Treatment Of Prolapse Research Articles

Same-day Discharge vs Planned Admission after Surgical Treatment for Apical Prolapse

Same day discharge (SDD) after surgery is becoming more common, with studies supporting the safety of this practice in gynecologic surgeries. The aim of this study was to compare short-term outcomes of same day discharge with planned admission in patients undergoing apical pelvic organ prolapse repair, through 30-day complications and 30- day unanticipated healthcare encounters. Female pelvic medicine and reconstructive surgery practice at a university affiliated tertiary medical center. Patients with apical prolapse who underwent surgical treatment during the study period were eligible for inclusion. Excluded were patients under the age of 18, cases planned for SDD with an unexpected admission, cases with a planned open procedure, and those performed in combination with another surgical service. none. A total of 296 patients were included in the final analysis. One-hundred and fifty-four patients had a planned admission (PA group) versus 142 who were discharged on the day of surgery (SDD group). There were no differences in reoperations, development of venous thromboembolism, and blood transfusions between the two groups. Patients in the SDD group were more likely to have no postoperative complications (95% vs 88.3%, p=0.037). Number of unanticipated urogynecology office visits, urgent/immediate care visits, readmissions, or unplanned phone calls were also similar between the two groups. There was a statistically significant difference observed in mean Emergency Department (ED) visits (0.16±0.40 in the PA group vs. 0.06±0.27 in the SDD group, p=0.02); however, this number was low in both groups. This comparative study suggests that same day discharge following apical prolapse repair is safe and may be considered for patients interested in this option.

Effectiveness of Self-cut vs Mesh-Kit Titanium-Coated Polypropylene Mesh for Transvaginal Treatment of Severe Pelvic Organ Prolapse

Transvaginal mesh (TVM) can increase the durability of vaginal surgical procedures for pelvic organ prolapse (POP) and may be indicated in certain situations despite concerns about mesh-related complications. In addition, the expense of commercial mesh kits has limited their use. The effectiveness, safety, and cost of a self-cut mesh procedure compared with a commercial mesh-kit procedure for the surgical treatment of women with POP is unclear. To assess the 1-year effectiveness and safety of self-cut titanium-coated polypropylene mesh compared with a precut commercial mesh kit for the transvaginal surgical treatment of women with severe symptomatic POP. This multicenter randomized noninferiority clinical trial was conducted at 11 hospitals in 8 provinces of China. A total of 336 women with symptomatic stage 3 to 4 POP were enrolled between January 22, 2018, and November 11, 2019, with follow-up through December 11, 2020. Participants were randomized to receive a TVM procedure using either self-cut mesh (self-cut mesh group) or a precut commercial mesh kit (mesh-kit group), both of which used the same titanium-coated polypropylene mesh. The primary outcome measure was composite surgical success at 1 year, which was defined as the absence of vaginal bulge symptoms, no additional retreatment for POP, and no vaginal prolapse at or beyond the hymen. Secondary outcomes included symptom-specific pelvic floor function and quality-of-life measures as well as perioperative complications, including mesh-related complications and hospitalization costs. Complications were categorized using the Clavien-Dindo system (with grade 1 indicating any deviation from the normal postoperative course but not requiring grade 2-4 interventions; grade 2, need for pharmacological treatment, blood transfusion, and/or total parenteral nutrition; grade 3, the need for surgical, endoscopic, and/or interventional radiological procedures; and grade 4, life threatening). Among 336 female participants (mean [SD] age, 63.3 [5.9] years; all of Chinese ethnicity), 169 patients were randomized to the self-cut mesh group, and 167 were randomized to the mesh-kit group. Three patients were unavailable for follow-up after 1 year. In the intention-to-treat analysis, 162 women (95.9%) in the self-cut mesh group had outcomes that met the definition of surgical success; this result was noninferior to the surgical success rate observed in the mesh-kit group (146 women [87.4%]; risk difference, 8.5%; 95% CI, 2.2%-14.3%; P = .006). The frequency of Clavien-Dindo grade 1 to 3 perioperative complications was not significant between groups (12 of 166 women [7.2%] in the self-cut mesh group vs 20 of 161 women [12.4%] in the mesh-kit group; P = .14). Vaginal mesh exposure rates in women examined at 1 year were similar (4 women [2.4%] in the self-cut mesh group vs 8 women [4.8%] in the mesh-kit group; P = .23). Median (IQR) total hospitalization costs were $3663.00 ($3258.90-$4495.10) in the self-cut mesh group vs $6144.00 ($5434.90-$7160.20) in the mesh-kit group (P < .01), representing savings of $2481.00 (40.4%) with the use of self-cut mesh. In this clinical trial, the composite surgical success rate of a self-cut mesh procedure was noninferior to that of a commercial mesh-kit procedure using the same titanium-coated polypropylene mesh and reduced hospitalization expenses by 40.4%. These findings suggest that the use of self-cut mesh procedures may be advantageous for the surgical treatment of some women with severe POP, particularly those in countries with low and middle income. ClinicalTrials.gov identifier: NCT03283124.

