Symptomatic Prolapse Research Articles

Review of Vaginal Approaches to Apical Prolapse Repair.

To review recent literature and provide up-to-date knowledge on new and important findings in vaginal approaches to apical prolapse surgery. Overall prolapse recurrence rates following transvaginal apical prolapse repair range from 13.7 to 70.3% in medium- to long-term follow-up, while reoperation rates for prolapse recurrence are lower, ranging from 1 to 35%. Subjective prolapse symptoms remain improved despite increasing anatomic failure rates over time. The majority of studies demonstrated improvement in prolapse-related symptoms and quality of life in over 80% of patients 2-3years after transvaginal repair, with similar outcomes with and without uterine preservation. Contemporary studies continue to demonstrate the safety of transvaginal native tissue repair with most adverse events occurring within the first 2years. Transvaginal apical prolapse repair is safe and effective. It is associated with long-term improvement in prolapse-related symptoms and quality of life despite increasing rates of prolapse recurrence over time. Subjective outcomes do not correlate with anatomic outcomes.

Introducing a new grading method for the diagnosis and grading of internal rectal prolapse in children

IntroductionInternal rectal prolapse is an irritating gastrointestinal disease and one of the causes of obstructive constipation in children under 15 years of age. This study aimed to introduce a new method and grading for diagnosing internal rectal prolapse in children. This study is based on the experience of the last ten years, which was re-evaluated as research using a control group. MethodThis is a prospective cross-sectional study. The results of the Delshad-Mash test were analyzed in 60 patients with internal rectal prolapse referred to (XXX) from January 2019 to June 2021. Another 60 children referred for non-digestive surgeries such as hernia and hypospadias with parental consent Were selected as a control group. The sensitivity of the Mesh Delshad test in diagnosing and measuring the degree of internal prolapse of the rectum was analyzed by placing the data in STATA software, version II. P < 0.05 was considered to show statistical significance. ResultsThis study included 120 patients (52 girls and 68 boys) with a body age of 6 months–15 years and a mean age of 45 ± 4.7 years. The study group consisted of 60 patients with symptoms of internal rectal prolapse and 60 patients without the symptoms described in the file. The ROC curve was used to evaluate the accuracy of the test. The ROC curve showed that the sensitivity and specificity for the mesh test as a diagnostic indicator are 89.71% and 92.31%, respectively. The thickness of the folded (prolapsed) mucosa was measured and divided into four degrees according to the rectum's internal prolapse. ConclusionAccording to the results and experiences obtained from this study, the Delshad Mesh method is beneficial for diagnosing internal rectal prolapse that has positive clinical symptoms.

All or nothing? A second look at partial levator avulsion.

To define associations between partial levator trauma and symptoms and signs of pelvic organ prolapse (POP). This was a retrospective study of 3484 women attending a tertiary urogynecology unit for symptoms of pelvic floor dysfunction between January 2012 and February 2020. All women underwent a standardized interview, clinical pelvic organ prolapse quantification (POP-Q) examination and tomographic ultrasound imaging of the pelvic floor. Women with full levator avulsion were excluded from analysis. Partial levator avulsion was quantified using the tomographic trauma score (TTS), in which slices 3-8 are scored bilaterally for abnormal insertions. Binomial multiple logistic regression was analyzed independently for the outcome variables prolapse symptoms, symptom bother and objective prolapse on clinical examination and imaging, with age and body mass index as covariates. Two continuous outcome variables, prolapse bother score and hiatal area on Valsalva, were analyzed using multiple linear regression. Of the 3484 women, ultrasound data were missing or incomplete in 164 due to lack of equipment, clerical error and/or inadequate image quality. Full levator avulsion was diagnosed in 807 women, leaving 2513 for analysis. TTS ranged from 0-10, with a median of 0. Partial trauma (TTS > 0) was observed in 667/2513 (26.5%) women. All subjective and objective measures of POP were associated significantly with TTS, most strongly for cystocele. Associations were broadly linear and similar for all slice locations but disappeared after accounting for hiatal area on Valsalva. Partial avulsion is associated with POP and prolapse symptoms. This association was strongest for cystocele, both on POP-Q and ultrasound imaging. The effect of partial avulsion on POP and prolapse symptoms is explained fully by its effect on hiatal area. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Incidence and Study of Sociodemographic Factors &amp; Other Risk Factor fors Pelvic Organ Prolapse

