Severity Of Pelvic Organ Prolapse Research Articles

Measuring Pelvic Organ Prolapse: An Evolution.

Advances in our understanding of pelvic organ prolapse (POP) have been made with the introduction of valid, reliable measures of anatomy and patient-reported outcome measures. This review provides an overview of the evolution of POP measurement and its implications for clinical practice and research. Since the introduction of the Pelvic Organ Prolapse Quantification (POPQ), studies have demonstrated that some degree of loss of anatomic support is normal, with as many as 40% of normal women having stage 2 prolapse. Vaginal support is dynamic and can wax and wane but is largely stable over time. Vaginal bulge symptoms are the most reliable and specific symptom for POP and the hymen is an important threshold for symptom development. Most pelvic floor symptoms have only weak to moderate correlation with the anatomic severity of POP. Treatment success rates are highly variable depending upon criteria used and definitions of anatomic success commonly used are too strict and often not clinically relevant. There is substantial discordance between subjective and anatomic measures of success, and both are dynamic, fluctuating between success and failure for many patients without intervening treatment. Pelvic organ prolapse is multidimensional, dynamic, and has a complex impact on patients. Patients' symptoms are more clinically relevant than anatomic support. Symptomatic cure, particularly the absence of vaginal bulge symptoms, is more clinically relevant than anatomic cure and composite outcomes can be misleading and overestimate failure rates. Future studies should compare treatments using continuous variables along multiple dimensions rather than using composite outcomes or dichotomizing patients into success or failure.

Послеоперационные рецидивы пролапса тазовых органов и их комбинированная безоперационная коррекция

Objective. To study the efficacy and safety of combined (laser + electromyostimulation + pelvic floor muscle training) nonsurgical correction of pelvic organ prolapse (POP) recurrences in the late postoperative period in reproductive-aged, pre- and postmenopausal patients with different types of POP. Patients and methods. A comprehensive clinical examination, surgical treatment, and dynamic outpatient follow-up (at 1, 6, 12, 24, 36, and 48 months) of 523 patients with different types and severity of POP were performed. Disease recurrences were diagnosed in 69 (13.2%) women, 52 of whom underwent a combined non-surgical corrective therapy (laser + electromyostimulation + pelvic floor muscle training) with subsequent efficacy evaluation after 6 and 12 months. Results. Postoperative recurrences of POP were most often observed 12–36 months after surgical intervention using only own tissues (26.6%), less frequently – when synthetic implants were used (12.7%) and, extremely rarely, when titanium endoprostheses were inserted (1.6%). The positive effect of combined non-surgical correction in 32 (61.5%) women was expressed in a lower number and intensity of symptoms, improvement in the quality of life according to the PFDI-20 scale, optimization of gynecological examination data and quantitative parameters according to the POP-Q classification system. Conclusion. Combined non-surgical therapy (laser + electromyostimulation + pelvic floor muscle training) for postoperative recurrences of POP contributed to the optimization of clinical picture, dynamic improvement of the quantitative parameters of postoperative prolapse according to the POP-Q classification system, improvement of the quality of life of women, their social and sexual rehabilitation, which demonstrates the efficacy and safety of the implemented therapeutic program. Key words: postoperative recurrences of pelvic organ prolapse, combined non-surgical therapy, fractional CO2 laser, electromyostimulation, pelvic floor muscle training

#359 : Impact of Genitourinary Prolapse on Quality of Life and Sexual Function in Women at Their Midlife