Laparoscopic Suture versus Ventral Mesh Rectopexy for the surgical Treatment of Internal Rectal Prolapse

Laparoscopic Suture versus Ventral Mesh Rectopexy for the surgical Treatment of Internal Rectal Prolapse

Role of Pessaries in the Treatment of Pelvic Organ Prolapse: A Systematic Review and Meta-analysis.

To evaluate the existing evidence on the efficacy of pessaries in improving quality of life when used for the treatment of pelvic organ prolapse (POP). We searched for the terms "pelvic organ prolapse" and "pessar/y/ies/ium or vaginal support device," and "safety or safe or outcome or complication or efficacy or effective or effectiveness" in PubMed, EMBASE, and CINAHL on March 16, 2020. A search was also performed on ClinicalTrials.gov , with no studies fitting our strict inclusion and exclusion criteria. Studies that reported pretreatment and posttreatment mean scores and SDs after pessary treatment for standardized questionnaires were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for prolapse were excluded. Three reviewers independently screened studies. Data abstraction was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were pooled for meta-analysis when reported by at least three studies. The primary study outcome was change in mean pretreatment and posttreatment questionnaire scores, which included those for the PFDI-20 (Pelvic Floor Distress Inventory- Short Form 20), PFIQ-7 (Pelvic Floor Impact Questionnaire - Short Form 7), and subscale POPIQ (Pelvic Organ Prolapse Impact Questionnaire Long Form). A random-effects model was used to combine estimates and capture between-study heterogeneity using the I 2 -statistic. Eight studies including 627 patients were included for systematic review. The mean (SD) age was 63.0±12.2 years, and the majority of patients had stage III prolapse (48.1%) followed by stage II prolapse (43.2%) when reported. Although variable, the majority of studies conducted 3-month follow-up. A negative change in pretreatment and posttreatment scores was noted, signifying improvement after pessary use: PFDI-20 mean change -46.1 (95% CI -65.4 to -26.8); PFIQ-7 mean change -36.0 (95% CI -46.0 to -26.0); POPIQ-7 (Pelvic Organ Prolapse Impact Questionnaire-7) mean change -16.3 (95% CI -26.8 to -5.7). No significant heterogeneity was found. Based on improvements in standardized questionnaire scores, pessaries are effective treatment options for POP. PROSPERO, CRD42020172618.

Tension-Free Vaginal Tape and Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: 3-Year Followup from a Randomized Clinical Trial.

