Pelvic Organ Prolapse Research Articles

Two-year Follow-up on Surgical Outcomes of vNOTES High Uterosacral Ligament Suspension for the Prophylaxis and Treatment of Pelvic Organ Prolapse: A Multicenter Prospective Cohort Study

We aimed to evaluate the medium-term outcomes of high uterosacral ligament suspension (HUSLS) with vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) in patients either suffering from pelvic organ prolapse (POP) or undergoing routine prophylaxis to prevent post-hysterectomy vaginal vault prolapse. Multicenter prospective cohort study SETTING: Three tertiary care hospitals PATIENTS: Patients who received vNOTES-HUSLS between January 1, 2021 and January 1, 2023, were included in the study. vNOTES-HUSLS MEASUREMENTS AND MAIN RESULTS: The data collected included surgery duration, intraoperative and postoperative complications, postoperative Visual Analog Scores (VAS), and Female Sexual Function Index (FSFI) pain subdomain scores. The changes in prolapse levels were measured using modified POP-Q scores, including the C, Ba, and Bp scores recorded prior to surgery and during the postoperative follow-up examination. Patient satisfaction was assessed using the Patient Global Impression of Improvement (PGI-I) questionnaire. The final analysis included 55 women. Of these, vNOTES-HUSLS was performed in 43 patients (78.2%) to treat apical prolapse, while the remaining 12 patients (21.8%) underwent prophylaxis following hysterectomy to prevent vaginal vault prolapse. The median follow-up period was 23.5 months, with a range of 12-37 months. Ba,C, and Bp points significantly improved in patients who underwent surgery for prolapse (p<0.001). There was no recurrence in the apical compartment following vNOTES-HUSLS for both performed prophylactic and treatment purposes after hysterectomy. Two (3.6%) patients were diagnosed with stage 3 anterior compartment prolapse. The overall vNOTES-HUSLS success rate was 96.4% at approximately two years follow-up. Bladder injury was detected as an intraoperative complication in one patient (1.8%). The overall satisfaction rate was 98.1% at the final follow-up. vNOTES-HUSLS was effective in the treatment and prophylaxis of apical prolapse, demonstrating high anatomical success rates. The procedure demonstrated a low complication rate, with intraoperative and postoperative complications each observed in 1.8%(n=1) of patients. The Medium-Term Outcomes of vNOTES High Uterosacral Ligament Suspension.

Abdominal Mesh Colpopexy Without Promontory Fixation: 10-Year Follow-up Results of the Peritoneocolpopexy Technique

ObjectivesTo restore apical vaginal prolapse support when the access to the promontory is challenging, a modified method of colpopexy may be needed. We present our 10-year results on the peritoneocolpopexy (PCP) technique without promontory fixation relying on unidirectional barbed delayed absorbable sutures (V-Loc). MethodsFourteen women who underwent PCP for vaginal vault prolapse between 2011 and 2014 participated in an IRB-approved prospective study (11 non-infected; 3 with infected mesh needing excision). Ten-year follow-up data including validated questionnaires (UDI-6, IIQ-7, QoL), pelvic organ prolapse quantifications (POP-Q), complications, re-operations, and secondary prolapses were collected. Paired statistical analyses compared various timepoints and mixed model analysis assessed questionnaire and POP-Q trends over time. ResultsMedian follow-up was 9.7 years (IQR: 6.0 – 0.7) to last POP-Q and 10.4 years (IQR: 9.6 – 11.5) to last contact. No patients were lost to follow-up. Mean baseline C point for all patients was -4.3 and -2.9; 1-year C point was -9.1 and -9.2 and -8.6 and -8.5, respectively at last visit. POP-Q findings improved between pre-PCP and 1-year post surgery and did not significantly change until the last visit. Trends in UDI-6, IIQ-7, QoL and POP-Q findings showed no significant change in any category per year (95% CI, p = 0.2 – 0.9). Secondary anterior compartment prolapse was noted in 3 patients with 1 requiring a repair. ConclusionsPeritoneocolpopexy provides durable vaginal apical support when access to the promontory is compromised. PCP can also be used to prevent secondary prolapse after an infected mesh removal.