Background and Aims: Pelvic organ prolapse (POP) is a common condition affecting women during their midlife, leading to various symptoms and decreased quality of life (QoL). This study aimed to assess the association of POP severity with QoL and sexual function in women at their midlife, with the objective of providing valuable insights for comprehensive care and effective management of POP. Method: A cross-sectional study included 130 symptomatic GUP women aged 40-60 years from Sir Salimullah Medical College & Mitford Hospital in Dhaka. Group 1 (85 women) had stage 1 GUP, while the remaining were in group 2. Face-to-face interviews and POP-Q staging were conducted, followed by statistical analysis using Chi-Square, Mann-Whitney U, and Spearman rank correlation tests to examine the association of GUP severity with QoL and sexual function between the groups. Results: The mean age of the participants was 51.24 years (SD=5.5). The majority of the respondents were above 50 years of age (56%), and 65.38% of the study population were in group 2. One-third of the respondents (35.38%) had stage III GUP whereas only 4.62% were in stage IV. The frequency of urinary symptoms was most commonly occurring (70%) where dribbling of urine was least frequent (38%). Sexual and bowel symptoms were correlated with advanced stage of disease where urinary symptoms were not associated with GUP severity. Sexual dysfunction symptoms were positively associated with uterine descent. Regarding quality of life, all nine domains of QoL scores had positive correlation with severity of GUP. Conclusion: This study reveals the correlation between POP and urinary, bowel, and sexual symptoms. Clinicians should assess these symptoms for comprehensive care, and further research is required to determine effective treatment options for women with POP.

Analysis of questions by patients with pelvic organ prolapse about vaginal pessaries resulting in a checklist for their physicians.

International guidelines recommend vaginal pessaries as a first-choice treatment of symptomatic pelvic organ prolapse (POP). Gynecologists rarely receive systematic training or just do not take the time to communicate with their patients. We hypothesized that we could identify key deficits and limitations of counseling before or during pessary therapy from questions directed to manufacturers with the aim to improve and promote health literacy of women with POP. We approached five manufacturers to provide anonymized inquiries related to pessary use. After exclusion of duplicates and questions about obstetric pessaries, 174 data sets from 145 patients remained. In 19/145 patients (13.1%), a 2nd degree, and in 94/145 (64.8%), a 3rd-4th degree of POP was identified. Four patients had additional urinary incontinence. In 32/145 (22.1%), the severity of POP could not be identified. The age of patients ranged from 27 to 98 (mean = 63.7) years. Most inquiries were related to the selected pessary models or sizes (40/174; 22.9%), self-management (20/174; 11.5%), and technical aspects such as shelf life or appropriate cleaning (26/174; 14.9%). Pain or voiding dysfunction was present in 17/174 remarks (9.7%). Lifestyle questions related to the use of pessaries during sport, menstruation, or mechanical anticonception. The cube pessary was in the focus of interest followed by the sieve bowl, urethra, ring, and Gellhorn device. The list of questions was summarized as a checklist stratified according to priorities. The checklist should help improve counseling and self-management of patients to optimize the benefit/risk ratio of conservative treatment of pelvic floor diseases.

Surgical treatment of pelvic organ prolapse using colpocleisis: A case series.

Pelvic organ prolapse (POP) is a common condition. With increasing lifespan and emphasis on quality of life worldwide, older women with POP may prefer surgical treatment, including colpocleisis. We reviewed the outcome of POP in a case series of colpocleisis. This study was conducted between 2006 and 2011. Patients had confirmed POP on examination and underwent partial and total colpocleisis. We compared patients' demographic characteristics, POP severity and surgical outcomes. In total, 55 patients were included. The patients were aged 78.9 + 6.7 years and had body mass index (BMI) of 26.9 ± 4.2. Among the total, 44 (80%) and 11 patients (20%) underwent partial and total colpocleisis respectively. Patients undergoing partial colpocleisis had procidentia less often than those undergoing total colpocleisis (18% v 64%, p=0.01). Mean blood loss and operative time were 157.6 ml ± 119.0 and 65.1 ± 20.3 minutes respectively. Partial colpocleisis had less blood loss (mean 135.7 v 227.2 ml, p=0.02) and shorter operative time (mean 62.6 v 75.0 min, p=0.18). Partial compared to total colpocleisis was associated with shorter operative time and less blood loss. Colpocleisis is a suitable surgical treatment for POP in elderly women who do not wish to preserve the vagina for sexual intercourse.

An evaluation of pelvic organ prolapses in perimenopausal and menopausal Chinese females.

