Pelvic Organ Prolapse Quantification Stage Research Articles

Intraoperative Complications and Perioperative and Surgical Outcomes of Single-Port Robotics-Assisted Sacrocolpopexy.

The objective was to assess intraoperative and postoperative complication rates, along with perioperative and surgical outcomes, following single-port robotics-assisted sacrocolpopexy. This retrospective case series included 200 patients who underwent single-port robotics-assisted sacrocolpopexy to treat Pelvic Organ Prolapse Quantification (POPQ) stage 2-4 symptomatic prolapse between April 2020 and August 2023 by a single surgeon. Intraoperative and postoperative complications and perioperative outcomes were evaluated for all the patients, whereas surgical outcomes for 74 patients were assessed at 1-year follow-up. Surgical failure was defined as the presence of any of the following: the presence of vaginal bulging symptoms, any prolapse beyond the hymen, or retreatment for prolapse. During the study period, 200 single-port robotics-assisted sacrocolpopexies were performed. The median age and body mass index were 65.0 years and 24.6kg/m2 respectively. Most patients had POPQ stage 3 or 4 prolapse and underwent concomitant total hysterectomy. The median total operation time was 212.0min, and none of the patients required conversion to laparoscopy or laparotomy. The intraoperative cystotomy rate was 2.5%, and one patient had a blood transfusion owing to presacral vessel injury. Postoperative complications of mesh exposure and wound hernia were 0.5% and 2.0% respectively. At 1 year postoperatively, the rate of composite surgical failure was 9.5%, with a 5.4% anatomical recurrence rate. None of the patients experienced apical prolapse recurrence, and one received anterior colporrhaphy for anterior compartment prolapse recurrence. Single-port robotics-assisted sacrocolpopexy is safe and effective, with low complication rates and favorable perioperative and surgical outcomes.

Preoperative prolapse phenotype is predictive of surgical outcome with minimally invasive sacrocolpopexy

The gold-standard treatment for advanced pelvic organ prolapse is sacrocolpopexy. However, the preoperative features of prolapse that predict optimal outcomes are unknown. This study aimed to develop a clinical prediction model that uses preoperative scores on the Pelvic Organ Prolapse Quantification examination to predict outcomes after minimally invasive sacrocolpopexy for stages 2, 3, and 4 uterovaginal prolapse and vaginal vault prolapse. A 2-institution database of pre- and postoperative variables from 881 cases of minimally invasive sacrocolpopexy was analyzed. Data from patients were analyzed in the following 4 groups: stage 2 uterovaginal prolapse, stage 3 to 4 uterovaginal prolapse, stage 2 vaginal vault prolapse, and stage 3 to 4 vaginal vault prolapse. Unsupervised machine learning was used to identify clusters and investigate associations between clusters and outcome. The k-means clustering analysis was performed with preoperative Pelvic Organ Prolapse Quantification points and stratified by previous hysterectomy status. The "optimal" surgical outcome was defined as postoperative Pelvic Organ Prolapse Quantification stage <2. Demographic variables were compared by cluster with Student t and chi-square tests. Odds ratios were calculated to determine whether clusters could predict the outcome. Age at surgery, body mass index, and previous prolapse surgery were used for adjusted odds ratios. Five statistically distinct prolapse clusters (phenotypes C, A, A>P, P, and P>A) were found. These phenotypes reflected the predominant region of prolapse (apical, anterior, or posterior) and whether support was preserved in the nonpredominant region. Phenotype A (anterior compartment prolapse predominant, posterior support preserved) was found in all 4 groups of patients and was considered the reference in the analysis. In 111 patients with stage 2 uterovaginal prolapse, phenotypes A and A>P (greater anterior prolapse than posterior prolapse) were found, and patients with phenotype A were more likely than those with phenotype A>P to have an optimal surgical outcome. In 401 patients with stage 3 to 4 uterovaginal prolapse, phenotypes C (apical compartment predominant, prolapse in all compartments), A, and A>P were found, and patients with phenotype A>P were more likely than those with phenotype A to have ideal surgical outcome. In 72 patients with stage 2 vaginal vault prolapse, phenotypes A, A>P, and P (posterior compartment predominant, anterior support preserved) were found, and those with phenotype A>P were less likely to have an ideal outcome than patients with phenotype A. In 297 patients with stage 3 to 4 vaginal vault prolapse, phenotypes C, A, and P>A (prolapse greater in posterior than in anterior compartment) were found, but there were no significant differences in rate of ideal outcome between phenotypes. Five anatomic phenotypes based on preoperative Pelvic Organ Prolapse Quantification scores were present in patients with stages 2 and 3 to 4 uterovaginal prolapse and vaginal vault prolapse. These phenotypes are predictive of surgical outcome after minimally invasive sacrocolpopexy. Further work needs to confirm the presence and predictive nature of these phenotypes. In addition, whether the phenotypes represent a progression of prolapse or discrete prolapse presentations resulting from different anatomic and life course risk profiles is unknown. These phenotypes may be useful in surgical counseling and planning.

