Management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane: a case report.

BACKGROUND: Pregnancy management is difficult when pelvic organ prolapse already exists. During pregnancy, childbirth, and the days following, clinicians may come across situations that present management dilemmas. Here, we present conservative management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane up to term. CASE PRESENTATION: A 35-year-old Ethiopian woman, gravida V, para IV, visited our emergency obstetrics and gynecology department at 32 weeks and 1 day of pregnancy in a prolapsed uterus on the 4th of April 2022. She was referred from primary hospital as a case of preterm pregnancy, pelvic organ prolapse, and preterm premature rupture of membrane after she presented with complaints of passage of clear liquor of 10 hours duration. She was successfully managed conservatively without application of pessary until she gave birth to a 3200 g healthy male neonate by elective cesarean section at 37 weeks of gestational age. At the same operation, cesarean hysterectomy was done. CONCLUSION: Women with preexisting pelvic organ prolapse complicated by premature rupture of membrane during the third trimester of pregnancy can be treated without the use of a pessary. Our case shows the importance of conservative management, which includes strict antenatal follow-ups, lifestyle modifications, and manual uterine reduction. Due to potential intrapartum problems from induction of labor with the occurrence of severe pelvic organ prolapse, we recommend cesarean delivery. However, to determine the optimal mode of delivery, additional comprehensive study with a large sample size is vital. If definitive management is warranted after delivery, we need to take a consideration of the status of prolapse, patient's choice, and family size.

Quality of Sexual Life after Native Tissue versus Polypropylene Mesh Augmented Pelvic Floor Reconstructive Surgery.

There are still controversies around reconstructive surgeries used in POP treatment. The aim of this study was to compare the QoSL after VNTR vs. TVM surgery due to POP via the use of PISQ-12 and FSFI questionnaires. The study included a group of 121 sexually active patients qualified for reconstructive surgery due to symptomatic POP, and 50 control. The average results of PISQ-12 before and after surgery were compared using the t-test. The significance of the mean differences in demographic groups was measured using the t-test for independent samples and one-way ANOVA. The results in the demographic groups were compared using the Mann-Whitney U test and the Kruskal-Wallis test. Fifty-eight women had VNTR, while 63 had TVM. Results of PISQ-12 revealed significant improvement in the sexual life after reconstructive surgery (27.24 vs. 32.43; p < 0.001, t = 8.48) both after VNTR and TVM. There were no significant differences in the assessment of the QoSL according to PISQ-12 and FSFI results between both analyzed groups of patients (PISQ-12: VNTR vs. TVM; t-test p = 0.19 and FSFI: VNTR vs. TVM; Mann-Whitney U test p = 0.54). VNTR is the treatment of choice in the case of uncomplicated primary POP.

Approaching Combined Rectal and Vaginal Prolapse.

Combined rectal prolapse and pelvic organ prolapse surgery provides significant quality-of-life benefits with improvements in bothersome symptoms of pain, bulge, constipation, urinary retention, as well as bowel and bladder incontinence. Robotic surgery is the ideal tool for a combined surgical repair. It allows enhanced suturing in the deep pelvis, three-dimensional (3D) visualization of the presacral space and easy mobilization of the rectum and dissection of the vagina. Combined procedures can be offered to patients with the advantages of a single operation and concurrent recovery period without increasing complications. In this article, we highlight our approach to combined prolapse repair.

Factors associated with sexual activity for women with pelvic floor dysfunction - a cross-sectional study / Fatores associados à atividade sexual de mulheres com distúrbios do assoalho pélvico - um estudo transversal

Abstract Objective To examine women with pelvic floor dysfunction (PFDs) and identify factors associated with sexual activity (SA) status that impacts quality of life (QoL). Methods We conducted a cross-sectional study that includedwomen> 18 years old who presented with at least one PFD symptom (urinary incontinence [UI] and/or pelvic organ prolapse [POP]), in outpatient clinics specializing in urogynecology and PFD in Fortaleza, state of Ceará, Brazil, using a service evaluation form and QoL questionnaires. Results The analysis of 659 women with PFD included 286 SA (43.4%) women and 373 non-sexually active (NSA) (56.6%) women, with a mean age of 54.7 (±12) years old. The results revealed that age (odds ratio [OR]= 1.07, 95% confidence interval [CI] 1.03-1.12) and post-menopausal status (OR= 2.28, 95% CI 1.08-4.8) were negatively associated with SA. Being married (OR= 0.43, 95% CI 0.21-0.88) was associated with SA. Pelvic organ prolapse (OR= 1.16, 95% CI 0.81-1.68) and UI (OR= 0.17, 95% CI 0.08-0.36) did not prevent SA. SF-36 Health Survey results indicated that only the domain functional capacity was significantly worse in NSA women (p= 0.012). Two King's Health Questionnaire domains in NSA women, impact of UI (p= 0.005) and personal relationships (p< 0.001), were significantly associated factors. Data from the Prolapse Quality-of-life Questionnaire indicated that NSA women exhibited compromised QoL. Conclusion Postmenopausal status and age negatively affected SA. Being married facilitated SA. Presence of POP and UI did not affect SA. However, NSAwomen with POP exhibited compromised QoL.