The aim of the study was to evaluate the prevalence of pelvic organ prolapse (POP) and correlate the various factors including, but not limited to, educational status, socio-economic condition, body mass index (BMI), menstrual history, with the status and severity of POP. A retrospective cross-sectional study was conducted between August 2021 and September 2022 and suspected patients of POP were considered from the outpatient Department of Gynecology and Obstetrics. The study has mainly used 3 indicators of socio-economic status, namely, occupation, education, and income. These factors were correlated and statistically analyzed with that of POP. The study findings revealed that there are more symptomatic patients who are illiterate as compared to asymptomatic POP and with increasing education status, there is a decrease in symptomatic POP patients (p<0.05). Also, there is a significant proportion of symptomatic POP patients in the lower class and lower middle class as compared to asymptomatic patients in each class, respectively (p<0.05). It also found that micturition difficulty and vaginal bulging are significantly correlated with the stages of POP (p<0.05). Educational status and socio-economic condition are significant indicators of the presence of symptoms or severity of POP. The study further concluded that menopausal females have more symptomatic POP as compared to pre-menopausal females.

Interactions between genetic variants and environmental risk factors are associated with the severity of pelvic organ prolapse.

Both environmental and genetic risk factors contribute to pelvic organ prolapse (POP). No genome-wide study has investigated the gene-environment (G × E) interactions. In this study, we aim to identify single nucleotide polymorphisms (SNPs) that may interact with the potential environmental factors, maximum birth weight, and age in Chinese women. We recruited 576 women for phase 1 and 264 women for phase 2 with stages III and IV prolapse from six geographic regions of China. Genomic DNAs from blood samples were genotyped using Affymetrix Axiom Genome-Wide CHB1 Array of 640,674 SNPs for phase 1 and Illumina Infinium Asian Screening Array of 743,722 SNPs for phase 2. Meta-analysis was used to combine the two results. Interactions of genetic variants with maximum birth weight and age on POP severity were identified. In phase 1, 502,283 SNPs in 523 women passed quality control and 450 women had complete POP-quantification measurements. In phase 2, 463,351 SNPs in 257 women passed quality control with complete POP-quantification measurements. Three SNPs rs76662748 ( WDR59 , Pmeta = 2.146 × 10 -8 ), rs149541061 ( 3p26.1 , Pmeta = 9.273 × 10 -9 ), and rs34503674 ( DOCK9 , Pmeta = 1.778 × 10 -9 ) respectively interacted with maximum birth weight, and two SNPs rs74065743 ( LINC01343 , Pmeta = 4.386 × 10 -8 ) and rs322376 ( NEURL1B - DUSP1 , Pmeta = 2.263 × 10 -8 ), respectively, interacted with age. The magnitude of disease severity associated with maximum birth weight and age differed according to genetic variants. This study provided preliminary evidence that interactions between genetic variants and environmental risk factors are associated with POP severity, suggesting the potential use of combining epidemiologic exposure data with selected genotyping for risk assessment and patient stratification.

Triple-compartment strategy for abdominal sacral colpopexy using PVDF mesh: one-year report of anatomical and subjective outcomes.

Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a triple-compartment open ASC strategy using polyvinylidene fluoride (PVDF) mesh in the treatment of patients with severe apical or uterine prolapse. Women with high-grade uterine or apical prolapse with or without cysto-rectocele were prospectively enrolled in the study from April 2015 to June 2021. We performed all-compartment repair using a tailored PVDF mesh for ASC. We assessed the severity of pelvic organ prolapse (POP) using the Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and 12 months after the operation. The patients completed the International Continence Society Questionnaire Vaginal Symptom (ICIQ-VS) questionnaire at baseline, 3, 6, and 12 months postoperatively. Thirty-five women with a mean age of 59.8±10.0 years were included in the final analysis. Stage III and stage IV prolapse was evident in 12 and 25 patients, respectively. After 12 months, the median POP-Q stage was significantly lower compared to the baseline (4 vs 0, p=<0.0001). Vaginal symptoms score was also reduced significantly at 3-month (7.5±3.5), 6-month (7.3±3.6), and 12-month (7.2±3.1) compared to the baseline (39.5±6.7) (p values < 0.0001). We did not observe any mesh extrusion or high-grade complications. Six (16.7%) patients had cystocele recurrence during the 12-month follow-up, and two of them needed reoperation. Our short-term follow-up showed that using an open ASC technique with PVDF mesh in treating high-grade apical or uterine prolapse is associated with a high rate of procedural success and low rates of complication.