We sought to determine whether polyacrylamide hydrogel (PAHG) is noninferior to tension-free vaginal tape (TVT) in the treatment of women with primary stress urinary incontinence (SUI). In this noninferiority trial, 223 women eligible for operative SUI treatment were randomized for TVT (110) or PAHG (113). Primary outcome was patient satisfaction and the noninferiority margin for the difference was 20%. Secondary outcomes were effectiveness and complications. At 3 years, 188 (84.3%) women attended the followup. The satisfaction score (visual analogue scale 0-100) median was 98.5 (IQR 90-100) in the TVT group and 90.0 (IQR 70-100) in the PAHG group, whereas a score ≥80 was reached in 87 (94.6%) and 65 (67.7%), respectively (difference 26.9%, 95% CI 16.7% to 36.8%). Thus, PAHG did not meet the noninferiority criteria set in our study. The cough stress test was negative in 88 (95.7%) of TVT patients vs 75 (78.1%) of PAHG patients (difference 17.5%, 95% CI 8.6% to 26.9%). Any peri- or postoperative complication before crossover between the groups was detected in 40 (43.5%) women in the TVT group and 23 (24.0%) women in the PAHG group (difference 19.5%, 95% CI 6.8% to 31.4%). In midterm followup, PAHG did not reach in patient satisfaction the noninferiority set in our study. Furthermore, mid urethral TVT slings show better subjective and objective cure rates than PAHG. However, complications were more often associated with TVT. Since the majority of PAHG treated women were also cured or improved, primary SUI women can be offered PAHG as a safe and durable alternative treatment.

Application of Mesh Materials and Effects of Representative Procedures in Pelvic Organ Prolapse Treatment

Pelvic organ prolapse (POP) affects 30%–70% of women’s health to varying degrees, and numerous risk factors have been confirmed. For patients with moderate to severe POP, surgical intervention is the primary solution. The application of mesh materials, especially tissue-engineered materials, is more desirable for surgical outcomes. Compared to those for traditional surgery, the recurrence and reoperation rates for mesh implantation are low. The continuous development and improvement of tissue engineering technology and various related procedures offer good prospects. However, there is still no consensus on the criteria for POP treatment. Therefore, in this review, we describe the effects of different types of mesh materials and several related representative implantation procedures, explore the potential concerns and future remedies, and provide information for optimizing mesh implantation and formulating POP clinical protocols.

Analysis on Effects of Laparoscopic Total Hysterectomy Combined with High Hysterosacral Ligament Suspension in the Treatment for Uterine Prolapse.

Objective To investigate the effect of laparoscopic total hysterectomy combined with high hysterosacral ligament suspension on the treatment for uterine prolapse. Methods A total of 100 patients with uterine prolapse treated in our two hospitals from January 2019 to December 2021 were included in this study, which were divided into two groups through the number double-blind method, with 50 patients in each group. The control group was treated with transvaginal total hysterectomy, and the research group was treated with laparoscopic total hysterectomy combined with high hysterosacral ligament suspension. The surgical effect on patients was evaluated through the pelvic organ prolapse quantification method (POP-Q). The patients' adverse reactions were compared. The quality of sexual life was evaluated with the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-31). And, the patients' quality of life was also evaluated with the pelvic floor distress inventory-short form 20 (PFDl-20). Results The surgical effect on the control group and the research group was 80.00% and 96.00%, respectively, with statistical significance (X2 = 6.601, P < 0.001). The incidences of adverse reactions of the two groups were 4.00% and 6.00%, respectively, which were comparable (X2 = 0.211, P = 0.646). The total PISQ-31 scores before surgery of the control group (97.07 ± 9.80) and the research group (97.02 ± 9.80) were comparable (t = 0.020, P = 0.984), and those after surgery were 112.55 ± 13.78 in the control group and 130.80 ± 17.42 in the research group, respectively, with statistical significance (t = 4.500, P < 0.001). And, the total PFDl-20 scores before surgery of the control group (72.50 ± 13.58) and the research group (72.50 ± 13.60) were comparable (t = 0.057, P = 0.098), and that after surgery were 56.10 ± 10.51 in the control group and 42.30 ± 8.05 in the research group, respectively, with statistical significance (t = 5.709, P < 0.001). Conclusion Laparoscopic total hysterectomy combined with high hysterosacral ligament suspension has an ideal effect in patients with uterine prolapse, with few adverse reactions, effectively promoting the improvement of the quality of patients' sexual life and their life. This combination has the significance of active promotion in the clinic.

Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy.

Treatment of recurrent rectal prolapse after a laparoscopic ventral mesh rectopexy.

The Effect of Age on Surgical Outcomes Following Uterine Preserving Surgery for Treatment of Apical Prolapse

Study ObjectiveThe aim of this study was to evaluate the effect of age on outcomes after uterine-preserving surgical treatment for apical prolapse. DesignRetrospective cohort study. SettingFemale pelvic medicine and reconstructive surgery unit at a tertiary, university-affiliated teaching medical center. PatientsWomen who underwent surgical management of apical prolapse with uterine preservation between 2010 and 2020. Excluded were women who had ≤1 month of follow-up and those for whom medical records were substantially incomplete. InterventionsNone. Measurements and Main ResultsIncluded in the study were 140 women who underwent apical prolapse repair with uterine preservation and who met the inclusion criteria. The cohort was divided into 2 groups: (1) women aged 65 years and older (≥65 group) and (2) women younger than 65 years of age (<65 group). Pre-, intra-, and postoperative data were compared between the groups. A total of 103 women (73.6%) were in the <65 group and 37 women (26.4%) in the ≥65 group. Mean age for the entire cohort was 58 ± 9.8 years, body mass index 25.9 ± 4.8 kg/m2, and duration of follow-up was 25.9 ± 21.0 months. Women in the ≥65 group had more comorbidities, were less sexually active, and were less likely to have a midurethral sling performed during their surgery. Clinical and anatomical success rates were somewhat higher in the ≥65 group; however, these differences did not reach statistical significance (97.3% vs 85.4%, p = .069 and 89.2% vs 81.2%, p = .264, respectively). Composite outcome success was higher in the ≥65 group (89.2% vs 72.5%, p = .039). Patient satisfaction recorded using the Patient Global Impression of Improvement questionnaire was high for both groups. A multivariable logistic regression analysis for the dependent parameter of composite outcome success was performed, during which none of the parameters investigated reached statistical significance. Subgroup analysis was performed including only women who were postmenopausal. This was done to address the possible confounding effect that menopausal status may have had on our results. No differences were found between the groups with regard to clinical, anatomical, and composite outcomes. ConclusionUterine-preserving surgery is a safe and effective surgical treatment for women aged ≥65 years.

Chronic Pelvic Pain, Quality of Life, and Patient Satisfaction After Robotic Sacrocolpopexy for Pelvic Organ Prolapse.

Background and objectiveWhen evaluating repair outcomes in robotic sacrocolpopexy (RSC) for the treatment of pelvic organ prolapse (POP), it has become evident that surgeons usually focus on anatomical improvements and neglect equally important parameters of patient satisfaction and quality of life (QoL). Investigating these factors would aid in achieving a more patient-centered approach to treatment. This study aimed to examine QoL and satisfaction outcomes in women after RSC.MethodsThis study analyzed self-reported patient data regarding RSC for POP performed between October 2009 and February 2017 by fellowship-trained urologists in female pelvic medicine and reconstructive surgery. These patients participated in a survey to assess overall satisfaction and QoL, as well as contributing factors, such as changes in bladder and bowel function, vaginal bulge, and vaginal pain on a 7-point Likert scale (ranging from markedly worse to markedly improved). Data were examined using multivariate regression analysis. Positive treatment response was defined as scores of 6 or 7, whereas negative response was defined as scores of 1 to 5.ResultsThe response rate was 41% (156/380), and the median age of the participants was 70 years [interquartile range (IQR): 63, 73]. Of note, 98.7% were Caucasian, with 73% currently in a significant relationship. The median duration since RSC was 2.12 years (IQR: 1.2, 3.7). Overall, 93 (66.9%), patients (23.0%), and 123 patients (88.5%) had a positive treatment response for bladder function, bowel function, and vaginal bulge, respectively. Furthermore, 66% of women had improved QoL, 84% reported improved overall satisfaction, and 91.4% stated that they would recommend RSC to a friend. After controlling for significant covariates, results of a multivariate analysis demonstrated positive treatment response for bladder function [odds ratio (OR): 14.6; p < 0.0001], bowel function (OR: 9.72; p = 0.003), and vaginal bulge (OR: 41.7; p < 0.0001), significantly associated with increased odds of having improved QoL, whereas positive treatment response for vaginal bulge (OR: 26.9; p = 0.023) and recommending RSC to a friend (OR: 175; p = 0.0009) were associated with positive overall satisfaction.ConclusionsOur findings endorse using RSC surgery for patients with POP based on both QoL improvement and overall post-procedure satisfaction perspective. This study may help encourage surgeons and clinicians to employ a surgical modality that incorporates each patient’s unique treatment desires and goals and provide patients with realistic post-procedure goals and expectations regarding treatment.