Resumo Objetivo Examinar mulheres com disfunções do assoalho pélvico (DAP) e identificar fatores associados ao status de atividade sexual (AS) e impacto na qualidade de vida (QV). Métodos Realizamos um estudo transversal, no qual participaram mulheres > 18 anos, que apresentaram pelo menos um sintoma de DAP (incontinência urinária [UI] e/ou prolapso de órgão pélvico [POP]), em ambulatórios especializados em uroginecologia e DAP emFortaleza, CE, Brasil, utilizando um formulário de avaliação de serviço e questionários de QV. Resultados A análise de 659 mulheres comDAP incluiu 286 mulheres sexualmente ativas (SA) (43,4%) e 373 mulheres não sexualmente ativas (NSA) (56,6%), com idade média de 54,7 (±12) anos. Os resultados revelaram que idade (odds ratio [OR]= 1,07; intervalo de confiança [IC] 95%: 1,03-1,12) e status pós-menopausa (OR= 2,28; IC 95% 1,08-4,8) foram negativamente associados à atividade sexual. O casamento (OR= 0,43; IC 95% 0,21-0,88) foi associado à AS. Por outro lado, POP (OR= 1,16; IC 95% 0,81-1,68) e IU (OR= 0,17; IC 95% 0,08-0,36) não impediram a AS. Os resultados do SF-36 Health Survey indicaram que apenas a capacidade funcional do domínio (p = 0,012) foi significativamente pior em mulheres NSA. Dois domínios King's Health Questionnaire (KHQ, na sigla em inglês) em mulheres NSA, impacto da IU (p = 0,005) e relacionamento pessoal (p< 0,001), foram fatores significativamente associados. Os dados do Prolapse Qualityof- life Questionnaire (P-QoL, na sigla em inglês) indicaram que as mulheres NSA apresentavam QV comprometida. Conclusão O status pós-menopausa e a idade afetaram negativamente a AS, enquanto o casamento facilitou a AS. A presença de POP e IU não afetou a AS. No entanto, as mulheres NSA com POP apresentaram QV comprometida.

Laparoscopic pelvic organ suspension with mesh: a modified technique and primary results / Suspensão laparoscópica de órgão pélvico com malha: uma técnica modificada e resultados primários

Abstract Background: Pelvic organ prolapse recurrence rate is an important issue which impacts the patient's quality of life and results in a new surgical procedure. We use a new technique of laparoscopic pelvic organ suspension (rectal suspension) for pelvic organ prolapse treatment in our center. We evaluated the results of this technique, three months after surgery and at the time of study reporting. Methods: All patients with pelvic organ prolapse for whom laparoscopic pelvic organ prolapse had been done were evaluated. Data were collected from the patient's charts and their short term follow up 3 months after the surgery and their last follow up visit. Demographic, history, physical examination, Wexner's fecal incontinence score and Altomare's Obstructed Defecation Syndrome score, post-operation complications and patient's satisfaction were analyzed, retrospectively. Results: All patients were female with a mean age of 57 ± 11.43 years (range 32-86 years). Mean BMI was 26.1 ± 3.73. Nine patients had rectal bleeding (31%), 18 had prolonged or difficult defecation (62%), 16 had rectal prolapse (55.2%), 11 had gas incontinence (37.9%), 9 had liquid stool incontinence (31%), 5 had stool incontinence (17.2%), 9 had vaginal prolapse (31%), 23 had constipation (79.3%), 9 complaint of pelvic pain (31%), 9 had urge or stress urinary incontinence (31%) and 13 had dyspareunia (44.8%). Conclusions: In conclusion, we believe this procedure has good results in short term follow up (3 months after surgery), but a high recurrence rate in the middle term follow up. Therefore, this procedure is no longer recommended.