Effect of Vaginal Microecological Alterations on Female Pelvic Organ Prolapse

Introduction and HypothesisThe objective was to investigate the correlation between endogenous vaginal microecological alterations and female pelvic organ prolapse (POP).MethodsPatients who underwent vaginal hysterectomy were retrospectively analyzed as the POP group (n = 30) and the non-POP group (n = 30). The vaginal microbial metabolites and enzyme levels were tested using the dry chemoenzymatic method. The mRNA and protein expression were tested using real-time quantitative PCR and immunohistochemistry. SPSS version 25.0 and GraphPad Prism 8.0 were performed for statistical analysis.ResultsCompared with the non-POP group, the vaginal pH, H2O2 positivity and leukocyte esterase positivity were higher in patients with POP (all p < 0.05). Further analysis showed that patients with pelvic organ prolapse quantification (POP-Q) stage IV had higher rates of vaginal pH, H2O2 positivity and leukocyte esterase positivity than those with POP-Q stage III. Additionally, the mRNA expression of decorin (DCN), transforming growth factor beta 1 (TGF-β1), and matrix metalloproteinase-3 (MMP-3) in uterosacral ligament tissues were higher, whereas collagen I and III were lower. Similarly, the positive expression of MMP-3 in uterosacral ligament tissue was significantly upregulated in the POP group compared with the non-POP group (p = 0.035), whereas collagen I (p = 0.004) and collagen III (p = 0.019) in uterosacral ligament tissue were significantly downregulated in the POP group. Correlation analysis revealed that there was a significant correlation between vaginal microecology and collagen metabolism. In addition, MMP-3 correlated negatively with collagen I and collagen III (p = 0.002, r = −0.533; p = 0.002, r = −0.534 respectively), whereas collagen I correlated positively with collagen III (p = 0.001, r = 0.578).ConclusionsVaginal microecological dysbiosis affects the occurrence of female POP, which could be considered a novel therapeutic option.

Validation of the Russian Version of the Prolapse Quality-of-life Questionnaire and its Application to Assess the Impact of Pelvic Organ Prolapse on Quality of Life and the Effect of Treatment in Women Undergoing Reconstructive Surgery.

The objective was to validate the translated Russian version of the prolapse quality-of-life (P-QoL) questionnaire and test its applicability to assess the impact of pelvic organ prolapse (POP) on QoL and the effect of treatment in women undergoing reconstructive surgery. Following a forward- and back-translation of the original English P-QOL questionnaire into Russian, the translated questionnaire was reviewed by a group of patients as well as an expert panel. Women with POP who were admitted to a university hospital for reconstructive surgery were recruited. All the women completed the P-QoL questionnaire, Pelvic Floor Distress Inventory (PFDI-20) and 36-Item Short Form Survey (SF-36) questionnaires before surgery. Clinical data and POP Quantification (POP-Q) Index according to the International Continence Society were obtained. Psychometric properties of the questionnaire were assessed. A total of 303 women with POP were included in the study. Most patients presented with POP-Q >2. The P-QoL questionnaire demonstrated good psychometric properties. High internal consistency was shown in all domains (Cronbach's alpha coefficient from 0.65 to 0.92). The test-retest reliability confirmed a highly significant stability between the total scores for each domain. Significant correlations of the P-QoL domains with the PFDI-20 and SF-36 scales (p < 0.05) were obtained, demonstrating satisfactory convergent validity. Discriminative construct validity was proved by the differences in the mean scores for P-QoL domains across POP-Q stages (p < 0.05): general health perceptions, role limitations, physical limitations, social limitations and severity measures were significantly higher for POP-Q stages 3 and 4 than for POP-Q stage 2 (p < 0.01); general health perceptions and severity measures were higher for POP-Q stage 4 than for POP-Q stage 3 (p < 0.05); sleep/energy was higher for POP-Q stage 3 than for POP-Q stage 2 (p < 0.05). Significant improvement of QoL in the 2months after surgery (p < 0.05) indicated that the P-QoL questionnaire is sensitive to change. The Russian version of the P-QoL questionnaire is characterized by appropriate psychometric properties. The P-QoL questionnaire is a useful tool for describing the QoL profile in women with POP before reconstructive surgery and evaluating treatment outcomes after the procedure.

