Diagnosis Of Pelvic Organ Prolapse Research Articles

Social Vulnerability Index and Surgical Management of Pelvic Organ Prolapse.

The aim of this study was to determine whether the Social Vulnerability Index (SVI) is associated with the type of surgery for pelvic organ prolapse (POP) focusing on sacrocolpopexy (SCP) and uterosacral ligament suspension (USLS). This was a retrospective case-control study that included patients from 8 hospitals within a large academic health system in New York between January 1, 2018 and January 1, 2023. All patients 15-85 years of age with a preoperative diagnosis of POP who underwent a hysterectomy with an SCP or USLS were included. Home addresses were linked to census tracts and SVI scores. Multiple logistic regression analyses were performed to evaluate the association between SVI quartiles and POP surgical management (SCP vs USLS). Six hundred one patients who underwent reconstructive surgery for POP were included in the study. The Social Vulnerability Index was not statistically significantly associated with POP surgical management (P = 0.26). After adjusting for potential confounders, there continued to be no association between SVI and POP management (P = 0.40). The adjusted model illustrated that age 65 years or greater was associated with decreased odds (adjusted odds ratio, 0.24; 95% confidence interval, 0.14-0.40) of SCP (P < 0.0001), whereas patients with hypertension were found to be at increased odds (adjusted odds ratio, 2.60; 95% confidence interval, 1.01-6.71). There was no statistically significant association between SVI and POP surgical management for SCP versus USLS. However, advanced patient age (65 years and greater) was associated with decreased odds, and hypertension was associated with greater odds of SCP.

Implication of Neighborhood Deprivation Index on Pelvic Organ Prolapse Management.

Differences in the rate of diagnosis of POP have been described based on race and ethnicity; however, there are few data available on the management and treatment patterns of POP based on multiple factors of socioeconomic status and deprivation. The objective of this study was to investigate the association between pelvic organ prolapse (POP) management and the Neighborhood Deprivation Index (NDI), a standardized multidimensional measure of socioeconomic status. This retrospective cohort study included female members of a large integrated health care delivery system who were 18 years or older and had ≥4 years of continuous health care membership from January 1, 2015, to December 31, 2019. Demographic, POP diagnosis, urogynecology consultation, and surgical treatment of POP were obtained from the electronic medical record. Neighborhood Deprivation Index data were extrapolated via zip code and were reported in quartiles, with higher quartiles reflecting greater deprivation. Descriptive, bivariate, and logistic regression analyses were conducted by NDI. Of 1,087,567 patients identified, 34,890 (3.2%) had a POP diagnosis. Q1, the least deprived group, had the highest prevalence of POP (26.3%). Most patients with POP identified as White (57.3%) and represented approximately a third of Q1. Black patients had the lowest rate of POP (5.8%) and comprised almost half of Q4, the most deprived quartile. A total of 13,730 patients (39.4%) had a urogynecology consultation, with rates ranging from 23.6% to 26.4% (P < 0.01). Less than half (12.8%) of patients with POP underwent surgical treatment, and the relative frequencies of procedure types were similar across NDI quartiles except for obliterative procedures (P = 0.01). When controlling for age, no clinically significant difference was demonstrated. Differences in urogynecology consultation, surgical treatment, and surgical procedure type performed for prolapse across NDI quartiles were not found to be clinically significant. Our findings suggest that equitable evaluation and treatment of prolapse can occur through a membership-based integrated health care system.

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.

4D DIA-PRM proteomic study identifying modulated pathways and biomarkers associated with pelvic organ prolapse

