Pelvic Organ Prolapse Stage Research Articles

Abdominal Sacrohysteropexy for uterovaginal prolapse: a prospective study on 33 cases

To evaluate the results of abdominal sacrohysteropexy using polypropylene mesh in women with uterovaginal prolapse, wishing to preserve their uteri. Prospective observational study. Tertiary referral Gynecology centre. Thirty-three women with symptomatic uterovaginal prolapse operated on by the same surgeon. Sacrohysteropexy performed using polypropylene mesh extending between the back of the uterus at the uterosacral ligaments and the sacrum. Subjective and objective relief of uterine prolapse and operative and post-operative complications. The mean age of the women was 46 years (range 29-65). All were multiparous with mean weight of 83.3 kg (70-96). Pelvic organ prolapse (POP-Q) stage 2 was found in 27 cases (81.8%) and stage 3 in six women (12.2%). Mean operative time was 45.76 min (30-75), and mean hospital stay was 2.45 days. One case suffered rectal injury, one case had median sacral vein injury, both were repaired immediately. Two cases had delayed voiding recovery. The mean follow up time was 6 months. At follow up, only two cases showed recurrence, and the objective and subjective success rates at 6 months were 93.93 and 81.8%, respectively. Abdominal sacrohysteropexy is a safe, efficient surgical technique for treatment of uterine prolapse in women who desire to preserve the uterus. This procedure has a high success rate and is an easy technique with short learning curve.

The prevalence of pelvic organ prolapse symptoms and signs and their relation with bladder and bowel disorders in a general female population

Introduction and hypothesisIn selected populations, pelvic organ prolapse (POP) was associated with bladder/bowel symptoms, but data on the general female population are lacking. Our aim was to obtain normative data on the prevalence of POP and pelvic floor dysfunction (PFD) symptoms and signs and to identify associations.MethodsValidated questionnaires on POP and PFD (urogenital distress inventory, (UDI) and defaecation distress inventory (DDI)) were sent to a general population of 2,979 women (aged 45–85 years). Data were analysed using the Kruskal–Wallis test, chi square test and Spearman’s rank correlation coefficient.ResultsResponse rate was 62.7%. Associations between POP stage and parity (0.002) and vaginal bulging (<0.001) are significant. Anatomical locations of POP and PFD symptoms correlated significantly with incontinence of flatus, feeling anal prolapse, manual evacuation of stool, vaginal bulging, constipation and pain during faecal urge (p ≤ 0.005).ConclusionsStrategies should be developed to alleviate obstructive bowel disorders associated with POP.

A systematic review of clinical studies on dynamic magnetic resonance imaging of pelvic organ prolapse: the use of reference lines and anatomical landmarks

The aim of our study was to provide a systematic literature review of clinical studies on pelvic organ prolapse staging with use of dynamic magnetic resonance (MR) imaging. The databases EMBASE and PubMed were searched. Clinical studies were included in case they compared pelvic organ prolapse stages as assessed on dynamic MR imaging (using a reference line) with a standardized method of clinical prolapse staging. Ten studies were included, which made use of seven different reference lines in relation to a wide variety of anatomical landmarks. Only few studies have compared pelvic organ prolapse stages as assessed by dynamic MR imaging and clinical examination in a standardized manner. The available evidence suggests that prolapse assessment on dynamic MR imaging may be useful in the posterior compartment, but clinical assessment and dynamic MR imaging seem interchangeable in the anterior and central compartment.

POP-Q, dynamic MR imaging, and perineal ultrasonography: do they agree in the quantification of female pelvic organ prolapse?

This study evaluates the agreement in prolapse staging between clinical examination, dynamic magnetic resonance (MR), imaging and perineal ultrasonography. Anatomical landmarks in the anterior, central, and posterior compartment were assessed in relation to three reference lines on dynamic MR imaging and one reference line on dynamic ultrasonography. These measurements were compared to the according POP-Q measurements. Agreement between the three methods was analyzed with Spearman's rank correlation coefficient (r(s)) and Bland and Altman plots. Correlations were good to moderate in the anterior compartment (r(s) range = 0.49; 0.70) and moderate to poor (r(s) range = -0.03; 0.49) in the central and posterior compartment. This finding was independent of the staging method and reference lines used. Pelvic organ prolapse staging with the use of POP-Q, dynamic MR imaging, and perineal ultrasonography only correlates in the anterior compartment.

