Presence Of Pelvic Organ Prolapse Research Articles

Reliability and Validation of the PFIQ-7 and PFDI-20 in the Luganda Language

Introduction and HypothesisPelvic floor disorders (PFDs) impact women worldwide and are assessed using instruments such as the Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). There are no known valid PFD instruments in Uganda. This study’s purpose was to translate and test the reliability and validity of the PFDI-20 and PFIQ-7 in Luganda. It was predicted that these instruments would be reliable and valid to assess the presence and impact of PFD in parous Luganda-speaking women.MethodsThe translated PFDI-20 and PFIQ-7 were administered to parous Luganda-speaking women and readministered 4–8 months after. The Pelvic Organ Prolapse Quantification (POP-Q) examination determined the presence of pelvic organ prolapse (POP) and a cough-stress test (CST) measured urinary leakage. Analysis was completed using Cronbach’s α co-efficient for internal consistency and Spearman’s correlation coefficients and Wilcoxon rank sum tests for construct validity.ResultsOf the 159 participants, 93 (58.3%) had stage II POP or higher. The PFDI-20 and PFIQ-7 demonstrated minimal bother and impact on activities of daily living respectively. The Urinary Distress Inventory 6 (UDI-6) scores on the PFDI-20 showed a strong positive association with the presence of urinary incontinence. When PFD was defined by responses to symptom assessment, the translated PFDI-20 and PFIQ-7 could differentiate between individuals with and without PFD.ConclusionsThe UDI-6 section of the PFDI-20 was found to be valid in Luganda. The PFIQ-7 and the entirety of the PFDI-20 were not found to be reliable or valid, likely because of the low prevalence of PFDs in the study population.

Evaluation of the distance from the anterior cervicovaginal junction to the anterior peritoneal reflection for anterior colpotomy during vaginal hysterectomy in Korean women.

This study aimed to know the distance of the cervicovaginal junction (CVJ) to the anterior peritoneal reflection (APR) as measured in surgical specimens, and assess the distance between the CVJ and APR to ensure safe anterior colpotomy for vaginal hysterectomy among Korean women.Patients who underwent vaginal hysterectomy were included in the analysis. According to the presence of pelvic organ prolapse or menopausal status, the distance from the CVJ to the APR was assessed preoperatively through transvaginal ultrasonography (TV-US), as well as intraoperatively using surgical specimens. The intraclass correlation coefficient was used to determine the reliability between 2 measurements.In total, 171 patients were included. The median distance from the CVJ to the APR measured on TV-US was 19.8 (3.3–41.3) mm. Meanwhile, the median distance from the CVJ to the APR measured using the surgical specimen was 26.0 (12.0–55.0) mm. The intraclass correlation coefficient for the absolute agreement between 2 measurements was 0.353 (95% confidence interval: 0.002–0.570; P < .001), which is indicative of poor reliability. The median distance from the CVJ to the APR measured using the surgical specimen did not differ significantly between the 2 groups according to pelvic organ prolapse (26.0 [12.0–55.0] vs 27.5 [17.0–55.0] mm, P = .076] and menopausal status (27.0 [15.0–55.0] vs 26.0 [12.0–55.0] mm, P = .237).TV-US does not an accurately measure the dissection plane length from the CVJ to the APR during anterior colpotomy. During vaginal hysterectomy, the median distance from the CVJ to the APR measured using the surgical specimen was 26 (12.0–55.0) mm, which can help decrease surgical complications.

Bladder rupture due to urogenital tract trauma caused by ox horn injury in a patient with pelvic organ prolapse: a case report

IntroductionGenitourinary tract trauma caused by ox horn injury in the presence of pelvic organ prolapse (POP) is an extremely rare phenomenon and associated with devastating morbidity.Case presentationA 50-year-old multiparous postmenopausal woman from rural northwest Ethiopia presented with the primary complaint of urinary incontinence 6 days after she suffered ox horn injury to her prolapsed genitalia. She had stage 3 pelvic organ prolapse with the leading point being the cervix. The anterior vaginal and posterior bladder walls were disrupted with visible draining of the left ureter. The wound was dirty and edematous with whitish discharge. She was admitted to the urogynecology ward and provided with wound care until the infection subsided. Apical prolapse suspension was performed using right sacrospinous fixation, and bladder repair was carried out 6 weeks following the prolapse suspension. She recovered well and was continent when discharged.ConclusionOx horn injury involving the female lower urogenital tract in the presence of POP is extremely rare. Late presentation after sustaining injury is associated with increased risk of morbidity and long hospital stay, and treatment requires multistage surgery.