Pelvic organ prolapse (POP) is a highly disabling condition that negatively affects the quality of life of millions of women worldwide. However, the underlying mechanisms associated with the development and progression of the disease remain poorly understood. Here, an untargeted four-dimensional data-independent acquisition (4D DIA)-based proteomics approach was applied to vaginal wall tissue samples from POP (n = 19) and control (n = 8) patients to identify potential diagnostic biomarker(s) for POP and examine the molecular mechanisms underlying the disease. Of the 5713 tissue proteins that were detected, 1957 proteins were significantly changed in POP patients. Further bioinformatics analysis revealed that multiple biological processes including protein digestion & absorption, retrograde endocannabinoid signaling, tyrosine metabolism, and nucleotide metabolism were significantly enriched and associated with the pathogenesis of POP. Interestingly, 16 of these differentially expressed proteins associated with four pathways were also identified by targeted parallel reaction monitoring (PRM) proteomics analysis on the same 27 tissue samples. Changes in 94 % (15/16) of these proteins were consistent with the 4D DIA data. Furthermore, most proteins displayed good diagnostic accuracy with high area under the curve (AUC) values (AUC＞0.8). Specifically, five proteins including ELN, COL6A2, ENTPD1, AOC3, and COX7A2 distinguished between POP and control patients with very high accuracy (AUC ≥ 0.95) in both 4D DIA and PRM analyses, and may therefore be potential diagnostic biomarkers for POP. In summary, the present study not only provided several potential biomarker(s) for effective POP diagnosis, but extended our knowledge of the key regulatory pathways associated with the disease.

Exercise-induced circulating exosomes potentially prevent pelvic organ prolapse in clinical practice via inhibition of smooth muscle apoptosis

BackgroundThis study aimed to explore the potential mechanisms of exercise to prevent pelvic organ prolapse (POP) and search for diagnostic indictors for POP. MethodsWe used two clinical POP datasets with patients’ information (GSE12852 and GSE53868), a dataset consisting of altered microRNA expression in circulating blood after exercise (GSE69717) for bioinformatic analysis and clinical diagnostic analysis, while a series of cellular experiments were conducted for preliminary mechanical validation. ResultsOur results show that AXUD1 is highly expressed in the smooth muscle of the ovary and is a key pathogenic gene in POP, while miR-133b is a key molecule in the regulation of POP by exercise-induced serum exosomes. The AUCs of AXUD1 for POP diagnosis were 0.842 and 0.840 in GSE12852 and GSE53868 respectively. At cut-off value = 9.627, the sensitivity and specificity of AXUD1 for predicating POP is 1.000 and 0.833 respectively for GSE53868, while at cut-off value = 3324.640, the sensitivity and specificity of AXUD1 for predicating POP is 0.941 and 0.812 separately for GSE12852. Analysis and experiments confirmed that miR-133b can directly regulate AXUD1. miR-133b mediated C2C12 myoblasts proliferation and inhibited hydrogen peroxide-induced apoptosis. ConclusionsOur study proved that AXUD1 is a good clinical diagnostic indicator for POP and provided a theoretical basis for future prevention of POP through exercise and a potential target for intervention in muscle dysfunction.

Pelvic Organ Prolapse: Overview, Diagnosis and Management

Pelvic organ prolapse (POP) is a common pelvic floor disorder (PFD) that affects quality of life (QoL) in millions of women in the United States and around the world. The normal position of pelvic organs relies on both the pelvic floor muscles/levator ani muscle and the connective tissue support for the uterus and vagina. Known risk factors for POP include age, parity, family history, genetic predisposition, and chronic straining. The diagnosis of POP depends mainly on history and clinical examination. After diagnosis, progression is slow, and regression is more common than expected. Treatment starts with patient education about the disorder and available treatments. It is important to note that “doing nothing” is always an option. If patient has troublesome symptoms, there are nonsurgical and surgical options. Nonsurgical options include pelvic floor muscle training and pessary therapy. Surgery is an option for patients with POP who decline nonsurgical options or for whom those options fail. Management of women with POP and other PFDs requires a multidisciplinary team to evaluate and formulate individualized plans to address the specific health and QoL issues facing each patient. (J GYNECOL SURG 39:3)

Pregnancy outcomes after abdominal sacrocervicopexy.