Polymorphism of a COLIA1 Gene Sp1 Binding Site in Korean Women with Pelvic Organ Prolapse

PurposeTo evaluate the possible influence of G→T substitution at the Sp1-binding site of the COLIA1 gene on the risk of pelvic organ prolapse (POP).Materials and MethodsThe study group consisted of 15 women with advanced stage POP. Fifteen control subjects with uterine myomas among the postmenopausal women were matched for age and parity. DNA was obtained from peripheral blood leukocytes. The fragments of the first intron of the COLIA1 gene were amplified by real time polymerase chain reaction. The polymorphism was identified using LightCycler Technology with hybridization probes. Sequencing reactions were performed on each template using commercial primer.ResultsTwo groups had no significant difference in medical history, surgical, and smoking history. The homozygous peaks in two groups were noted at 57℃ on melting curve analysis. Sequencing reactions confirmed the G/G alleles in the 30 specimens tested. We could not find any polymorphism at the Sp1-binding site in COLIA1 gene with advanced stage POP. Statistical significance was considered to be p < .05.ConclusionThe polymorphism of the Sp1-binding site in the COLIA1 gene did not contribute to the development of POP in Korea.

High Levator Myorrhaphy for Transvaginal Suspension of the Vaginal Apex: Long-Term Results

We evaluated the long-term outcome and complications of high levator myorrhaphy for vaginal apical defects. A total of 286 patients underwent high levator myorrhaphy. Patients underwent preoperative and postoperative urogynecologic assessment, including evaluation of prolapse stage according to the international pelvic organ prolapse staging system and conventional urodynamic testing. Quality of life was evaluated using the prolapse quality of life questionnaire. We considered failure as vaginal prolapse stage 2 or greater according to the pelvic organ prolapse staging system. A total of 272 patients with a mean age of 60.4 years were available for analysis. Mean followup was 5 years. In 247 patients we associated tension-free cystocele repair with Marlex mesh. In 50.7% of patients high levator myorrhaphy was done with curative intent, while in the remaining 49.3% it was a preventive measure. Complications included a rectal tear in 2 cases, Marlex mesh erosion in 23 (8.4%), vaginal vault abscess in 1, pararectal hematoma in 2 and buttock pain in 2. Anatomical evaluation at followup revealed a 96.7% cure rate for apical defects and a 26.8% incidence of cystocele. We observed improvement in filling, voiding and post-void symptoms. Quality of life evaluation showed improvement in all domains. We detected a 9.6% incidence of de novo dyspareunia. High levator myorrhaphy is a safe and effective procedure for preventing and curing vaginal apical defects. The simplicity of this surgical procedure, its short learning curve, the lack of severe complications and its low costs combined with symptomatic relief and improvement in quality of life encourage its use for the cure and routine prevention of vaginal apical prolapse.

Pelvic support, pelvic symptoms, and patient satisfaction after colpocleisis

The objective was to study the effect of colpocleisis on pelvic support, symptoms, and quality of life and report-associated morbidity and postoperative satisfaction. Women undergoing colpocleisis for treatment of pelvic organ prolapse (POP) were recruited at six centers. Baseline measures included physical examination, responses to the Pelvic Floor Distress Inventory, and Pelvic Floor Impact Questionnaire. Three and 12 months after surgery we repeated baseline measures. Of 152 patients with mean age 79 (+/-6) years, 132 (87%) completed 1 year follow-up. Three and 12 months after surgery, 90/110 (82%) and 75/103 (73%) patients following up had POP stage < or = 1. All pelvic symptom scores and related bother significantly improved at 3 and 12 months, and 125 (95%) patients said they were either 'very satisfied' or 'satisfied' with the outcome of their surgery. Colpocleisis was effective in resolving prolapse and pelvic symptoms and was associated with high patient satisfaction.

