Risk Of Pelvic Organ Prolapse Research Articles

Risk Factors for Pelvic Organ Prolapse: Wide-Angled Mendelian Randomization Analysis.

We hypothesized that some metabolic factors, lifestyle factors, and socioeconomic factors may have a causal effect on pelvic organ prolapse (POP). We selected instruments from corresponding genome-wide association studies (GWAS), which identified independent single nucleotide polymorphisms strongly associated with 12 potential risk factors. Summary statistics for POP were derived from two GWAS datasets, serving for discovery and replication stage. The primary analysis involved the use of the inverse-variance weighting mendelian randomization (MR) method, with additional sensitivity MR analyses conducted. The univariable mendelian randomization (UVMR) analysis in both the discovery and replication stage provided evidence for significant causal effects between higher waist-to-hip ratio adjusted for body mass index (WHRadjBMI) levels, lower high-density lipoprotein cholesterol (HDL-C) levels, and lower educational attainment and higher POP risk, as well as a suggestive positive causal effect between triglycerides and POP. The multivariable mendelian randomization (MVMR)analysis showed that only HDL-C among the three blood lipid fractions could reduce the risk of POP. Mediation analysis indicated that HDL-C may partially mediate the effect of WHRadjBMI on POP risk, and the causal effect between educational attainment and POP may be mediated through WHRadjBMI and HDL-C. Our study's evidence supported a causal relationship between WHRadjBMI, triglycerides, HDL-C, educational attainment, and POP risk. This highlights that clinicians may guide the general female population to control obesity and blood lipid levels to reduce the risk of POP.

Obesity and Native Tissue Repairs: A Secondary Analysis of the OPTIMAL Trial.

The Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) Trial compared sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) surgical outcomes. Increasing body mass index (BMI) is associated with an increased risk of pelvic organ prolapse, and the prevalence of obesity is increasing worldwide. The purpose of this study was to better understand the effect of obesity on the results of native tissue vaginal apical suspension procedures. This was a secondary analysis of the OPTIMAL Trial data set. Subgroup analysis was performed to compare surgical failure rates between SSLF and ULS across BMI subgroups after 2 years. There were 75, 120, 63, and 39 patients in the normal, overweight, class 1 obesity, and class 2 obesity or greater BMI subgroups, respectively. There were no statistically significant differences in surgical failure rates between SSLF and ULS within BMI subgroups; however, failure rates increased in the ULS group between the nonobese and obese groups (normal, 35.9% SSLF vs 30.6% ULS [P = 0.81]; overweight, 38.6% vs 30.2% [P = 0.44]; class 1 obesity, 38.7% vs 40.6% [P = 0.92]; class 2 obesity or greater, 21.1% vs 45% [P = 0.21]). The risk of surgical failure between SSLF and ULS was not significant across BMI subgroups. Additional investigation is required to further elucidate whether SSLF or ULS is a more reliable option for obese patients.

Accelerometer-measured physical activity, sedentary behavior, and risk of incident pelvic organ prolapse: a prospective cohort study in the UK Biobank

BackgroundPrevious studies on physical activity (PA) and pelvic organ prolapse (POP) were largely limited to self-reported PA in athletes, soldiers, and women in postpartum. We aimed to investigate the association of accelerometer-measured PA and sedentary behavior with the risk of POP in middle-aged and elderly women.MethodsIn this prospective cohort derived from the UK Biobank, the intensity and duration of PA and sedentary behavior were measured with wrist-worn accelerometers over a 7-day period in 2013–2015 for 47,674 participants (aged 42.8–77.9 years) without pre-existing POP. Participants were followed up until the end of 2022, during which incident POP was ascertained mainly by the electronic health records. Multivariable-adjusted Cox proportional hazards models and restricted cubic splines were used to assess the associations of interest. Isotemporal substitution models were applied to test the effects of substituting a type of activity with equivalent duration of others.ResultsDuring a median follow-up of 8.0 years, 779 cases of POP were recorded. The duration of light-intensity PA (LPA) was positively whereas sedentary time was negatively associated with the risk of POP. Every additional 1 h/day of LPA elevated the risk of POP by 18% (95% confidence interval [CI], 10%–26%). In contrast, the risk decreased by 5% (95% CI, 0–8%) per 1 h/day increment in sedentary behavior. No associations were found between moderate-intensity PA (MPA) or vigorous-intensity PA (VPA) and POP, except that women who had a history of hysterectomy were more likely to develop POP when performing more VPA (53% higher risk for every additional 15 min/day). Substituting 1 h/day of LPA with equivalent sedentary time was associated with a 18% (95% CI, 11%–24%) lower risk of POP. The risk can also be reduced by 17% (95% CI, 7%–25%) through substituting 30 min/day of LPA with MPA.ConclusionsMore time spent in LPA or less sedentary time was linked to an elevated risk of POP in middle-aged and elderly women, while MPA or VPA was not. Substituting LPA with equivalent duration of sedentary behavior or MPA may lower the risk of POP.