Backgound: The burden of pelvic organ prolapse in parous women is enormous. Bangladeshi women suffers a lot due to (POP) pelvic organ prolapse. Minor prolapse or laxity is generally ignored. When serious functional disability develops, women seek treatment advice. Home delivary and subinvolutions during puerperium is thought to predispose to urogenital prolapse. Here the incidence of different degree of prolapse and associated risk factors are assessed. Materials and method; This prospective observational study was carried out in outpatient department of gynaecology and obstetrics of SSMCMH during the period of January 2018 to September 2018. 100 parous women with subjective symptom of prolapse were included. Degree of prolapse and related risk factors were identified. Results: Here 53% had Pelvic Organ Prolapse Quantification System (POP-Q) grade 1,32% had grade II and 15% had grade III and IV. Majority showed anterior vaginal wall defect. Cystocoele was 77% and perineal tear was 79%. Rectocoele was also present in 60% cases. Risk increases with increasing age 45% was &gt;60 years. Multipara (&gt;4 child) had the highest incidence. Also H/O home delivery, delivery by untrained personal, puerperial unusual work load increases the risk. Conclusion : POP is a common condition. Here the prevalence of grade I and II were high. But grade III and IV requiring surgical treatment among the women was 12% and 3% respectively .Incidence rises with increasing age, parity, prolonged and difficult labour . Birth spacing &lt;2 years and neglected puerperial period also contribute. Sir Salimullah Med Coll J 2022; 30: 129-132

Assessing the Impact of Vaginal Hysterectomy with Vaginal Mesh Attachment on Outcomes and Complications during Minimally Invasive Sacrocolpopexy

To compare mesh complications and failure rates after 1 year in laparoscopic minimally invasive sacrocolpopexy (MISC) with ultralightweight mesh attached vaginally during total vaginal hysterectomy (TVH), laparoscopically if posthysterectomy (PH), or laparoscopically during supracervical hysterectomy. Single-center retrospective cohort study. Tertiary referral center. Women with symptomatic pelvic organ prolapse who elected for MISC. Laparoscopic MISC with ultralightweight mesh attached vaginally during TVH, laparoscopically if PH, or laparoscopically during supracervical hysterectomy. Composite failure was defined as recurrent prolapse symptoms, prolapse past the hymen, or retreatment for prolapse. Between 2010 and 2017, 650 patients met the inclusion criteria with 278 PH, 82 supracervical hysterectomy, and 290 vaginal hysterectomy patients. Median follow-up was similar for all groups (382 days vs 379 vs 345; p=.31). The majority in all groups were white (66.6%), nonsmokers (74.8%), postmenopausal (82.5%), and did not use estrogen (70.3%). Mesh complications did not differ among groups (1.6% PH, 2.5% supracervical hysterectomy, 2.2% vaginal hysterectomy; p >.99). There was no difference in anatomic failure (5% PH, 1.2% supracervical hysterectomy, 2.1% vaginal hysterectomy; p=.07), reoperation for prolapse (1.4% vs 1.2% vs 0.7%; p=.57), or composite failure (9.0% vs 3.7% vs 4.8%; p=.07). TVH with vaginal mesh attachment of ultralightweight mesh had similar adverse events, mesh exposure rates, and failure rates to those of laparoscopic PH sacrocolpopexy or supracervical hysterectomy with laparoscopic mesh attachment.

A pilot trial of movement-based pelvic floor physical therapy to address pelvic floor myofascial pain and lower urinary tract symptoms.

Pelvic floor myofascial pain (PFMP) is associated with lower urinary tract symptoms (LUTS). The objective of this study was to test movement-based pelvic floor physical therapy (PT) for patients with PFMP and LUTS. We hypothesized that movement-based PT designed to target PFMP would result in significant improvement in both PFMP and concomitant LUTS. This pilot trial enrolled patients with moderate-to-severe PFMP on palpation who were referred to movement-based PT to diagnose and treat pelvic floor dysfunction in the context of body alignment and movement patterns. The primary outcome was change in Urogenital Distress Inventory (UDI) scores after PT. Factors associated with PT attendance were also measured. We aimed to enroll 55 participants to achieve 80% power to detect a difference in 11 points on the UDI scores with an alpha-level of 0.05, accounting for a 10% loss to follow-up. The sample size was increased to 65 owing to a higher-than-expected loss-to-follow-up rate. Sixty-five patients were enrolled and 62 analyzed. Thirty-eight (61.3%) attended PT, and 30 (48.4%) completed a follow-up PT Attendance (PTA) survey. Overall, UDI score and irritative, obstructive, and stress subscales (p<0.0001) improved in participants who attended PT as well as mean myofascial examination scores at each site. Participants who attended movement-based PT demonstrated an improvement in LUTS. Future studies should extend our findings by: first, confirming whether the myofascial pain-directed elements of PT improved LUTS; second, investigating whether movement-based PT improves prolapse symptoms; and third, including a non-PT control arm to rule out the possible influence of a placebo effect and behavioral modifications on LUTS and PFMP.

Pelvic pain is a common prolapse symptom and improvement after ventral mesh rectopexy is more frequent than deterioration or de novo pain.