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.

Modified laparoscopic high uterosacral ligament suspension for treatment of apical prolapse: A feasibility study.

The purpose of this study was to evaluate the feasibility of modified laparoscopic high uterosacral ligament suspension (LHUS) in women with apical prolapse who require uterine preservation. This retrospective feasibility study analyzed the demographic characteristics, procedure, and 3-year follow-up data of 23 women who underwent modified LHUS at our institution. Outcome measures included clinical and anatomical cure. Patient satisfaction was measured by the Patient Global Impression of Improvement (PGI-I). The improvement on quality of life was evaluated by pelvic floor distress inventory-short form 20 (PFDI-20). The operation time was 50 ± 17 min, the blood loss was 100 ml (50-300 ml), and the postoperative hospital stay was 3.5 days (3-6 days). At a median follow-up time of 4.3 years (3-6 years), the clinical cure rate was 91.6% and the anatomical cure rate was 87.0%. The values of Aa, Ba, C, and D points were significantly higher than those observed before operation (p < 0.05). According to PGI-I, 20 patients were satisfied, and the overall subjective satisfaction rate was 87%. The scores of PFDI-20 after operation were significantly lower than those recorded before operation (p < 0.05). Modified LHUS has the advantages of short operation time, fast postoperative recovery, low 3-year recurrence rate, and high patient satisfaction in women with apical prolapse who require uterine preservation, which is worthy of clinical promotion.

Natural history of lower urinary tract symptoms in treatment-seeking women with pelvic organ prolapse; the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN)