101 Evaluation of Vaginal Infusion with Ampicillin on Incidence of Pelvic Organ Prolapse in Late Gestation Sows

Abstract Within the last decade, increased sow mortality resulting from pelvic organ prolapse (POP) has become a growing concern in the swine industry. Despite being widely acknowledged as a prevailing sow welfare and production issue, mitigation strategies are lacking. Previous studies have demonstrated changes in the vaginal microbiome are associated with increased risk for POP during late gestation. Therefore, the vaginal microbiome represents a potential target for prevention strategies. The objective of the current study was to evaluate effects of vaginal infusion using ampicillin on POP incidence. We hypothesized that altering the vaginal microbiome through the use of antibiotics would reduce POP risk during late gestation. Ampicillin was infused into the vagina at two timepoints during late gestation. The first dose (10 mL at 200 mg/mL) was administered approximately three weeks prior to farrowing followed by a second, equivalent dose at approximately three days pre-farrowing. Sows were randomly assigned to treated (TRT; n = 824) and non-treated (CON; n = 739) groups based on gestation pen. Eighty-seven percent of sows in the TRT group received both infusions of ampicillin. At gestation week 15, sows (n = 1076) were evaluated for prolapse risk using a 3-point perineal scoring system. Briefly, a perineal score (PS) of 1 (PS1) presumes little to no risk of prolapse, a PS of 2 (PS2) presumes moderate risk of POP, and a PS of 3 (PS3) presumes high risk of prolapse. From the 1,076 sows assigned a PS, 46.5%, 49.7% and 3.8% of sows were scored PS1, PS2, or PS3, respectively. Ampicillin treatment did not affect PS (P = 0.20) during late gestation, with 45.6%, 51.6% and 2.8% of CON sows and 47.2%, 48.1% and 4.7% of TRT sows scoring a PS1, PS2, or PS3, respectively. Additionally, treatment did not affect POP incidence (P = 0.74), with 4.5% of CON sows and 4.7% of TRT sows subsequently experiencing POP. When evaluating litter characteristics, ampicillin treatment did not affect number of total born, liveborn, or stillborn piglets (P ≥ 0.54). However, an effect of PS was observed on total born and stillborn piglets (P ≤ 0.01), and a tendency to effect number of liveborn piglets (P = 0.06). Sows assigned a PS3 during late gestation had fewer piglets born alive, presumably due to the increased number of stillborn piglets. Additionally, PS3 sows had 1 more total piglet on average within their litters compared with PS1 assigned sows (P = 0.01). In conclusion, vaginal infusion of ampicillin had no effect on PS, POP incidence or litter characteristics, but PS did have an effect on the number of piglets born alive. This project was supported by the National Pork Board and the Foundation for Food and Agriculture Research.

Evaluation for causal effects of socioeconomic traits on risk of female genital prolapse (FGP): a multivariable Mendelian randomization analysis

BackgroundAlthough observational studies have established some socioeconomic traits to be independent risk factors for pelvic organ prolapse (POP), they can not infer causality since they are easily biased by confounding factors and reverse causality. Moreover, it remains ambiguous which one or several of socioeconomic traits play predominant roles in the associations with POP risk. Mendelian randomization (MR) overcomes these biases and can even determine one or several socioeconomic traits predominantly accounting for the associations.ObjectiveWe conducted a multivariable Mendelian randomization (MVMR) analysis to disentangle whether one or more of five categories of socioeconomic traits, “age at which full-time education completed (abbreviated as “EA”)”, “job involving heavy manual or physical work (“heavy work”)”, “average total household income before tax (income)”, “Townsend deprivation index at recruitment (TDI)”, and “leisure/social activities” exerted independent and predominant effects on POP risk.MethodsWe first screened single-nucleotide polymorphisms (SNPs) as proxies for five individual socioeconomic traits and female genital prolapse (FGP, approximate surrogate for POP due to no GWASs for POP) to conduct Univariable Mendelian randomization (UVMR) analyses to estimate causal associations of five socioeconomic traits with FGP risk using IVW method as major analysis. Additionally, we conducted heterogeneity, pleiotropy, and sensitivity analysis to assess the robustness of our results. Then, we harvested a combination of SNPs as an integrated proxy for the five socioeconomic traits to perform a MVMR analysis based on IVW MVMR model.ResultsUVMR analyses based on IVW method identified causal effect of EA (OR 0.759, 95%CI 0.629–0.916, p = 0.004), but denied that of the other five traits on FGP risk (all p > 0.05). Heterogeneity analyses, pleiotropy analyses, “leave-one-out” sensitivity analyses and MR-PRESSO adjustments did not detect heterogeneity, pleiotropic effects, or result fluctuation by outlying SNPs in the effect estimates of six socioeconomic traits on FGP risk (all p > 0.05). Further, MVMR analyses determined a predominant role of EA playing in the associations of socioeconomic traits with FGP risk based on both MVMR Model 1 (OR 0.842, 95%CI 0.744–0.953, p = 0.006) and Model 2 (OR 0.857, 95%CI 0.759–0.967, p = 0.012).ConclusionOur UVMR and MVMR analyses provided genetic evidence that one socioeconomic trait, lower educational attainment, is associated with risk of female genital prolapse, and even independently and predominantly accounts for the associations of socioeconomic traits with risk of female genital prolapse.