Rate of urinary tract infection after urodynamic study in pelvic floor clinic.

Background:One of the complications of urodynamic study is urinary tract infection. The aim of this study was to determine the rate of urinary tract infection (UTI) after UDS in patients referred to the pelvic floor clinic with regard to the specific conditions of these patients, such as presence of pelvic organ prolapse and high post voiding residual volume (PVR).Methods:In a prospective descriptive-analytic study, 146 female candidates for UDS from January 2016 to June 2017 entered the study. Patients were examined for urinary tract infection before UDS (up to 5 days before USD) and were enrolled in the study if they did not have bacteriuria or urinary tract infection. Patients did not receive antibiotic prophylaxis before performing UDS. The patients were asked to do U/A and U/C three days after the UDS test.Results:Among the 146 patients, 9 (6.2%) patients had considerable bacteriuria and 7 (4.8%) patients had UTI. The mean maximum detrusor pressure during urination and abnormal PVR before UDS had a significant correlation with positive urinary cultures after UDS (p<0.05).Conclusion:The results showed that this diagnostic procedure is low risk and the prophylactic antibiotic therapy is not required before UDS in pelvic floor clinic. It seems that prophylactic antibiotic therapy is only appropriate in case of PVR greater than 50 ml and possibly of the high detrusor pressure.

Prevalence of Pelvic Floor Disorders in Female CrossFit Athletes.

This study aimed to estimate the prevalence of pelvic floor disorders by symptoms in female CrossFit athletes in the United States and characterize subjects reporting pelvic organ prolapse symptoms, urinary incontinence, and fecal incontinence. A 27-question anonymous questionnaire was distributed to owners of CrossFit-affiliated gyms. Select questions from validated questionnaires were used to define symptoms. Positive responses with "moderate, or quite a bit" bother defined the presence of urinary incontinence (with stress or urgency). A response of "yes" to "having a bulge or something falling out" defined the presence of pelvic organ prolapse. A response of "yes" to "lose stool beyond your control" questions defined the presence of fecal incontinence. Three hundred fourteen respondents had mean age of 36 ± 10 years and a mean body mass index of 25.2 ± 4 kg/m. Forty-four percent reported ≥1 vaginal delivery. For each workout, respondents reported lifting mean weights of 91 to 217 lb, and 90% reported participation in ≥3 CrossFit workouts per week. Pelvic floor disorder symptoms reported included the following: pelvic organ prolapse, 3.2% (10/314); urinary incontinence, 26.1% (82/314); and fecal incontinence, 6% (19/314). Higher age, parity, and number of vaginal deliveries were associated with urinary incontinence. Higher parity and number of vaginal deliveries were associated with prolapse. Fecal incontinence was not associated with age, body mass index, or obstetric history. The prevalence of pelvic floor symptoms in female CrossFit athletes from the general population is likely similar to the general population; however, the prevalence of bothersome urinary incontinence is higher than the general population in women younger than 40 years.

MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females

Objective: Dyssynergic defecation (DD) and pelvic floor prolapse often coexist in female functional defecation disorder. A retrospective study was performed to evaluate the ability of dynamic MR sequences with the straining and defecation phase to detect paradoxical puborectalis contraction and occult multiple-compartments disorders. Methods: Fifty-three females clinically diagnosed with DD underwent magnetic resonance defecography. The dynamic sequences consist of rest, squeeze, straining, and defecation. The straining phase (pre rectal filling) and defecation phase (post rectal filling) were acquired to assess for pelvic floor relaxation and pelvic organ descent. MR images were analyzed by 2 radiologists with regard to paradoxical puborectalis contraction (changes in the anorectal angle [ARA]) and the presence of pelvic organ prolapse in straining phase and defecation phase independently. Statistical analysis was performed using Wilcoxon’s matched-pairs signed-ranks test and Crosstabs test for matched pairs. Results: Among the 53 patients with DD, 24 individuals (45.3%) were diagnosed DD with multifocal disorders. Comparison between the straining and the defecation phase revealed that there was no significant difference in the change of the ARA (p > 0.05), while significant differences were found in cystocele, vaginal or cervical prolapse, rectocele and descending perineum syndrome between the straining and the defecation phase (p < 0.05). The defecation phase with impaired evacuation distinguished additional anterior/middle compartments findings in female DD patients. Conclusion: The straining phase and the defecation phase have the same ability in assessing paradoxical puborectalis contraction of the DD. Compared with the straining phase, the defecation phase provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing the abnormal anorectal function, the defecation phase with the discharge of the rectal filling demonstrates maximum anterior/middle pelvic organ descent in DD patients.