Topical lidocaine for pessary removal and reinsertion pain reduction: a randomized clinical trial

BackgroundVaginal pessaries are an inexpensive non-surgical treatment for pelvic organ prolapse and stress urinary incontinence. Pessary maintenance includes periodic removal, cleaning, and reinsertion, which can be painful. Lidocaine-prilocaine cream has been shown to significantly reduce pain during pessary maintenance exams. In some practices, Lidocaine HCl 2% jelly may be more readily available and serve as an alternative to lidocaine-prilocaine cream. However, the effect of Lidocaine HCl 2% jelly use during pessary maintenance exams has not been tested. ObjectiveTo estimate the effect of Lidocaine HCl 2% jelly versus lubricating jelly on pain at the time of office pessary removal and reinsertion. Study DesignThis study is a single-blind, randomized clinical trial among patients presenting to a urogynecology office at a tertiary care center. Participants were randomized to the application of 5cc of Lidocaine HCl 2% jelly or a water-based lubricating jelly five minutes before pessary removal. Visual analog scale pain scores were collected from the participants at baseline, at pessary removal, and at pessary reinsertion. The primary outcome was the visual analog scale pain score at the time of pessary removal. A sample size of 33 per group (n=66) was planned to estimate an absolute mean difference in visual analog pain scale of 2.05 cm at the time of pessary removal. ResultsBetween September 2022 and June 2023, 192 women were screened, and 66 were enrolled. Thirty-three participants were randomized into the lubricating jelly group and 33 participants were randomized into the Lidocaine HCl 2% jelly group. The two groups were similar in baseline characteristics. Most participants were postmenopausal, using vaginal estrogen, wearing a 70 mm ring pessary with support for pelvic organ prolapse, and reported being very satisfied with the pessary. Other pessaries worn included ring without support, incontinence rings with and without support, Gellhorn, and donut. The pessary sizes ranged from 51 mm to 96 mm. There was no significant difference in pessary type and size between groups. Visual analog scale pain scores at pessary removal were low in both groups: 3.23±3.00 cm in the lubricating group and 2.66±2.77 cm in the lidocaine group. After adjusting for baseline pain, there was no significant difference in pain at pessary removal between the lidocaine jelly and the lubricating jelly groups (mean difference=-0.56 cm, 95% CI: -1.97 to 0.85; p=0.44). Despite no significant difference in visual analog scale pain scores, 71.2% of participants reported a desire for numbing jelly at future pessary examinations. ConclusionPain during pessary removal and reinsertion is low. Compared to lubricating jelly, lidocaine jelly did not further reduce pain during pessary examinations.

Body image and pelvic floor dysfunction in pregnancy and postpartum: A prospective one-year follow-up cohort study.

To determine the prevalence of pelvic floor dysfunction (PFD) among pregnant women, their clustering and their association with body image disturbance (BID) up to 1 year postpartum. Monocentric prospective cohort study. University Hospitals Leuven. Pregnant women attending for pregnancy care, first assessed prior to 14 weeks of gestation and agreeing to follow-up until 1 year postpartum. Standardised questionnaires reporting on PFD and BID at 12-14 and 28-32 weeks of gestation, and again at 6-8 weeks and 1 year postpartum. We calculated the prevalence of PFD, how the cases clustered and how the cases correlated with BID using a linear mixed-model analysis. A minimum of 174 women with complete follow-up were required. The questionnaires used were the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF), St. Mark's Incontinence Score (SMIS), Patient Assessment of Constipation Symptoms (PAC-SYM), Pelvic Organ Prolapse Distress Inventory (POPDI), Pelvic Organ Prolapse/Incontinence Sexual Questionnaire IUGA Revised (PISQ-IR) and the Body Image Disturbance Questionnaire (BIDQ). Out of 208 women, 92.8% reported one or multiple symptoms of PFD at 28-32 weeks of gestation, dropping to 73.6% by 1 year postpartum. The most common symptoms were constipation (65.3% at 28-32 weeks of gestation and 42.8% at 1 year postpartum) and urinary incontinence (56.8% at 28-32 weeks of gestation and 35.1% at 1 year postpartum). After correcting for body mass index, parity and mode of delivery, the severity of BID was associated with the ICIQ-UI SF score (β = 0.016, range 0.007-0.024), the PAC-SYM score (β = 0.006, range 0.002-0.011) and the POPDI score (β = 0.009, range 0.005-0.012), but not with the SMIS score (β = 0.015, range -0.001 to 0.031) or the PISQ-IR score, in sexually active women. Urinary incontinence, constipation and symptoms of prolapse have a measurable impact on BID.