The relationship between the degree of prolapse and bone mineral density in postmenopausal women with pelvic organ prolapse

This study aimed to investigate the relationship between the degree of prolapse and bone mineral density (BMD) in postmenopausal women with pelvic organ prolapse (POP). Materials and Methods: This retrospective study includes 40 postmenopausal women who were operated for POP. While patients who had grade &lt;3 vaginal cuff prolapse were accepted as low grade prolapse, patients with grade ≥ 3 vaginal cuff prolapse were accepted as high grade prolapse. Patients' demographic characteristics, obstetric and gynecological history, laboratory findings and dual- energy X-ray absorptiometry results (lumbar spine BMD, lumbar spine T and Z scores, femur neck BMD, femur neck T and Z scores) were recorded as study parameters. Results: There were no significant differences between the groups in terms of age, body mass index, gravida, parity, follicle-stimulating hormone levels. BMD of the femur neck and lumbar spine were significantly higher in the low grade prolapse group than in the high grade prolapse group. T score of the femur neck were significantly higher in the low grade prolapse group than in the high grade prolapse group. In addition, estradiol levels of the high grade prolapse group was lower than the low grade prolapse group. BMD and T score of the femur neck and BMD of the lumbar spine were found to be significantly lower in the high grade prolapse group, suggesting that, there may be an association between the severity of POP and the risk of osteoporosis in postmenopausal women.

Association of HOXA13 Gene Expression among Premenopausal Women with the Severity of Pelvic Organ Prolapse: A Cross-sectional Study

Association of HOXA13 Gene Expression among Premenopausal Women with the Severity of Pelvic Organ Prolapse: A Cross-sectional Study

Intermediate-term follow-up of laparoscopic pectopexy cases and their effects on sexual function and quality of life: a cross-sectional study.

ABSTRACTBACKGROUND:Apical prolapsus refers to downward displacement of the vaginal apex, uterus or cervix. Pelvic organ prolapse (POP) can significantly affect women’s daily activities and sexuality.OBJECTIVE:To investigate, at the mid-term follow-up after laparoscopic pectopexy surgery, whether this procedure improved the patients’ quality of life and sexual function.DESIGN AND SETTING:In this cross-sectional study, data on patients who underwent laparoscopic pectopexy in the Gazi Yasargil Education and Research Hospital were evaluated.METHODS:Thirty-five patients with symptomatic apical prolapse and POP quantification stage II and higher were included in this study. We used the Turkish version of the female sexual function index (FSFI) questionnaire to assess preoperative and postoperative sexual dysfunction, and the Turkish version of the Prolapse Quality of Life Questionnaire (P-QOL) to evaluate the severity of POP and its impact on quality of life.RESULTS:The mean age, parity and length of follow-up of the patients were 36.08 ± 9.04 years, 4.00 ± 1.86 and 28.88 ± 5.88 months, respectively. The most common complications were de novo rectocele in three patients (8.6%) and de novo cystocele in two patients (5.7%). All the FSFI and P-QOL scores were statistically significantly improved in the postoperative period (P < 0.001 for all scores of both FSFI and P-QOL).CONCLUSION:The quality of life and sexual function of the patients who underwent laparoscopic pectopexy were found to have become statistically improved at the midterm follow-up. Laparoscopic pectopexy was found to be a viable, effective and safe procedure.