The association of pelvic organ prolapse with overactive bladder and other lower urinary tract symptoms, and the natural history of those symptoms are not well characterized. Previous cross-sectional studies demonstrated conflicting relationships between prolapse and lower urinary tract symptoms. This study primarily aimed to determine the baseline association between lower urinary tract symptoms and prolapse and to assess longitudinal differences in symptoms over 12 months in women with and without prolapse. Secondary aims were to explore associations between lower urinary tract symptoms and prolapse treatment. We hypothesized that: (1) prolapse is associated with the presence of lower urinary tract symptoms, (2) lower urinary tract symptoms are stable over time in patients with and without prolapse, and (3) prolapse treatment is associated with lower urinary tract symptom improvement. Women enrolled in the Symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study with adequate 12-month follow-up data were included. Prolapse and lower urinary tract symptom treatment during follow-up was guided by standard of care. Outcome measures included the Lower Urinary Tract Symptoms Tool total severity score (in addition to overactive bladder, obstructive, and stress urinary incontinence subscales) and Urogenital Distress Inventory-6 Short Form. Prolapse (yes or no) was defined primarily when Pelvic Organ Prolapse Quantification System points Ba, C or Bp were >0 (beyond the hymen). Mixed-effects models with random effects for patient slopes and intercepts were fitted for each lower urinary tract symptom outcome and prolapse predictor, adjusted for other covariates. The study had >90% power to detect differences as small as 0.4 standard deviation for less prevalent group comparisons (eg, prolapse vs not). A total of 371 women were analyzed, including 313 (84%) with no prolapse and 58 (16%) with prolapse. Women with prolapse were older (64.6±8.8 vs 55.3±14.1 years; P<.001) and more likely to have prolapse surgery (28% vs 1%; P<.001) and pessary treatment (26% vs 4%; P<.001) during the study. Average baseline Lower Urinary Tract Symptoms Tool total severity scores were lower (fewer symptoms) for participants with prolapse compared with those without (38.9±14.0 vs 43.2±14.0; P=.036), but there were no differences in average scores between prolapse groups for other scales. For all urinary outcomes, average scores were significantly lower (improved) at 3 and 12 months compared with baseline (all P<.05). In mixed-effects models, there were no statistically significant interactions between pelvic organ prolapse measurement and visit and time-dependent prolapse treatment groups (P>.05 for all regression interaction coefficients). The Lower Urinary Tract Symptoms Tool obstructive severity score had a statistically significant positive association with Pelvic Organ Prolapse Quantification System Ba, Bp, and point of maximum vaginal descent. The Lower Urinary Tract Symptoms Tool total severity scale had a statistically significant negative association with Pelvic Organ Prolapse Quantification System Ba and point of maximum vaginal descent. No other associations between prolapse and lower urinary tract symptoms were significant (P>.05 for all regression coefficients). Symptom differences between prolapse groups were small: all regression coefficients (interpretable as additive percentage change in each score) were between -5 and 5 (standard deviation of outcomes ranged from 14.0-32.4). Among treatment-seeking women with urinary symptoms, obstructive symptoms were positively associated with prolapse, and overall lower urinary tract symptom severity was negatively associated with prolapse. Lower Urinary Tract Symptoms Tool scores improved over 12 months regardless of prolapse status, including in those with treated prolapse, untreated prolapse, and without prolapse.

Ultrasound features of endometrial pathology in women without abnormal uterine bleeding: results from the International Endometrial Tumor Analysis study (IETA3).

