Symptomatic Pelvic Organ Prolapse Research Articles

Automatic identification and segmentation of slice of minimal hiatal dimensions in transperineal ultrasound volumes.

To develop and validate a tool for automatic selection of the slice of minimal hiatal dimensions (SMHD) and segmentation of the urogenital hiatus (UH) in transperineal ultrasound (TPUS) volumes. Manual selection of the SMHD and segmentation of the UH was performed in TPUS volumes of 116 women with symptomatic pelvic organ prolapse (POP). These data were used to train two deep-learning algorithms. The first algorithm was trained to provide an estimation of the position of the SMHD. Based on this estimation, a slice was selected and fed into the second algorithm, which performed automatic segmentation of the UH. From this segmentation, measurements of the UH area (UHA), anteroposterior diameter (APD) and coronal diameter (CD) were computed automatically. The mean absolute distance between manually and automatically selected SMHD, the overlap (dice similarity index (DSI)) between manual and automatic UH segmentation and the intraclass correlation coefficient (ICC) between manual and automatic UH measurements were assessed on a test set of 30 TPUS volumes. The mean absolute distance between manually and automatically selected SMHD was 0.20 cm. All DSI values between manual and automatic UH segmentations were above 0.85. The ICC values between manual and automatic UH measurements were 0.94 (95% CI, 0.87-0.97) for UHA, 0.92 (95% CI, 0.78-0.97) for APD and 0.82 (95% CI, 0.66-0.91) for CD, demonstrating excellent agreement. Our deep-learning algorithms allowed reliable automatic selection of the SMHD and UH segmentation in TPUS volumes of women with symptomatic POP. These algorithms can be implemented in the software of TPUS machines, thus reducing clinical analysis time and simplifying the examination of TPUS data for research and clinical purposes. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Medium-term outcomes 2 years after laparoscopic sacrocolpopexy: a retrospective cohort study in Japan

This study was performed to investigate medium-term outcomes and reoperation rates after laparoscopic sacrocolpopexy (LSC). We examined 119 patients undergoing LSC for symptomatic pelvic organ prolapse (POP). The primary outcomes were subjective failure and anatomical failure at 2 years; a score ≥ 2 on question 3 of the PFDI-20 was considered to indicate subjective failure. POP-Q stage 2 or higher in any compartment was considered to indicate anatomical failure. Secondary outcomes were reoperations for POP recurrence, mesh-related complications, and stress urinary incontinence (SUI). The rates of subjective failure and anatomical failure were 4.2% (n = 5) and 9.2% (n = 11), respectively. Reoperations were needed in 13.4% (n = 16) of patients, including SUI with tape procedure in 7.5% (n = 9), POP recurrence in 4.2% (n = 5), and mesh-related complications in 1.6% (n = 2). The subjective failure rate at 2 years after LSC was acceptably low. Impact Statement What is already known on this subject? Laparoscopic sacrocolpopexy (LSC) has clinical efficacy equivalent to open sacrocolpopexy, and there is evidence that LSC involves less blood loss and shorter length of hospital stay. However, there is still insufficient evidence to assess medium-term outcomes after LSC in Japan. What the results of this study revealed? The findings of this study showed excellent medium-term rates of subjective failure (4.2%) and anatomical failure (8.4%) after LSC. We demonstrated that patients with persistent postoperative vaginal bulge (subjective failure) also had no improvement in postoperative urinary and colorectal symptoms. Our cohort had low rates of reoperation (13.4%) after LSC. The most common reoperations were for stress urinary incontinence (SUI) (7.5%), followed by pelvic organ prolapse (POP) recurrence (4.2%) and mesh-related complications (1.6%). What are the implications of these findings in clinical practice and/or further research? This study showed that LSC is a safe and effective treatment for POP. Comparative evaluation of anatomical outcomes and the patient’s condition is required to understand the extent to which LSC positively impacts a woman’s pelvic floor-related quality of life.

Total Autologous Fascia Lata Sacrocolpopexy for Treatment of Pelvic Organ Prolapse: Experience in Thirty-Four Patients