MRI biomarker of muscle composition is associated with severity of pelvic organ prolapse

The pathophysiology of pelvic organ prolapse is largely unknown. We hypothesized that reduced muscle mass on magnetic resonance defecography (MRD) is associated with increased pelvic floor laxity. The aim of this study was to compare the psoas and puborectalis muscle mass composition and cross-sectional area among patients with or without pelvic laxity. An observational retrospective study was conducted on women > age 18years old who had undergone MRD for pelvic floor complaints from January 2020 to December 2020 at Stanford Pelvic Health Center. Pelvic floor laxity, pelvic organ descent, and rectal prolapse were characterized by standard measurements on MRD and compared to the psoas (L4 level) and puborectalis muscle index (cross-sectional area adjusted by height) and relative fat fraction, quantified by utilizing a 2-point Dixon technique. Regression analysis was used to quantify the association between muscle characteristics and pelvic organ measurements. The psoas fat fraction was significantly elevated in patients with abnormally increased resting and strain H and M lines (p < 0.05) and increased with rising grades of Oxford rectal prolapse (p = 0.0001), uterovaginal descent (p = 0.001) and bladder descent (p = 0.0005). In multivariate regression analysis, adjusted for age and body mass index, the psoas fat fraction (not muscle index) was an independent risk factor for abnormal strain H and M line; odds ratio (95% confidence interval) of 17.8 (2-155.4) and 18.5 (1.3-258.3) respectively, and rising Oxford grade of rectal prolapse 153.9 (4.4-5383) and bladder descent 12.4 (1.5-106). Puborectalis fat fraction was increased by rising grades of Oxford rectal prolapse (p = 0.0002). Severity of pelvic organ prolapse appears to be associated with increasing psoas muscle fat fraction, a biomarker for reduced skeletal muscle mass. Future prospective research is needed to determine if sarcopenia may predict postsurgical outcomes after pelvic organ prolapse repair.

Surgical treatment of pelvic organ prolapse in women aged ≥75 years in Hong Kong: a multicentre retrospective study.

Pelvic organ prolapse (POP) is common among older women. With the increasing lifespan and emphasis on quality of life worldwide, older women increasingly prefer surgical treatment for POP. We reviewed the surgical treatment of POP in older women to characterise its safety, effectiveness, and the type most often selected. This multicentre, retrospective study was conducted at four hospitals between 2013 and 2018. Included patients were aged ≥75 years and had undergone POP surgery. We compared patient demographic characteristics, POP severity, and surgical outcomes between reconstructive and obliterative surgeries; these comparisons were also made among vaginal hysterectomy plus pelvic floor repair (VHPFR), transvaginal mesh surgery (TVM), vaginal hysterectomy (VH) plus colpocleisis, and colpocleisis alone. In total, 343 patients were included; 84.3% and 15.7% underwent reconstructive and obliterative surgeries, respectively. Overall, 246 (71.7%), 43 (12.5%), 20 (5.8%), and 34 (9.9%) patients underwent VHPFR, TVM, VH plus colpocleisis, and colpocleisis alone, respectively. Patients who were older (81.9 vs 79.6 y; P=0.001), had vault prolapse (38.9% vs 3.5%; P<0.001), and had medical co-morbidities (37% vs 4.8%; P<0.001) chose obliterative surgery more frequently than reconstructive surgery. Obliterative surgeries had shorter operative time (73.5 min vs 107 min; P<0.001) and fewer surgical complications (9.3% vs 28.0%; P=0.003). Vaginal hysterectomy plus pelvic floor repair had the highest rate of surgical complications (most were minor), while colpocleisis alone had the lowest rate (30.1% vs 8.8%; P=0.01). Pelvic organ prolapse surgeries were safe and effective for older women. Colpocleisis may be appropriate as primary surgery for fragile older women.

The effect of pelvic floor muscle training for women with pelvic organ prolapse: a meta-analysis.

