Risk Factors For Pelvic Organ Prolapse Research Articles

Association of Central and General Obesity Measures With Pelvic Organ Prolapse.

To examine the association between the combination of central and general obesity measures and the risk of pelvic organ prolapse (POP). Waist/height ratio and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) for 251,143 participants (aged 39-71 years) without pre-existing POP from the UK Biobank were collected at enrollment between 2006 and 2010. Participants were followed through December 19, 2022. Incident POP was identified using International Classification of Diseases, Tenth Revision codes and operating procedure codes in the medical records. Cox proportional hazards model was used to estimate the association between obesity measures and incident POP. Population-attributable fractions were calculated to indicate the proportion of cases that were attributable to obesity measures. During a median follow-up of 13.8 years, 9,781 POP cases were recorded. Central obesity (waist/height ratio 0.5 or greater) was associated with a 48% increased risk of POP regardless of BMI (hazard ratio [HR] 1.48; 95% CI, 1.41-1.56). Approximately 21.7% (95% CI, 19.1-24.4%) of all POP cases were attributable to central obesity. In addition, overweight without central obesity (BMI 25-29.9 and waist/height ratio less than 0.5) was associated with a 23% higher risk of POP (HR 1.23; 95% CI, 1.14-1.34), and this accounted for 2.0% (95% CI, 1.1-2.9%) of all POP cases. The magnitude of increased POP risk associated with central obesity varied by age (younger than 60 years vs 60 years or older: 57% vs 39%) and by history of hysterectomy (no vs yes: 54% vs 27%). Central obesity and overweight without central obesity are risk factors for POP.

Inflammatory Cells in Control and Prolapsed Uterosacral Ligament Tissue

Pelvic organ prolapse (POP), a downward descent of the vagina and/or uterus through the vaginal canal, is a prevalent condition affecting up to 40% of women. Several risk factors of POP have been identified, including childbirth, connective tissue defects, and chronic intra-abdominal pressure; however, the underlying etiologies of POP development are not fully understood, leading to a high burden on patients and the healthcare systems. The uterosacral ligaments are key support structures of the uterus and upper vagina. Our previous work describes observed histopathological changes in uterosacral ligament (USL) tissue and demonstrates the presence of neutrophils in a subgroup of POP individuals. This presence of neutrophils prompted an examination for the presence of a broader spectrum of inflammatory cell types in the USL. Immunohistochemical staining was performed to identify neutrophils, lymphocytes, macrophages, and mast cells outside of the vasculature. All 4 inflammatory cell types were increased in the POP-HQ system-defined POP-Inflammatory (POP-I) phenotype USL tissue relative to the USL tissues of control or other POP-HQ phenotypes. Focal T-lymphocyte and macrophage co-accumulations were observed in the arterial walls from some patients of the POP-vascular (POP-V) phenotype suggesting previous arterial injury. In addition, 1 control and 2 POP-V subjects’ USLs contained arterial wall foamy macrophages, evidence of atherosclerosis. These findings further support a complex etiology for POP and indicate that personalized approaches to preventing and treating the condition may be warranted.