The aim of this work was to assess the relationship between pelvic pain and rectal prolapse both before prolapse surgery and in the long term after ventral mesh rectopexy (VMR). Patients undergoing VMR between 2004 and 2017 were contacted. Outcomes including the severity of pelvic pain were recorded using a numeric rating scale. Four hundred and seventy eight of the 749 patients (64%) were successfully contacted. Of these, 39% reported pre-existing pelvic pain prior to VMR (group A) and 61% were pain free (group B). The median follow-up time was 8.0 years (interquartile range 5.0-10.0 years). Symptoms of obstructed defaecation were significantly more common (p= 0.002) in group A (91/187, 49%) than in group B (101/291, 35%). In contrast, faecal incontinence was more common (p= 0.007) in group B (75/291, 26%) than in group A (29/187, 15%). In group A, 76% showed improvement in pelvic pain after VMR: 61% were pain free and 39% had partial improvement in their pre-existing pelvic pain. Patients with persistent pelvic pain were younger (p= 0.01) and more likely to have revisional surgery after VMR (p= 0.0003), but there was no relation to the indication for surgery (p= 0.59). In group B, 15% reported de novo pelvic pain after VMR, and this was more common in women under 50 years old (p= 0.001), when obstructed defaecation was the indication (p= 0.03), in mesh erosion (p= <0.05) and when associated with revisional surgery (p= 0.005). Pelvic pain is common (39%) in patients undergoing prolapse surgery, and VMR improves this pain in most patients (76%). However, a significant number of patients fail to improve (12%), experience worsening of pain (12%) or develop de novo pelvic pain (15%).

Vaginal laser therapy versus hyaluronic acid suppositories for women with symptoms of urogenital atrophy after treatment for breast cancer: A randomized controlled trial

BackgroundUrogenital atrophy affects >50 % of women after breast cancer (BC) and there is reluctance to use local estrogen for this group. Hormone-free therapies like intravaginal laser therapy and hyaluronic acid suppositories have been shown to produce symptom relief in women with BC and urogenital atrophy, but have not been tested against each other. The aim of this study was to compare these nonhormonal modalities in women with urogenital atrophy after BC in a randomized fashion. Study designWe randomly assigned 43 women (aged 49–58 years, mean age 54 years) with urogenital atrophy and a history of BC to receive intravaginal laser therapy (2 courses within 1 month) or hyaluronic acid suppositories (3 times/week continuously for three months). The primary endpoint was score on the Vaginal Health Index after 3 months. Secondary endpoints were subjective bother on a numeric rating scale for all urogenital atrophy domains, quality of life, sexual health and pelvic organ prolapse symptoms using validated questionnaires. ResultsOf the 43 women who participated, 22 were randomized to intravaginal laser therapy, and 21 to vaginal suppositories. At 3 months score on the Vaginal Health Index had improved significantly in both groups (p = 0.001), without a significant difference between treatment groups (p = 0.232). Significant improvement was also seen in both groups for subjective bother of urogenital atrophy, quality of life and sexual health, without significant differences between laser or hyaluronic acid therapy. ConclusionsBoth intravaginal laser therapy and hyaluronic acid suppositories are effective treatment options for women after BC suffering from urogenital atrophy. No difference was found between treatment regimens.ClinicalTrials.gov identifier: NCT03816735, https://clinicaltrials.gov/ct2/show/NCT03816735

Ischial spinous fascia fixation in the laparoscopic radical hysterectomy: a new surgical method to prevent pelvic organ prolapse

: Radical hysterectomy has a profound effect on pelvic floor function and the quality of life of patients with cervical cancer. How to maximize the retention of sexual function and prevent pelvic floor dysfunction remains an issue worth discussing. Currently, the main prophylactic surgical treatment usually refers to the hysterosacral ligament suspension during benign hysterectomy, but there is a lack of research on how to prevent pelvic organ prolapse during radical hysterectomy. Peking Union Medical College Hospital performed the first such preservation surgery by applying an ischial spinous fascia fixation suture technique to suspend the vagina arch on the ischial spinous fascia. We present a surgical technique for ischial spinous fascia fixation in the laparoscopic radical hysterectomy. This surgery can reduce the incidence of vaginal wall prolapse as it is safe and feasible to suspend the vagina stump because the ischial spine fascia is dense and devoid of important blood vessels and nerves. The use of tissue-autografting helps to relieve prolapse symptoms and restore pelvic anatomy, hence maintaining the patient’s sexual function. The prognosis of early cervical cancer is generally good. It is helpful to understand the incidence of pelvic floor dysfunction after cervical cancer surgery and to take targeted surgical preventive measures during the operation to improve the quality of life of patients. The prognosis of early cervical cancer is generally good. Understanding the incidence of pelvic floor dysfunction after cervical cancer surgery and taking targeted surgical preventive measures during surgery are helpful to improve the quality of life of patients. Ischial spinous fascia fixation is worthy of further promotion and validation.