Hysterectomy on benign indication and risk of pelvic organ prolapse surgery: A national matched cohort study.

Hysterectomy is a frequently performed gynecological procedure but long-term effects remain understudied. Pelvic organ prolapse reduces life quality significantly. The lifetime risk of undergoing pelvic organ prolapse surgery is 20% and parity is known to be the largest risk factor. Studies have shown an increased risk of pelvic organ prolapse surgery after hysterectomy; however, few have studied the compartments which are affected and how this association is affected by surgical route and parity. In this Danish nationwide cohort study, we identified women born in 1947-2000 who underwent hysterectomy during 1977-2018 who were indexed on the day of hysterectomy. We excluded women who immigrated when older than 15 years, who underwent pelvic organ prolapse surgery prior to index, and who were diagnosed with a gynecological cancer prior to or within 30 days of index. Women who underwent hysterectomy were matched 1:5 to references on age and year of hysterectomy. Women were censored at the time of death, emigration, a gynecological cancer diagnosis, radical or unspecified hysterectomy or December 31, 2018, whichever came first. The risk of pelvic organ prolapse surgery after hysterectomy was computed using Cox proportional hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, calendar year, parity, income and educational level. We included 80 444 women who underwent hysterectomy and 396 303 reference women. Women who underwent hysterectomy had a significantly higher risk of undergoing pelvic organ prolapse surgery: HRadjusted 1.4 (95% CI 1.3-1.5). In particular, the risk of a posterior compartment prolapse operation was increased: HRadjusted 2.2 (95% CI 2.0-2.3). The risk of prolapse surgery increased with increased parity and by an additional 40% after hysterectomy. Cesarean sections did not seem to increase the risk of prolapse surgery. This study shows that hysterectomy, regardless of surgical route, leads to an increased risk of pelvic organ prolapse surgery, especially in the posterior compartment. The risk of prolapse surgery increased with the number of vaginal births, and not cesarean sections. Women should be thoroughly informed about the risk of pelvic organ prolapse and other treatment options should be considered before choosing hysterectomy to treat benign gynecological diseases -particularly women who have had numerous vaginal births.

Association between vaginal or cesarean delivery and later development of stress urinary incontinence or pelvic organ prolapse: A retrospective population-based cohort study.

Child delivery mode may be associated with pelvic floor disorders. We explored the association between different delivery modes and later development of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in Taiwanese women. This was a retrospective population-based cohort study. Women who delivered babies between January 1, 2000, and December 31, 2018, were selected for this study. The study used Taiwan's National Health Insurance (NHI) Research Database. After propensity score matching, 51,587 women who underwent cesarean section (C/S) and 51,587 women who underwent vaginal delivery (VD) were recruited. Primary outcomes were the presence of SUI and POP after delivery. The incidence of SUI (1.6/1000 person-years) and POP (1.5/1000 person-years) was higher in the VD group than in the C/S group (0.8 and 0.6 in 1000 person-years). VD was associated with an increased risk of SUI [hazard ratio (HR): 2.79, 95% confidence interval (CI): 2.45-3.17] and POP (HR: 1.96, 95% CI: 1.75-2.19) compared to C/S. We also found that age (HR: 1.06, 95% CI: 1.05-1.08 in SUI, HR: 1.08, 95% CI: 1.07-1.09 in POP) and Charlson Comorbidity Index (CCI) (HR: 1.28, 95% CI: 1.12-1.46 in SUI, HR: 1.27, 95% CI: 1.13-1.43 in POP) were associated with an increased risk of SUI and POP. The cumulative incidence of SUI and POP was higher in the VD group than in the C/S group (log-rank test, P < 0.05). The current study was the largest retrospective cohort study regarding the influence of delivery mode on SUI and POP so far. VD was found to be associated with an increased risk of SUI and POP compared with C/S. Postpartum care for pelvic physical therapy should be provided particularly to women undergoing VD.