The primary aim of this study was to describe the ultrasound features of various endometrial and other intracavitary pathologies in women without abnormal uterine bleeding (AUB) using the International Endometrial Tumor Analysis (IETA) terminology. The secondary aim was to compare our findings with published data on women with AUB. This was a prospective observational study of women presenting at one of seven centers specialized in gynecological ultrasonography, from 2011 until 2018, for indications unrelated to AUB. All patients underwent transvaginal ultrasound using the IETA examination and measurement techniques. Ultrasonography was performed as part of routine gynecological examination or follow-up of non-endometrial pathology, or as part of the work-up before undergoing treatment for infertility, uterine prolapse or ovarian pathology. Ultrasound findings were described using the IETA terminology. Endometrial sampling was performed after the ultrasound scan. The histological endpoints were endometrial atrophy, proliferative or secretory endometrium, endometrial hyperplasia without atypia, endometrial polyp, intracavitary leiomyoma, endometrial intraepithelial neoplasia (EIN), endometrial cancer (EC) and insufficient tissue. The findings in our cohort of women without AUB were compared with those in a published cohort of women with AUB who were examined with transvaginal ultrasound between 2012 and 2015 using the same IETA examination technique and terminology. In this study (IETA3), we included 1745 women without AUB who underwent a standardized transvaginal ultrasound examination followed by either endometrial sampling with histological diagnosis (n = 1537) or at least 1 year of clinical and ultrasound follow-up (n = 208). Of these, 858 (49.2%) women were premenopausal and 887 (50.8%) were postmenopausal. Histology showed the presence of EC and/or EIN in 29 (1.7%) women, endometrial polyps in 1028 (58.9%), intracavitary myomas in 66 (3.8%), proliferative or secretory changes or hyperplasia without atypia in 144 (8.3%), endometrial atrophy in 265 (15.2%) and insufficient tissue in five (0.3%). Most cases of EC or EIN (25/29 (86.2%)) were diagnosed after menopause. The mean endometrial thickness in women with EC or EIN was 11.2 mm (95% CI, 8.9-13.6 mm), being on average 2.4 mm (95% CI, 0.3-4.6 mm) thicker than their benign counterparts. Women with malignant endometrial pathology manifested more frequently non-uniform echogenicity (22/29 (75.9%)) than did those with benign endometrial pathology (929/1716 (54.1%)) (difference, +21.8% (95% CI, +4.2% to +39.2%)). Moderate to abundant vascularization (color score 3-4) was seen in 31.0% (9/29) of cases with EC or EIN compared with 12.8% (220/1716) of those with a benign outcome (difference, +18.2% (95% CI, -0.5% to +36.9%)). Multiple multifocal vessels were recorded in 24.1% (7/29) women with EC or EIN vs 4.0% (68/1716) of those with a benign outcome (difference, +20.2% (95% CI, +4.6% to +35.7%)). A regular endometrial-myometrial junction was seen less frequently in women with EC or EIN (19/29 (65.5%)) vs those with a benign outcome (1412/1716 (82.3%)) (difference, -16.8% (95% CI, -34.2% to +0.6%)). In women with endometrial polyps without AUB, a single dominant vessel was the most frequent vascular pattern (666/1028 (64.8%)). In women with EC, both in those with and those without AUB, the endometrium usually manifested heterogeneous echogenicity, but the endometrium was on average 8.6 mm (95% CI, 5.2-12.0 mm) thinner and less intensely vascularized (color score 3-4: difference, -26.8% (95% CI, -52.2% to -1.3%)) in women without compared to those with AUB. In both pre- and postmenopausal women, asymptomatic endometrial polyps were associated with a thinner endometrium, and they manifested more frequently a bright edge, a regular endometrial-myometrial junction and a single dominant vessel than did polyps in symptomatic women, and they were less intensely vascularized. We describe the typical ultrasound features of EC, polyps and other intracavitary histologies using IETA terminology in women without AUB. Our findings suggest that the presence of asymptomatic polyps or endometrial malignancy may be accompanied by thinner and less intensely vascularized endometria than their symptomatic counterparts. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Influence of postoperative serum inflammatory factors, stress indicators, urination function, sexual function and clinical efficacy of laparoscopic pelvic floor reconstruction without mesh implantation in the treatment of pelvic Oorgan prolapse

Pelvic organ prolapse is seriously harmful to women's health and daily activities, and the incidence rate increases with age, which is more common among middle-aged and elderly women. Common treatment schemes are prone to relapse or complications. The purpose of this article was to study the clinical effect of laparoscopic pelvic floor reconstruction without mesh implantation in the treatment of pelvic organ prolapse and the influence of postoperative serum inflammatory factors, stress indicators, urination function and sexual function. The clinical curative effect of the operation plan was evaluated by the determination of POP-Q value and objective cure rate. The enzyme-linked immunosorbent assay determined the serum inflammatory factors and stress indexes before and after the operation. Urination function was detected by a urodynamics detector, and sexual function was investigated by a PISQ-12 questionnaire. The results show that laparoscopic pelvic floor reconstruction without mesh implantation has good clinical efficacy in the treatment of pelvic organ prolapse, with less stimulation to patients and less inflammation. After the operation, the patient's maximum urine flow rate exceeded 18mL/s, the sexual function score exceeded 45 points, and the urination function and sexual function were effectively improved.

Apreliminary clinical report of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organprolapse.