Missed diagnosis of pelvic organ prolapse complicated with cervical cancer: a retrospective case series of five patients and review of literature

Missed diagnosis of pelvic organ prolapse complicated with cervical cancer: a retrospective case series of five patients and review of literature

Optimised Protocol for Managing Failed Catheterisation: Leveraging Bedside Retrograde Urethrography and Cystourethroscopy.

Introduction Urethral catheterization is a routine procedure often required for many hospitalized patients. Various conditions, such as meatal stenosis, stricture urethra, false passage, benign prostatic hyperplasia, bladder neck contractures, and impacted urethral stones, can contribute to difficulty in catheterisation. In the setting of failed attempts at per urethral catheter placement, the subsequent intervention is suprapubic catheter (SPC) insertion. SPC placement has its associated complications and causes inconvenience to the patients. We framed an algorithm to minimise the need for SPC insertion in cases of difficult per urethral catheterisation in a non-trauma setting. This study aimed to evaluate the common causes of difficult per urethral catheterisation and establish the efficacy of our algorithm in managing difficult catheterisation with bedside retrograde urethrography (RGU) and cystoscopy while avoiding SPC placement. Materials and methods This prospective observational study was conducted from September 2022 to June 2024. Patients admitted with urinary retention or requiring routine catheterisation, with one failed attempt at catheterisation, were included in the study. Our algorithm for the management of difficult catheterisation in a non-trauma setting, to avoid SPC, integrates a bedside RGUand retrograde urethroscopy using either a 15.5 Fr cystoscope sheath or a 6 Fr ureteroscope to identify the urethral pathology, followed by dilatation and per urethral catheterisation. Results Among 55 patients (aged 34-82 years), 48 (87.27%) were male and seven (12.73%) were female. The most common indication for catheterisation was routine catheterisation for output monitoring (n = 30; 54.54%), followed by acute retention (n = 25; 45.45%). Bulbar urethral stricture (n = 28; 50.9%) was the most common cause of difficult catheterisation, followed by meatal/sub-meatal narrowing (n = 13; 23.63%), enlarged prostate or high bladder neck (n = 4; 7.27%), and impacted stones (n = 3; 5.45%). Successful catheterisation was achieved in 48 male patients following urethroscopy with a 6 Fr ureteroscope or 15.5 Fr cystoscope. In females, reducing the pelvic organ prolapse enabled catheterisation in two cases, while five required serial dilatation and catheterisation. Successful per-urethral catheterisation was achieved in all 55 (100%) patients, thus avoiding SPC. Conclusions Conventional blind catheterisation techniques have limited success in the setting of failed initial catheterisation. This approach, which employs bedside fluoroscopy and direct visualisation of the urethra using a cystoscope or ureteroscope, helped achieve higher success rates (n = 55; 100%) for difficult per-urethral catheterisation and avoided the need for SPC. Proper implementation of this protocol for dealing with difficult per-urethral catheterisation will reduce the unnecessary burden on the healthcare system by minimising the potential iatrogenic urethral injuries and reducing the need for SPC.

At the Scrub Sink: Permanent Versus Absorbable Sutures for Sacrocolpopexy Vaginal Mesh Fixation.

Thirty years ago, open sacrocolpopexy was the main route for the procedure, and at that time, most surgeons used permanent sutures to attach the mesh to the vagina. With the changes to laparoscopic and robotic-assisted routes, some urogynecologists started using delayed absorbable sutures while others continued using permanent sutures. The current data suggest no increased failures with delayed absorbable sutures. Given that the risk of suture exposure is almost eliminated with delayed absorbable sutures, it is reasonable to use delayed absorbable sutures in attaching the mesh to the vagina over permanent sutures. Regardless of the suture selection, the 10% long-term mesh exposure rate after sacrocolpopexy should prompt us to continue discussing and working on solutions to lower the mesh exposure rate and improve prolapse surgery outcomes for our patients.