PROSPECT: 4- and 6-year follow-up of a randomised trial of surgery for vaginal prolapse

Introduction and hypothesisOur aim was to compare the mid-term results of native tissue, biological xenograft and polypropylene mesh surgery for women with vaginal wall prolapse.MethodsA total of 1348 women undergoing primary transvaginal repair of an anterior and/or posterior prolapse were recruited between January 2010 and August 2013 from 35 UK centres. They were randomised by remote allocation to native tissue surgery, biological xenograft or polypropylene mesh. We performed both 4- and 6-year follow-up using validated patient-reported outcome measures.ResultsAt 4 and 6 years post-operation, there was no clinically important difference in Pelvic Organ Prolapse Symptom Score for any of the treatments. Using a strict composite outcome to assess functional cure at 6 years, we found no difference in cure among the three types of surgery. Half the women were cured at 6 years but only 10.3 to 12% of women had undergone further surgery for prolapse. However, 8.4% of women in the mesh group had undergone further surgery for mesh complications. There was no difference in the incidence of chronic pain or dyspareunia between groups.ConclusionsAt the mid-term outcome of 6 years, there is no benefit from augmenting primary prolapse repairs with polypropylene mesh inlays or biological xenografts. There was no evidence that polypropylene mesh inlays caused greater pain or dyspareunia than native tissue repairs.

Validation and translation of the Hungarian version of the Australian Pelvic Floor Questionnaire (APFQ-H)

Introduction and hypothesisThe aims of the study were the translation, cultural adaptation, and validation of self-administered Australian Pelvic Floor Questionnaire (APFQ) on a Hungarian population.MethodsThe validation was performed in 294 women over 18 who agreed to answer the Hungarian version of the APFQ. The validation of the questionnaire included evaluation of content/face validity, internal consistency, construct validity, test-retest reproducibility, discriminant validity and convergent validity.ResultsAcceptable and good internal consistency was observed in all four dimensions [McDonald’s ω (95% confidence interval) coefficients were > 0.7 for each dimension: bladder 0.888, bowel 0.790, prolapse 0.895 and sexual function 0.738]. Test-retest analyses revealed high reproducibility with intraclass correlation coefficients (bladder 0.83, bowel 0.92, prolapse 0.96 and sexual function 0.87). Prolapse symptom score correlated significantly with Pelvic Organ Prolapse Quantification (POP-Q), and bladder score correlated significantly with the results of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ UI SF) (convergent validity). Scores distinguished between patients with pelvic floor disorders and controls (high discriminant validity).ConclusionsHungarian version of the self-administered APFQ is a reliable and valid instrument for evaluating symptom severity and impact of pelvic floor dysfunction on the quality of life of Hungarian women.

Obstetric fistula in Bangladesh: estimates from a national survey with clinical validation correction

Obstetric fistula, which develops after a prolonged or obstructed labour, is preventable and treatable. However, many women are still afflicted with the condition and remain untreated in low-income and middle-income countries. Concerns have also been raised that an increasing trend of caesarean sections is increasing the risk and share of iatrogenic obstetric fistula in these countries. The true prevalence of this condition is not known, which makes it difficult for health planners and policy makers to develop appropriate national health strategies to address the problem. The estimation of obstetric fistula with surveys is difficult because self-reporting of incontinence symptoms is subject to misclassification bias. In this study, we aimed to estimate the prevalence and burden of obstetric fistula in Bangladesh. For a valid estimation addressing misclassification bias, we implemented the study in two steps. First, we did the Maternal Morbidity Validation Study (MMVS) among a population of 65 740 women in Sylhet, Bangladesh, to assess the sensitivity, specificity, positive predictive values (PPVs), and negative predictive values of the survey questions. This was done through confirmation of the diagnosis with clinical examinations of suspected cases by female physicians; a sample of women who screened positive for pelvic organ prolapse and other urinary incontinence symptoms were also examined and used as controls for clinical diagnosis confirmation. Second, we used the estimated diagnostic test values, after correcting for verification bias, to adjust the reported prevalence in the nationally representative Bangladesh Maternal Mortality and Health Care Survey 2016 for the unbiased estimation of obstetric fistula prevalence in Bangladesh. The MMVS, done from Aug 3 to Dec 9, 2016, identified 67 potential cases of obstetric fistula; of them, 57 (85%) women completed the clinical examination, and 19 were confirmed as obstetric fistula cases. The adjusted sensitivity of the self-reports of obstetric fistula was 100% (95% uncertainty interval [UI] 99·8-100) and the observed specificity was 99·9% (95% UI 99·9-100) among women aged 15-49 years. However, the PPV was low, at 31·6% (95% UI 19·2-46·2), suggesting that almost two thirds of the self-reported cases were not true obstetric fistula cases. We estimated an adjusted obstetric fistula prevalence rate of 38 (90% UI 25-58) per 100 000 women aged 15-49 years in Bangladesh. Nationally, we estimated about 13 376 (90% UI 8686-20 112) women of reproductive age living with obstetric fistula. Additionally, we estimated 4081 (1773-8790) women aged 50-64 years to be living with obstetric fistula in Bangladesh; overall, we estimated that there are 17 457 (10 459-28 902) women aged 15-64 years in Bangladesh with obstetric fistula. The burden of obstetric fistula is still high in Bangladesh. Prevention and provision of surgical treatment to so many women will need coordinated efforts, planning, allocation of resources, and training of surgeons. US Agency for International Development, Government of Bangladesh, and UKAid.