A Randomized Clinical Trial Comparing Dubuisson Laparoscopic Lateral Suspension with Laparoscopic Sacropexy for Pelvic Organ Prolapse: Short-Term Results.

Laparoscopic sacrocolpopexy (LSC) is the gold standard for the treatment of apical prolapse, although dissection of the promontory may be challenging. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical repair with similar anatomical and functional outcomes, according to recent studies. The purpose of this study was to compare these operative techniques. Women with uterine Pelvic Organ Prolapse Quantification (POP-Q) stage 2 were enrolled in this prospective study and were randomly allocated to the LLS or LSC group. At the 12-month follow-up, primary measures included both anatomical and functional outcomes. Perioperative parameters and complications were recorded. A total of 93 women were randomized, 48 in the LLS group and 45 in the LSC group, with 2 women lost to follow-up in both groups. LSC anatomic success rates were 81.82% for the apical compartment and 95.22% for the anterior compartment. LLS anatomic success rates for the apical and anterior compartments were 90% and 92.30%, respectively. The mean operative time for LLS was 160.3 min, while for LSC it was 168.3 min. The mean blood loss was 100 mL in both procedures. Conversion to laparotomy was necessary in three women. Mesh erosion was not observed in any of the cases. In terms of the complication, Clavien-Dindo grade 1 was observed in two patients in the LLS group and a complication rated grade 3b was observed in one patient in LSC group. LLS is a good alternative to LSC, with promising anatomical and quality-of-life results.

Clinical outcomes of LeFort colpocleisis: A single-center experience from Turkey

Background/Aim. LeFort colpocleisis (LFC) is a procedure for treating pelvic organ prolapse (POP) in women. The aim of the study was to assess the sociodemographic characteristics, anatomical outcomes, satisfaction, and clinical outcomes of patients who underwent LFC for POP. Methods. The study retrospectively and consecutively included 103 patients who underwent LFC for stage III and stage IV POP between January 2010 and December 2022. The participants? sociodemographic characteristics and clinical outcomes were documented. The Turkish version of the Pelvic Floor Distress Inventory (PFDI-20) questionnaire was used to determine quality of life. Results. The patients? mean age was 73.1 ? 26.7 years, mean body mass index 27.4 ? 3.8 kg/m2, parity 4.8 ? 1.5, smoking rate 12.6%, POP quantification (POP-Q) stage III 30.1%, and POP-Q stage IV 69.9%. Their satisfaction rate results were 93.3%. Significant differences were observed in the preoperative period compared to the postoperative period in constipation (40.7% vs. 26.2%; p = 0.038), difficult defecation (22.3% vs. 8.7; p = 0.012), fecal incontinence (18.4% vs. 7.7%; p = 0.039), stress urinary incontinence (25.2% vs. 4.8%; p &lt; 0.001), urge incontinence (49.5% vs. 27.1%, p = 0.001), voiding dysfunction (37.8% vs. 23.3%; p = 0.002), and urinary retention (42.7% vs. 12.6%; p &lt; 0.001). Postoperative PFDI-20 scores were also significantly lower compared to the preoperative period (57.19 ? 16.57 vs. 21.62 ? 6.96; p &lt; 0.001). Conclusion. This study showed that LFC has been established as a surgical procedure with high anatomical success, high patient satisfaction rates, and minimal complications, especially in advanced POP with age-related comorbidities.

External validation of the de novo stress urinary incontinence prediction model after pelvic organ prolapse surgery in Korean women: a retrospective cohort study