Resumo Introdução: A taxa de recorrência do prolapso de órgãos pélvicos é uma questão importante que afeta a qualidade de vida do paciente, resultando em um novo procedimento cirúrgico. Os autores adotaram uma nova técnica de suspensão laparoscópica de órgãos pélvicos (suspensão retal) no tratamento de prolapso de órgãos pélvicos. Os resultados dessa técnica foram avaliados três meses após a cirurgia e no momento do relato do estudo. Métodos: Todos os pacientes com prolapso de órgão pélvico submetidos a suspensão laparoscópica foram avaliados. Os dados foram coletados do prontuário do paciente, na visita de acompanhamento três meses após a cirurgia e na última visita de acompanhamento. Os dados demográficos, histórico médico, avaliação física, escore de incontinência fecal de Wexner, escore da síndrome da defecação obstruída de Altomare, complicações pós-operatórias e satisfação do paciente foram analisados retrospectivamente. Resultados: Todos os pacientes eram do sexo feminino, com média de idade de 57 ± 11,43 anos (variação de 32 a 86 anos). O índice de massa corporal médio foi de 26,1 ± 3,73. Nove (31%) pacientes apresentaram sangramento retal; 18 (62%), defecação prolongada ou difícil; 16 (55,2%), prolapso retal; 11 (37,9%), incontinência gasosa; nove (31%), incontinência fecal líquida, cinco (17,2%), incontinência fecal; nove (31%), prolapso vaginal; 23 (79,3%), constipação; nove (31%), queixa de dor pélvica; nove (31%), incontinência urinária de urgência ou esforço e 13 (44,8%), dispareunia. Conclusões: Os autores acreditam que este procedimento apresenta bons resultados no seguimento de curto prazo (três meses após a cirurgia), mas uma alta taxa de recorrência no acompanhamento a médio prazo. Portanto, esse procedimento não é mais recomendado.

Analysis of factors related to urinary incontinence and pelvic organ prolapsed on the 42-day after delivery / 中国医师进修杂志

Objective@#To investigate the factors related to urinary incontinence and pelvic organ prolapsedon the 42-day after delivery.@*Methods@#A retrospective analysis was made on the data of 1 713 cases of pregnant women who received regular birth examination and delivered from June 2017 to September 2017 and whose medical records exsited on the 42-day after delivery. In this study, 1 402 patients were in vaginal delivery and 311 patients were in cesarean delivery. The occurrence of urinary incontinence and pelvic organ prolapsed and the general case characteristics of patients were analyzed.@*Results@#The incidence rate of stress urinary incontinence in vaginal delivery group was significantly higher than that in cesarean delivery group: 11.20%(157/1 402) vs. 5.79%(18/311), P=0.004. The incidence rate of urgency urinary incontinence and pelvic organ prolapse in two groups had no significant differences (P > 0.05). The age, prepregnancy body mass index (BMI), the rate of vaginal delivery in urinary incontinence patients were significantly higher than those in without urinary incontinence patients: (32.8 ± 3.6) years vs. (30.4 ± 3.8) years, P=0.006; (25.6 ± 5.1) kg/m2 vs. (23.5 ± 4.4) kg/m2, P=0.001; 90.04%(217/241) vs. 80.50%(1 185/1 472), P=0.004. The age, pre pregnancy BMI in pelvic organ prolapsed patients were significantly higher than those in without pelvic organ prolapsed patients: (32.3 ± 3.7) years vs. (31.5 ± 4.8) years, P=0.033; (24.4 ± 4.2) kg/m2 vs. (23.7 ± 3.4) kg/m2, P=0.013.@*Conclusions@#Pelvic floor dysfunction is more prone to maternal postpartum who receives side cutting or forceps delivery recently, and these maternal postpartum educations should be strengthened to reduce the incidence of severe pelvic floor dysfunction.

Quantitative evaluation on puborectalis function in patients with pelvic organ prolapse using shear wave elastography / 中国医学影像技术

Objective To evaluate the contraction function of puborectalis (PR) with shear wave elastography (SWE).Methods Twenty-eight patients with pelvic organ prolapse (POP-Q Ⅲ group and POP-Q Ⅳ group,each n=14) and 28 healthy volunteers (control group) were enrolled.The Young's modulus of PR in the front,middle and back of pubic rectal muscles of each group at resting and maximal rectal state were measured with shear wave elastography,and then were statistically analyzed.Results Youngs modulus of maximum rectal state of each group was higher than that of resting state (all P＜0.05).At resting and maximal rectal state,the Young's modulus and their differences in POP-Q Ⅲ group and POP-Q Ⅳ group were significantly different compared with control group (all P＜0.05),but those in POP-Q Ⅲ group and POP-Q Ⅳ group were not (all P＞0.05).Conclusion Decrease of PR systolic function can be observed in patients with pelvic organ prolapse,and SWE can be used to detect abnormal function of PR systolic function.