Various methods are used in pelvic organ prolapse (POP) surgery. Organ-preserving methods are gaining importance and popularity. Although the success rates of abdominal sacrocervicopexy, which is one of these methods, are known, data on pregnancy outcomes are insufficient. The aim of this study was to investigate pregnancy outcomes after abdominal sacrocervicopexy. This study included 72 patients with a diagnosis of POP who underwent abdominal sacrocervicopexy with monofilament polypropylene mesh in Diyarbakir Gazi Yaşargil Training and Research Hospital between 2008 and 2016.Anterior and posterior colporrhaphy operations were performed. Postoperatively, these patients were followed up for a mean of 29.68 ± 6.55 (20-49) months. Pregnancy and recurrence outcomes of those who became pregnant were recorded and analyzed. On average, pregnancies occurred 23.2 (18-30) months after the operation. During follow-up, eight patients became pregnant and gave birth without any issues or complications. One had a normal vaginal delivery, and seven gave birth by cesarean section. One of the pregnant women had a twin pregnancy. When 24 patients who underwent bilateral tubal ligation and postmenopausal (n = 2) were excluded, the pregnancy rate was found to be 17.3%. The weeks of the deliveries were 35 weeks (twin pregnancy), 38 weeks (n = 2), 39 weeks (n = 3), and 40 weeks (n = 1), for an average of 38.5 weeks. Eight patients who had undergone abdominal sacrocervicopexy had healthy pregnancies and deliveries.

Quality of life among women with a diagnosis of pelvic organ prolapse at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: an institutional based cross-sectional study.

Pelvic organ prolapse is among the most common gynecologic problems worldwide. It greatly influences women's quality of life. However, research regarding the effect of pelvic organ prolapse on quality of life is limited in our study area. An institutional-based study design among women with the diagnosis of pelvic organ prolapse at Felege Hiwot Comprehensive Specialized Hospital was employed from May to July 2018. Interviewer-administered questionnaire and Prolapse Quality of Life assessment tool were used to collect data. Gynecologic speculum examination was done to collect objective data. Data were entered into Epi info version 7 and then exported in to SPSS, version 20.0, for analysis. Descriptive statistics and logistic regression were used. All the statistical tests were significant at P < 0.05. The average prolapse quality of life score was 48.35 ± 22.75 SD. The physical limitation (score: 69.83 ± 28.77 SD) and general health perception (score: 67.39 ± 20.26 SD) domains were the most affected life domains. Younger age (AOR = 3.02 [95% CI: 1.22-7.45]), being illiterate (AOR = 3.52 [95% CI: 1.12-11.10]), and having stage IV POP (AOR = 2.84 [95% CI: 1.16-7.00]) were associated with lower quality of life. The QOL score showed huge variability among the study participants. The physical limitation and general health perception domains were most affected. Being illiterate, being < 35 years old, and having stage IV pelvic organ prolapse were the factors associated with lower quality of life.

How do reproductive history and anthropometry in midlife relate to later risk of pelvic organ prolapse? A prospective cohort study.

The objective was to examine the association between reproductive and anthropometric factors and later risk of pelvic organ prolapse (POP). We carried out a prospective cohort study including 11,114 female nurses > 44years from the Danish Nurse Cohort. In 1993, the study population was recruited through the Danish Nurse Organization and self-reported data on age, height, weight, age at menarche, age at first birth and number of childbirths were obtained. POP diagnosis was obtained from the National Patient Registry. Risk of POP was estimated using COX regression and presented as hazard ratios (HR) with 95% confidence intervals (CI). Overall, 10% of the women received a diagnosis of POP within a median follow-up of 22years. A 4% increase in risk of POP was seen for each increasing BMI (kg/m2) unit at baseline. Compared to women of normal weight, higher risks of POP were seen in overweight (HR 1.18: 1.02-1.36) and obese women (HR 1.33: 1.02-1.74), while underweight had a lower risk (HR 0.51: 0.27-0.95). Compared to women with one childbirth, women with no childbirths had a reduced risk of 57% while increased risks of 46%, 78% and 137% were observed in women with two, three and four childbirths. Women with menarche before the age of 12 tended to have a higher risk of POP as did women who were 30-33years at their first childbirth. POP is a common health problem in women, and BMI and number of childbirths are strong predictors.

Adherence to Pelvic Floor Physical Therapy Referrals in Women With Fecal Incontinence.