Клинико-анамнестический портрет пациентки с генитальным пролапсом

Background. Pelvic organ prolapse (POP) is one of the most common and poorly understood gynecological diseases that is reported in 60% of women, and this indicator shows no downward trend. There is still no consensus on etiology and pathogenesis of genital prolapse (GP), despite numerous studies and hypotheses. Determining predictors of POP, allocating groups at high risk are among the key links of preventive strategy for management of patients with POP. Aim. To expand the knowledge about the risk factors of POP, determine the clinical and anamnestic portrait of woman with genital GP. Methods. The prospective cohort study was carried out in 2018–2020 at the Department of Obstetrics and Gynecology with Perinatology Course, Institute of Medicine, Peoples' Friendship University of Russia. The study involved 110 patients divided into groups based on the GP severity (group I – vaginal prolapse, group II – incomplete uterine prolapse, group III – complete uterine prolapse). Results. When studying the patients’ clinical and anamnestic characteristics, it was found that the groups were comparable based on all major parameters. There were significant age differences between patients (p<0.05): elderly women were most often found in the group with complete uterine prolapse (group III). There were no significant differences (p>0.05) in social status, tobacco smoking, allergic reactions to medication, BMI, menarche, menstruation duration in all groups. Assessment of parity showed that the groups were comparable. Evaluation of extragenital diseases showed that there was a predictably larger number of patients with hypertension in group III, which was reflected by significant inter-group differences (p<0.05). The analysis of comorbidities also revealed a relatively small share of women with varicose veins, osteochondrosis, bronchial asthma and chronic bronchitis, which was confirmed by the lack of significant differences (p>0.05). Conclusion. Allocation of groups at high risk of severe POP based on clinical and anamnestic predictors is the most important aspect of preven-tion and prediction of GP. Such targeted approach will make it possible to prevent prolapse progression to advanced stages and improve the out-comes of conservative and surgical treatment of patients.

The Relationship of Polymorphism of LYSYL Oxidase Like-1 Gene and Pelvic Organ Prolapse in Balinese Women

Background: Pelvic organ prolapse (POP) data from Sanglah General Hospital Bali revealed proportion of 91.2% Balinese women, and that proportion was not decreased even with modification of workload and contraception. One of the associated factor is the decrease of expression of elastin and proteins involved in elastin metabolism, such as lysyl oxidase-like 1 (LOXL-1). There is genetic factor in the pathogenesis of prolapse, and polymorphism of elastogenesis-related gene, such as LOXL1 gene, associated with elastinopathy. Methods: We conducted an observational case control study in Balinese women population. Balinese women are women who have lineage of at least 3 generations (from grandparents) from Balinese people. Thirty patients with prolapse were taken as cases and 30 patients non prolapse as controls. DNA was isolated from venous blood, and then LOXL1 gene amplificated by polymerase chain reaction and then electrophoresis, and finally the DNA products were sequenced. Data was analyzed wih SPSS 21.0 for Windows. To determine whether the LOXL1 gene polymorphism is a risk factor for POP, a Chi-Square test was performed, and then variables were controlled by multivariate analysis using conditional logistic regression tests. Results: From the distribution of polymorphism, there were 13 samples in the case group (43.34% of the case group), compared to 5 samples in the control group (16.67% of the control group), and for the distribution of non-polymorphism, there were 17 samples in the case group (56.66% of the case group), compared to 25 samples in the control group (83.33% of the control group). From the analysis of polymorphism of LOXL1 gene rs2304719 in Balinese women, we found OR 3.824, CI 95% 1.150-12.713, p = 0.024). The LOXL1 gene polymorphism remains a risk factor for prolapse occurrence after the control variables were controlled by multivariate analysis using conditional logistic regression tests. The LOXL1 gene polymorphism, after the four control variables were controlled, gave a risk for prolapse incidence of 3,791 times by multivariate analysis (adjusted OR = 3.791; 95% CI = 1.065-13.496; p = 0.04). Conclusion: Polymorphism of LOXL1 gene rs2304719 is a risk factor for prolapse in Balinese women. Study for other gene polymorphisms are needed, before we can make a multigene panel testing for risk assessment. We hope in the future, multigene panel testing will be simpler, easier and cheaper, so that women at risk can be identified, and then can be informed and advised to avoid or reduce risk factors for prolapse. Keywords: DNA sequencing, elastinogenesis, elastinopathy, fibroblast, genetic factor of prolapse, multigene panel testing, polymerase chain reaction, uterosacral ligament

PEOPLE: Lifestyle and comorbidities as risk factors for pelvic organ prolapse-a systematic review and meta-analysis PEOPLE: PElvic Organ Prolapse Lifestyle comorbiditiEs.