Natural history of lower urinary tract symptoms in treatment-seeking women with pelvic organ prolapse; the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN)

The association of pelvic organ prolapse with overactive bladder and other lower urinary tract symptoms, and the natural history of those symptoms are not well characterized. Previous cross-sectional studies demonstrated conflicting relationships between prolapse and lower urinary tract symptoms. This study primarily aimed to determine the baseline association between lower urinary tract symptoms and prolapse and to assess longitudinal differences in symptoms over 12 months in women with and without prolapse. Secondary aims were to explore associations between lower urinary tract symptoms and prolapse treatment. We hypothesized that: (1) prolapse is associated with the presence of lower urinary tract symptoms, (2) lower urinary tract symptoms are stable over time in patients with and without prolapse, and (3) prolapse treatment is associated with lower urinary tract symptom improvement. Women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study with adequate 12-month follow-up data were included. Prolapse and lower urinary tract symptom treatment during follow-up was guided by standard of care. Outcome measures included the Lower Urinary Tract Symptoms Tool total severity score (in addition to overactive bladder, obstructive, and stress urinary incontinence subscales) and Urogenital Distress Inventory-6 Short Form. Prolapse (yes or no) was defined primarily when Pelvic Organ Prolapse Quantification System points Ba, C or Bp were >0 (beyond the hymen). Mixed-effects models with random effects for patient slopes and intercepts were fitted for each lower urinary tract symptom outcome and prolapse predictor, adjusted for other covariates. The study had >90% power to detect differences as small as 0.4 standard deviation for less prevalent group comparisons (eg, prolapse vs not). A total of 371 women were analyzed, including 313 (84%) with no prolapse and 58 (16%) with prolapse. Women with prolapse were older (64.6±8.8 vs 55.3±14.1 years; P<.001) and more likely to have prolapse surgery (28% vs 1%; P<.001) and pessary treatment (26% vs 4%; P<.001) during the study. Average baseline Lower Urinary Tract Symptoms Tool total severity scores were lower (fewer symptoms) for participants with prolapse compared with those without (38.9±14.0 vs 43.2±14.0; P=.036), but there were no differences in average scores between prolapse groups for other scales. For all urinary outcomes, average scores were significantly lower (improved) at 3 and 12 months compared with baseline (all P<.05). In mixed-effects models, there were no statistically significant interactions between pelvic organ prolapse measurement and visit and time-dependent prolapse treatment groups (P>.05 for all regression interaction coefficients). The Lower Urinary Tract Symptoms Tool obstructive severity score had a statistically significant positive association with Pelvic Organ Prolapse Quantification System Ba, Bp, and point of maximum vaginal descent. The Lower Urinary Tract Symptoms Tool total severity scale had a statistically significant negative association with Pelvic Organ Prolapse Quantification System Ba and point of maximum vaginal descent. No other associations between prolapse and lower urinary tract symptoms were significant (P>.05 for all regression coefficients). Symptom differences between prolapse groups were small: all regression coefficients (interpretable as additive percentage change in each score) were between -5 and 5 (standard deviation of outcomes ranged from 14.0-32.4). Among treatment-seeking women with urinary symptoms, obstructive symptoms were positively associated with prolapse, and overall lower urinary tract symptom severity was negatively associated with prolapse. Lower Urinary Tract Symptoms Tool scores improved over 12 months regardless of prolapse status, including in those with treated prolapse, untreated prolapse, and without prolapse.