Vitamin D Deficiency and Lower Urinary Tract Symptoms in Women

ObjectiveThe association of vitamin D deficiency and pelvic floor dysfunction has been examined by numerous studies. Lower urinary tract symptoms (LUTS) associated with bladder filling and voiding functions are common in both sexes. A recent study reports a higher incidence of LTUS in men over 50 years old with vitamin D deficiency. The aim of the study is to investigate whether there is a difference in the Lower Urinary Tract Symptoms frequency between women with vitamin D deficiency and the control group or not. Study designIn this case control study, a total of 150 women who had a measured vitamin D level within a month were divided into two groups, one with a serum vitamin D deficiency and the other with a normal vitamin D level. Both groups were evaluated in terms of menopausal status, numbers of pregnancy and delivery, pelvic examination findings, pelvic floor muscle strength, level of pelvic organ prolapse, LUTS scores, and the findings were recorded. Both groups were compared for the presence of lower urinary system symptoms. The BFLUTS validated for Turkish-speaking populations was used to assess lower urinary system symptoms. Statistical analyses were performed via IBM SPSS Statistics 23.0. The results were considered significant at p < 0.05 and a confidence interval of 95%. ResultsVitamin D deficiency was detected in 67.3% of the participants. No significant differences were found between the groups regarding variables that could affect lower urinary system symptoms such as menopausal status, presence of pelvic organ prolapse and neonatal weight (fetal macrosomia) The Pelvic Floor Muscle Strength was significantly lower in the group with vitamin D deficiency than the control group. BFLUTS scores of premenopausal women with vitamin D deficiency were found to be similar to the control group, likewise no significant differences in the BFLUTS scores were detected in postmenopausal women. ConclusionAlthough vitamin D deficiency causes a significant reduction in pelvic floor muscle strength, no significant correlation was found between lower urinary tract symptoms and vitamin D deficiency. There is a necessity of prospective randomized controlled trials to investigate the relationship between vitamin D deficiency and pelvic floor functions.

Proliferative behavior of vaginal fibroblasts from women with pelvic organ prolapse

ObjectivePelvic organ prolapse (POP) significantly impacts quality of life of women, especially with advancing age. Cell proliferation is a critical parameter in both normal and pathophysiological processes. We sought to examine fibroblast proliferation in premenopausal women with and without POP and menopausal women with POP, and examine whether TGF-β1, a fibroblast mitogen, could stimulate proliferation in vaginal fibroblasts from these populations. Study designVaginal wall biopsies were obtained from asymptomatic women (controls) and women with POP (cases). Fibroblasts were cultured from these tissues. Vaginal fibroblasts were treated with or without TGF-β1. Cell proliferation rate (mitotic index) was measured with time-lapse dark-field microscopy. Cell mitosis was counted with ImageJ software after analysis of time-lapse images as Quick time movies. ResultsThere was no significant difference in mitotic index throughout different time points of observation between premenopausal controls and cases of similar ages. However, a significant difference in mitotic index was seen between premenopausal and menopausal cases (p=0.01), with the menopausal group exhibiting significantly lower mitotic indices. When treated with different doses of TGF-β1, premenopausal control fibroblast proliferation increased with 5ng/ml of TGF-β1 compared to non-treated fibroblasts (p=0.04). TGF-β1 stimulation did not affect fibroblasts from either premenopausal or menopausal cases. ConclusionsVaginal fibroblast proliferation decreases with age and this association does not appear to be affected by the presence of pelvic organ prolapse. TGF-β1 stimulation increased cell proliferation of premenopausal control fibroblasts. In contrast, there was no response seen in fibroblasts from premenopausal and menopausal cases.