The literature is scarce regarding the effects of comorbidities, clinical parameters, and lifestyle as risk factors for pelvic organ prolapse (POP). This study was performed to systematically review the literature related to body mass index (BMI), waist circumference, diabetes mellitus (DM), hypertension (HT), dyslipidemia, chronic constipation, smoking, chronic cough, occupation, and striae and varicose veins as determinants for POP. Search terms in accordance with Medical Subject Headings were used in PubMed, Embase, LILACS, and the Cochrane Library. Clinical comparative studies between women with and without POP and containing demographic and/or clinical raw data related to lifestyle and/or comorbidities were included. The ROBINS-I (risk of bias in non-randomized studies of interventions) instrument was used. Fixed-effects and random-effects models were used for homogeneous and heterogeneous studies, respectively. Forty-three studies were included in the meta-analysis. BMI < 25 kg/m2 was found to be a protective factor for POP [OR 0.71 (0.51, 0.99); p = 0.04], and BMI > 30 kg/m2 was a risk factor for POP [OR 1.44 (1.37, 1.52); p < 0.00001]. Waist circumference (≥ 88 cm) was reported as a risk factor for POP [OR 1.80 (1.37, 2.38); p < 0.00001], along with HT [OR 1.18 (1.09, 1.27); p = 0.04], constipation [OR 1.77 (1.23, 2.54); p < 0.00001], occupation [OR 1.86 (1.21, 2.86); p < 0.00001], persistent cough [OR 1.52 (1.18, 1.94); p < 0.0001]), and varicose veins [OR 2.01 (1.50, 2.70); p = 0.12]. BMI < 25 kg/m2 is protective while BMI > 30 kg/m2 is a risk factor for POP. Large waist circumference, dyslipidemia, HT, constipation, occupation, persistent cough, and varicose veins are also determinants for POP.

Development of symptomatic pelvic organ prolapse over 10 years of mid-life follow-up is affected by occupational lifting and/or pushing for parous women

ObjectiveTo document the risk of new-onset symptomatic pelvic organ prolapse (POP) among perimenopausal women and examine whether occupational lifting and/or pushing is a risk factor in the development of POP over a 10-year follow-up window. Study designSecondary analysis of prospective, longitudinal data from the Study of Women's Health Across the Nation (SWAN) cohort study. Main outcome measuresWe analyzed women with current employment at the start of SWAN who were followed annually during mid-life. At baseline, women self-reported the frequency of occupational lifting and pushing, which was classified as Never, Infrequent (less than half the time), or Frequent (half the time or more) occupational lifting and/or pushing. Women were asked about new-onset symptomatic POP from the second to tenth annual follow-up. Modified Poisson regression was used to quantify crude and adjusted risk ratios (RRs) and 95 % confidence intervals (CIs) for POP according to load-bearing categories. Parous women were modelled separately, as initial analyses suggested effect modification by parity status. ResultsIn our sample of 1590 parous women, 8.2 % reported new-onset symptomatic POP over 10 years of follow-up. Multivariable analysis revealed that Infrequent (aRR 1.51, 95 % CI 1.04–2.20) and Frequent (aRR 2.03, 95 % CI 1.29–3.17) occupational lifting and/or pushing were associated with the development of POP. ConclusionFrequent occupational lifting and/or pushing significantly increased parous women's risk of developing POP symptoms. This strengthens existing evidence that occupational exposures can be risk factors for POP. Gender-based education and prevention strategies in the workplace and in primary health care are necessary to reduce the burden of this condition for mid-life women.

Pelvic Floor Dysfunction in Right Hemiplegic Female in Rural Nepal

Pelvic floor dysfunction i.e., Pelvic Organ Prolapse (POP) and Urinary incontinence (UI) is seen to be more prevalent in rural part of Nepal and majority of these conditions are seen in females of reproductive age. Pelvic floor dysfunction negatively impacts female's quality of life and if it is associated with female with disability, it increases the severity of their physical, mental, and social well-being and can hinder their full and effective participation in society. Thus, educational programs regarding sex education should be conducted focusing on vulnerable population to increase awareness, advocacy about their sexual and reproductive rights including causes and risk factors of POP and UI.

