings: small pelvic prolapse (n = 2), moderate pelvic prolapse (n = 10), large pelvic prolapse (n = 9), rectocele (n = 8), or rectal intussusception (n = 3). Only intrarectal pressure on HR-ARM weakly correlated with size of rectocele (r = 0.46; P = 0.03) and degree of pelvic organ prolapse (r = 0.48; P = 0.02). The remainder of the HR-ARM parameters did not significantly correlate with DP-MRI findings. Patients with dyssynergy were not more likely to have rectoceles > 3 cm (44.4% versus 35.7%; P = 0.5) or large prolapses (44.4% versus 50%, P = 1.0), compared with those without dyssynergy, on HR-ARM. We were unable to find a correlation between HR-ARM findings and structural pelvic defects on DP-MRI. Therefore, these two technologies provide complementary information in the evaluation of defecatory dysfunction.

Midpubic Line to Stage Pelvic Organ Prolapse by MRI Defecography As Compared to POP-Q

Objective: To compare the degree of pelvic organ prolapse (POP) as measured by the pelvic organ prolapse quantification (POP-Q) system to the degree of prolapse as measured by magnetic resonance imaging (MRI) defecography and to merge clinical and radiologic terminology in reference to POP. Methods: A retrospective analysis of 29 patients who presented with POP and defecatory complaints and underwent MRI defecography (2008-2011). POP-Q scores were recorded by two attending urogynecologists. A radiologist, blinded to the clinical POP-Q scores, measured the maximum prolapse of the anterior vagina, posterior vagina, and vaginal apex/cervix on each subject’s MRI. Results: Prolapse as measured by MRI defecography was significantly more advanced as compared to the clinical POP-Q measurements in all three compartments studied. The differences were both statistically significant and potentially, clinically relevant. A mean difference of 2.0 centimeters ± 1.5 SD, 2.3 centimeters ± 2.7 SD, and 5.0 centimeters ± 2.0 SD was observed in the anterior, apical, and posterior vaginal compartments, respectively.

Determinants of pelvic organ prolapse among the women of the western part of Nepal: A case–control study

This study was carried out in order to identify the determinants of pelvic organ prolapse (POP) among the women of the western part of Nepal. This was a matched case-control study. Cases were defined as women diagnosed with third and fourth degree POP, and the control group consisted of women who were screened and confirmed of not having any degree of POP. Cases (n = 183) and controls (n = 183) were randomly selected and for each case, one control was selected, matched by age and place of residence. A semistructured interview was carried out to obtain the information for both groups. Bivariate analysis along with conditional logistic regression analysis was carried out to identify the association between selected variables with POP. The results showed the significant association between number of vaginal deliveries, tear of vagina in the last childbirth, sphincter damage in the last childbirth and duration of labor in the last childbirth with POP, after adjusting for educational status of the women, carrying heavy loads, type of usual work and incidence of diarrhea. The results suggest that prolonged labor along with vaginal delivery having sphincter and vaginal tear are the determinants of POP and program managers should strongly consider these factors to develop interventions targeting the prevention of POP.

Prolapsus uro-génital : analyse de la sexualité préopératoire

The aim of our study was to assess the link between pelvic organ prolapse (POP) characteristics and sexual well-being using validated tools.A prospective analysis was carried out in 148 women with a POP. The degree of prolapse was measured by using the Pelvic Organ Prolapse Quantification (POPQ). Pelvic Floor Distress Inventory (PFDI-20) questionnaire score was used to estimate the severity of symptoms. Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire short form (PISQ-12) scores determined sexual function level.No correlation was found concerning the global sexual function score and the POP stage (P=0.24). Pelvic and urinary symptoms were associated with a decrease in sexual function score (P=0.04 and P=0.002). Defecation symptoms were correlated with decreased sexual satisfaction (P ≤ 0.05) and were associated with premature ejaculation (P ≤ 0.05). Urinary symptoms were associated with dyspareunia (P ≤ 0.01), avoidance of sexual activities (P ≤ 0.05), negative emotions during intercourse (P ≤ 0.01) and decreased sexual excitement (P ≤ 0.05). Pelvic symptoms were significantly tied to avoidance of sexual activities (P ≤ 0.01), dyspareunia (P ≤ 0.05) and a poorer orgasm quality (P ≤ 0.05).The degree of pelvic organ prolapse was not statistically associated with sexual function. However, urinary, pelvic and defecatory (ano-rectal) symptoms were associated with a decrease in the couple's sexual well-being.

Development of a culturally specific assessment tool for pelvic organ prolapse in a Mayan population

Pelvic organ prolapse is a common condition that can significantly affect a woman's life, including her sexual, urinary, and social functioning. In Guatemala, anecdotal evidence suggests that the daily activities of Mayan women contribute to and worsen the degree of pelvic organ prolapse. The objective of this research was to develop a culturally specific assessment tool to better evaluate how pelvic organ prolapse affects the daily activities of Mayan women in rural Guatemala. A survey was created entitled a Culturally Specific Assessment Tool for Pelvic Organ Prolapse (CSAT-POP). The survey was administered to a 19 Mayan women with various degrees of pelvic organ prolapse in Montellano, Guatemala. Participants were asked using a Likert scale about how their pelvic organ prolapse affected their ability to perform 7 culturally specific activities of daily living. The survey was administered through an on-site interpreter who translated the CSAT-POP into Spanish and Quiché. Nineteen women were assessed using the CSAT-POP. Their mean age was 49.2 ± 28 years, and the median parity was 6.8 children (range 1-11). Three culturally specific activities: performing vigorous activities, gathering wood, and carrying water, were identified as the activities most impacted by pelvic organ prolapse. Of the participants, 15-20% were unable to perform these activities on a daily basis. However, preparing food, washing clothes, and caring for children were the activities reported by women with pelvic organ prolapse which required the least amount of assistance. The CSAT-POP identified several activities specific to the rural Mayan community in Guatemala which are difficult to perform with pelvic organ prolapse. By using culturally specific activities of daily living, the CSAT-POP allowed for more relevant assessment, identification, and treatment of women with pelvic organ prolapse in Guatemala.