Determinants of pelvic organ prolapse among gynecologic patients, Northeastern Ethiopia, 2020: A case-control study.

The majority of women in developing countries, including Ethiopia, do not seek medical help; as a result, they face substantial impacts on their health. There is a lack of attention to screening women at high risk for pelvic organ prolapse. Identifying the determinants of pelvic organ prolapse is essential for the early screening and prevention of adverse health outcomes in women. To identify the determinants of pelvic organ prolapse among gynecologic patients at Akesta Hospital, 2020. An unmatched case-control study was conducted among 70 cases and 140 controls. The study participants were selected using a systematic sampling technique. Data were collected by reviewing patient charts. The data were entered into EpiData version 4.6 and analyzed using SPSS version 25. Text, tables, and figures were used for data presentation. P values less than 0.2 in binary logistic regression were entered in multivariable logistic regression. Finally, P values less than 0.05 were considered significant factors for the determinants of pelvic organ prolapse. A total of 189 respondents participated in the study. Of the total respondents, 63 were cases and 126 were controls. Patients whose parity was four or above developed pelvic organ prolapse three times more likely than those whose parity number was less than four (adjusted odds ratio = 3.05; 95% confidence interval: 1.35-6.90; P = 0.007). Patients who are overweight are 8.5 times more likely to develop pelvic organ prolapse than patients with normal weight (adjusted odds ratio = 8.5, 95% confidence interval: 2.75-26.51; P = 0.001). Patients with a history of intestinal obstruction were five times more likely to develop pelvic organ prolapse than their counterparts (adjusted odds ratio = 4.87, 95% confidence interval: 1.61-14.75, P = 0.005). Educational level, being overweight, having four parities and above, minimum duration of labor, history of urinary retention, and intestinal obstruction were determinants of pelvic organ prolapse. Screening should target women with illiteracy, overweight, and whose parity is four and above. Early diagnosis and treatment of urinary retention and intestinal obstruction should be provided to women with pelvic organ prolapse.

Low Expression of p53 in Sacrouterine Ligament as A Risk Factor for Stage III-IV Uterine Prolapse

Introduction: As life expectancy increases, so does the incidence of pelvic organ prolapse (POP). Low expression of p53 may lead to reduced production and deposition of elastin in the extracellular matrix thus it may increase the risk for POP. This study aims to determine the relationship between p53 expression and the incidence of grade III-IV POP. Methods: This observational case-control study involved women with grade III-IV POP that underwent a total hysterectomy at Sanglah General Hospital Denpasar as the case group. The control group was non-prolapsed women who were matched to the case for the variables of age, parity, body mass index (BMI), and occupation to minimize bias. The p53 expression was grouped into low (&lt;146.90) and high (≥146.90) expressions according to the optimal cut-off value obtained from the receiver operating characteristic curve. Bivariate analysis between p53 expression and risk of POP was performed using the Chi-square test. Results: A total of 44 patients were included in this study with 22 patients with grade III-IV POP and 22 patients without POP. There were no significant differences in age, parity, BMI, and occupation between the two groups. Low p53 expression increased the risk of stage III-IV uterine prolapse by 20.25 times higher (OR = 20.25; 95% CI = 4.375-93.722; p = 0.000). Conclusion: The low p53 expression in the sacrouterine ligament is a significant risk factor for grade III and IV POP.

The Matrix Metaloproteinase-1 Gene Polymorphisms as Risk Factor of Pelvic Organ Prolapse in Balinese Woman

Pelvic organ prolapse (POP) is a gynecological problem that can worsen the psychosocial, economic, and sexual function of women and often relapses after surgery. POP is associated with weakness of the pelvic floor supporting structures. Pelvic organ prolapse is associated with a reduced quality of life for millions of women worldwide. The purpose of this study was to determine the role of the MMP-1 rs 1799750 gene polymorphisms as a risk factor for pelvic organ prolapse in Balinese women. This observational case-control study involves 30 patients with pelvic organ prolapse as the case group and 30 patients without pelvic organ prolapse as the control group. The study was conducted at the Integrated Biomedical Laboratory, Faculty of Medicine, Udayana University. Three milliliters of venous blood samples were taken from each patient and DNA examination was performed to determine MMP-1 gene polymorphisms. Risk assessment of the MMP-1 gene polymorphism for pelvic organ prolapse was done by controlling for confounding variables, including age, parity, heavy work, body mass index, menopausal status, and history of hysterectomy, through multivariate logistic regression conditional test. Result from this study is the MMP-1 gene polymorphism increased the risk of pelvic organ prolapse 4.33 times compared to non-prolapsed in Balinese women (OR 4.33, 95%CI 1.20 -15.61, p = 0.020). After controlling for various confounding variables, MMP-1 gene polymorphism still increased the risk of pelvic organ prolapse up to 5.52 times (AOR 5.52, 95%CI 1.352-22.50, p = 0.02). Conclusion from this study is MMP-1 gene polymorphism significantly increases the risk of pelvic organ prolapse in Balinese women.