This study aimed to determine the incidence of patient adherence with prescribed pelvic floor physical therapy (PFPT) in women presenting with fecal incontinence (FI) and to describe patient characteristics associated with nonadherence. This is a retrospective cohort study of women presenting with FI who were prescribed PFPT between January 2010 and December 2019. Adherence with PFPT was defined as either completion of documented recommended physical therapy sessions or discharge from therapy by the therapist before completion of the prescribed sessions. Complete data were available for 248 patients. A total of 159 (64.1%) patients attended at least 1 session of PFPT. Patients who did not attend any sessions were more likely to have a concurrent diagnosis of pelvic organ prolapse (69.7% vs 55.3%, P = 0.03). When controlled for confounding variables, concurrent prolapse remained associated with nonattendance (adjusted odds ratio of 1.9 [95% confidence interval, 1.0-3.3]). Of the patients who attended PFPT, the adherence rate was 32.7% (n = 50), whereas the rate was 20% for the total cohort. Nonadherent patients were more likely to have a higher body mass index (28.9 vs 26.9, P = 0.02), but this was no longer statistically significant once other patient characteristics were controlled for. Of the entire cohort, 136 (54.8%) followed up with their physicians after the initial referral to PFPT. Of the 59 patients, 43.7% were offered second-line therapy. Of the women prescribed PFPT for a diagnosis of FI, approximately two thirds attended at least a single session, but only one third of those patients were adherent with the recommended therapy.

Trends in Apical Suspension at the Time of Hysterectomy for Pelvic Organ Prolapse: Impact of American College of Obstetricians and Gynecologists Recommendations.

The aim of the study was to compare national surgical practice patterns of performing apical suspension procedures (ASPs) at the time of hysterectomy for pelvic organ prolapse (POP) before and after the publication of the American College of Obstetricians and Gynecologists (ACOG) 2017 Practice Bulletin on POP. The American College of Surgeons National Surgical Quality Improvement Program database was queried for hysterectomy cases performed for POP indications for the years 2015-2016 and 2018-2019. The primary outcome was the use of ASP at the time of hysterectomy for POP. Secondary outcomes included the use of anterior, posterior, and paravaginal prolapse repair procedures. Multivariable regression analysis was performed to identify factors associated with performing a hysterectomy without an ASP. A total of 11,336 cases were included, and apical prolapse was the primary POP diagnosis in 86.3% of these cases. There was no statistically significant change in the utilization of ASPs in 2018-2019 compared with 2015-2016 (51.4% vs 49.8%, P = 0.081). Urogynecologists were significantly more likely than general gynecologists to perform ASPs (65.6% vs 37.5%, P < 0.001), which was confirmed on multivariable logistic regression analysis (adjusted odds ratio, 3.257; P < 0.001). The use of concomitant anterior repairs (44.1% vs 39.5%, P < 0.001) and posterior repairs (47.5% vs 41.3%, P < 0.001) increased in the 2018-2019 cohort. There was no overall increase in the utilization of concomitant ASPs at the time of hysterectomy done for POP indications despite the 2017 American College of Obstetricians and Gynecologists practice bulletin. Urogynecologists were more likely to perform ASPs than general gynecologists.

Historical and forecasted changes in utilization of same day discharge following minimally invasive hysterectomy