Examining the impact of weight loss and exercise on pelvic organ prolapse (POP) management

Introduction: Pelvic organ prolapse is a descent of pelvic organs such as the bladder, cervix, apex of the vagina, and rectum which create herniation and slide into the direction of the vagina entrance. Pelvic prolapse is caused by ligament and muscle weakness, and its risk increases with age, parity, and obesity. Proper exercise and weight loss can be a key component of pelvic prolapse management, especially in the I-III stages. Those interventions may decrease the need for pelvic surgery and the risk of complications that can arise from it. Purpose of the study: This study aimed to explore the effectiveness of weight loss and exercise on pelvic organ prolapse (POP) symptoms and staging. Materials and methods: A comprehensive analysis of research papers available on PubMed, and Google Scholar was undertaken using the keywords: ‘weight loss pelvic prolapse’, ‘exercise in pelvic prolapse’, ‘pelvic floor dysfunction’, ‘pelvic floor muscle training’, ‘hypopressive exercises’, ‘biofeedback prolapse’ Results: Conventional weight loss does not reduce the intensity of the pelvic prolapse symptoms. However, weight loss that is achieved via bariatric surgery is effective in reducing symptoms arising from pelvic organ prolapse. Furthermore, the bigger the amount of weight loss the greater improvement in symptoms. Pelvic floor muscle training showed improvement in symptoms and in the staging of pelvic organ prolapse. Hypopressive exercises are not as effective as pelvic floor muscle training. Biofeedback and supervised exercises are helpful in proper exercise execution, and thus may improve the strength of the pelvic floor muscles.

VNOTES versus Laparoscopic Uterosacral Ligament Suspension for Apical Pelvic Organ Prolapse: Perioperative and Short-Term Outcomes.

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a novel approach in gynecological surgery. This study was aimed at comparing perioperative and short-term postoperative outcomes of vNOTES versus laparoscopic approaches to uterosacral ligament suspension (USLS) for apical pelvic organ prolapse. A retrospective cohort study included all women who underwent vNOTES versus laparoscopic USLS at two university-affiliated centers between 2017 and 2023. The relationships between variables were tested using Fisher's exact test or t test, including a sub-analysis comparing hysterectomy and hysteropexy outcomes within the groups. Logistic regression assessed the influence of baseline factors and operative factors on the primary and main secondary outcomes of interest. This study comprised 47 vNOTES and 54 laparoscopic USLS cases (including 11 and 15 hysteropexies respectively). Baseline demographics in the two groups were similar. There were no differences in operative outcomes and no instances of ureteral injury. The vNOTES technique allowed for the use of significantly more sutures per side (2.0 [2.0-4.0] vs 1.0 [1.0-1.0], p = 0.001). Postoperative complications within 6 weeks demonstrated no significant differences. Both groups exhibited comparable rates of baseline subjective POP symptoms (100% vs 96.2%, p = 1.00) which improved significantly at 6 weeks (4.3% vs 11.1%, p = 0.282). At 6 weeks, anatomical success was achieved by significantly more patients with vNOTES (93.5% vs 78.6%, p = 0.042). Baseline and 6-week POP symptoms in the hysterectomy and hysteropexy subgroups were similar. Both vNOTES and laparoscopic USLS demonstrated comparable subjective success rates at 6 weeks postoperatively. The vNOTES approach demonstrated improved anatomical success at 6 weeks, but the difference was not significant after adjusting for operative factors.

Female genital prolapse and risk of psychiatric disorders: A two-sample Mendelian randomization analysis

BackgroundThere is a growing body of evidence suggests a strong link between female genital prolapse (FGP) and mental health. However, the causal relationship between FGP and psychological disorders remains unclear. ObjectivesBidirectional Mendelian Randomization (MR) analysis has been applied to investigate the potential impact of FGP on the risk of seven common psychiatric disorders. MethodsThe two-sample MR analysis was conducted using genetic instruments such as Inverse variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode from the genome-wide association study (GWAS) summary data in European populations. In addition, the Cochrane's Q test, MR-Egger intercept test, MR pleiotropy residual sum and outliers (MR-PRESSO) test and leave-one-out analysis were employed to assess the sensitivity and heterogeneity. ResultsThe MR results revealed that FGP exhibited a potential marginal protective effect on bipolar disorder (BD) (odds ratio(OR) = 0.92, 95%confidence interval (95%CI: 0.85–0.99, P = 0.03) as well as schizophrenia(OR = 0.91, 95%CI:0.85–0.98, P = 0.01). Nevertheless, there was no causal correlation between genetically predicted FGP and obsessive compulsive disorder (OCD) (OR = 0.98, 95%CI:0.80–1.20, P = 0.84),depression (broad) (OR = 1.00, 95%CI:0.99–1.01, P = 0.76), major depression(OR = 0.98, 95%CI:0.94–1.03, P = 0.43), anxiety disorders (OR = 1.00, 95%CI:0.94–1.07,P = 0.97) and post-traumatic stress disorder(PTSD) (OR = 1.18, 95%CI:0.88–1.57,P = 0.27),respectively. In addition, BD was found to have a potential significant influence on FGP in the inverse MR analysis (OR = 0.83, 95%CI:0.72–0.97, P = 0.02). No significant heterogeneity or horizontal pleiotropy detected, and the results were deemed stable based on sensitivity analysis and leave-one-out test . LimitationsThere are shortcomings such as data limitations, population bias, potential pleiotropy, and stratified analysis. ConclusionsWhile there is potential causal relationship between FGP and BD or schizophrenia, it does not exhibit any correction with OCD, depression (broad), major depression, anxiety disorders and PTSD among European populations.