Effect of Urinary Incontinence and Its Subtypes on Quality of Life of Women in Eastern Turkey

To determine the bothersomeness and effect on quality of life (QOL) of different types of urinary incontinence (UI) in married women living in eastern Turkey. A total of 1049 married women was evaluated in the present population-based, cross-sectional study. QOL was assessed using a validated form of the Turkish version of the Incontinence Impact Questionnaire Short Form. The effects of UI subtype on the overall QOL score and on the individual domain scores were determined. The relationship between several demographic characteristics such as age, weight, education level, number of pregnancies, number of live deliveries, and presence of pelvic organ prolapse and the QOL changes was examined. The mean age of the women was 44.62 ± 11.01 years (range 17-80). Of the women with UI, 76.2% stated that the UI had a negative effect on their QOL. Women with mixed UI and severe UI had the worst QOL scores. The QOL changes for the different domains revealed that entertainment activities were affected least, and emotional health and feelings of frustration were the 2 domains that showed the most significant deterioration. Furthermore, older and unemployed women, housewives, women living in urban areas, and women with multiple births, difficult labor, and increased weight experienced significant negative effects on their QOL. Our results have shown that, regardless of different factors, UI has significant negative effects on QOL. The presented data emphasize the importance of the high prevalence of UI in our region and its negative effects on QOL. Thus, additional policies are needed for the prevention of the negative effects of UI.

Should we consider assessment of bone mineral density earlier in postmenopausal women with pelvic organ prolapse?

Objective To investigate a possible association between the presence of pelvic organ prolapse and osteopenia or osteoporosis in early postmenopausal women.Design Eighty-seven postmenopausal women between the ages of 55 and 60 years who had been admitted to the Gynecology or Menopause Outpatient clinics of Marmara University, School of Medicine were included in the study. Quantification of pelvic organ prolapse was performed for each patient. The bone mineral density measurements of the lumbar vertebrae by dual-energy X-ray absorptiometry were compared between the groups with and without pelvic organ prolapse.Results The mean T-scores for the lumbar area for women with or without pelvic organ prolapse were comparable between the study groups.Conclusions It appears that presence of pelvic organ prolapse in early postmenopausal women is not helpful in predicting osteoporosis.

The long-term effect of raloxifene on the genitourinary tract

Objective To investigate the effect of long-term treatment with raloxifene on pelvic organ prolapse and urinary incontinence.Methods This was a case–control study in patients attending the Centre for Metabolic Bone Disease. Eighty-two women were included. The average age was 69 years (range 60–85 years). Thirty-nine women had taken raloxifene for an average of 55 ± 25 months and 43 had taken bisphosphonates for an average of 41.96 ± 15.93 months. The Prolapse Quality of Life (P-QOL), version 4 and Incontinence Impact questionnaire (IIQ-7) and Urogenital Distress Inventory, short form (UDI-6) were used to evaluate presence of pelvic organ prolapse and urinary incontinence. Women symptomatic with prolapse were offered a pelvic examination to define the type and severity of the prolapse. Women giving a history of urinary incontinence were offered urodynamic evaluation to establish the cause of the incontinence. The main outcome measures were prevalence and severity of pelvic organ prolapse and urinary incontinence and its impact on quality of life.Results Over 50% of the women complained of incontinence in both groups, 51% (22) of women taking raloxifene and 53% (28) of the controls. Prolapse was present in two women in the raloxifene group (5%) and six women (11%) in the control group. Urge incontinence was similar in both prevalence (15 vs. 21 women) and severity between cases and controls. Stress incontinence, on the contrary, had a similar prevalence (20 vs. 19 women) but was more severe in the controls (p = 0.004). There was no difference in mean scores of IIQ-7 and P-QOL for quality of life between cases and controls.Conclusions Raloxifene taken long-term does not appear to adversely affect urinary incontinence or prolapse.