Intrapartum risk factors associated with pelvic organ prolapse at 6 months postpartum

Pregnancy and childbirth are known risk factors associated with the development of pelvic organ prolapse; specific intrapartum risk factors are not well characterized. This study aimed to determine intrapartum factors associated with increased risk of pelvic organ prolapse identified after delivery. A planned secondary analysis of a multicenter randomized clinical trial of delayed vs immediate pushing among nulliparous women at ≥37 weeks of gestation in labor with neuraxial analgesia was conducted at 6 academic and community hospitals in the United States. Intrapartum characteristics were identified, and Pelvic Organ Prolapse Quantification assessments at 6 weeks and 6 months after delivery were performed. The primary outcome was pelvic organ prolapse, defined as stage 2 or greater prolapse using the Pelvic Organ Prolapse Quantification assessment at 6 months. Multivariable logistic regression was used to refine risk estimates while adjusting for randomization group, macrosomia, and maternal age. Among the 941 women participating in the pelvic floor follow-up, 793 women had Pelvic Organ Prolapse Quantification assessments at 6 weeks with 91 of 793 women (11.5%) demonstrating stage 2 or greater prolapse. Of the 728 women followed up at 6 months, stage 2 or greater prolapse was identified in 58 of 728 women (8.0%). Prostaglandin use for induction of labor was associated with an increased risk at 6 months (adjusted odds ratio, 2.15; 95% confidence interval, 1.18-3.91; P<.01). The length and type (spontaneous vs induced) of the first stage of labor were not significantly associated with stage 2 or greater prolapse. Moreover, increased length of the second stage of labor and duration of pushing were not associated with stage 2 or greater prolapse. After adjusting for confounding factors, cesarean delivery was protective of pelvic organ prolapse at 6 months (adjusted odds ratio, 0.12; 95% confidence interval, 0.02-0.90). The management of the first and second stages of labor, including time length, was not associated with stage 2 or greater prolapse at 6 months. The findings that prostaglandin exposure was associated with increased risk likely were not directly affecting the risk of prolapse but may be surrogates for other labor features that deserve exploration. Cesarean delivery was associated with protection from stage 2 or greater pelvic organ prolapse at 6 months, consistent with previous literature.

Type B Progesterone Receptor Polymorphism Increases the Risk of Pelvic Organ Prolapse in Balinese Women

This study aims to determine the role of type B progesterone receptor gene polymorphisms as a risk factor for pelvic organ prolapse in Balinese women. This paired case-control study involves 29 patients with pelvic organ prolapse as the case group and 29 patients without pelvic organ prolapse as the control group. The study was conducted at Sanglah Hospital, Denpasar and the Integrated Biomedical Laboratory, Faculty of Medicine, Udayana University. Three milliliters of venous blood samples were taken from each patient and PCR examination was performed to determine the type b progesterone receptor gene polymorphisms. Risk assessment of the type b progesterone receptor gene polymorphism for pelvic organ prolapse was done by controlling for confounding variables, including age, parity, body mass index, occupation, menopausal status, and history of hysterectomy, through multiple logistic regression tests. The type b progesterone receptor gene polymorphism increased the risk of pelvic organ prolapse three times compared to non-prolapsed in Balinese women (OR 3.90, 95%CI 1.16-13.07, p = 0.023). After controlling for various confounding variables, type b progesterone receptor gene polymorphism still increased the risk of pelvic organ prolapse up to four times (AOR 4.54, 95%CI 1.16-17.68, p = 0.029). The type b progesterone receptor gene polymorphism significantly increases the risk of pelvic organ prolapse in Balinese women.