Evaluation of iliococcygeal fixation procedure for pelvic organ prolapse: preoperative properties and short term postoperative outcomes

Aim: The aim of this study was to evaluate the short-term outcomes of patients who underwent iliococcygeal fixation (ICF) for the surgical treatment of pelvic organ prolapse (POP) and to assess the safety and feasibility of the ICF procedure. Patients and Methods: Our study is retrospectively done with the data of 50 POP patients who underwent ICF in our clinic within the dates 01.04.2022 and 31.03.2024. A total of 44 women were found to be eligible for follow-up. Demographic data and pre- and post-operative clinical data at 3 months were assessed. Results: According to the findings of our study, the difference between the median duration of surgery in NSD and CS patients is statistically significant, and the duration of surgery is longer in NSD patients (80 minutes (70-85) vs 60 minutes (50 -67,5), (p&amp;lt;0,05)). Only one recurrence, one hematoma and infection, and one bladder injury had occurred. Conclusion: According to our study, ICF is a safe, durable and surgically feasible procedure that can be done concomitantly with other procedures. Thus, we strongly advocate this procedure until the ideal mesh is found since it avoids many serious complications of SSLF.

A novel suturing technique for natural tissue repair in cystocele treatment

BackgroundRecently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy.MethodsWe retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients’ clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients’ complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups.ResultsThe two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p < 0.001) and significantly lower postoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p < 0.001).ConclusionsThe rug-weaving plication technique may offer a viable alternative for cystocele repair without mesh, using natural tissue and potentially reducing mesh-related complications and recurrence rates.Clinical trial numberNCT06410469 (03/05/2024).

Thermodynamic Work of High-Grade Uterine Prolapse Patients Undergoing Transvaginal Mesh Repair with Total Hysterectomy.

The objective benefit of transvaginal mesh with concomitant total hysterectomy (TVM-HTX) repair to high-grade uterine prolapse (UP) patients has not been fully established. This study aimed to clarify the impact of TVM-HTX on the voiding function of high-grade UP patients by comparing pre- and post-operatively measured pressure-flow and pressure-volume investigations. Urodynamic and thermodynamic studies were conducted on 15 high-grade UP patients (stage III/IV, POP-Q system) who underwent TVM-HTX (January 2019-December 2022) in a tertiary-care university hospital. The parameters analyzed included voiding resistance (Rvod), voiding pressure (Pvod), voiding flow (Fvod), voided volume (Vvod), voiding time (Tvod), and the trajectory-enclosed area of the pressure-volume loop (Apv). Post-operative results showed a significant reduction in Rvod (p < 0.001, N = 15), Pvod (p = 0.021, N = 15), and Apv (p = 0.006, N = 15), along with an increase in Fvod (p = 0.003, N = 15) and a decrease in Tvod (p < 0.001, N = 15). The operation-associated changes in Rvod (ΔRvod) correlated with alterations in Pvod and Fvod (ΔPvod and ΔFvod, r = 0.444, p = 0.004, r = 0.717, p = 0.003, respectively; both N = 15); ΔFvod correlated with the change in Tvod (ΔTvod, r = 0.629, p = 0.012, N = 15) but not with that in ΔVvod (r = 0.166, p = 0.555, N = 15). Changes in Apv (ΔApv) correlated with ΔPvod (r = 0.563, p = 0.029, N = 15) but not with ΔVvod (r = 0.353, p = 0.197, N = 15). Collectively, TVM-HTX reduced the voiding resistance, which improved the voiding efficacy and decreased the pressure gradient required for driving urine flow, thereby lessening the bladder's workload.