To describe changes in same day discharges (SDD) following minimally invasive hysterectomy (MIH) in a national surgical database across a 9-year period and forecast anticipated utilization over the subsequent decade. A cross-sectional secondary analysis of the 2011-2019 National Surgical Quality Improvement Program (NSQIP) Database combined with an autoregressive linear forecasting model of SDD utilization from 2020-2029. MIH were identified by current procedural terminology (CPT) code and indication for surgery based on primary diagnosis ICD-CM coding. Individuals with an oncologic diagnosis or concomitant non-gynecologic procedure were excluded. Multivariable logistic regression was used to control for individual-level confounding factors. 239,242 MIH were included in the analysis. Over the 9-year period, there was a sustained increased utilization of SDD across all MIH (13.0% in 2011 to 23.7% in 2019; Cochran Armitage test for trend P<0.001). Surgery for a diagnosis of pelvic organ prolapse was associated with a 15.8% lower rate of SDD compared to those with another benign indication (P<0.001) and this gap increased across time (P<0.001) (Figure 1). Moreover, the observed differences persisted when controlling for individual confounders including age, ASA classification, BMI, functional status, presence of major medical comorbidities, and route of hysterectomy (aOR for prolapse 0.40 (95% CI 0.38, 0.42)). Route of hysterectomy also affected SDD rate, with total laparoscopic hysterectomy having the highest rate of SDD (28.3%) while total vaginal hysterectomy was associated with the lowest (12.0%) (aOR for vaginal hysterectomy 0.47 (95% CI 0.45, 0.48). Based on the demonstrated trends, forecasting models estimate overall utilization of SDD will increase to 48.5% (95% CI 38.7-58.4) by 2029 (Figure 2). While utilization is increasing, the overall rate of SDD following MIH remains low, particularly among individuals undergoing surgery for pelvic organ prolapse and by a vaginal approach. Given its well established safety profile, additional strategies to facilitate SDD of patients undergoing MIH should be adopted.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse.

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.

Value of Transperineal Ultrasound in Short-term Evaluation of Pelvic Organ Prolapse after Transvaginal Mesh Implantation

Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence. Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group. Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(P=0.000)and 0.235(P=0.001),respectively.There were altogether 37 cases diagnosed inconsistently between TPUS and POP-Q,including 14(9.52%)cases of anterior compartment prolapse and 23(15.65%)cases of posterior compartment prolapse.TPUS diagnosed 32 more cases of prolapse than POP-Q,which included 13(8.84%)cases of anterior compartment prolapse and 19(12.93%)cases of posterior compartment prolapse.The incidence of hiatal ballooning in the TPUS prolapse group was significantly higher than control group(51.35% vs.33.94%,χ2=3.950,P=0.047).The incidence of levator avulsion showed no significant difference between the two groups(P=1.000). Conclusions TPUS diagnosis of POP after TVM surgery has consistency with the POP-Q diagnosis of International Continence Society.TPUS can detect more POP cases,and thus it may act as a supplement for clinical diagnosis.Hiatal ballooning is associated with POP recurrence after TVM surgery.

The Combined Measurement of Pelvic Organ Mobility and Hiatus Area Improves the Sensitivity of Transperineal Ultrasound When Detecting Pelvic Organ Prolapse.

Objective: To evaluate whether the combined measurement of pelvic organ mobility and levator hiatus area improves the sensitivity of transperineal ultrasound (the index test) for diagnosing pelvic organ prolapse (POP).Methods: We retrospectively recruited women who had been examined in a tertiary gynecological center for symptoms of lower urinary tract incontinence and/or POP between January 2017 and June 2018. We excluded patients who had undergone hysterectomy previously or those who had received corrective surgery. All subjects underwent a standardized interview, POP quantification (POP-Q) examination (a reference standard for patients and controls), and ultrasound measurements of the levator hiatus area at rest (rHA), on contraction (cHA), and on Valsalva (vHA). We also determined the mobility of the bladder neck (BNM), cervix (CM), and rectum ampulla (RAM). Receiver operating characteristic (ROC) curve analyses were performed to determine cut-off values for diagnosis. Diagnostic performance was assessed by sensitivity, specificity, and area under curve (AUC).Results: A total of 343 women were eligible for analysis, including 247 POP patients (stage 2–3 by POP-Q) and 96 controls. Compared with controls, POP cases had significantly higher values for rHA, vHA, cHA, BNM, CM, and RAM. Each parameter was identified as a significant discriminator for POP and controls, as determined by ROC curve analysis, although the cut-off value varied slightly between different parameters. The combination of rHA, vHA, and cHA (with any HA that was ≥ the cut-off) improved the sensitivity from 64–89 to 89–93%. The combination of pelvic organ mobility with rHA, vHA, and cHA, further increased the sensitivity from 89–93 to 95–97%.Conclusion: The combination of levator hiatus area and pelvic organ mobility improved the sensitivity of transperineal ultrasound in the diagnosis of POP, whether used as a frontline test to assist POP-Q grading or to monitor the effect of pelvic floor exercise programs.

Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases.

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

Proteins in plasma as a potential biomarkers diagnostic for pelvic organ prolapse.

BackgroundPelvic organ prolapse (POP) is the most common and widespread type of female pelvic floor dysfunction disease (PFD). At present, the diagnosis of POP is mainly based on a complicated systematic evaluation of the clinical phenotype, medical history, and relevant functional examinations. Rapid and simple tests that are based on biochemical biomarkers that surpass the sensitivity and specificity of the current methods for the diagnosis of POP will greatly facilitate the timely diagnosis and treatment of women with POP.MethodsA protein array was used to screen plasma samples collected from healthy controls and women with POP. Enzyme-linked immunosorbent assays (ELISAs) were used to determine the levels of three novel and potentially useful analytes: heat shock protein 10 (HSP10), zinc finger CCCH domain-containing protein 8 (ZC3H8), and unc-45 myosin chaperone A (UNC45A). We then determined the diagnostic value of each of these analytes as potential diagnostic biomarkers for clinical application.ResultsThe mean levels of HSP10, ZC3H8, and UNC45A, were lower in the plasma samples from 76 patients with POP than in 56 samples from healthy controls (P<0.05). Comparisons between patients with POP and healthy controls demonstrated the sensitivity and specificity of HSP10 (73.7% and 71.4%), ZC3H8 (71.1% and 62.5%), and UNC45A (70.7% and 62.5%).ConclusionsAnalysis indicated that plasma levels of HSP10, ZC3H8, and UNC45A, are sensitive and specific biomarkers for the diagnosis of POP.

Trends in the Diagnosis and Management of Combined Rectal and Vaginal Pelvic Organ Prolapse

ObjectiveTo examine the rates of surgical repair of comorbid rectal prolapse (RP) and pelvic organ prolapse (POP) over time in a large population-based cohort. Materials and MethodsWe queried Optum, a national administrative claims database, from 2003 to 2017. We evaluated female patients age 18 or older with a diagnosis of POP and/or RP. Sociodemographic characteristics, comorbidities, and rates of procedures were collected. ResultsWe identified 481,051 women diagnosed with RP and/or POP. Only 2.0% of women in the cohort had comorbid POP and RP. While 29.9% of women with RP had dual prolapse, only 2.1% of women with POP had both diagnoses. Overall, 25.8% of women had one or more surgical repairs. Surgical repairs were done in 26.0% of women with POP, 15.0% of women with RP, and 48.2% of women with comorbid POP/RP, though only 19.8% of patients with dual diagnoses had both RP and POP repairs. Over the study period, the rate of multidisciplinary surgical repairs increased by 2.7-fold. ConclusionThe prevalence of comorbid RP and POP among women in our cohort is low (2.0%). Rates of multidisciplinary surgery have increased possibly due to the increased use of imaging, laparoscopic surgery, and awareness of the shared pathophysiology of the disease.