ObjectiveTo develop a technique for open/robotic sacrocolpopexy using autologous fascia lata autograft. We report our experience in our first 34 patients. MethodsThe operation utilizes a 4-5-cm x 15-18-cm piece of fascia lata harvested through a 3-4-inch lateral upper thigh incision. The graft is configured into a traditional Y-shaped configuration using CV-2 Goretex sutures and is used to perform sacrocolpopexy. Patients were followed by history and physical, POP-Q scores, and symptoms related to thigh harvest including visual analog pain (VAP) scores. Treatment failure was defined as symptomatic pelvic organ prolapse (POP) involving apical descent. ResultsAutologous fascia lata sacrocolpopexy was performed on 34 patients with a mean age of 62. Mean follow-up was 13 months (range 2-42). Thirteen cases were open sacrocolpopexies, and 21 were robotic. Concurrent procedures included hysterectomy (9), vaginal mesh excision (7), bowel resection and rectopexy (5), and autologous sling (5). POP symptoms resolved in all 34 patients, and there were no treatment failures. The overwhelming majority of harvest site issues were minor and managed expectantly. Mean VAP score at the harvest site was 0.4 (range 0-3). Three patients developed non-bothersome thigh bulges. One patient developed a harvest site seroma. Twelve patients reported mild, non-bothersome harvest site paresthesias. No thromboembolic events occurred. ConclusionAutologous fascia lata sacrocolpopexy is an efficacious treatment for patients who desire non-mesh POP repair. Most harvest site issues are minor and typically resolve with expectant management alone. Continued follow-up of this series is ongoing to determine long-term success of this operation.

Surgical Management of Pelvic Organ Prolapse in a Woman with Right Pelvic Kidney

A thorough knowledge of both normal and variant abdominopelvic anatomy is important to the surgeon treating patients with pelvic organ prolapse and pathology in the pelvis. Knowledge of the location of the kidney and ureters is mandatory in treating women with pelvic organ prolapse and a pelvic kidney. This case report describes surgical management for a woman with the right pelvic kidney and symptomatic pelvic organ prolapse.

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

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

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

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

International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training

Introduction and hypothesisThis manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP.MethodsAn international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0–10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0–10).ResultsAfter exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT.ConclusionsThere are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.

Single-center study for robotic-assisted laparoscopic sacropexies: a one-fits-all strategy for pelvic organ prolapse?

PurposeSarcopenia has been established as the “gold standard” for the treatment of pelvic organ prolapse (POP). Minimal invasive laparoscopy can help to reduce the risks of open access surgery. We compare the surgical results and outcomes of robotic-assisted sacropexies.MethodsIn this monocentric retrospective study we enrolled 49 patients operated on symptomatic POP. Patients were divided into two groups according to the type of robotic-assisted sacropexy: patients with a history of hysterectomy received robotic-assisted sacrocolpopexy (RSCP; n = 19), while patients with subtotal hysterectomy received robotic-assisted cervicosacropexy (RCSP; n = 30). Failure was defined as recurrence of the disease with a need for reoperation. Validated questionnaires (the Pelvic Floor Distress Inventory—20 (PFDI-20) and Pelvic Floor Impact Questionnaire—7 (PFIQ-7)), were used for evaluation of patients quality of life postoperatively.ResultsThe comparison between RCSP versus RSCP showed that the latter is related to slightly but not significantly increased recurrence rates and a higher impact of POP symptoms on quality of life in long-term follow-up (p = 0.04). Perioperative data showed similar complication rates in both RSP types but shorter postoperative time of bladder catheterization in the case of RCSP (p = 0.008).ConclusionsThe monocentric long-term data confirm that RSP is a safe and effective method of surgical POP treatment, regardless of the site of the anatomical compartment. In comparison to RSCP, RCSP is associated with a lower impact of POP symptoms on patients’ quality of life with a tendency to slightly lower rates of POP recurrence.

Pragmatic estimations of obstetric fistula in Bangladesh

Pragmatic estimations of obstetric fistula in Bangladesh

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

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

Rate of Mesh Erosion After Sacrocolpopexy With Concurrent Supracervical Compared With Total Hysterectomy: A Systematic Review and Meta-analysis.

To estimate the effect of concomitant supracervical hysterectomy compared with total hysterectomy during abdominal sacrocolpopexy on the rate of mesh erosion by performing a systematic review and meta-analysis of the existing literature. From database inception through January 2022, we explored MEDLINE, Web of Science, EMBASE, CINAHL, ClinicalTrials.gov , and Cochrane Central Register of Controlled Trials. Studies comparing the rate of mesh erosion in women undergoing abdominal sacrocolpopexy who had concomitant supracervical hysterectomy compared with total hysterectomy were included. Two reviewers separately ascertained studies, obtained data, and gauged study quality. The rate of mesh erosion was compared, and odds ratios (ORs) with 95% CIs were estimated. Nineteen studies with 10,572 women who underwent abdominal sacrocolpopexy were identified, including 4,285 women in the supracervical group and 6,287 women in the total hysterectomy group. The overall mean postprocedure follow-up time was 30.7±15.1 months (median 12.4, range 1.5-44.2). The median (95% CI) point prevalence of mesh erosion was 0.36% (0-1.9%) in women who had supracervical hysterectomy compared with 3.8% (1.8-8.7%) in women who had total hysterectomy. The overall rate of mesh erosion in women who had supracervical hysterectomy was lower compared with women who had total hysterectomy (pooled OR 0.26, 95% CI 0.18-0.38, I 2 0%). In women with symptomatic apical pelvic organ prolapse who undergo abdominal sacrocolpopexy with concomitant hysterectomy, supracervical hysterectomy is associated with a lower risk of mesh erosion compared with total hysterectomy. PROSPERO, CRD42022301862.