BackgroundDe novo stress urinary incontinence (SUI) may develop following pelvic organ prolapse surgery. Performing prophylactic continence surgery may reduce the risk of de novo SUI and subsequent continence surgery; however, it may increase the risk of complications. Therefore, many surgeons try to identify women at high risk for de novo SUI and perform continence surgery selectively. Recently, a model for predicting the risk of de novo SUI after prolapse surgery was developed using data from the Outcomes following vaginal Prolapse repair and midUrethral Sling (OPUS) trial; its prediction accuracy was significantly better than that of the stress test alone. However, few studies have verified its prediction accuracy in discrete populations. The aim of this study was to externally validate the prediction model for de novo SUI after prolapse surgery in Korean women.MethodsThis retrospective cohort study included 320 stress-continent women who underwent prolapse surgery for pelvic organ prolapse quantification stage 2–4 anterior or apical prolapse and who completed a 1-year follow-up. Predicted probabilities by the de novo SUI online risk calculator were compared with observed outcomes and quantitated using the model’s area under the curve and calibration plot. Subgroup analyses were also performed by the type of prolapse surgery.ResultsThe de novo SUI prediction model showed moderate discrimination in our study cohort; area under the curve (95% confidence interval) = 0.73 (0.67–0.78) in the whole cohort, 0.69 (0.61–0.78) in women who underwent native tissue repair or colpocleisis, and 0.74 (0.65–0.82) in those who underwent sacrocolpopexy. Calibration curves demonstrated that the model accurately predicted the observed outcomes of de novo SUI in women who underwent native tissue repair or colpocleisis but underestimated outcomes in those who underwent sacrocolpopexy. The predicted probability cutoff points corresponding to an actual risk of 50% were 40% in women who underwent native tissue repair or colpocleisis and 30% in those who underwent sacrocolpopexy.ConclusionsThe de novo SUI prediction model is acceptable for use in Korean women and may aid in shared decision-making regarding prophylactic continence procedure at the time of prolapse surgery.

Efficacy of laparoscopic pectopexy versus laparoscopic sacrocolpopexy and antibacterial performance of nanosilver-coated urethral catheter for postoperative catheterization in patients with pelvic organ prolapse

This study aimed to compare the clinical efficacy of laparoscopic sacrocolpopexy (LSC) and laparoscopic pectopexy (LP) for the treatment of pelvic organ prolapse (POP) and to evaluate the antibacterial effect of nanosilver-coated urethral catheters. The clinical data of 112 patients with POP, including 56 patients who underwent LP and 56 patients who underwent LSC, from March 1, 2019 to March 31, 2021 were retrospectively evaluated. All patients underwent routine catheterization with nanosilver-coated urethral catheters after surgery. The baseline data, intraoperative and postoperative efficacy, serum inflammatory indexes and postoperative complications were compared. The surgery was successfully completed in both groups, and a total of 10 patients in both group underwent intraoperative repair of the anterior and posterior vaginal walls. The surgical duration was significantly shorter and the intraoperative blood loss was significantly lower in the LP group than in the LSC group (P &lt;0.05 for both). In both groups, the POP quantification stage, which was ≥I prior to surgery, was ≤I at six months after surgery. The PFIQ-7, PFDI-20 and PISQ-12 scores were significantly improved in both groups (P &lt;0.05 for all), and the improvements were significantly better in the LP group than in the LSC group (P &lt;0.01). During the 6-month follow-up period, no patient developed urinary tract infection. The levels of postoperative serum inflammatory factors WBC, ESR and CRP were increased in the LSC group and higher than those in the LP group, highlighting the significant anti-infection effect of the nanosilver-coated catheter. Mesh exposure occurred in one patient in the LSC group. In the LSC group, postoperative symptoms including abnormal defecation, lower abdominal pain/soreness, new stress urinary incontinence, and dyspareunia. In the LP group, abnormal defecation and lower abdominal pain were present in one patient each. The rate of postoperative complications was higher in the LSC group than in the LP group. While both LSC and LP could restore pelvic floor anatomic structure and organ function in patients with POP, shorter surgical duration, less blood loss, and better therapeutic effect were observed in patients undergoing LP. Nanosilver-coated antibacterial catheters exhibited good antibacterial effect in patients with routine catheterization after surgery. This study provides a new treatment plan for the treatment of pelvic organ prolapse, and also provides a new nursing method for postoperative urinary tract infection.

Effect of structured pelvic floor muscle training on pelvic floor muscle contraction and treatment of pelvic organ prolapse in postpartum women: ultrasound and clinical evaluations.

The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. Sixty patients who volunteered for a PFMT assessment at 6-8weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women.