MP05-03 USEFULNESS OF VESICAL NECK MOVEMENT MEASUREMENT BY CINEMRI IN PREDICTING STRESS URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE REPAIR SURGERY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse (MP05)1 Apr 2020MP05-03 USEFULNESS OF VESICAL NECK MOVEMENT MEASUREMENT BY CINEMRI IN PREDICTING STRESS URINARY INCONTINENCE AFTER PELVIC ORGAN PROLAPSE REPAIR SURGERY Masao Kataoka*, Hitomi Imai, Yuki Yoshida, Toru Meguro, Ruriko Honda, Kanako Matsuoka, Seiji Hoshi, Junya Hata, Yuichi Sato, Hidenori Akaihata, Souichiro Ogawa, Nobuhiro Haga, and Yoshiyuki Kojima Masao Kataoka*Masao Kataoka* More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Toru MeguroToru Meguro More articles by this author , Ruriko HondaRuriko Honda More articles by this author , Kanako MatsuokaKanako Matsuoka More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Junya HataJunya Hata More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Souichiro OgawaSouichiro Ogawa More articles by this author , Nobuhiro HagaNobuhiro Haga More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000819.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It has been reported that urinary symptoms, especially stress urinary incontinence may worsen after pelvic organ prolapse repair surgery. In this study, we try to evaluate the possibility that the parameters obtained by cine MRI could be a predictor of stress urinary incontinence after POP repair. METHODS: 116 patients who underwent POP repair with a diagnosis of pelvic organ prolapse were included in the analysis. All patients were performed reinforcement of the anterior vaginal wall using a mesh. In patients with uterine prolapse and large rectocele, mesh was also placed on the posterior vaginal wall. In all cases, cine MRI was performed before surgery. Urethral length, urethral mobility (UM), vesical neck movement (VNM) were evaluated, and correlation analysis with postoperative urinary symptoms were performed. RESULTS: Among 90 preoperative SUI negative cases, postoperative SUI was observed in 38 cases (42%).Among the preoperative SUI negative cases, the VNM of the group with postoperative SUI and the group without postoperative SUI were 10.9 ± 6.7 mm and 4.4 ± 3.7 mm, respectively, with a significant difference (p <0.01). There was a correlation between preoperative VNM and de novo SUI (r: 0.51, 95% CI: 0.28-0.68, p <0.01, ROC curve: AUC 0.78, cut off value 6.5 mm). On the other hand, among 26 preoperative SUI positive cases, SUI was persisted in 6 cases (23%). Among them, there was a significant difference in VNM of 14.0 ± 7.1mm and 5.3 ± 3.9mm in the postoperative SUI persisted group and postoperative SUI disappearance group (p <0.01). Correlation was observed between preoperative VNM and postoperative SUI (r: 0.51, 95% CI: 0.28-0.68, p <0.01, ROC curve: AUC 0.70, cut off value 7.6 mm). CONCLUSIONS: VNM evaluation by cine MRI was considered to be a useful tool with excellent objectivity that can predict SUI after POP repair without depending on the operator's skill like Barrier test. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e41-e42 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Masao Kataoka* More articles by this author Hitomi Imai More articles by this author Yuki Yoshida More articles by this author Toru Meguro More articles by this author Ruriko Honda More articles by this author Kanako Matsuoka More articles by this author Seiji Hoshi More articles by this author Junya Hata More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Souichiro Ogawa More articles by this author Nobuhiro Haga More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

44: Vaginal cyst presenting as pelvic organ prolapse

The purpose of this video is to describe an unusual case of a large vaginal cyst presenting as pelvic organ prolapse and to demonstrate techniques for vaginal reconstruction. A 47-year-old gravida 4 para 2 presented with pelvic fullness, which she thought was prolapse. On pelvic exam, a 4-centimeter cystic mass was located on the posterior vagina and protruded past the hymen. Magnetic resonance imaging showed a 3.5 x 2.8 x 3.8 cm posterior vaginal wall cyst without solid components, septations, nodularity, or other suspicious features. The patient desired corrective surgery, so she underwent vaginal excision of the cyst. When in the operating room, exam under anesthesia confirmed the posterior vaginal wall mass. There was no evidence of pelvic floor prolapse. The vaginal mucosa overlying the cyst was incised. Allis clamps were placed on the mucosal edges bilaterally to provide traction. The cyst wall was sharply dissected off the vaginal mucosa. During the dissection, the cyst cavity was entered and a large amount of fluid was expulsed. The cyst was completely excised from the underlying tissue. The rectovaginal fascia was reinforced and plicated with interrupted 2-0 absorbable sutures. The posterior vaginal mucosa was trimmed and re-approximated with a running locking 2-0 absorbable suture. Hemostasis was ensured along the suture line. Rectovaginal exam confirmed no injury to the rectum. The patient was discharged home in a stable condition. Pathology demonstrated a benign simple cyst and benign vaginal mucosa without dysplasia. She was seen for a postoperative visit, at which time there was a healing but intact suture line along the posterior vaginal mucosa. It is important to include vaginal cysts in the differential diagnosis of pelvic organ prolapse. Vaginal removal and reconstruction can be performed successfully.