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

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

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.

Self-management of vaginal cube pessaries may be a game changer for pelvic organ prolapse treatment: a long-term follow-up study

Introduction and hypothesisLoss of anatomical support for the pelvic organs results in pelvic organ prolapse (POP). We hypothesized that daily self-management of a cube pessary might be a safe, feasible long-term treatment in women with symptomatic POP.MethodsA cohort of 214 symptomatic POP patients (stage 2+) were enrolled prospectively (January to December 2015). Each patient was size-fitted with a space-filling cube pessary and completed a questionnaire online or by phone ≥5 years after her initial fitting. Change in quality of life (QoL) was measured with the Patient Global Impression of Improvement (PGI-I).ResultsOf 185 women included in our analyses, 174 (94%) were continuing to use their pessary 4 weeks post-insertion. Among those, 143 (82.2%) used the pessary successfully for ≥5 years. A large majority of these patients (88.8% [127 out of 143]) described their condition as much or very much improved compared with their pretreatment status (PGI–I). Adverse secondary effects (ASEs) were infrequent [15.4% (22 out of 143)]; when they did occur, they were mild, including smelly vaginal discharge (15 out of 22) and slight vaginal bleeding caused by the fitting procedure (6 out of 22).ConclusionsDaily self-management of cube pessaries was found to be a safe and effective treatment for improving POP-related symptoms and QoL in the long term.

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

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

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

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

Development and initial validation of a pictorial survey to assess for symptomatic pelvic organ prolapse and urinary incontinence in western Kenya.

Introduction and hypothesisVisual tools are a valuable tool for ascertaining patient symptoms, especially in populations with low literacy rates. The objective was to develop and validate a pictorial scale for assessing symptomatic pelvic organ prolapse (POP) and urinary incontinence among women in western Kenya.MethodsIllustrations of POP, stress urinary incontinence (SUI), and urgency urinary incontinence (UUI) were developed by an artist. Virtual Zoom interviews were conducted with gynecology providers in Kisumu soliciting feedback on the illustrations. Cognitive interviews with patients were then conducted. Validation of the illustrations was performed against the gold standard of clinical history and examination amongst patients presenting for outpatient care at three Kisumu hospitals.ResultsSixteen provider interviews were conducted. The illustrations were revised to reflect each disorder more clearly, and performed well during cognitive interviews with 8 patients (aged 21 to 76). One hundred patients were included in the validation study. Nine patients had symptomatic POP, whereas 32 had UUI and 25 had SUI. Sensitivity and specificity for the SUI illustration was 80% (95% CI 61–91%) and 97% (95% CI 72–98%) and for UUI they were 81% (95% CI 65–91%) and 99% (95% CI 92–100%) respectively. POP illustrations had lower sensitivity and specificity, with the best performing illustration having sensitivity of 67% (95% CI 35–88%) and specificity of 99% (95% CI 94–100%), which improved when only bulge or pressure symptoms were included.ConclusionsWe present a newly developed pictorial scale to assess for clinical urinary incontinence and POP that may be adapted and evaluated in other settings for clinical and research purposes.Supplementary informationThe online version contains supplementary material available at 10.1007/s00192-022-05214-5

Use of Silicon Vaginal Pessary for Treatment of Pelvic Organ Prolapse

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

Redo laparoscopic sacrocolpopexy for POP recurrence: Is it the right call?

ObjectivesAs Laparoscopic Sacrocolpopexy (LSCP) has proven to be the gold-standard for treating Pelvic Organ Prolapse, management of recurrence after its failure is a challenge with upcoming interest. In these patients, repeat LSCP might represent a suitable surgical choice. Study designWe present a retrospective observational study analysing safety, feasibility and outcomes of Redo LSCP. Data of 20 patients with POP recurrence who underwent previous sacrocolpopexy were recruited, and all successfully underwent a repeat LSCP. ResultsMedian 24-months follow-up demonstrated a statistically significant improvement of objective and subjective outcome. No intra and postoperative complications were noted. Anatomical cure rate was 95%. Subjective cure rate was 100%, with a statistically significant POP symptoms resolution and improvement of voiding and storage symptoms.We compared perioperative data and outcome of Redo patients to a population who underwent LSCP for a first-time diagnosed POP. The findings demonstrated that surgery did not differ from standard procedure in terms of intra/postoperative complications, hospital stay, blood loss, except for operative time. ConclusionsMinimally invasive Redo LSCP appears to be a safe and effective procedure in treating recurrent and symptomatic Pelvic Organ Prolapse. Our series shows low recurrence rates, comparable to data from patients who underwent their primary surgery for POP.

Modern possibilities for the prevention of pelvic organ prolapse

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