181 Evaluation of the Fecal Microbiota in Commercial Sows with Variable Risk for Pelvic Organ Prolapse During Late Gestation

Abstract Sow mortality has increased during the last decade with a large portion due to pelvic organ prolapse (POP) manifesting during late gestation and early lactation. Approximately 21% of sow mortality is attributed to POP, creating a significant economic and animal welfare concern. The study objective was to identify differences in sow fecal microbiota associated with POP risk and to determine if fecal and vaginal microbial communities are correlated. Using an established perineal scoring (PS) system, 2,864 sows were assigned PS1 (low), PS2 (moderate), or PS3 (high) based on phenotypic observations and presumed POP risk during gestation week 15. Of those sows scored, 1.0%, 2.7%, and 23.4% of PS1, PS2, and PS3 assigned sows, respectively, subsequently experienced POP. At the time of scoring, fecal swabs were collected from sows (n = 213) and DNA was extracted for 16S rRNA gene Illumina MiSeq sequencing, and analyzed using mothur, phyloseq and SAS. Additionally, co-occurrence networks were constructed between fecal and vaginal microbial communities using CoNet (V1.1.1), to identify correlations in taxa abundance. Differences in fecal community composition (PERMANOVA; P &amp;lt; 0.05), structure (alpha diversity measurements; P &amp;lt; 0.05), and 13 individual operational taxonomic units (OTU; Q &amp;lt; 0.05) were detected between PS1 and PS3 sows. The abundance of several taxa were correlated across sample collection sites, suggesting the fecal and vaginal microbial communities may influence one another. Collectively, fewer differences exist in fecal microbiota in sows differing risk for POP than previously observed in vaginal microbiota, suggesting the vaginal microbial communities may be a better indicator of POP risk. Understanding correlations between the fecal and vaginal microbial communities may provide strategies or targets for combatting POP. This project was supported by the National Pork Board and the Foundation for Food and Agriculture Research.

Surgical management of pudendal nerve entrapment after sacrospinous ligament fixation.

ObjectiveTo analyse the efficacy of sacrospinous ligament (SSL) suture removal on the reduction of pain symptoms in the case of suspected pudendal nerve entrapment after sacrospinous ligament fixation (SSLF).DesignRetrospective cohort study.SettingTertiary referral centre, the Netherlands.PopulationA cohort of 21 women having their SSLF sutures removed because of SSLF‐related pain symptoms.MethodsClinical record review.Main outcome measuresThe primary outcome was reduction of pain after SSL suture removal. Secondary outcome measures were time interval between suture placement and suture removal, complete suture removal, adverse events and recurrence of pelvic organ prolapse (POP).ResultsA total of 21 women underwent SSL suture removal for severe and/or persistent pain, which was confirmed on clinical examination: 95% of the women (20/21) reported pain reduction after suture removal, and 57% reported complete pain relief. The time interval between suture placement and suture removal was at a median of 414 days (range 8–1855 days). Sutures could be completely removed in 86% of cases (18/21). One woman had excessive blood loss (520 ml) without blood transfusion. At 6–8 weeks after surgery, 10% of the women (2/21) had renewed symptomatic POP, stage ≥ 2, for which additional POP surgery was indicated.ConclusionsWhen performed by an experienced clinician, SSL suture removal is feasible and efficacious, with low morbidity. In addition, the risk of recurrent POP in the short term appeared to be low.Tweetable abstractThe surgical removal of sacrospinous ligament sutures is safe and efficacious for pain relief, even remote from initial placement.

The impact of levator ani muscle trauma and contraction on recurrence after prolapse surgery

Introduction and hypothesisThe objective was to explore the impact of levator ani muscle (LAM) trauma and pelvic floor contraction on symptoms and anatomy after pelvic organ prolapse (POP) surgery.MethodsProspective study including 200 women with symptomatic POP ≥ grade 2 examined 3 months prior to and 6 months after surgery. Prolapse in each compartment was graded using the Pelvic Organ Prolapse Quantification (POP-Q) system, and women answered yes/no to a question about bulge sensation. Pelvic floor muscle contraction was assessed with transperineal ultrasound measuring proportional change in levator hiatal anteroposterior diameter from rest to contraction. LAM trauma was diagnosed using tomographic ultrasound imaging. Statistical analysis was performed using multivariate logistic regression analysis.ResultsA total of 183 women (92%) completed the study. Anatomical recurrence (POP ≥ grade 2) was found in 76 women (42%), and a bulge sensation was reported by 35 (19%). Ninety-two women (50%) had LAM trauma, and this was associated with increased risk of anatomical recurrence (OR 2.1 (95% CI 1.1–4.1), p = 0.022), but not bulge sensation (OR 1.1 (95% CI 0.5–2.4), p = 0.809). We found a reduced risk of bulge sensation for women with absent to weak contraction compared with normal to strong contraction (OR 0.4 (95% CI 0.1–0.9), p = 0.031), but no difference in risk for POP ≥ 2 after surgery (OR 1.5 (95% CI 0.8–2.9), p = 0.223).ConclusionsLevator ani muscle trauma was associated with increased risk of anatomical failure 6 months after POP surgery. Absent to weak pelvic floor muscle contraction was associated with reduced risk of bulge sensation after surgery.