Lung cancer in never smokers in Florida: 1981-2003

Oxidative stress is associated with the pathogenesis of pelvic organ prolapse (POP). Because glutathione S-transferases (GSTs) are the major detoxification enzymes which protect cells against oxidative stress, genetic variations in the GST gene may modulate the risk of POP. This study aimed to determine the association between advanced POP and the polymorphisms of GSTM1, GSTT1 and GSTP1 (rs1695).This is a hospital-based case-control study. The POP group consisted of 189 women diagnosed with POP stage III or IV, and the control group consisted of 156 postmenopausal women with POP stage 0 or I. The GSTM1 and GSTT1 null mutations were detected by multiplex PCR, and the GSTP1 Ile105Val polymorphism was genotyped by real-time PCR analysis using a TaqMan assay.There was no significant association between the GSTM1 and GSTT1 null mutations and advanced POP (p > 0.05). The distribution of the GSTP1 Ile105Val genotypes, however, was significantly different between the POP and control groups (AA/AG/GG rates = 74.1%/25.9%/0% vs. 64.1%/32.1%/3.8%, p = 0.008), and the G allele frequency was significantly lower in the POP group than in the control group (13.0% vs. 19.9%, p = 0.014). Women with the non-AA genotype had a 0.63-fold lower risk of developing advanced POP than women with the AA genotype (95% CI, 0.39–0.99), and women with the G allele had a 0.60-fold lower risk of advanced POP than women with the A allele (95% CI, 0.40–0.90).The GSTP1 Ile105Val polymorphism is a protective factor against advanced POP.

Levator trauma is associated with pelvic organ prolapse

To estimate the risk of prolapse associated with levator avulsion injury among a urogynaecological clinic population. Retrospective observational study. Tertiary urogynaecological unit. A total of 934 women seen for interview, examination using the pelvic organ prolapse quantification (POP-Q) staging system and imaging of the levator ani muscle by four-dimensional translabial ultrasound. Retrospective review of charts and stored imaging data. Pelvic organ prolapse stage II and higher and presence of defects of the levator ani muscle. After exclusion of 137 women with a history of anti-incontinence or prolapse surgery, and a further exclusion of 16 women in whom either examination or imaging was impossible, we compared prolapse and imaging data in 781 women. Mean age was 53 years (range 15-89 years), and median parity was 2 (range 0-12). Women reported stress incontinence (76%), urge incontinence (69%), frequency (47%), nocturia (49%) and symptoms of prolapse (38%). Significant prolapse (stage II or higher) was diagnosed in 415 (53%) women, and 181 (23%) women were found to have levator avulsion defects. Prolapse was seen in 150/181 (83%) women with avulsion and in 265/600 (44%) women without avulsion, giving a relative risk (RR) of 1.9 (95% CI 1.7-2.1). The association was strongest for cystocele (RR 2.3, 95% CI 2.0-2.7) and uterine prolapse (RR 4.0, 95% CI 2.5-6.5). Women with levator avulsion defects were about twice as likely to show pelvic organ prolapse of stage II or higher than those without. This effect is mainly due to an increased risk of cystocele and uterine prolapse.

Optimism in Women Undergoing Abdominal Sacrocolpopexy for Pelvic Organ Prolapse

Although studies suggest that optimism can predict health outcomes, the relationship has not been tested in women with pelvic organ prolapse (POP). This study sought to explore the relationship between optimism, prolapse severity, and symptoms before operation; and examine whether optimism predicts postsurgical functional status, treatment satisfaction, and treatment success. Data from the randomized Colpopexy and Urinary Reduction Efforts (CARE) study, in which stress continent women undergoing sacrocolpopexy to repair stage II to IV POP completed a baseline assessment of optimism and validated symptom and quality-of-life measures at baseline and 24 months. Relationships between optimism and demographics, clinical status, and functional and quality-of-life outcomes were assessed. Of 322 Colpopexy and Urinary Reduction Efforts study participants, 305 (94.7%) completed 24-month followup interviews. At baseline, there were no notable differences in optimism with respect to POP stage or history of earlier operations for prolapse or urinary incontinence. At baseline, women with greater optimism reported markedly better physical and mental functioning (p <or= 0.001) and less symptom distress (p <or= 0.01). Two years after operation, the difference in symptom experience across the three optimism categories narrowed; all women reported improved health status, fewer symptoms, and less impact on daily activities. Satisfaction with treatment and perception of treatment success were not associated with optimism. In women planning operation for POP, optimism is related to pelvic symptom severity, but is not associated with satisfaction with treatment or treatment success. Abdominal sacrocolpopexy resulted in substantial improvements in quality of life and functional outcomes that were not notably influenced by optimism.