This study was aimed at evaluating the effect of pelvic floor muscle training (PFMT) as a conservative treatment for patients with pelvic organ prolapse (POP). A comprehensive search to identify eligible randomized controlled trial (RCT) studies was conducted using electronic databases including PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase up to 10 June 2021. Results were presented as risk ratio (RR), the weighted mean difference (WMD), with 95% confidence interval (95% CI) using the random effects model. Outcome variables were pooled using Review Manager version 5.3. Thirteen studies were included. Our results demonstrated that women who received PFMT intervention had a greater improvement than controls in prolapse symptom score (POP-SS; mean difference [MD] -1.66, 95% CI -2.36 to -0.97, p < 0.00001] and POP stages (risk ration [RR] 1.51, 95% CI 1.14-2.01, p = 0.004). The number of participants who felt better after PFMT was higher (RR 1.98, 95% CI 1.21-3.24, p = 0.006). Subgroup analysis showed that the symptoms of prolapse and the degree of prolapse were improved significantly in the short term, but there was no significant difference in the long-term effect. In addition, there was no significant difference in the impact of PFMT on the elderly and the quality of life. More RCTs are needed to evaluate the effect of PFMT on the elderly and whether the quality of life can be improved. We found that PFMT can improve subjective symptoms and objective POP severity. More research is needed on the long-term effect.

Pre-operative surgical planning for minimally-invasive sacral colpopexy: integrating patient choice into surgical approach

Pelvic organ prolapse (POP) occurs when organs in the female pelvis herniate into the vaginal canal. Moderate to severe cases of POP can cause sexual, urinary, and defecatory dysfunction and often require surgical intervention. Sacral colpopexy (SCP) is a safe, durable procedure widely used to treat apical POP. It is typically performed in a minimally-invasive manner via laparoscopic or robot-assisted surgery, but can be converted to an open abdominal approach intraoperatively if unforeseen challenges arise. There is ample literature describing patient risk factors for intraoperative conversion, but little to describe patient preference in surgical approach. The purpose of this study was to examine factors that may influence a patient’s decision to choose to undergo laparotomy vs. opting for a native-tissue vaginal repair. 128 patients between the ages of 32-82 who underwent SCP to treat apical POP were included in the study. Each patient participated in a pre-operative conversation with the operating surgeon during which the patient indicated their preference of surgical approach if intraoperative conversion was deemed necessary. Each patient chose one of two options: to convert the procedure to an open SCP or to convert the procedure to a different, less durable vaginal repair. The data of interest, including demographic information, medical history, and POP severity were collected pre-operatively and were entered into a secure database. Of the 128 patients who underwent SCP, 74% (n=95) elected to undergo laparotomy if intraoperative conversion were to become necessary and 26% (n=33) opted for a native-tissue vaginal repair. The average age of patients who chose laparotomy was 60 years old, which was significantly younger than patients who chose vaginal repair (m=64y, p=0.03). Patients who chose laparotomy were also significantly more likely to have a higher BMI than their counterparts who chose vaginal repair (p=0.03). There was no statistically significant association between groups regarding race, education, marital status, severity of POP, or symptomatology. When given the opportunity to indicate their preference, most patients chose to undergo a more invasive surgery with higher rates of complication to receive SCP, which likely reflects the prolapse patient’s desire for the most durable and effective procedure for treating POP. The group opting for native-tissue vaginal repair was significantly older, which is likely due to a greater risk of complication and longer recovery with open abdominal surgery. Patients with a higher BMI were more likely to choose laparotomy, which could reflect the increased risk of POP recurrence with high BMI, especially after vaginal repair. More research is needed to further examine what influences patient preference of surgical approach in elective surgery.

Effects of Adding Ultrasound Biofeedback to Individualized Pelvic Floor Muscle Training on Extensibility of the Pelvic Floor Muscle and Anterior Pelvic Organ Prolapse in Postmenopausal Women.