How do reproductive history and anthropometry in midlife relate to later risk of pelvic organ prolapse? A prospective cohort study.

The objective was to examine the association between reproductive and anthropometric factors and later risk of pelvic organ prolapse (POP). We carried out a prospective cohort study including 11,114 female nurses > 44years from the Danish Nurse Cohort. In 1993, the study population was recruited through the Danish Nurse Organization and self-reported data on age, height, weight, age at menarche, age at first birth and number of childbirths were obtained. POP diagnosis was obtained from the National Patient Registry. Risk of POP was estimated using COX regression and presented as hazard ratios (HR) with 95% confidence intervals (CI). Overall, 10% of the women received a diagnosis of POP within a median follow-up of 22years. A 4% increase in risk of POP was seen for each increasing BMI (kg/m2) unit at baseline. Compared to women of normal weight, higher risks of POP were seen in overweight (HR 1.18: 1.02-1.36) and obese women (HR 1.33: 1.02-1.74), while underweight had a lower risk (HR 0.51: 0.27-0.95). Compared to women with one childbirth, women with no childbirths had a reduced risk of 57% while increased risks of 46%, 78% and 137% were observed in women with two, three and four childbirths. Women with menarche before the age of 12 tended to have a higher risk of POP as did women who were 30-33years at their first childbirth. POP is a common health problem in women, and BMI and number of childbirths are strong predictors.

Postoperative complications and pelvic organ prolapse recurrence following combined rectal prolapse and pelvic organ prolapse surgery compared to pelvic organ prolapse surgery only

The primary objectives were to compare the <30-day postoperative complications and POP recurrence in women undergoing combined pelvic organ prolapse (POP) and rectal prolapse (RP) surgeries to those undergoing POP-only surgery. Multicenter, retrospective case-control study at five academic hospitals and part of the AUGS-SGS Fellows Pelvic Research Network. Patients undergoing combined RP+POP surgery were matched by age, POP stage by leading compartment and POP procedure to those undergoing POP-only surgery from March 2003 and March 2020. Primary outcome measures were <30-day complications separated into Clavien-Dindo (CD) classes as well as 1) subsequent POP surgeries and 2) POP recurrence defined as patients who complained of vaginal bulge symptoms postoperatively. Data and percentages are presented for the combined surgery group followed by POP-only surgery group. Two hundred and four women underwent combined surgery for RP+POP and 204 women underwent surgery for POP only. Average age (59.3±1.0 vs 59.0±1.0) and parity (2.3 vs 2.6) was similar in each group. Average follow-up time was 307.2±31.5 days for the combined cohort and 487.7±49.9 days for the POP-only cohort. One hundred and nine patients (26.7%) had at least one 30-day complication. The proportion of patients who had a complication in the combined group and POP-only group was similar (27.0% vs 26.0%, p=0.82). CD scores were similar between the groups (10.3% vs 9.3% Grade 1, 11.8% vs 12.3% Grade 2, 3.9% vs 4.4% Grade 3, 1.0% vs 0% Grade 4, 0.5% vs 0% Grade 5). Combined patients were less likely than POP-only patients to develop postop UTIs and urinary retention, but were more likely to be treated for wound infections and pelvic abscesses. After adjusting for combined vs POP-only surgery, patients who had anti-incontinence procedures (aOR=1.85, 95% CI 1.16, 2.94, p=0.02) and perineorrhaphies (aOR=1.68, 95% CI 1.05, 2.70, p=0.02) were more likely to have <30-day postoperative complications. Twelve patients in the combined group and 15 patients in the POP-only group (5.9% vs 7.4%, p=0.26) had subsequent POP repair. Twenty-one patients in the combined surgery and 28 patients in the POP-only group (10.3% vs 13.7%, p=0.26) reported recurrent POP. On multivariable analysis adjusted for number of prior POP repairs, combined vs POP-only group and perineorrhaphy at the time of surgery, patients were more likely to have a subsequent POP surgery if they had had 2 or more prior POP repairs (aOR=6.06, 95% CI 2.10, 17.5, p=0.01). In this case-control study, patients undergoing combined POP+PR surgery had a similar risk of <30-day complications compared to patients undergoing POP-surgery alone. Combined patients also had a similar risk of recurrent POP and subsequent POP surgery compared to patients undergoing POP-only surgery.