Pelvic organ prolapse symptoms in relation to POPQ, ordinal stages and ultrasound prolapse assessment

Adequate staging of pelvic organ prolapse is important in clinical practice and research. The ability of the POPQ, ordinal stages and ultrasound prolapse assessment were evaluated for their ability to discriminate between women with and without prolapse symptoms. The leading edge of the predominant compartment in the three assessment systems was used for the calculation of receiver operating characteristics curves. Two hundred and sixty five (265) consecutive women were evaluated. The area under the receiver operating characteristics curve for the three staging systems ranged from 0.715 to 0.783. POPQ staging and ordinal staging performed equally well in the prediction of prolapse symptoms (p = 0.780), and both performed better as compared with ultrasound prolapse assessment (p = 0.048 and p = 0.015, respectively). Prolapse staging can equally be performed by the POPQ and ordinal stages systems as far as the discrimination between women with and without prolapse symptoms is concerned. The ultrasound prolapse assessment does not perform better as compared with these two systems.

Vaginal reconstructive surgery for severe pelvic organ prolapses: A ‘uterine-sparing’ technique using polypropylene prostheses

Objective The Ulmsten's “Integral Theory” for pelvic floor dysfunctions is based on the need to reinforce fascias and ligaments with prostheses to obtain a reconstitution of the pelvic floor's anatomy. In September 2004 we developed a “uterine-sparing” surgical technique to correct such pathologies and in this paper we present results obtained. Primary outcome was to evaluate the technique's efficacy, secondary outcomes the resolution of stress urinary incontinence, postoperative pain (VAS scale), safety and complications. Study design This prospective study included patients affected by stage 3 and 4 uterine-vaginal prolapse who wished to conserve their uterus. Those with (1) minor degrees of severity, (2) unfit for surgery, (3) with a clear indication to hysterectomy (i.e. endometrial cancer), (4) with an elevated operative risk (American Society of Anaesthesiologists—ASA score III and IV), (5) previous vaginal surgeries and (6) with moderate/severe defecation problems were excluded. The technique consisted in a sacrospinous colposuspension with polypropylene mesh. The pelvic status was classified according to the international Pelvic Organ Prolapse staging system (POP-Q). Postoperative pain was scored with the VAS Scale. All patients were given the King's Health questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Wexner questionnaire. Results From September 2004 to November 2006 we treated 80 patients. Polypropylene prostheses (Gynemesh-Soft PS, 10 cm × 15 cm – GyneMesh, Gynecare Ethicon – Somerville, NJ, USA) were used to reconstruct the pubo-cervix or the recto-vaginal fascia. We performed an anterior-central vaginal reconstruction in 35 (43.8%) patients, central-posterior in 25 (31%) and total reconstruction in 20 (25%). The median follow-up was 21 months (range 18–26). The severe pelvic prolapse, evaluated with the POP-Q System, was completely treated in all the patients and no recurrences were observed. The urodynamic examination showed a complete resolution of the stress urinary incontinence in 10 patients (83%). Sexual activities improved in all patients. We recorded three vaginal erosions and one patient complained of a postoperative dyspareunia. Conclusions This pilot study suggests that our technique is safe and effective and can efficiently repair the pelvic organs prolapse, without undergoing hysterectomy and with a low rate of vaginal erosions.