The aim of the study was to determine effects of adding transperineal ultrasound (TPUS) biofeedback to individualized pelvic floor muscle training (PFMT) on extensibility of the pelvic floor muscle and anterior pelvic organ prolapse (POP) in postmenopausal women. A total of 77 patients with POP at stage I or stage II were admitted to Beijing Shijitan Hospital, China, from January 2017 to October 2018. They were randomly divided into a control group (CG) (n = 37) or a study group (SG) (n = 40). Both SG and CG received a 12-week PFMT including health education, verbal instruction, and home training. However, the SG, but not the CG, received additional TPUS biofeedback. Data of these patients were retrospectively reviewed. The distance from the lowest point of the bladder to the inferior-posterior margin of the symphysis pubis (BSP) and the levator hiatus area (LHA) were measured on maximal Valsalva via TPUS before and after the 12-week PFMT. Correct pelvic floor muscle contraction (PFMC) rates before and after PFMT were compared between the two groups. The correct PFMC rate was higher in the SG than that in the CG (92.5% vs. 73%; x2 = 5.223, p=0.022). The BSP was increased but the LHA was reduced after the 12-week PFMT in both groups compared to those before PFMT (all p < 0.05). However, after the PFMT, the SG showed greater improvement than the CG for both BSP (0.77 ± 0.71 cm vs. 0.11 ± 0.66 cm, p < 0.05) and LHA (20.69 ± 2.77 cm2 vs. 22.85 ± 3.98 cm2, p < 0.05). TPUS might be an effective biofeedback tool for PFMT in clinical practice. Individualized PFMT with TPUS biofeedback could significantly attenuate POP severity and strengthen the extensibility of pelvic floor muscle in postmenopausal women when they are under increased intraabdominal pressure.

To Assess Social Demographic Characteristics of Women with Pelvic Organ Prolapse

Introduction: One of the prevalent clinical conditions in daily gynecological treatment is pelvic organ prolapses (POP), particularly in parous women. The entity comprises vaginal wall descent and/or uterine descent. Pelvic organ prolapse is a common pelvic disorder among women.&#x0D; Objective: To determine the social demographic characteristics and types of pelvic organ prolapse and to find out the association between social demographical characteristics with pelvic organ prolapse.&#x0D; Methods: The descriptive survey was used and the sampling technique was non probability convenient sampling technique and the sample size was 60.&#x0D; Results: Twenty six (43.3%) women were belongs to in the age group of 33-40 years. 54 (90%) of women were married.29 (48.3% ) of women never had abortion. 26 (43.3%) of women had normal delivery whereas 17(28.3) had instrumental delivery .19 (31.3%) of women had perineal tear, 20 (33.30%) of women had cervical tear in previous pregnancy . 21(35% ) of women had cystocele whereas 20(33.3) has rectocele . There is significance association between the of age of women, marital status, occupation, Place of previous delivery, type of previous delivery, complications during previous labour except the parity with pelvic organ prolapse.&#x0D; Conclusion: Pelvic organ prolapse is common gynecological condition .The patients are relatively middle age group. Parity, Occupation, Injuries to birth canal was may be contributory to severity of pelvic organ prolapse.

Comparison of mood state in severe pelvic organ prolapse patients before and after surgery

ObjectiveThis study aimed to compare the mood state of patients with severe pelvic organ prolapse (POP) before and after surgery. MethodsThis prospective study enrolled 100 patients with severe POP who were surgically treated between October 2016 and February 2019. The clinical severity of POP was evaluated using the POP Quantification (POP-Q) System. Mood state evaluation, using the Hamilton anxiety (HAMA) and the Hamilton depression (HAMD) scale, was performed preoperatively and at 3 and 6 months postoperatively. ResultsThe POP-Q stage was significantly improved postoperatively (P ​< ​0.05). Preoperatively, the patients had varying degrees of anxiety symptoms (mean HAMA score, 11.94 ​± ​5.59 points) and depression symptoms (mean HAMD score, 5.56 ​± ​2.58 points); these scores were significantly decreased at 3 months (mean HAMA score, 4.67 ​± ​2.02 points; mean HAMD score, 3.58 ​± ​1.61 points) and 6 months postoperatively (mean HAMA score, 4.88 ​± ​2.57 points; mean HAMD score, 3.38 ​± ​1.60 points) (P ​< ​0.05). There were no differences in the HAMD and HAMA scores in both traditional prolapse surgery patients and mesh pelvic reconstruction patients preoperatively and at 3 and 6 months postoperatively (P＞0.05). ConclusionsPatients with severe POP have different anxiety and depression symptoms preoperatively. Successful individualized surgical treatment is effective for improving the clinical severity of severe POP and might alleviate or improve POP-related anxiety or depression symptoms.