Long-term outcomes and quality of life after Manchester procedure for pelvic reconstructive surgery in women with cervical elongation

ObjectiveNative-tissue techniques for Pelvic Organ Prolapse (POP) repairs, such as the Manchester Procedure (MP), have recently been revitalized. However, there are conflicting opinions regarding correcting cervical elongation support by the MP, and the risk of possible poor outcomes and postoperative complications.Therefore, this study aimed to investigate anatomical and patient-reported outcomes during one year after MP. DesignProspective cohort study. SettingThis study was conducted on women who underwent the MP for cervical elongation between 2010 and 2020. PatientsWomen with apical compartment prolapse up to stage 3 due to cervical elongation. InterventionsManchester Procedure. MeasurementsPre and postoperative evaluations by POP Quantification (POP-Q) system were performed, and patients filled out the quality-of-life questionnaires including Pelvic Floor Distress Inventory Short Form 20 (PFDI-20), and POP/Urinary Incontinence Sexual Questionnaire (PISQ-12) before and 12 months after the procedure. Anatomical outcomes were measured by POP-Q and the changes in POP-related symptoms were evaluated and reported. Main Results33 participants were recruited in the study. Significant anatomical improvements were obtained in all compartments after the surgery. After 12 months in POP-Q examination, the mean (±SD) of Ba was changed from +1.82 (±1.71) to −1.18 (±1.50), C was changed from −1.25 (±2.81) to −6 (±1.82), and D from −6.30 (±1.42) to −7.1 (±1.25) respectively (P < 0.001). POP-Q stage 0–1 was obtained inof7% in the apical compartment (C < −1), but only in 45.4% in the anterior compartment (Ba < −1). A significant reduction in symptom scores was obtained for PFDI-20 (P < 0.01) and PISQ-12 (P = 0.011). ConclusionsOur findings suggest that the MP provides adequate apical support with improvement in anatomic and subjective findings for patients with cervical elongation.

Evaluation of sexual function and vaginal prolapse after radical cystectomy in women: a study to explore an under-evaluated problem

Introduction and hypothesisThe objective was to evaluate sexual function, vaginal prolapse, and quality of life (QoL) in women after radical cystectomy (RC) using validated questionnaires and pelvic organ prolapse quantification (POP-Q) measurement.MethodsFemale bladder cancer patients who underwent RC at our tertiary care center were included (January 2008 to March 2022). Patients received three validated questionnaires (International Consultation on Incontinence Questionnaire Vaginal Symptoms [ICIQ-VS] Part A, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire IUGA revised [PISQ], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire [EORTC] C30/BLM30). Patients who consented were examined with vaginal POP-Q measurement.ResultsOut of 322 patients, 193 were still alive, 54 patients were lost to follow-up, and 43 were excluded, resulting in 96 patients who received the questionnaire. Finally, 35 patients were included, of whom 17 patients consented to vaginal examination. Complaints due to vaginal symptoms were low (ICIQ-VS 6.17 + 5.37). Sexual activity was reported by 12 patients (34.3%); 23 patients (65.71%) were not sexually active. No apical prolapse was found in POP-Q measurement; 6 patients (35.3%) had anterior, and 14 patients (82.4%) posterior prolapse; the highest prolapse stage was 2. No significant differences were found regarding POP stages, sexual function, and QoL (all p > 0.05) when comparing continent and incontinent urinary diversions. Comparing the vaginal approach (no sparing vs sparing), significant differences were found in only two PISQ subscales (significantly higher scores after vagina sparing, p = 0.01 and p = 0.02).ConclusionsThe type of urinary diversion, POP-Q stages, and tumor stages did not show significant differences regarding sexual function, QoL, and prolapse complaints in women after RC, whereas a vagina- sparing approach showed significant differences only in two subscales without clinical relevance.

Histoarchitectonics of paraurethral tissue in women with stress urinary incontinence

Aim: to reveal morphological features of paraurethral tissue in postmenopausal women with stress urinary incontinence (SUI).Materials and Methods. A prospective cross-sectional trial was conducted, which included 30 women with SUI combined with POP-Q (Pelvic Organ Prolapse Quantification) stage I–II cystocele, aged 55 to 75 years. All patients underwent surgical treatment such as anterior colporrhaphy, cystocele plasty with own tissues, urethropexy with synthetic loop followed by morphological study of histological samples.Results. Profound alterations in architectonics of the connective tissue were revealed. Structural changes occurring in the paraurethral tissue are characterized by fragmentation of collagen and elastin fibers as well as their critically lowered thickness and volume, and destruction of strong inter-fiber bonds. This indicates about disintegration of the collagen-elastin skeleton being a part of the ligamentous apparatus involved in urinary retention.Conclusion. The study of the morphological aspects related to stress incontinence including use of immunohistochemical research methods will provide deeper insights into pathogenetic mechanisms behind such pathological condition. Thus, it will be possible to implement a personalized approach to the tactics of management and the choice of therapeutic method for patients with SUI aimed to increase in its effectiveness.