1767 PREOPERATIVE SYMPTOM OF HESITATING URINARY STREAM IS ASSOCIATED WITH SURGICAL FAILURE AND POSTOPERATIVE VOIDING DYSFUNCTION FOLLOWING BURCH COLPOSUSPENSION OR PUBOVAGINAL RECTUS FASCIAL SLING SURGERY

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy III1 Apr 20101767 PREOPERATIVE SYMPTOM OF HESITATING URINARY STREAM IS ASSOCIATED WITH SURGICAL FAILURE AND POSTOPERATIVE VOIDING DYSFUNCTION FOLLOWING BURCH COLPOSUSPENSION OR PUBOVAGINAL RECTUS FASCIAL SLING SURGERY Tatiana Sanses, Linda Brubaker, Yan Xu, Stephen Kraus, Jerry Lowder, Gary Lemack, Peggy Norton, Sharon Tennstedt, and Toby Chai Tatiana SansesTatiana Sanses Baltimore, MD More articles by this author , Linda BrubakerLinda Brubaker Maywood, IL More articles by this author , Yan XuYan Xu Watertown, MA More articles by this author , Stephen KrausStephen Kraus San Antonio, TX More articles by this author , Jerry LowderJerry Lowder Pittsburgh, PA More articles by this author , Gary LemackGary Lemack Dallas, TX More articles by this author , Peggy NortonPeggy Norton Salt Lake City, UT More articles by this author , Sharon TennstedtSharon Tennstedt Watertown, MA More articles by this author , and Toby ChaiToby Chai Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1677AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess whether pre-operative voiding symptoms correlated with post-operative voiding dysfunction (VD) or surgical failure in women who underwent Burch colposuspension or autologous fascial sling in the Stress Incontinence Surgical Treatment Efficacy Trial. METHODS Urogenital Distress Inventory (UDI) and subjects' categorical responses (yes or no) to physical accommodations in voiding and to characteristics of urinary stream were collected preoperatively (see table) along with urodynamic data. The definitions of overall surgical, stress-specific failures and VD (any catheter use after 6 weeks) were previously published. Logistic regression models associating symptoms with outcomes, controlling for treatment group, site and degree of pelvic organ prolapse, were used. Preoperative voiding symptoms No. Who Answered “Yes” % (n=651) Dribbling Stream 504 77.4 Hesitating Stream 214 32.9 Spurting Stream 208 32.0 Slow Stream 207 31.8 Bending to Urinate 179 27.5 Straining to Urinate 107 16.4 Steady Stream (No) 106 16.3 Pressing to Urinate 81 12.4 Leaning to Urinate 54 8.3 Other descriptions of Stream 49 7.5 Pushing to Urinate 41 6.3 Doing something else to Urinate 29 4.5 Standing to Urinate 22 3.4 RESULTS Percentages of subjects who answered “yes” for each of the preoperative voiding symptoms are shown in the table. Hesitating urinary stream was the only symptom associated with post-operative VD [OR 2.40 (95% CI 1.31-4.75, p=0.006)], overall [OR 1.55 (95% CI 1.02-2.35, p=0.04)], and stress-specific [OR 1.58 (95% CI 1.07-2.34, p=0.02)] treatment failures. Despite no significant association between pre-operative UDI-obstructive subscore and post-operative VD, an increase of 10 points on the pre-operative UDI-obstructive subscore was associated with overall [OR 1.10 (95% CI 1.00-1.20, p=0.049) and stress-specific [OR 1.21 (95% CI 1.10-1.32, p<0.0001)] treatment failures. Subjects with hesitating urinary stream had lower mean Qmax on non-instrumented uroflow (23.6 ± 10.7 vs. 26.4 ± 11.3 cc/sec, p=0.004) and higher mean Pdet at Qmax on pressure flow study (21.7 ± 12.9 vs. 17.7 ± 12.1 cm water, p=0.003), but no significant difference in mean post-void residual volume when compared to subjects without this symptom. CONCLUSIONS Preoperative symptom of hesitating urinary stream was associated with poorer outcomes. The prevalence of this complaint at 33% may make it more useful as a predictor than a common complaint (i.e. dribbling at 78%) or an uncommon complaint (i.e. pushing to urinate at 6%). Further studies into association of hesitating urinary stream and postoperative outcomes may be fruitful. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e684 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tatiana Sanses Baltimore, MD More articles by this author Linda Brubaker Maywood, IL More articles by this author Yan Xu Watertown, MA More articles by this author Stephen Kraus San Antonio, TX More articles by this author Jerry Lowder Pittsburgh, PA More articles by this author Gary Lemack Dallas, TX More articles by this author Peggy Norton Salt Lake City, UT More articles by this author Sharon Tennstedt Watertown, MA More articles by this author Toby Chai Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...