Comprehensive management of patients with pelvis organ prolapse and metabolic syndrome

Background. Genital prolapse (GP) and stress urinary incontinence (SUI) are characterized by a failure of connective tissue skeleton of the pelvic floor structures, and there are many risk factors in their pathogenesis. Metabolic syndrome (MS), which includes obesity and abnormalities in the lipid and carbohydrate profile, contributes to the initiation of pelvic organ prolapse (POP) due to increased intra-abdominal pressure and the presence of comorbidities. Endothelial dysfunction associated with MS aggravates the existing metabolic disorders, resulting in the formation of a vicious circle and an increase in the likelihood of recurrence of genital prolapse symptoms and НМ during tension in the postoperative period. Aim. The search for rational algorithms for the comprehensive management of patients with POP and MS. Materials and methods. A comparative analysis of effectiveness of treatment with the use of surgical method or drugs which affect the metabolic profile in patients with GP and SUI was carried out. Results. Drugs which contribute the restoration of lipid and carbohydrate profiles, and microcirculatory vasculature normalization, attenuate negative effects of MS components on the integrity of pelvic floor structures. Comprehensive management of patients with POP and MS with surgical correction of GP and SUI, as well as the use of drugs affecting metabolism, is highly effective and predictive in regard to POP severity and the risk of recurrence of clinical symptoms in the postoperative period. Conclusion. Adequate restoration of the endothelial layer in patients with pelvic floor muscle incompetence and endothelial dysfunction reduces the likelihood of developing mesh-associated complications after the surgical stage of treatment.

Vaginal Colposuspension Using the Uphold Lite Mesh System versus Transvaginal Hysterectomy with Uterosacral Ligament Suspension for Treatment of Apical Prolapse: A Comparative Study

To compare clinical and anatomic outcomes as well as patient satisfaction in women undergoing vaginal colposuspension using the Uphold Lite system (Boston Scientific Corporation, Marlborough, MA) and transvaginal hysterectomy with uterosacral ligament suspension (VUSLS) for the treatment of apical prolapse. Retrospective cohort study. Female pelvic medicine and reconstructive surgery unit at a university-affiliated tertiary medical center. Women with apical prolapse who underwent either vaginal colposuspension using the Uphold Lite system (uterine-preserving as well as after previous hysterectomy) or VUSLS from 2010 to 2019. Excluded were women with 1 month or less of follow-up. None. A total of 164 women were included in the study: 112 women underwent VUSLS, and 52 underwent colposuspension using the Uphold Lite mesh system. Age, body mass index, maximal birth weight, comorbidity rates, and pelvic organ prolapse severity were similar between the groups. The clinical cure rate was similarly high in both groups, with 91.1% in the women who underwent VUSLS and 88.5% in those in the Uphold Lite group (p = .60). No differences were noted between the groups with regard to anatomic cure rate or composite outcome success rate (73.9% vs 76.0%, p = .77 and 70.3% vs 74.0%, p = .63, in the VUSLS and Uphold Lite groups, respectively). An advantage was noted in the VUSLS group with regard to patient satisfaction with 98.1% of the women stating that their condition was very much better (Patient Global Impression of Improvement questionnaire: A) or much better (Patient Global Impression of Improvement questionnaire: B) compared with 83.9% of the women in the Uphold Lite group (p = .023). In an attempt to assess the association between different variables and the composite outcome, a multivariate analysis was performed in which increased body mass index, menopausal status, and increased preoperative genital hiatus were found to decrease composite outcome success. Vaginal colposuspension using the Uphold Lite system and VUSLS for the treatment of apical prolapse have comparable results with high clinical success rates.