Epidemiology of prolapse and incontinence questionnaire: validation of a new epidemiologic survey

The epidemiology of prolapse and incontinence questionnaire (EPIQ) was developed to screen for female pelvic floor disorders (PFD). Content and face validity, reliability, internal consistency and criterion validity of the EPIQ to detect the presence of pelvic organ prolapse (POP), stress urinary incontinence (SUI), overactive bladder (OAB) and anal incontinence (AI) is presented. Cronbach's alpha; Spearman's, kappa, intraclass correlations, factor analysis and Chi-Squared tests were used for analysis. Questions related to PFD proved internally consistent (alpha = 0.91) and reproducible (correlations >0.70) for all but three items on the EPIQ. Positive and negative predictive values of the EPIQ to detect PFD were: POP = 76% and 97%, SUI = 88% and 87%, OAB = 77% and 90% and AI = 61% and 91% respectively. EPIQ is a psychometrically validated screening instrument that may identify women at high risk of having pelvic floor disorders in large undiagnosed populations.

A comparison of anticipated pain before and pain rating after the procedure in patients who undergo cystourethroscopy

Objective: The purpose of this study was to compare anticipated pain before the procedure and actual pain rating after the procedure in female patients who undergo cystourethroscopy. Study Design: Eighty-seven consecutive female patients completed a 10-cm visual analog pain scale before and after cystourethroscopy. A 24F urethroscope was used initially to inspect the urethra and was followed by a systematic survey of the bladder with a 17F cystoscope that was lubricated with 2% lidocaine gel. The visual analog pain scale scores were evaluated for significance with the use of the Student t test and the Pearson correlation coefficient. Results: Visual analog pain scale analysis demonstrated a mean anticipated pain score of 3.75 cm before the procedure versus a mean pain rating score of 2.83 cm after the procedure (P <.05). Neither a history of previous cystoscopy (visual analog pain scale score, 3.03 vs 2.30 cm; P =.18) nor talking with someone about the procedure beforehand (visual analog pain scale score, 2.74 vs 2.89 cm; P =.76) influenced the lower pain rating after the procedure. There was no significant correlation between age, parity, body mass index, or presence of pelvic organ prolapse and anticipated or realized pain perception. Conclusion: Patients who undergo cystourethroscopy consistently anticipate higher degrees of discomfort than they actually perceive during the procedure. (Am J Obstet Gynecol 2003;189:66-9.)

Risk factors for an elevated postvoid residual urine volume in women with symptoms of urinary urgency, frequency and urge incontience.

The aim of this study was to identify factors in patients with symptoms of urgency/frequency or urge incontinence that predict that the postvoid residual urine volume (PVR) will be elevated. A restrospective chart review was carried out of all patients new to our urogynecology practice between June 1998 and May 1999, with symptoms of urgency, frequency and/or urge incontinence. Demographic variables, symptoms and physical findings were correlated with the presence of an elevated PVR (>100 ml) using logistic regression analysis. An elevated PVR was found in 10% (33/336) of patients with urge incontinence (UI). and in 5% (3/57) of patients with urgency/frequency without UI. In patients with UI the presence of pelvic organ prolapse (POP) > or = stage II, symptoms of voiding difficulty and the absence of the symptom of stress incontinence, predicted 82% of patients with an elevated PVR.

Urethral collagen morphologic characteristics among women with genuine stress incontinence

Objective: This was a study of the morphologic characteristics of urethral collagen in women with stress incontinence and continent control women. Study Design: Urethral needle biopsy specimens were obtained from 31 women. Fifteen women were continent, and the other 16 had undergone full urogynecologic assessment for symptoms of urinary incontinence. Biopsy specimens were assessed under electron microscopy. Mean collagen fibril diameter was measured and collagen morphologic characteristics were assessed. Results: The biopsy specimens from 30 women were included in the analysis. Collagen fibril diameter did not vary with continence status, the presence of pelvic organ prolapse, age, race or hormonal status. Alterations in collagen fibril morphologic characteristics were evident in the biopsy specimens from nine patients with incontinence. The alterations in collagen morphologic characteristics fell into three patterns, which for convenience were referred to as the obscured pattern, the dense pattern, and the degenerative pattern. Conclusion: Altered collagen morphologic characteristics are found in some patients with stress incontinence, and possible causes for those alterations are suggested by their appearances. (Am J Obstet Gynecol 2000;182:1565-74.)