The rs2165241 polymorphism of the Loxl1 gene in postmenopausal women with pelvic organ prolapse

Objective This study aimed to verify the presence of polymorphism rs2165241 of the lysyl oxidase-like 1 (Loxl1) gene and its association with pelvic organ prolapse (POP) in Brazilian women and determine risk factors for POP development. Methods The study was previously approved by the local research and ethics board. Postmenopausal women were included and divided into POP (stages III and IV) and control (stages 0 and I) groups. Peripheral blood samples were collected, and the DNA sequence of interest was analyzed by real-time reverse-transcriptase polymerase chain reaction. We used logistic regression and considered a recessive model of inheritance for the analysis, with p < 0.05 for significance. Results A total of 836 women were assessed: 426 POP cases and 410 controls. The frequencies of CC, CT and TT genotypes were similar in both groups. Age (odds ratio [OR] = 1.1, 95% confidence interval [CI] = 1.07; 1.14), number of vaginal births (OR = 17.06, 95% CI = 5.94; 48.97), family history (OR = 2.87, 95% CI = 1.57; 5.22) and weight of largest newborn (OR = 1.001, 95% CI = 1.0003; 1.001) were independent risk factors for POP, while multiple cesarean sections (two or more) was protective (OR = 0.17, 95% CI = 0.07; 0.42). Conclusion No association was detected between rs2165241 of the Loxl1 gene and POP.

Age and/or postmenopausal status as risk factors for pelvic organ prolapse development: systematic review with meta-analysis.

Age is named as a risk factor for pelvic organ prolapse (POP), despite not being the primary outcome for many observational studies. Postmenopausal status is another associated factor but has many confounders. We aimed to systematically review the role of age and/or postmenopausal status in POP development. Systematic review addressing age and hormones, more specifically by postmenopausal status, from inception to March 2020 in four databases (PubMed, Embase, WOS, Cochrane Library). Quality of evidence was classified by the ROBINS-I classification for non-randomized studies. Experimental studies, animal studies, studies linking age with recurrent POP and case series were excluded. Effect estimates were collected from adjusted odds ratio plus 95% confidence intervals. Significance level was 5%. A discussion exploring mechanistic factors was also included. Nineteen studies (11 cross sectional, 6 cohort and 2 case control) were included for quantitative analysis. Only two studies presented a low overall risk of bias for age; most of the domains were of moderate risk. Every additional year was responsible for a 10% increase in the risk to develop POP (OR = 1.102 [1.021-1.190]; i2= 80%, random analysis, p= 0.012). This trend was confirmed when age was dichotomized into a cutoff of 35 (p= 0.035) and 50 (p< 0.001)years. Although an increase in the risk for POP was noted in postmenopausal women, this did not reach statistical significance (OR = 2.080 [0.927-4.668], i2= 0%, p= 0.076). Age is a risk factor for POP; postmenopausal status was not statistically associated with POP, prompting the need for further studies addressing this factor.

COL3A1 rs1800255 polymorphism is associated with pelvic organ prolapse susceptibility in Caucasian individuals: Evidence from a meta-analysis.

BackgroundThe collagen 3 alpha 1 (COL3A1) rs1800255 polymorphism has been reported to be associated with women pelvic organ prolapse (POP) susceptibility, but the results of these previous studies have been contradictory. The objective of current study is to explore whether COL3A1 rs1800255 polymorphism confers risk to POP.MethodsRelevant literatures were searched by searching databases including Pubmed, Embase, Google academic, the Cochrane library, China National Knowledge Infrastructure (CNKI). Search time is from database foundation to March 2021.ResultsA total of seven literatures were enrolled in the present meta-analysis, including 1642 participants. Overall, no significant association was found by any genetic models. In subgroup analysis based on ethnicity, significant associations were demonstrated in Caucasians by allele contrast (A vs. G: OR = 1.34, 95%CI = 1.03–1.74,), homozygote comparison (AA vs. GG: OR = 3.25, 95%CI = 1.39–7.59), and recessive genetic model (AA vs. GG/GA: OR = 3.22, 95%CI = 1.40–7.42).ConclusionsThe present meta-analysis suggests that the COL3A1 is a candidate gene for POP susceptibility. Caucasian individuals with A allele and AA genotype have a higher risk of POP. The COL3A1 rs1800255 polymorphism may be risk factor for POP in Caucasian population.