Infracoccygeal sacropexy reinforced with posterior mesh interposition for apical and posterior compartment prolapse

Objective To assess the efficacy, safety and functional outcome of infracoccygeal sacropexy reinforced with posterior mesh interposition performed alone or in combination with the implantation of other prosthetic materials for prolapse repair. Study design Seventy-two patients requiring prolapse repair for apical and/or posterior compartment prolapse, operated between March 2002 and September 2005. Patients underwent physical examination for prolapse assessment according to the international pelvic organ prolapse staging system and were evaluated for objective and subjective prolapse symptoms pre- and post-operatively. Objective success was defined by the midline posterior vaginal wall at stage 0 or 1, while subjective success was defined by a score above or equal to 7.5 measured on a visual analogue scale (0, very disappointed; 10, very satisfied). Follow-up was done at 6 weeks, 6 months and then once a year. Results Seventy-two patients with a mean age of 65 years were followed-up with a median of 26.3 months (range 10–43). Stages 3 and 4 represented 65.3% of all apical and/or posterior compartment prolapse. Fifty-nine patients had a concomitant anterior prolapse repair. Both objective and subjective success rates were 97.2%. All subjective prolapse symptoms decreased after surgery. The only intraoperative complication was one rectal injury. Vaginal erosion rate was 13.9% and mesh infection rate was 4.2%. Vaginal erosions statistically occurred less often with monofilament polypropylene (5.7%, 2/35) than with multifilament polypropylene (13.6%, 3/22) or polyester (33.3%, 5/15) ( p < .04). Conclusion Infracoccygeal sacropexy reinforced with posterior mesh interposition provides effective and promising results in correcting apical and/or posterior compartment prolapse. Analysis of long-term success rates and comparison with previously accepted surgical procedures are required to determine the place of this procedure in the strategy of genital prolapse repair.

The Clinical Experience of Genital Pelvic Organ Prolapse with the Prolift™ System

Purpose: In the surgical treatment of pelvic organ prolapse (POP), treatment failure and re-operation rates are relatively high when conventional mesh-free surgical methods are employed. Recently, a transvaginal prolapse repair method using surgical mesh has come into broad usage. The principal objective of this study was to report on the clinical efficacy and safety of transvaginal mesh repair of genital prolapses using the Prolift system. Materials and Methods: We included 31 (mean age 61.1 years) patients who had undergone pelvic organ prolapsed treatment with the Prolift system. The evaluation included a medical history, physical examination including Pelvic Organ Prolapse staging system (POP-Q), a urodynamic study, and a Pelvic Floor Distress Inventory (PFDI). An anatomic cure after intervention was defined as stage 0 and an improvement was defined as stage I. Anatomic failures were defined as stage II or higher. The patients were monitored at 4, 12 and 52 weeks postoperatively, and the mean follow-up period was 13.7 months. Results: Preoperative anterior vaginal wall prolapse to the POP-Q was stage II in 13, III in 14, IV in 4, uterine or vaginal vault prolapse stage II in 3, III in 6, IV in 1 and posterior vaginal wall prolapse stage II in 3, and stage III in 7. Anterior, posterior and total repair were performed in 21 (67.8%), 1 (3.2%), and 9 (29.0%) patients, respectively. 90.3% (28/31) of the patients had been anatomically cured upon follow-up examination, and 93.5% (29/31) reported being satisfied with the result of the operation. Pre-and postoperative urinary symptoms, as well as prolapse symptoms as evaluated by PFDI, were improved significantly. Conclusions: Pelvic floor surgery using the Prolift system appears to be both effective and safe. (Korean J Urol 2008;49:739-744) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Risk factors for pelvic organ prolapse

Objectives: To evaluate the risk factors for pelvic organ prolapse (POP) and to determine the relationship between these risk factors and stage or other components of POP. Methods: 244 patients with primary POP and 314 women without POP were included. Age, parity, smoking, body mass index (BMI), menopause, and hormone replacement therapy (HRT) were investigated. Result: Independent risk factors for POP included age over 70, parity higher than 3, and menopause. Age, parity, menopause, and HRT were significantly associated with stage of POP. Genital hiatus (GH) and perineal body (PB) showed a significant positive and negative correlation with age and parity, respectively. Menopause and HRT were also associated with them. Conclusion: Age, parity and menopause are possible risk factors of POP and associated with the lengths of GH and PB in POP women. Further, these risk factors and HRT are significantly correlated with the severity of the disease.