Association Between Frailty and Pelvic Organ Prolapse in Elderly Women: A Retrospective Study

Introduction and HypothesisThis study evaluated the association between pelvic organ prolapse (POP), frailty, and sarcopenia to explore how POP treatment can extend healthy life expectancy in elderly women.MethodsWe conducted a retrospective study of prospectively collected data, comparing women with mild POP (stages 0–II) with those with advanced POP (stages III and IV). The inclusion criteria for this study were women who visited the clinic with at least one symptom of pelvic floor dysfunction and underwent imaging studies between April 2020 and November 2022. Initially, 119 patients met these inclusion criteria. Patients were excluded if they had a history of previous POP treatment, did not respond to the study survey, or were lost to follow-up. After applying these exclusion criteria, 82 patients were included in the final analysis, of whom 65 underwent surgery (laparoscopic sacrocolpopexy, colpocleisis, tension-free vaginal tape, and native tissue repair). Assessments included POP Quantification, Kihon Checklist, Pelvic Organ Prolapse Quality of Life (P-QOL) questionnaire, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Incontinence Symptom Questionnaire (ICIQ-SF). Pelvic muscles were measured using MRI or CT. Immunohistochemical analysis of estrogen receptor alpha (ERα), estrogen receptor beta , and androgen receptor was performed on surgical specimens from 43 patients.ResultsThe median age of participants was 75 years. Of the 82 patients, 48 (58.5%) were classified as frail or pre-frail, and 22 (26.8%) exhibited motor impairment. Advanced POP (stages 3 and 4) was seen in 41 patients. These patients had more motor function impairments (advanced, 16; mild, 6; p = 0.01). Patients with advanced POP had poorer P-QOL, ICIQ-SF (median: 9.5 vs 4, p = 0.006) and OABSS (7 vs 4, p = 0.008) scores, and smaller pubococcygeus muscle diameter (2.5 vs 3 cm, p = 0.017). Postoperatively, significant improvements were seen in P-QOL (all domains except personal relationships: p < 0.001), total IPSS (11 vs 4, p < 0.001), OABSS (6 vs 5, p = 0.033), and ICIQ-SF scores (6 vs 2, p < 0.001). ERα expression was associated with preoperative frailty (r = −0.37, p = 0.014).ConclusionsAdvanced POP correlates with poorer QOL, worse urinary symptoms, and reduced pubococcygeus muscle diameter, consistent with sarcopenia, compared with mild POP.

Robotic-assisted sacrocolpopexy with hinotori, a brand-new surgical robot system produced in Japan; report of initial clinical case series.

Robot-assisted sacrocolpopexy (RASC) is increasingly common due to the increased uptake of surgical robot systems. The aim of this retrospective study was to assess the perioperative outcomes of the first patient cohort to undergo RASC using a brand-new surgical robot system, the hinotori surgical system (robot-assisted sacrocolpopexy with hinotori surgical system [h-RASC]). This study also aimed to compare the outcomes of this group with those of the group of patients who had undergone RASC with the da Vinci surgical system (d-RASC). This study included 15 patients per group. Operative times, blood loss, complications, overactive bladder symptom score (OABSS; subjective measure), and urodynamic outcomes (objective measure) were compared between the groups. All cases were completed without serious problems during RASC procedure. Perioperative outcomes were similar between the groups except for longer operation time (min) (h-RASC 266 vs. d-RASC 229; p < .01) and console time (min) (178 vs. 159; p = .02) in the h-RASC group than in the d-RASC. De novo stress urinary incontinence (SUI) and pelvic organ prolapse (POP) recurrence were comparable. LUTS improved in the postoperative OABSS total score (preoperative 6 vs. postoperative 3; p < .01) in the h-RASC group. However, OABSS assessment (h-RASC -3 vs. d-RASC -4; p = .38) was similar between the two groups. Urodynamic studies showed similar outcomes in the median Qmax (maximum flow rate) values in both groups. This is the first report focusing on RASC using the hinotori surgical system. RASC using the hinotori surgical system could provide favorable perioperative outcomes as comparable with those of the existing da Vinci system.