Genital hiatus measurements predict cuff prolapse risk in prolapse surgery

Background/Aim: Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse because there are no consensus or guidelines address the degree of apical support loss at which an apical support procedure should routinely be performed. The aim of this study was to evaluate whether preoperative genital hiatus (GH), perineal body (PB), and total vaginal length (TVL) are associated with prolapse recurrence after apical prolapse surgery. Methods: Our cohort study included 98 patients who underwent vaginal hysterectomy apical suspension due to uterovaginal prolapse of grade 2 or higher according to Pelvic Organ Prolapse Quantification (POP-Q) staging between 2020 and 2021. Patients with a history of gynecologic malignancy, those who could not tolerate surgery or anesthesia, those who had previously undergone pelvic organ prolapse surgery, those with concomitant stress urinary incontinence, and those with abnormal cervical smear results were excluded. Patients were followed for 2 years at intervals of 3 months in the first year after the surgery. The last POP-Q was performed 24 months after surgical intervention. Surgical failure or recurrence was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery, or bothersome vaginal bulge. Patients were given the Pelvic Organ Prolapse Symptom Score (POP-SS) questionnaire before surgery and 6 months postoperatively, and the severity of symptoms was compared between the groups with and without postoperative recurrence. Logistic regression (LR) analysis was performed to determine the factors affecting recurrence. Areas under the ROC curve were calculated as a differential diagnosis for the presence of recurrence, and the predictive value (cut-off) of variables was determined using sensitivity, specificity, positive predictive value, negative predictive value, and LR (+) values. Results: While surgery was successful in 80 patients, genital relapse was seen in 18 patients. The mean preoperative perineal body was 3.05 (0.28) cm, mean preoperative GH was 3.9 (0.39) cm, and mean preoperative TVL was 8.54 (1.33) cm. The mean GH of the group with recurrence was significantly higher than the group without recurrence (P=0.004). The mean preoperative POP-SS score was 15.14 (1.86), and the postoperative POP-SS score was 4.01 (3.74). The postoperative POP-SS score mean of the recurrence (+) group was significantly higher than the group without recurrence (P&lt;0.001). For the genital hiatus, the cut-off &gt;4 cm had a sensitivity of 61.11%, specificity of 76.25%, positive predictive value of 36.70%, negative predictive value of 89.70%, and LR (+) value of 2.57. For POP-SS Preop-Postop Change %, the cut-off &lt;60 had a sensitivity of 94.44%, specificity of 98.75%, positive predictive value of 94.40%, negative predictive value of 98.80%, and LR (+) value of 75.56. Conclusion: Apical vaginal support loss is highly associated with genital hiatus size. In particular, according to all study definitions, a Pelvic Organ Prolapse-Quantification measurement genital hiatus of &gt;4 cm is a strong predictor of apical support loss. This simple measurement can be used to screen for apical support loss and further evaluate apical vaginal support before planning a hysterectomy or prolapse surgery.

Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse: a randomised controlled trial and prospective cohort (SALTO-2 trial).

To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP-Q stage ≥2 vaginal vault prolapse (VVP). Multicentre randomised controlled trial (RCT) and prospective cohort study alongside. Seven non-university teaching hospitals and two university hospitals in the Netherlands. Patients with symptomatic post-hysterectomy vaginal vault prolapse, requiring surgical treatment. Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP-Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively. Primary outcome was disease-specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri-operative data, complications and sexual function. A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease-specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129). LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow-up period of 12 months.

Appearance of levator ani muscle subdivision defects on level III vaginal support structures in women with and without pelvic organ prolapse: an MRI study

Introduction and hypothesisInjury of the levator ani muscle (LAM) is a significant risk factor for pelvic organ prolapse (POP). The puborectalis (PRM) and pubovisceral (PVM) subdivisions are level III vaginal support structures. The null hypothesis was that there is no significant difference in patterns of LAM subdivisions in healthy nulliparous women. Secondarily, we evaluated the presence of different LAM injury in a POP-symptomatic cohort.MethodsThis retrospective magnetic resonance imaging study included: 64 nulligravidae without any pelvic floor dysfunction (PFD) and 526 women of various parity with symptomatic POP. Primary outcome was PVM and PRM morphology on the axial planes: the attachment site on the pubic bone, and the visible separation/border between the PVM and PRM. The attachment was scored as “normal” or “abnormal”. The “abnormal” attachment was divided in two types: “type I”—loss of the muscle substance, but preservation of the overall muscle architecture—and “type II”—muscle detachment from the pubic bone.ResultsThe puboanal muscle (PAM) subdivision was evaluated as a representative part of the PVM. The PAM and PRM attachments and separation were distinguished in all asymptomatic nulliparae. PAM and PRM attachments did not significantly differ. POP group characteristics were parity 1.9 ± 0.8, instrumental delivery 5.6%, hysterectomy or POP surgery 60%, all Pelvic Organ Prolapse Quantification (POP-Q) stages, LAM defect 77.6% (PRM: 77.1%; PAM: 51.3%). Type I injuries were more frequent (PRM 54.7%; PAM 53.9%) compared with type II (PRM 29.4%; PAM 42.1%).ConclusionsA LAM defect was present in 77.6% of women with symptomatic POP. In PRM and PAM subdivisions type I injury was more frequent than type II.