Urodynamic Prolapse Reduction Alters Urethral Pressure but Not Filling or Pressure Flow Parameters

To test the hypothesis that advanced stages of pelvic organ prolapse can result in a functional obstruction of the urethra, we studied the effects of manual prolapse reduction on urodynamic and urethral electromyographic parameters in women with stage III and IV pelvic organ prolapse. Women with advanced pelvic organ prolapse undergoing clinical multichannel urodynamics with concentric needle electromyography of the urethra were invited to participate in this institutional review board approved study. Women underwent filling cystometry and electromyography with prolapse everted and with prolapse reduced. Women were randomized to cystometry order (reduced vs everted). All subjects underwent a third study with prolapse reduction. Maximum urethral closure pressure and quantitative electromyography of the striated urethral sphincter were determined at maximum cystometric capacity. During the pressure flow study voiding parameters, including urethral electromyography quieting, were determined. The nonparametric paired sign test was used to evaluate differences in urodynamic parameters and quantitative electromyography with pelvic organ prolapse reduced and unreduced. Results were considered significant at the 5% level. The 31 participants had mean age of 60 years (range 36 to 78) and 83% were white. There were no clinically significant differences in maximum cystometric capacity, voided volume, maximal flow and detrusor pressure at maximal flow or time to maximal flow between the reduced and everted prolapse states. Prolapse reduction resulted in a clinically and statistically significant decrease in maximum urethral closure pressure (-31%) but it had no impact on quantitative urethral electromyography. These findings demonstrate that, although prolapse reduction significantly decreases maximum urethral closure pressure, it does not alter intrinsic neuromuscular activity of the striated urethral sphincter. Prolapse reduction does not alter any other filling or pressure flow parameter.

Midterm Follow-up of High-Grade Genital Prolapse Repair by the Trans-obturator and Infracoccygeal Hammock Procedure after Hysterectomy

ObjectiveTo prospectively assess the anatomic and functional outcome of high-grade genital prolapse repair using a nonabsorbable hammock placement with anterior trans-obturator and posterior infracoccygeal extensions after hysterectomy. MethodsForty-four women with stage III or IV prolapse underwent surgery between January 2002 and June 2005. Patients had physical examination for prolapse assessment according to the International Continence Society pelvic organ prolapse staging system and were evaluated for subjective prolapse symptoms preoperatively and postoperatively. Follow-up was done at 6 wk and 6 mo and then once a year. ResultsMedian follow-up was 29.3 mo (range: 9–47 mo). Thirty-six (81.8%) women had optimal anatomic results and seven (15.9%) had persistent asymptomatic stage I prolapse. One patient (2.7%) had symptomatic recurrence of a posterior vaginal wall stage III prolapse. The subjective cure rate was 97.7% (43 of 44). All subjective symptoms of prolapse decreased after surgery. The only intraoperative complication was an uneventful rectal injury. The rates of vaginal erosions and mesh infections were 13.6% and 4.5%, respectively. ConclusionsThese results suggest that nonabsorbable hammock placement using anterior trans-obturator and posterior infracoccygeal extensions could be a safe and effective treatment for high-grade genital prolapse. Further studies are warranted to determine long-term outcome and to compare this approach with previously accepted surgical procedures.

Laparoscopic uterosacral uterine suspension: A minimally invasive technique for treating pelvic organ prolapse