Pregnancy, labour and delivery as risk factors for pelvic organ prolapse: a systematic review.

Pregnancy and childbirth are considered risk factors for pelvic organ prolapse (POP). The long latency between obstetric events and morbidity hinders the establishment of cause-effect relationships. Recently, intermediate outcomes such as organ descent and levator avulsion (LA) have been identified. We aimed to assess the effect of obstetric events on symptoms and signs of POP and on LA. We systematically reviewed the literature by searching PubMed/MEDLINE, Embase and Cochrane Library. We included studies in women examining associations between obstetric events and symptoms and signs of POP and LA, assessed through questionnaires, clinical examination and pelvic floor imaging. Two reviewers evaluated the studies for eligibility and for methodological quality/susceptibility to bias. We extracted study results and clustered them by outcome: symptoms of POP (sPOP), clinical findings of POP (cPOP) and LA. When appropriate, we performed a random-effect meta-analysis and reported the summary odds ratios (OR) with 95% confidence intervals. Heterogeneity across studies was assessed using the I2 statistic. The first vaginal delivery was a risk factor for POP as measured by sPOP (OR: 2.65 [1.81-3.88]), cPOP (OR: 4.85 [2.15-10.94]) and in association with LA (OR: 41.6 [4.13- 419.41]). Forceps delivery was a risk factor for POP as measured by sPOP (OR: 2.51 [1.34-4.69]), cPOP (OR: 1.68 [1.21-2.34]) and in association with LA (OR: 5.92 [3.75-9.34]). Birth exclusively by caesarean was protective for sPOP (OR: 0.38 [0.29-0.51]) and for cPOP (OR: 0.29 [0.20-0.41]) and it did not confer any additional risk compared to nulliparity. This review confirms a strong aetiological link between vaginal birth and POP, with the first vaginal and forceps delivery being the main determinants.

Post-cystectomy Enterocele: A Case Series and Review of the Literature

ObjectiveTo present a case series and literature review on post radical cystectomy (RC) pelvic organ prolapse (POP) to heighten awareness of the symptoms, imaging findings, and risk factors associated with this complication and discuss opportunities for prevention. Women with muscle invasive bladder cancer undergo RC with anterior exenteration, significantly disrupting the pelvic floor. These women are at risk for POP. MethodsWe present 4 cases of high-grade POP in women who underwent RC for bladder cancer. We reviewed the literature by conducting a Boolean search in PubMed with the terms “(“radical cystectomy”) AND (“enterocele” OR “pelvic organ prolapse” OR “rectocele” OR “vaginal vault prolapse”).” ResultsAll 4 women reported a bulge sensation in the vagina and physical exam confirmed POP. Three had radiographic findings consistent with high-grade enterocele at rest. Three experienced prolonged intra-abdominal pressure rise post-RC that may have further weakened pelvic floor support, while the fourth had a history of surgery for high-grade POP. Nine articles on POP following RC were identified. Four focused on treatment and 3 focused on prevention. ConclusionAdministration of a single validated question would have identified all 4 cases of postoperative enterocele and is sensitive to detect most women who are experiencing POP. Attention to the pelvic floor on cross-sectional imaging with identification of features that indicate POP, such as herniation of intestinal contents below the pubo-coccygeal line, will identify and/or confirm high-grade enterocele. Familiarity with risk factors for POP and identification of weakened vaginal wall support opens up the opportunity for prevention.