Efficacy of minimally invasive pectopexy with concomitant I-stop-mini sling for women with pelvic organ prolapse and overt stress urinary incontinence: A retrospective cohort study.

To compare the efficacy of minimally invasive pectopexy with I-stop-mini (MPI) and minimally invasive sacrocolpopexy with Obtryx (MSO). Women with pelvic organ prolapse quantification (POP-Q) stage III or more and overt stress urinary incontinence from May 2018 to May 2021 were included. Patients with meshes fixed on the cervix or vaginal vault and bilateral pectineal ligament with I-stop-mini were classified into the MPI group, while those fixed on the apex and sacral promontory with Obtryx were classified into the MSO group. The primary outcomes were 1-year-postoperative POP-Q stage, patient-reported urinary and prolapse outcomes (Urogenital Distress Inventory-6, International Consultation on Incontinence Questionnaire-Short Form, and Pelvic Organ Prolapse Distress Inventory-6), 1-h pad test, and sexual life quality (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire). Secondary outcomes included operative data and adverse events. The efficacy of MPI was similar to that of MSO according to the primary outcomes. MPI had shorter operative times (133.4 ± 30.6min versus 199.3 ± 20.9min, P=0.001) and lower incidence rate of abdominal pain (0% vs 20%, P=0.02) and groin pain (8% vs 40%, P=0.01) than MSO. MPI showed similar efficacy to MSO, but demonstrated shorter operative times and lower incidence rates of abdominal and groin pain.

Predicting the occurrence of stress urinary incontinence after prolapse surgery: a machine learning-based model.

Previous prediction models for postoperative stress urinary incontinence (SUI) cannot be applied to patients receiving transvaginal mesh (TVM) surgery and colpocleisis or those with preoperative subject urinary incontinence. This study aimed to develop and validate a new machine learning model and compare it to previous models. Female patients who underwent prolapse surgeries for stage 2-4 anterior or apical prolapse between January 1, 2015, and December 31, 2019, at Peking Union Medical College Hospital were enrolled. Prolapse surgeries included native tissue repair, LeFort/colpocleisis, sacrocolpopexy, and TVM surgery. The existing models to predict postoperative SUI were externally validated. Subsequently, the dataset was randomly divided into 2 sets in a 4:1 ratio. The larger group was used to construct and internally validate models of logistic regression, random forest, and extreme gradient boosting (XGBoost), which were then externally validated. The discrimination of the prediction models was evaluated using the area under the curve, while the calibration of the models was measured using the Spiegelhalter z test, mean absolute error (MSE), and calibration curves. Overall, 555 patients were enrolled, and 116 experienced SUI 1 year postoperatively. Previous logistic models had poor performance, with areas under the curve of 0.544 and 0.586. In the model construction, the areas under the curve were 0.595, 0.842, and 0.714 for the logistic, random forest, and XGBoost models, respectively. However, only the XGBoost model exhibited good discrimination and calibration for both internal and external validations. Body mass index (BMI), C point of pelvic organ prolapse (POP) quantification stage, age, Aa point of POP quantification stage, and TVM surgery were the 5 most important predictors of postoperative SUI in the XGBoost model. Previous models had poor discrimination and calibration among a Chinese population. Hence, we developed and validated an XGBoost model, which performed well irrespective of the preoperative subjective urinary incontinence (preUI) and surgical methods. Further validation is still required.

Triple-compartment strategy for abdominal sacral colpopexy using PVDF mesh: one-year report of anatomical and subjective outcomes.

Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a triple-compartment open ASC strategy using polyvinylidene fluoride (PVDF) mesh in the treatment of patients with severe apical or uterine prolapse. Women with high-grade uterine or apical prolapse with or without cysto-rectocele were prospectively enrolled in the study from April 2015 to June 2021. We performed all-compartment repair using a tailored PVDF mesh for ASC. We assessed the severity of pelvic organ prolapse (POP) using the Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and 12 months after the operation. The patients completed the International Continence Society Questionnaire Vaginal Symptom (ICIQ-VS) questionnaire at baseline, 3, 6, and 12 months postoperatively. Thirty-five women with a mean age of 59.8±10.0 years were included in the final analysis. Stage III and stage IV prolapse was evident in 12 and 25 patients, respectively. After 12 months, the median POP-Q stage was significantly lower compared to the baseline (4 vs 0, p=<0.0001). Vaginal symptoms score was also reduced significantly at 3-month (7.5±3.5), 6-month (7.3±3.6), and 12-month (7.2±3.1) compared to the baseline (39.5±6.7) (p values < 0.0001). We did not observe any mesh extrusion or high-grade complications. Six (16.7%) patients had cystocele recurrence during the 12-month follow-up, and two of them needed reoperation. Our short-term follow-up showed that using an open ASC technique with PVDF mesh in treating high-grade apical or uterine prolapse is associated with a high rate of procedural success and low rates of complication.

Learning curves and perioperative outcomes of single-incision robotic sacrocolpopexy on two different da Vinci® surgical systems.

This study aimed to report a single surgeon's early experience and learning curves of single-incision robotic sacrocolpopexy on two different robotic surgical platforms, namely, the single-site approach on da Vinci Xi® and single-port approach on da Vinci SP® surgical systems. This retrospective study included 123 consecutive cases of robotic sacrocolpopexy performed between June 2017 and June 2021 for the patients with Pelvic Organ Prolapse Quantification stage 2-4 symptomatic prolapse. First consecutive 57 cases were performed under the da Vinci Xi® system applying the single-site manner, whereas the following 66 cases were done under the da Vinci SP® system. The primary outcome was intraoperative and perioperative complication rates, and the secondary outcome was learning curve of single-incision robotic sacrocolpopexy under the two different robotic surgical platforms. Learning curves based on the operation time were obtained through cumulative sum analysis. The mean age of each group was 65.6 ± 8.7years for single-site robotic sacrocolpopexy and 63.7 ± 7.6years for the single-port one (p = 0.202). More than 80% of patients for each group had advanced prolapse stages and underwent concomitant total hysterectomy. The overall baseline characteristics did not differ significantly between groups. The median operation time for each group were 201.0 and 201.5min, respectively. Both groups showed comparable perioperative outcomes in terms of operation time, intraoperative blood loss, and length of hospital stay. Intraoperative cystostomy rates were 1.8% and 3.0%, respectively, and revealed no statistical difference (p = 0.736). The learning curves were comparable, and the surgeon required less than 15 cases for both single-site and single-port robotic sacrocolpopexies to stabilize operation time. Comparable learning curves and favorable intraoperative and perioperative outcomes of single-incision robotic sacrocolpopexy using two different robotic surgical systems show that both are feasible options for robotic sacrocolpopexy.

Is vitamin D replacement effective in the treatment of postpartum urinary incontinence?

The main objective of this study was to compare the effectiveness of pelvic floor muscle training, and vitamin D replacement in the treatment of urinary incontinence in the postpartum period of pregnant women with vitamin D deficiency. The study was planned as an ancillary study of a study on the determination of the relationship between vitamin D deficiency and urinary incontinence in third-trimester pregnant women. Total 61 women who defined urinary incontinence at postpartum 8th week were included in the study. The participants were divided into two groups: the vitamin D replacement group and the pelvic floor muscle training (PFMT) group. Participants in both groups received appropriate treatment for 12 weeks. İnitial evaluations of which Pelvic Organ Prolapse-Quantification stage, International Consultation on Incontinence Modular Questionnaire on Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) query, and pelvic floor muscle strength were repeated after 12 weeks of treatment for each patient. In the vitamin D replacement group, there was a significant increase in Oxford scores measured after treatment compared with pre-treatment and a significant decrease in ICIQ-FLUTS scores. In the comparison of the groups, it was determined that the changes in the Oxford and ICIQ-FLUTS scores of the vitamin D group after treatment were significantly higher than those of the PFMT group. In this pilot study, it was determined that the effectiveness of vitamin D replacement in the treatment of pelvic floor dysfunction in pregnant women with hypovitaminosis D was significantly higher than PFMT. Vitamin D replacement may be useful in the treatment of urinary incontinence in pregnant women with hypovitaminosis D.