DETERMINANTS OF PELVIC ORGAN PROLAPSE AMONG WOMEN VISITING ARBA MINCH, SAWLA AND JINKA GENERAL HOSPITALS, SOUTHERN ETHIOPIA

Background: Pelvic organ prolapse is one of the most common gynecological health problems; it can severely limit a woman's psychological, social, physical, and sexual function. The factors causing pelvic organ prolapse have been poorly understood. Therefore this study aimed to investigate the determinants of pelvic organ prolapse among women visiting Arba Minch, Sawla, and Jinka General Hospitals, Southern Ethiopia. Method: Institution-based case-control study was conducted from July 10 to August 31, 2020, in Arba Minch, Sawla, and Jinka general hospital. A total of 348 participants were included in the study. Cases and controls were identified by health professionals using the pelvic organ prolapse symptom score (POP-SS). Data was collected by using a pre-tested interviewer-administered questionnaire. Bivariate logistic regression was done to identify variables candidate for Multivariable logistic regression at p-value &lt;0.25. Multivariable logistic regression analysis was done and p-value &lt;0.05 and 95%CI of AOR were used to declare the level significance. Result: Age of the mother at first delivery (AOR=4, 95% CI: 1.48-11.53), carrying heavy object (AOR=2.8, 95% CI: 1.9-7.62), place of previous delivery (AOR=3.6, 95% CI: 1.37-9.47), mode of previous delivery (AOR=3, 95% CI: 1.73-8.44), family history of pelvic organ prolapse. (AOR=4, 95% CI: 1.63-11.2), body mass index (AOR=4, 95% CI: 1.82-12.9) and household food insecurity (AOR=3, 95% CI: 1.51-7.75) were identified as the determinants of pelvic organ prolapse. Conclusion: In this study age of the mother at first delivery, carrying a heavy object, place of previous delivery, mode of previous delivery, body mass index, family history of pelvic organ prolapse, and household food insecurity were factors found to be significantly associated with pelvic organ prolapse. Therefore, to prevent pelvic organ prolapse health care providers should counsel mothers for maintaining normal weight and skilled delivery. Also, women in the community should be screened for food insecurity and linked with the agriculture sector.

Characteristics associated with composite surgical failure over 5 years of women in a randomized trial of sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral ligament suspension

Among women with symptomatic uterovaginal prolapse undergoing vaginal surgery in the Vaginal hysterectomy with Native Tissue Vault Suspension vs Sacrospinous Hysteropexy with Graft Suspension (Study for Uterine Prolapse Procedures Randomized Trial) trial, sacrospinous hysteropexy with graft (hysteropexy) resulted in a lower composite surgical failure rate than vaginal hysterectomy with uterosacral suspension over 5 years. This study aimed to identify factors associated with the rate of surgical failure over 5 years among women undergoing sacrospinous hysteropexy with graft vs vaginal hysterectomy with uterosacral suspension for uterovaginal prolapse. This planned secondary analysis of a comparative effectiveness trial of 2 transvaginal apical suspensions (NCT01802281) defined surgical failure as either retreatment of prolapse, recurrence of prolapse beyond the hymen, or bothersome prolapse symptoms. Baseline clinical and sociodemographic factors for eligible participants receiving the randomized surgery (N=173) were compared across categories of failure (≤1 year, >1 year, and no failure) with rank-based tests. Factors with adequate prevalence and clinical relevance were assessed for minimally adjusted bivariate associations using piecewise exponential survival models adjusting for randomized apical repair and clinical site. The multivariable model included factors with bivariate P<.2, additional clinically important variables, apical repair, and clinical site. Backward selection determined final retained risk factors (P<.1) with statistical significance evaluated by Bonferroni correction (P<.005). Final factors were assessed for interaction with type of apical repair at P<.1. Association is presented by adjusted hazard ratios and further illustrated by categorization of risk factors. In the final multivariable model, body mass index (increase of 5 kg/m2: adjusted hazard ratio, 1.7; 95% confidence interval, 1.3-2.2; P<.001) and duration of prolapse symptoms (increase of 1 year: adjusted hazard ratio, 1.1; 95% confidence interval, 1.0-1.1; P<.005) were associated with composite surgical failure, where rates of failure were 2.9 and 1.8 times higher in women with obesity and women who are overweight than women who have normal weight and women who are underweight (95% confidence intervals, 1.5-5.8 and 0.9-3.5) and 3.0 times higher in women experiencing >5 years prolapse symptoms than women experiencing ≤5 years prolapse symptoms (95% confidence interval, 1.8-5.0). Sacrospinous hysteropexy with graft had a lower rate of failure than hysterectomy with uterosacral suspension (adjusted hazard ratio, 0.6; 95% confidence interval, 0.4-1.0; P=.05). The interaction between symptom duration and apical repair (P=.07) indicated that failure was less likely after hysteropexy than hysterectomy for those with ≤5 years symptom duration (adjusted hazard ratio, 0.5; 95% confidence interval, 0.2-0.9), but not for those with >5 years symptom duration (adjusted hazard ratio, 1.0; 95% confidence interval 0.5-2.1). Obesity and duration of prolapse symptoms have been determined as risk factors associated with surgical failure over 5 years from transvaginal prolapse repair, regardless of approach. Providers and patients should consider these modifiable risk factors when discussing treatment plans for bothersome prolapse.