Study Objective To assess the surgical outcomes of laparoscopic uterosacral uterine suspension and describe the surgical technique. Design Retrospective chart review (Canadian Task Force classification II-3). Setting University tertiary medical center. Patients Twenty-three patients with symptomatic uterine prolapse and desire for uterine preservation who underwent surgical repair. Intervention Laparoscopic uterine uterosacral uterine suspension. Measurements Preoperative and postoperative evaluations were completed. The stage of pelvic organ prolapse was assessed using the ICS pelvic organ prolapse quantification (POP-Q) examination. Descriptive statistics and paired t testing were used for statistical analysis. Results Nineteen of 23 patients (82.6%) had preoperative prolapse stage 2 or greater. Nine patients (40.9%) had uterine prolapse beyond the hymen. After operation there were significant improvements in the stage of prolapse (2 vs 0, p < .01). The POP-Q scores for point C and D were significantly further away from the hymen after operation than compared with the preoperative values (−0.6 vs −7.8, and −5.0 vs −8.6; p < .01) respectively. There were no intraoperative complications. The estimated blood loss (mean ± SD) was 111.5 ± 139.4 mL. The hospital stay (mean ± SD) was 2.2 ± 1.7 days. None of the patients had symptomatic prolapse during the mean follow-up of 15.9 months. Conclusion Laparoscopic uterine suspension appears to be a safe and effective treatment option for uterine prolapse in patients who desire uterine preservation.

Comparison of the Q-Tip Test and Voiding Cystourethrogram to Assess Urethral Hypermobility Among Women Enrolled in a Randomized Clinical Trial of Surgery for Stress Urinary Incontinence

We compared 2 measures of urethral hypermobility, the Q-tip test and voiding cystourethrogram, preoperatively in women recruited in 1 center participating in a multicenter randomized clinical trial comparing Burch colposuspension with autologous rectus fascia sling. Following institutional review board approval, women with stress urinary incontinence and pelvic organ prolapse stage 2 or less underwent a standardized standing voiding cystourethrogram and a Q-tip test at a 45 degree angle reclining position preoperatively. Urethral angle at rest and straining were measured with a radiological ruler (voiding cystourethrogram) or goniometer (Q-tip) by 2 different investigators blinded to each other findings. In 43 patients the mean urethral angle at rest and UAS were 20 degrees +/- 12 and 51 degrees +/- 20, by voiding cystourethrogram compared to 16 degrees +/- 9 and 58 degrees +/- 10 by Q-tip test, respectively. The mean angle difference (urethral angle with straining minus urethral angle at rest) was greater for the Q-tip test (42 degrees +/- 9) than that for the voiding cystourethrogram test (32 degrees +/- 17; p < 0.05). Fewer patients (14% by Q-tip, 28% by voiding cystourethrogram) had urethral hypermobility using the definition of urethral angle at rest greater than 30, while almost all patients (91% by voiding cystourethrogram, 100% by Q-tip) had urethral hypermobility using the definition of urethral angle with straining greater than 30. However, using the definition of urethral angle with straining minus urethral angle at rest greater than 30, only 58% of patients had urethral hypermobility by voiding cystourethrogram compared to 98% by Q-tip. The voiding cystourethrogram and the Q-tip test measure urethral hypermobility differently. This may affect which patients are classified as having urethral hypermobility, and the choice of anti-incontinence surgery.

Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study

The aim of this study was to evaluate the anatomical and functional results of a low-weight polypropylene mesh coated with an absorbable film in prolapse surgery by vaginal route. We have conducted a prospective multicentre study in 13 gynaecological and urological units. There were 230 patients requiring repair for anterior or posterior vaginal prolapse included. The present report is based on the analysis of the first 143 patients evaluated after at least 10 months follow-up. All patients were operated by the vaginal route using a specially designed mesh (Ugytex, Sofradim, France). Prolapse severity were evaluated using the Pelvic Organ Prolapse staging system. Symptoms and quality of life were evaluated preoperatively and during follow-up using the validated Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) self-questionnaires. Mean age was 63 years (37-91). Anterior, posterior and anterior-posterior repair with the mesh were performed in 67 (46.9%), 11 (7.7%) and 65 (45.4%) patients, respectively. With a mean follow-up of 13 months (10-19), 132 patients were considered anatomically cured (92.3%) with a recurrence rate of 9 of 132 for cystocele (6.8%) and 2 of 76 for rectocele (2.6%). Nine vaginal erosions occurred (6.3%), six of them necessitated another procedure by simple excision. The rate of de novo dyspareunia was 12.8%. At follow-up, improvement of PFDI and PFIQ scores were highly significant (p<0.0001). The use of low-weight polypropylene mesh coated with a hydrophilic absorbable film for vaginal repair of genital prolapse seems to decrease local morbidity while maintaining low recurrence rates.