Analysis of the Clinical Value of Laparoscopic Sacrocolpopexy to Support the Posterior Compartment in Women with Multicompartment Prolapse Including Rectocele.

Background/Objectives: Laparoscopic sacrocolpopexy is regarded as the gold standard treatment for apical or multicompartment prolapse, predominantly with anterior compartment descent. However, the optimal surgical approach for concurrent rectocele is still debated. The aim of this study was to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥stage II), analyzing the anatomical outcomes, the necessity for concomitant or subsequent posterior repair, and the impact on bowel function in women undergoing surgery. Methods: Data from all women who underwent laparoscopic sacrocolpopexy with or without posterior repair between 01/2017 and 07/2022 for symptomatic multicompartment prolapse, including apical and posterior compartment descent ≥ stage II, were retrospectively evaluated. All women underwent a standardized urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system, and completed the German-validated Australian Pelvic Floor Questionnaire before and after surgery (6-12 weeks). Preoperative anatomic support and bowel symptoms were compared with postoperative values. Results: In total, 112 women met the criteria for surgical correction. The majority (87%) had stage II posterior descent, with only 10% undergoing concurrent posterior repair during laparoscopic sacrocolpopexy. Significant (p < 0.001) objective improvement was seen for all compartments post- compared with preoperatively (Ba: 0 (-1/2) vs. -3 (-3/-2), C: -1 (-2/0) vs. -8 (-12/-7), Bp: 0 (-1/0) vs. -3 (-2/-2); (median (25%/75% quartiles)). Subsequent surgery for persistent rectocele and/or stool outlet symptoms was required in 4% of cases. Most bowel-specific questions in the German-validated Australian Pelvic Floor Questionnaire showed significant improvement (p < 0.001). Conclusions: Nerve-sparing sacrocolpopexy alone appears to be a suitable surgical approach to correct multicompartment prolapse, including a rectocele ≥ stage II, and results in a reduction of objective signs and symptoms of pelvic organ prolapse.

Prevalence and incidence of pelvic organ prolapse, bowel and urinary dysfunction in the Integrated Woman's Health Program

ObjectiveDespite its high prevalence, little information is available on the natural history of pelvic floor dysfunction. We aimed to determine the prevalence, incidence and persistence of pelvic organ prolapse (POP), bowel and urinary symptoms over 6–7 years and its associated factors. Study designWomen from a midlife cohort in Asia completed baseline and 6–7-year follow-up assessments. Sociodemographic characteristics and health conditions were obtained at baseline using validated questionnaires. Body mass index (BMI) and physical performance were objectively measured. Main outcome measuresPOP, bowel, and urinary dysfunction were measured using the Pelvic Floor Distress Inventory Short Form 20 at both timepoints. Binary logistic regression was used to analyze independent associations between baseline risk factors and prevalent, new, and persistent symptoms. ResultsOf the 1201 women enrolled at baseline, 62.3 % had symptoms in at least one domain of pelvic floor dysfunction. Poor sleep, poorer perceived health, and disability were associated with prevalent pelvic floor symptoms, while poor sleep doubled the adjusted risk of incident POP (adjusted odds ratio, aOR: 2.3, 95 % Confidence Interval: 1.4–3.9), bowel (aOR: 2.3, 1.4–3.7) and urinary (aOR: 1.7, 1.1–2.9) symptoms at the 6.6-year follow-up visit. Postmenopausal women had reduced risks of prevalent POP (aOR: 0.5, 0.3–0.7) and urinary symptoms (aOR: 0.4, 0.3–0.6), as well as a reduced risk of developing incident urinary symptoms (aOR: 0.4, 0.2–0.8). Good physical performance scores at baseline reduced the risk of incident bowel symptoms (aOR: 0.5, 0.2–0.9), whereas obesity increased the risks of persistent symptoms. ConclusionPoor sleep quality independently predicted incident pelvic floor dysfunction, while poor physical performance was associated with incident bowel symptoms.