Prevalence, Knowledge and Awareness of Pelvic Floor Disorder among Pregnant Women in a Tertiary Centre, Malaysia.

Pelvic floor disorders are common and of concern, as the majority of maternity healthcare providers seldom discuss this issue with patients compared to other antenatal issues. The aim of this study is to determine the prevalence and to assess the knowledge and awareness of pelvic floor disorder (PFD) among pregnant women in a tertiary centre in Malaysia. We also aim to assess the association between women’s risk factors regarding their knowledge and awareness of pelvic floor disorder so that primary prevention strategies can be planned, initiated and implemented in the future. This is a cross-sectional study with a total of four hundred twenty-four pregnant women that were recruited over a 6-month duration from May to November 2017 in a tertiary centre in Malaysia. The Pelvic Floor Distress Inventory (PFDI-20) was used to evaluate pelvic floor distress symptoms during pregnancy, namely urinary incontinence, pelvic organ prolapse and faecal incontinence. A validated Prolapse and Incontinence Knowledge Questionnaire (PIKQ), which consists of 24 items, was used to assess respondents’ knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP). A total of 450 participants were approached, but 424 participants agreed to participate, showing a response rate of 94.3%. The median age was 31.5 years old, and 33.3% were primiparity. Overall, 46.1% of pregnant women had at least one symptom of pelvic floor disorder during pregnancy. Of these, 62.3% experienced urinary incontinence, 41.1% experienced symptoms of pelvic organ prolapse, and 37.8% experienced symptoms of faecal incontinence. The overall median score of PIKQ was 12.0 (8.0, 17.0). The median score for PIKQ—UI was 7.0 (5.0, 9.0) and the median score for PIKQ—POP was 6.0 (4.0, 8.0). There were 341 (80.4%) pregnant women that had a low level of knowledge in UI, and 191 (45.0%) had a low level of knowledge in POP. Having a tertiary level of education and receiving antenatal specialist care were both associated with better proficiency in both the PIKQ—UI (p < 0.001) and PIKQ—POP (p < 0.001) subscales. Pelvic floor disorder during pregnancy was common. A knowledge of pelvic floor disorder was lacking among pregnant women in this study. Having a tertiary education and receiving antenatal specialist care were both associated with better knowledge proficiency. This study hopefully serves as a basic platform for future educational programs to bridge the knowledge gaps in PFD among pregnant women.

Prevalence of symptomatic pelvic organ prolapse and associated factors in Southern Nations, Nationalities, People's Region referral hospitals, Ethiopia.

Pelvic organ prolapse is one of the major causes of morbidity among women that affect their quality of life. Despite the severity of the problem, there is limited information in Ethiopia. Therefore, this study was aimed at assessing the prevalence of symptomatic POP and its associated factors. An institution-based cross-sectional study was carried out in the referral hospitals of Southern Nations, Nationalities, People's Region, Ethiopia. Women were initially interviewed about their prolapse symptoms using validated questionnaires, and if they answered yes to one or more of the questions, they were examined by gynecologists using simplified POP quantification. Pelvic examination results and patient-reported symptoms were used to determine symptomatic POP. A multivariate logistic regression analysis model was used to identify factors associated with symptomatic prolapse. A total of 1,196 respondents were included in this study. The prevalence of symptomatic POP was found to be 20.1%. Age of women ≥55 years (AOR=8.39; 95% CI 3.41-20.62), carrying heavy objects for ≥ 5 h (AOR= 5.18; 95% CI 2.51-10.69), parity ≥4 times (AOR=2.98; 95% CI 1.60-5.53), history of home delivery (AOR= 2.90; 95% CI 1.50-5.61), giving birth through assisted vaginal delivery (AOR=5.01; 95% CI 1.73-14.53), history of chronic constipation (AOR=2.66; 95% CI 1.38-5.15), and a history of a chronic cough (AOR=9.18; 95% CI 4.52-18.61) were associated with symptomatic POP. In this study the prevalence of symptomatic POP is high. Older age, long hours of carrying heavy objects, a high parity, last birth through assisted vaginal delivery, a history of home delivery, a history of chronic constipation, and a history of a chronic cough were found to be associated with symptomatic POP.