Doğum şekli ve paritenin pelvik organ prolapsusu ve üriner inkontinans gelişimi üzerine etkisi

Aim: To investigate the effect of delivery mode and parity number on development of pelvic organ prolapse (POP) and urinary incontinence (UI).&#x0D; Materials and methods: 1500 women who had undergone surgery for POP and UI between 2007-2012 were retrospectively evaluated. After exclusion criteria, 875 women were included. 353 women with history of POP surgery were compared with 129 controls who had no POP and 201 patients with history of anti-incontinence surgery were compared with 192 controls who had no such surgery. Multiple effect of possible factors on the development of POP and UI was determined by logistic regression.&#x0D; Results: The characteristics of POP group and the controls, as well as anti incontinence surgery group and controls were similar, except parity number. The risk of having a POP surgery was higher with increasing number of parity. The highest risk was found in women with a history of 5 and more deliveries. For UI, multiparity seemed as a risk factor, however the risk of undergoing incontinence surgery did not increase with increasing number of parity. Delivery mode was not a risk factor for either POP or anti-incontinence group.&#x0D; Conclusion: The risk of POP increases with increasing number of parity, and also multiparity is a risk factor for UI. Women planning more than one delivery should be informed about this concern. Since the impact of delivery mode has not been shown clearly, we believe the incidence of pelvic floor dysfunction can be decreased with proper obstetric

Intrapartum Risk Factors for Pelvic Organ Prolapse Postpartum

Pregnancy and childbirth are thought to be significant risk factors associated with the development of pelvic organ prolapse; specific intrapartum risk factors are not well characterized. The objective was to determine intrapartum factors associated with increased risk of pelvic organ prolapse identified postpartum.

Pelvic organ prolapse following hysterectomy on benign indication: a nationwide, nulliparous cohort study

Hysterectomy is commonly performed and may increase the risk of pelvic organ prolapse. Previous studies in parous women have shown an increased risk of pelvic organ prolapse surgery after hysterectomy. Parity is a strong risk factor for pelvic organ prolapse and may confuse the true relation between hysterectomy and pelvic organ prolapse. This study aimed to investigate whether hysterectomy performed for benign conditions other than pelvic organ prolapse leads to an increased risk of pelvic organ prolapse surgery in a cohort of nulliparous women. We conducted a historical matched cohort study based on a nationwide population of nulliparous women born in 1947 to 2000 and living in Denmark during 1977 to 2018 (N=549,197). The data were obtained from the Danish Civil Registration System, the Danish National Patient Registry, the Fertility Register, and Statistics Denmark. Women who had a hysterectomy performed in 1977 to 2018 were included in the study (n=9535). For each of these women we randomly retrieved five nonhysterectomized women matched on age and calendar year to constitute the reference group (n=47,370). Cox proportional hazard regression analyses were performed to compare the risk of pelvic organ prolapse surgery in the 2 groups of women. The study included 56,905 women whom we observed for up to 42 years, entailing 809,435 person-years in risk. Overall, 9535 women who underwent a hysterectomy were matched individually with 47,370 reference women. Subsequently, a total of 29 women (30.4%) who underwent a hysterectomy and 85 reference women (17.9%) had a pelvic organ prolapse surgery performed, corresponding to incidence rates of 20.5 and 12.7 per 100,000 risk years, respectively. In addition, the risk of pelvic organ prolapse surgery increased by 60% in women who underwent a hysterectomy compared with women in the reference group (crude hazard ratio, 1.6; 95% confidence interval, 1.0-2.5; P=.04; adjusted hazard ratio, 1.6; 95% confidence interval, 1.0-2.5; P=.04). After the exclusion of women who underwent vaginal hysterectomy and their matches, the results were significantly the same (crude hazard ratio, 1.5; 95% confidence interval, 1.0-2.4; P=.05). Furthermore, we found higher rates of pelvic organ prolapse surgery in women who had a subtotal hysterectomy, total hysterectomy, or vaginal and laparoscopic-assisted vaginal hysterectomies than in women in the reference group. Hysterectomy increased the risk of pelvic organ prolapse surgery for nulliparous women by 60%. Previous studies of multiparous women have similarly shown an increased risk of prolapse after hysterectomy. As the most common risk factor for pelvic organ prolapse-vaginal birth-was not included and women were >72 years of age in this study, the numbers of pelvic organ prolapse surgeries were low. Despite the low absolute risk of pelvic organ prolapse surgery in nulliparous women, they were important in investigating the association between hysterectomy and pelvic organ prolapse, excluding vaginal birth, which is the most common risk factor for pelvic organ prolapse. As this cohort study of nulliparous women found an increased risk of pelvic organ prolapse surgery after hysterectomy, it is implied that the uterus per se protects against pelvic organ prolapse. As such, gynecologists should be aware of the risks associated with hysterectomy, and alternative uterus-sparing treatments should be considered when possible. Furthermore, women should be informed about the risks before being offered a hysterectomy.