Recurrent pelvic prolapse after pelvic organ prolapse suspension (POPS): Analysis and treatment of an emerging clinical issue

ObjectivesTo investigate pelvic organ prolapse (POP) after a novel abdominal prosthetic surgical technique – ‘pelvic organ prolapse suspension’ (POPS) – that has been proposed recently as an easily reproducible laparoscopic technique for the treatment of multicompartmental POP and rectal prolapse. This study also aimed to analyse treatment strategies of recurrent POP after POPS, reporting on anatomical, subjective and functional outcomes following recurrence surgery. MethodsPatients with a symptomatic prolapse relapse after POPS were collected and analysed prospectively at a single tertiary care institution. Each patient was offered a multidisciplinary clinical and radiological evaluation pre-operatively. ResultsTwenty-five women with a median age of 59 [interquartile range (IQR) 49–73] years were enrolled in the study. Of these, 88 % were menopausal. All patients had high-grade (Pelvic Organ Prolapse Quantification System stage > 2) recurrent posterior vaginal wall-predominant prolapse after POPS. Multicompartmental prolapse was found in 64 % of patients. All women complained of vaginal bulging associated with obstructed defaecation syndrome (ODS) symptoms. Surgical treatment consisted of laparoscopic ventral rectopexy (VR) in all 25 cases (100 %), and concomitant sacral colpopexy (SCP) with previous mesh removal in 16 cases (64 %). No anatomical recurrences were observed after median follow-up of 12 (IQR 3–18) months. Overall subjective improvement after surgery was high in all patients (Patient Global Improvement Index ≤ 2). ConclusionsRecurrent POP following POPS appears to predominantly involve the posterior vaginal wall, with associated ODS symptoms. A multidisciplinary approach is advisable for treatment of these patients. Minimally invasive VR alone or in combination with SCP seems to represent an effective treatment.

Where are we in 2024 in the development of materials for surgical treatment of pelvic organ prolapse and stress urinary incontinence?

There is a long history of implantation of absorbable and nonabsorbable materials to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP). The focus of this review is to review the development of new materials for use in the surgical management of both pelvic conditions following an unacceptable level of severe complications in the use of polypropylene mesh (PPM). We discuss current concepts relating to the development of new materials with particular reference to our experience with polyurethane mesh. Our review highlights the strategies that manufacturers and researchers are employing to improve PPM using collagen gels and stem cells, or to find alternatives. We conclude that current preclinical safety testing is inadequate, and the field requires better in vivo testing. Specifically, we highlight novel techniques demonstrating the degradation of polypropylene potentially elucidating the link between PPM degradation and induction of inflammation leading to adverse side effects. This field badly needs innovation in developing new materials and in testing these to ensure materials will benefit patients. A collaboration between materials scientists and clinicians is needed to facilitate the translation of basic research and preclinical testing into patient benefit for the treatment of SUI and POP.

The role of GZMA as a target of cysteine and biomarker in Alzheimer's disease, pelvic organ prolapse, and tumor progression.

Objective: This study aims to investigate how changes in peripheral blood metabolites in Alzheimer's Disease (AD) patients affect the development of Pelvic Organ Prolapse (POP) using a multi-omics approach. We specifically explore the interactions of signaling pathways, gene expression, and protein-metabolite interactions, with a focus on GZMA and cysteine in age-related diseases. Methods: This study utilized multi-omics analysis, including metabolomics and transcriptomics, to evaluate the perturbations in peripheral blood metabolites and their effect on POP in AD patients. Additionally, a comprehensive pan-cancer and immune infiltration analysis was performed on the core targets of AD combined with POP, exploring their potential roles in tumor progression and elucidating their pharmacological relevance to solid tumors. Results: We identified 47 differential metabolites linked to 9 significant signaling pathways, such as unsaturated fatty acid biosynthesis and amino acid metabolism. A thorough gene expression analysis revealed numerous differentially expressed genes (DEGs), with Gene Set Enrichment Analysis (GSEA) showing significant changes in gene profiles of AD and POP. Network topology analysis highlighted central nodes in the AD-POP co-expressed genes network. Functional analyses indicated involvement in critical biological processes and pathways. Molecular docking studies showed strong interactions between cysteine and proteins PTGS2 and GZMA, and molecular dynamics simulations confirmed the stability of these complexes. In vitro validation demonstrated that cysteine reduced ROS levels and protected cell viability. GZMA was widely expressed in various cancers, associated with immune cells, and correlated with patient survival prognosis. Conclusion: Multi-omics analysis revealed the role of peripheral blood metabolites in the molecular dynamics of AD and their interactions with POP. This study identified potential biomarkers and therapeutic targets, emphasizing the effectiveness of integrative approaches in treating AD and POP concurrently. The findings highlight the need for in-depth research on novel targets and biomarkers to advance therapeutic strategies.