Use of Silicon Vaginal Pessary for Treatment of Pelvic Organ Prolapse

Background: Use of vaginal pessary as a conservative therapy for pelvic organ prolapse is very common and upto 77% of clinicians uses ring pessary for 1 line management of prolapse. Aim to treat prolapse by conservative approach is to alleviate the symptoms of prolapse and avert or delay the need for surgery. Aim of this study was to find out improvements of symptoms related to pelvic organ prolapse and satisfaction rate after 3 months of using vaginal pessary. &#x0D; Materials and methods: A prospective observational study was conducted from January 2019 –to June 2019 in the Department of Gynaecology and Obstetrics of Bangabandu Memorial Hospital, Chattogram. Total 31 patients were included with symptomatic Pelvic Organ Prolapse (POP) willing to use pessary. Primary outcome were improvement of symptoms and their satisfaction from baseline to 3 months. &#x0D; Results: Age of the respondents were between 25-80 years with a mean of 50 ( +-12) years, maximum respondents were postmenopausal 54.8% .Out of 31 respondents 27(87.1%) continue pessary use upto 3 months and their after, 2(6.5%) cases spontaneous expulsion took place, 2(6.5%) discontinue the use. Compare with base line findings significant improvement in patients symptoms were observed at 3 months. Nearly all symptoms related to pelvic organ prolapse resolved from baseline to to 3 months: buldge (92.3% to 7.7% , p &lt; 0.001), dragging pain in lower abdomen (100% to 14.8% , p&lt;0.001). Urinary symptoms voiding difficulty improved in 88% ( p&lt;0.001), urinary urgency improved in 81.8% (p&lt;0.001), urge and stress incontinence improved in 100% (p&lt;0.001). Incomplete empting of bowel improved in 100%(p&lt;0.001). During follow up 4(12.9%) women complain of vaginal discharge. At 3months 88.9% women were satisfied with pessary and 3(11.1%) were dissatisfied. &#x0D; Conclusion: This study showed that treatment with use of ring pessary in women with pelvic organ prolapse had significant improvements in the symptoms with high satisfaction rate. &#x0D; JCMCTA 2022 ; 33 (1) : 118-123

Does Cystocele Type Vary Between Vaginally Parous and Nulliparous Women?

To evaluate whether cystocele type varies with vaginal parity. Retrospective analysis of 464 vaginally nulliparous women seen at 2 urogynecology units between November 2006 and November 2019. A control group consisted of 871 vaginally parous women seen between July 2017 and November 2019. Patients underwent a standardized interview, POPQ, urodynamic testing, and translabial ultrasound. On imaging, significant cystocele was defined as bladder descent to ≥10 mm below symphysis pubis. Volume datasets were analyzed offline and blinded against clinical data. Of 5266 women seen during the inclusion period, 464 were vaginally nulliparous. Three were excluded due to missing data, leaving 461. A control group of 871 parous women was generated from patients seen during the last 2.5 years of the inclusion period. Vaginally nulliparous women were presented at a younger age compared to vaginally parous women (P < .001). Symptoms of prolapse were reported in 104 (22%) nulliparae and 489 (56%) parous women (P < .0001). Vaginally parous women demonstrated more bladder descent (P < .0001) and more cystocele (418/871 versus 43/461, P < .0001), with a higher proportion of type III cystocele (cystocele with intact retrovesical angle) (20/43 versus 273/ 418, P < .0001). Cystourethrocele (Green type II) was more common in nulliparae and cystocele type III in parous women (P=.015). On multivariate analysis, these differences in proportions remained significant (P=.049). Nulliparity was associated with a higher proportion of Green type II cystoceles. Green type III cystocele was more common in vaginally parous women, suggesting that the latter may be more likely to be due to childbirth-related pelvic floor trauma.

Modern possibilities for the prevention of pelvic organ prolapse

In the practice of an obstetrician-gynecologist, the problem of pelvic organ prolapse is increasingly being raised. Symptoms of pelvic organ prolapse are noted from a young age, gradually progressing and reducing the patient’s quality of life. Various surgical methods of treatment also don’t solve the problem of prolapse. The recurrence rate after correction of prolapse with own tissues reaches 40%, and operations using mesh implants have a number of specific complications, the fight against which sometimes becomes more difficult than primary intervention. Despite the steady increase in the prevalence of the disease, effective methods of dealing with it have not yet been developed. Also, the tactics of managing patients at the initial stage of prolapse, when there are complaints, but they are not given enough attention, both by the doctor and the patient, are not defined. The main risk factors for the disease are: perineal ruptures during childbirth, episiotomy, menopause, repeated pregnancies and childbirth, polyhydramnios, multiple pregnancy, fetal macrosomia, conditions accompanied by a chronic increase in intraabdominal pressure, heavy physical labor, impaired innervation and circulation of the pelvic floor, genetic predisposition, hysterectomy and connective tissue dysplasia. The review is devoted to the causes and methods of prevention of pelvic organ prolapse at the present stage. Methods such as pelvic floor muscles training, including in the biofeedback mode using vaginal simulators, electrical impulse stimulation, high-intensity focused electromagnetic stimulation, and non-ablative Er:YAG laser therapy are considered. A systematic literature search was carried out using Scopus, web of Science, MedLine, PubMed and eLibrary data base system.