Prevalence and risk factors for pelvic organ prolapse in Kilimanjaro, Tanzania: A population based study in Tanzanian rural community.

IntroductionThe prevalence and risk-factors of pelvic organ prolapse (POP) in Tanzania are unknown. To help elucidate the problem, we assessed POP and associated risk-factors among Tanzanian women by deploying the POP-Q classification system.MethodA cross sectional community based study conducted in Hai, Rombo and Same Districts, Kilimanjaro Region, Tanzania. Women aged 18–90 were recruited through multi-stage random sampling from January to May 2015. Home-based questionnaire interviews were performed and the women were subsequently invited to the nearest health clinic for pelvic examination. Trained physicians used the POP-Q classification system to assess the POP stage.ResultsA total of 1195 women were interviewed and invited for pelvic examination; 1063(89%) women presented at the clinic of whom 1047(88%) accepted a clinical examination. Of 1047 examined women, 64.6% had an anatomical POP stage II–IV and 6.7% had a severe POP that descended 1 cm or more below the hymen. POP stage II–IV was associated with being aged 35+ years, being a farmer, doing petty trading and having delivered 3 times or more. Severe POP was associated with carrying heavy objects for ≥ 5 hours (OR 4.70;1.67–13.2), having delivered 5 times or more (OR 10.2;2.22–48.6) and having delivered at home (OR 2.40;1.36–4.22).ConclusionPOP is a common condition among rural Tanzanian women where 64.6% are having POP grade II-IV and 6.7% are having a severe POP descending 1 cm or more below the hymen. Risk-factors are increasing age, heavy lifting, high parity and home-delivery.

Study on the risk factors of pelvic organ prolapse by evidence-based medicine

Pelvic organ prolapse (POP) is a common pelvic floor dysfunction disease caused by multiple factors in female. The main clinical manifestation is pelvic organ protrusion to the vaginal cavity. This disease not only affects the health and the quality of life of women and but also affects their mental health. At present, with the improvement of people′s quality of life, reducing the occurrence of POP has become a urgent problem. Therefore, understanding its risk factors is the foundation for our research and development of prevention strategies. The risk factors of POP are summarized based on the principle of evidence-based medicine, which provides scientific basis for the prevention of POP. Key words: Pelvic organ prolapse; Factor analysis, statistical; Evidence-based medicine; Review

Tenascin-C is Strongly Expressed in the Anterior Vaginal Walls of Women with Pelvic Organ Prolapse

Objectives: To compare the expression of tenascin in the anterior vaginal wall in women with pelvic organ prolapse and without pelvic organ prolapse (POP).&#x0D; &#x0D; Method: This study was a cross sectional study. The study was conducted in RS Dr. Wahidin Sudirohusodo and other network hospitals of Obstetrics and Gynecology Department of Hasanuddin University, Makassar, from 1st January 2011 to 1st April 2012. This study assessed the expression of tenascin in 35 women with pelvic organ&#x0D; prolapse grade III and IV and the controls were 35 women without pelvic organ prolapse. Tenascin expression was assessed by immunohistochemical&#x0D; examination using tenascin antibody staining (mouse monoclonal antibody Novacastratenascin C, code NCLTenasC). Sampling was done by consecutive sampling. Data processed by the chi-square. The significance level used was 0.05.&#x0D; &#x0D; Result: The result of this research shows that with exception of history of bearing baby &gt; 4000 gr weight (p=0.572); age, parity, menopausal status, and body mass index were significantly different between the group. This indicates that the variable does not affect the&#x0D; calculation of research data. While parity, menopausal status and body mass index (BMI), from an analysis of risk factors for POP were associated with increased intensity of tenascin is significant in postmenopausal status, and BMI &gt; 25 (overweight) (p

Determinants of pelvic organ prolapse among gynecologic patients in Bahir Dar, North West Ethiopia: a case-control study.