ObjectiveTo study the efficacy and safety of transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation in the treatment of moderate and severe pelvic organ prolapse.DesignPatients were selected into this study on a voluntary basis to evaluate the short-term efficacy of this surgery by comparing the OP-Q scores before the operation, three months after the operation, and six months after the operation.Setting and PatientsEvaluate the clinical efficacy and safety by a retrospective analysis of the clinical data of the 18 patients with POP-Q grade III–IV pelvic organ prolapse treated by the Department of Gynecology of Nanjing Medical University Affiliated Changzhou No.2 People's Hospital from April 2020 to November 2020, and their post-operation follow-ups.InterventionsPatients with postoperative follow-ups found no obvious relapse without intervention measures.Measurements and Main ResultsThe transvaginal natural orifice transluminal endoscopic Sacrospinous Ligament Fixation was performed successfully, and the anterior and posterior walls of vagina and/or trans-vaginal hysterectomy were repaired as appropriate. Except the total vaginal length (TVL), the P values of numerical analysis for all points before, three months after, and six months after the operation were all <0.05, being statistically significant.ConclusionThis method is effective in the treatment of moderate and severe pelvic organ prolapse with few complications, but more cases and longer-term follow-up data are needed to determine the long-term effect of this procedure. For the selection of puncture sites, more anatomical data are needed to get more accurate result.

Efficacy Analysis of Laparoscopic Lateral Abdominal Wall Suspension in the Treatment of Uterine Prolapse

Efficacy Analysis of Laparoscopic Lateral Abdominal Wall Suspension in the Treatment of Uterine Prolapse

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.

Six-year follow-up outcomes of the P(LLA-CL)/Fg bio-patch for anterior vaginal wall prolapse treatment.

There were few data about the long-term outcomes of bio-compatible patches for pelvic organ prolapse (POP). The efficacy of poly (L-lactide-co-caprolactone) blended with fibrinogen [P(LLA-CL)/Fg] bio-patches were investigated for anterior vaginal wall prolapse treatment in a 6-year follow-up. The P(LLA-CL)/Fg bio-patch was fabricated through electrospinning. Nineteen patients with symptomatic anterior prolapse (Pelvic Organ Prolapse Quantification [POP-Q] stage ≥ 2) were treated with anterior pelvic reconstruction surgery using a P(LLA-CL)/Fg bio-patch and were followed up at 1, 2, 3, 6 months, and 6 years. The primary outcome was objective anatomical cure (anterior POP-Q stage ≤ 1). Secondary outcomes included complications, MRI evaluation, and scores of the Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and the Pelvic Floor Distress Inventory-20 (PFDI-20). The micro-morphology of the bio-patch resembled the extracellular matrix, which was suitable for the growth of fibroblasts. Sixteen (84.2%) patients were finally assessed, with a mean follow-up of 6.08 ± 0.18 years. The cure rate without anterior prolapse recurrence was 93.8% at 6 years. Compared with baseline, the POP-Q measurements of Aa, Ba, and C points and scores of PFIQ-7 and PFDI-20 manifested significant differences at all times (all p < 0.05). One (5.26%) case of bio-patch-related infection, 1 (5.26%) case of urinary retention, and no exposures and erosion occurred. MRI evaluation showed that the bio-patch gradually degraded to fragments at 1 month and was completely absorbed at 3 months. Among long-term follow-ups, anterior pelvic reconstruction surgery with a P(LLA-CL)/Fg bio-patch demonstrated significant improvements in anatomical correction of anterior pelvic prolapse and pelvic function without severe morbidity.

Current status of transvaginal mesh implants use in the surgical treatment of stress urinary incontinence and pelvic prolapse

The use of synthetic implants in stress urinary incontinence and pelvic prolapse surgery is being actively debated today, not only among experts in the field but also in the media, the patient community, and even in legal and political set. Such response has had a natural effect on the clinical application of the technology. An absurd situation is observed in some countries: the bans imposed by the authorities have directly or indirectly restricted patients' access to the most sophisticated technologies with proven efficacy. This literature review aims to systematize the perspectives of the scientific and regulatory communities in leading countries on the use of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic prolapse.