Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse

ABSTRACT The exact prevalence of pelvic organ prolapse is difficult to establish. The anatomical changes do not always consist with the severity or the symptoms associated with prolapse. There are many risk factors associated with pelvic organ prolapse and this review aims to identify the epidemiology and pathophysiology while looking at the known risk factors for pelvic organ prolapse. PubMed search involved a number of terms including: epidemiology, risk factors, reoccurrence indicators, management and evaluation. Several risk factors have been associated with pelvic organ prolapse, all contribute to weakening of the pelvic floor connective tissue/collagen, allowing the pelvic organs to prolapse through the vaginal walls. Among the risk factors are genetic background, childbirth and mode of delivery, previous hysterectomy, menopausal state and the ratio between Estrogen receptors. The "Integral theory" of Petros and the "Levels of Support" model of Delancey enable us to locate the defect, diagnose and treat pelvic organ prolapse. The currently available demographic data is not reliable enough to properly estimate the true extent of pelvic organ prolapse in the population. However, standardization of the diagnosis and treatment may significantly improve our ability to estimate the true incidence and prevalence of this condition in the coming years.

Safety and short term outcomes of a new truly minimally-invasive mesh-less and dissection-less anchoring system for pelvic organ prolapse apical repair

ABSTRACT Objective To evaluate the safety and short term outcomes of a new, truly minimally-invasive, mesh-less and dissection-less anchoring system for pelvic floor apical repair. Methods A prospective study was conducted using the NeuGuide™ device system for pelvic floor apical repair. The primary effectiveness outcome was centro-apical pelvic floor prolapse by POP-Q after six months. The primary safety outcome was intra-operative, immediate (first 48 h) post-operative complications and adverse effects after six months. A standardized questionnaire (UDI-6) to assess quality of life at entry and during follow-up visits was used. Patients’ six months-follow-up and evaluation are reported. Results The mean age of the study population (n=10) was 63.8±12.0 years. All patients had a previous prolapse surgery. Five had a previous hysterectomy and two had stress urinary incontinence symptoms. During surgery six patients had a concurrent colporrhaphy. There was no injury to the bladder, rectum, pudendal nerves, or major pelvic vessels and no febrile morbidity was recorded. At six months, no cases of centro-apical recurrence were noted. Patients were satisfied with the procedure and had favorable quality of life scores. Using the UDI-6 questionnaire an improvement, in all domains was seen. Moreover, although the sample size was small, the improvement in urge and overflow incontinence related domains were demonstrated to be statistically significant. Conclusions This new NeuGuide™ device allows rapid and safe introduction of a suspending suture through the sacrospinous ligament and makes sacrospinous ligament fixation easy to perform, while avoiding dissection and mesh complications.

Cómo eliminar el círculo vicioso de la obesidad: [revisión] / Could the viscous cycle of obesity be restricted?: [review]

Las preocupaciones mundiales más tradicionales de la salud pública, es decir la desnutrición y las enfermedades infecciosas, han sido reemplazadas por el sobrepeso y la obesidad como principal factor de mala salud. En efecto, el sobrepeso y la obesidad son prevalentes y están en aumento en todo el mundo. Cerca de un tercio de las mujeres en edad reproductiva son clasificadas como obesas, y otro 25% de las mujeres de este grupo de edad tienen sobrepeso. Las tasas de resultados adversos perinatales y comorbilidades también se encuentran en aumento. La obesidad materna previa al embarazo es un factor de riesgo importante de los resultados perinatales adversos. Se sabe que la obesidad se asocia con complicaciones obstétricas graves en la madre y el feto. La obesidad es un factor de riesgo para macrosomía, al igual que la diabetes pregestacional y gestacional, que también son más frecuentes entre las pacientes con sobrepeso y obesas. El tratamiento quirúrgico de la obesidad, es decir, la cirugía bariátrica, es un área de rápido crecimiento de la práctica quirúrgica actual. Esto refleja tanto la capacidad de los procedimientos de cirugía bariátrica para proporcionar una solución a un problema que de otro modo es irresoluble como la evolución de procedimientos más seguros y menos invasores...