IntroductionPelvic organ prolapse (POP) is a significant public health problem in developing countries including Ethiopia. However, less has been documented on risk factors of POP. Therefore, the aim of this study was to identify the determinants factors of POP.MethodsAn unmatched case–control study was conducted among gynecologic patients in Bahir Dar city, North West Ethiopia, from July to October 2014. A total of 370 women (selected from outpatient departments) were included in the study. Cases (clients with stage III or IV POP) and controls (who declared free of any stages of POP) were identified by physicians using the Pelvic Organ Prolapse Quantitative Examination tool. Data analysis was carried out by SPSS version 20.0. Descriptive, bivariate, and multivariable logistic regression analyses were performed. Statistical differences were considered at P<0.05, and the strength of association was assessed by odds ratio (OR) and respective confidence intervals (CIs).ResultsThis study revealed that determinants such as age of women (>40 years) (adjusted OR [AOR] =3.0 [95% CI: 1.59–5.89]), sphincter damage (AOR =8.1 [95% CI: 1.67–39.7]), family history of POP (AOR =4.9 [95% CI: 1.94–12.63]), parity (≥4) (AOR =4.5 [95% CI: 2.26–9.10]), nonattendance of formal education (AOR =4.3 [95% CI: 1.25–14.8]), carrying heavy objects (AOR =3.1 [95% CI: 1.56–6.30]), body mass index (BMI) <18.5 kg/m2 (AOR =3.1 [95% CI: 1.22–7.82]), and delivery assisted by nonhealth professionals (AOR =2.6 [95% CI: 1.24–5.56]) were significantly associated with POP.ConclusionIn our study, sphincter damage, family history of POP, being uneducated, having ≥4 vaginal deliveries, carrying heavy objects, BMI <18.5 kg/m2, age ≥40 years, and having delivery assisted by nonhealth professional were the independent determinants of POP. Therefore, skilled delivery, further promoting family planning and girls’ education, early pelvic floor assessment, and counseling on avoidance of carrying heavy objects are recommended.

Risk index for pelvic organ prolapse based on established individual risk factors.

To identify known risk factors for pelvic organ prolapse (POP) in a hospital cohort and to develop a prolapse risk index (PRI). Risk factors for POP were recorded in women who underwent surgery with symptomatic POP (n = 500) or non-POP gynaecological conditions (n = 236). Descriptive statistics were determined by Chi-squared and Mann-Whitney U tests. Stepwise multivariate regression analysis was performed for all patients and subgroups by age (<60 and ≥60 years). Primary outcome measures were variables with the strongest impact on prolapse and PRI development. Secondary: specificity, sensitivity, positive and negative predictive values (PPV and NPV, respectively), and Cohen's kappa statistic (κ). Stepwise multivariate regression analysis (n = 736) showed difficult obstetric history [odds ratio (OR) 10.04], family history of POP (OR 7.28), and ≥10 years since menopause (OR 4.53) were independent risk factors for prolapse (P < 0.001). When one of the three variables with the strongest influence on POP development was present, the PRI for all women showed a PPV of 82%, NPV of 68%, and κ of 0.47 for predicting symptomatic POP requiring treatment. In women under 60 years (n = 349), logistic regression revealed difficult obstetric history (OR 9.108), positive family history (OR 8.016), and body mass index (OR 2.274) as independent risk factors. Eighty-seven percent of our patient cohort with symptomatic POP requiring therapy could be identified by the PRI, which may be useful for counselling and education.

Risk factors for pelvic organ prolapse and its recurrence: a systematic review.

Introduction and hypothesisPelvic organ prolapse (POP) is a common condition with multifactorial etiology. The purpose of this systematic review was to provide an overview of literature on risk factors for POP and POP recurrence.MethodsPubMed and Embase were searched with “pelvic organ prolapse” combined with “recurrence” and combined with “risk factors,” with Medical Subject Headings and Thesaurus terms and text words variations until 4 August 2014, without language or publication date restrictions. Only cohort or cross-sectional studies carried out in western developed countries containing multivariate analyses and with a definition of POP based on anatomical references were included. POP recurrence had to be defined as anatomical recurrence after native tissue repair without mesh. Follow-up after surgery should have been at least 1 year. Articles were excluded if POP was not a separate entity or if it was unclear whether the outcome was primary POP or recurrence.ResultsPubMed and Embase revealed 2,988 and 4,449 articles respectively. After preselection, 534 articles were independently evaluated by two researchers, of which 15 met the selection criteria. In 10 articles on primary POP, 30 risk factors were investigated. Parity, vaginal delivery, age, and body mass index (BMI) were significantly associated in at least two articles. In 5 articles on POP recurrence, 29 risk factors were investigated. Only preoperative stage was significantly associated in at least two articles.ConclusionParity, vaginal delivery, age, and BMI are risk factors for POP and preoperative stage is a risk factor for POP recurrence.

Pelvic organ prolapse and stress urinary incontinence, do they share the same risk factors?

ObjectiveTo determine whether there are differences in the etiologies of two of the most common pelvic floor disorders (PFD), pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Study designThis cross-sectional descriptive study included 1042 women, referred to a pelvic floor unit in a tertiary Spanish hospital, between 2008 and 2012.Subjects at their fist visit were interviewed and examined generally and specifically (medical and urogynecological history). Collected parameters included: age, weight, height, medical and surgical background (including in-depth obstetrical and gynecological characteristics). The participants were classified into 3 different groups (POP, SUI, and mixed pathology). Descriptive analyses of each variable and multinomial logistic regression were performed to determine factors associated with POP and SUI. ResultsPatients with POP were older, thinner, with greater parity and their newborns tended to be heavier. Furthermore, forceps, vaginal tears and vaginal surgeries were more common in the POP group. In contrast, family history was an important factor for the development of SUI, with a 6.45-fold increase (95% CI: 3.69–11.24). Two protective factors were identified for POP, cesarean section reduces the risk by 3 fold (OR=0.33) (95% CI: 0.13–0.85) whereas pelvic floor rehabilitation produces a 2 fold reduction (OR=0.49) (95% CI: 0.31–0.76). ConclusionsOur data study demonstrates differences in potential triggers and risk factors for POP and SUI. Cesarean section and pelvic floor rehabilitation have a protective effect on preventing the development of POP. Bringing up that a personal medical care and a specific urogynecological follow-up should be developed for those who are more susceptible or at risk of PFD.

Collagen type III alpha 1 polymorphism (rs1800255, COL3A1 2209 G&gt;A) assessed with high-resolution melting analysis is not associated with pelvic organ prolapse in the Dutch population

The rs1800255, COL3A1 2209G>A polymorphism in the alpha 1 chain of collagen type III has been associated with an increased risk of pelvic organ prolapse (POP). In one of our previous studies however, polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) misdiagnosed rs1800255, COL3A1 2209G>A in 6% of cases. The high-resolution melting (HRM) analysis on the contrary obtained a 100% accordance for this specific polymorphism and was used in the present study to validate this risk factor for POP. In this case-control study, women with and without symptoms of POP were included and compared. DNA was extracted from blood samples. HRM analysis was used to assess for the presence of the homozygous rs1800255. Groups were compared using the Pearson chi-square, Mann-Whitney, and t tests. The discrepancy between HRM and PCR-RFLP results was investigated using PCR-RFLP results available from our previous study. The study included 354 women: 272 patients with POP and 82 controls; 18 (7%) cases versus 3 (4%) controls had a homozygous rs1800255, COL3A1 2209G>A polymorphism (odds ratio 1.9, 95% confidence interval 0.5-6.9, compared to the wild type), and thus no association between POP and the homozygous polymorphism could be demonstrated. A discrepancy between HRM and PCR-RFLP results was found in 8% of the samples. The previously found statistically significant association between the rs1800255, COL3A1 2209G>A polymorphism as measured with PCR-RFLP and POP could no longer be demonstrated. This raises concerns regarding the results of other association studies using PCR-RFLP.