Expression and Significance of Metalloproteinase and Collagen in Vaginal Wall Tissues of Patients with Pelvic Organ Prolapse.

PURPOSE: The purpose of this study is to investigate the roles of matrix metalloproteinases (MMPs) and collagen in female patients with pelvic organ prolapse (POP). METHODS: Sixty POP patients comprised the POP group (23 cases of grade II prolapse (POP-subgroup 1) and 37 cases of grade III-IV prolapse (POP-subgroup 2)]; another 35 non-POP patients comprised the control group. Reverse transcription polymerase chain reaction and immunohistochemistry were used to detect the relative mRNA and protein expression of MMP-1, MMP-8, tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), and type I and III collagen in the anterior vaginal wall tissues. RESULTS: The relative mRNA and protein expression of MMP-1 and MMP-8 in the anterior vaginal wall tissues of POP-subgroup 2 was significantly higher than those in POP-subgroup 1 and the control group (P<0.05). The relative mRNA and protein expression of TIMP-1 in POP-subgroup 2 was significantly lower than those in POP-subgroup 1 and the control group (P<0.05). Similarly, the expression of types I and III collagen was significantly lower than those in POP-subgroup 1 and the control group (P<0.05). CONCLUSIONS: Reduced expression of types I and III collagen and TIMP-1 as well as the increased expression of MMP-1 and MMP-8 in the anterior vaginal wall tissues play important roles in the onset of POP.

Automatic vertebra segmentation on dynamic magnetic resonance imaging.

The automatic extraction of the vertebra's shape from dynamic magnetic resonance imaging (MRI) could improve understanding of clinical conditions and their diagnosis. It is hypothesized that the shape of the sacral curve is related to the development of some gynecological conditions such as pelvic organ prolapse (POP). POP is a critical health condition for women and consists of pelvic organs dropping from their normal position. Dynamic MRI is used for assessing POP and to complement clinical examination. Studies have shown some evidence on the association between the shape of the sacral curve and the development of POP. However, the sacral curve is currently extracted manually limiting studies to small datasets and inconclusive evidence. A method composed of an adaptive shortest path algorithm that enhances edge detection and linking, and an improved curve fitting procedure is proposed to automate the identification and segmentation of the sacral curve on MRI. The proposed method uses predetermined pixels surrounding the sacral curve that are found through edge detection to decrease computation time compared to other model-based segmentation algorithms. Moreover, the proposed method is fully automatic and does not require user input or training. Experimental results show that the proposed method can accurately identify sacral curves for nearly 91% of dynamic MRI cases tested in this study. The proposed model is robust and can be used to effectively identify bone structures on MRI.

Validation of the traditional Chinese version of the prolapse quality of life questionnaire (P-QOL) in a Mandarin-speaking Taiwanese population.

OBJECTIVE: To validate the traditional Chinese translated version of the prolapse quality of life questionnaire (P-QOL). MATERIALS AND METHODS: The P-QOL questionnaire was translated into traditional Chinese characters and administered to women recruited from gynecologic outpatient clinics of Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. After the test-retest reliability and internal consistency were established in a pilot study, all participants completed the P-QOL questionnaire and were examined in the lithotomy position using the Pelvic Organ Prolapse Quantification System (POP-Q). The construct validity was assessed by comparing symptom scores and quality-of-life domain scores between symptomatic and asymptomatic women. RESULTS: Of the 244 women recruited, 159 were symptomatic for pelvic organ prolapse, and 85 were asymptomatic. The test-retest reliability confirmed a significant positive monotonic correlation between the total scores of each domain (n = 30, Spearman's rho was from 0.411 to 0.888, p < 0.05 of all). All items achieved a Cronbach α > 0.80 showing good internal consistency. Among the 18 symptom questions, the scores differed significantly between symptomatic and asymptomatic women for 12/18 symptom questions. These 12 questions referred to the prolapse/vaginal symptoms. All the quality of life domains differed significantly (p < 0.05) between symptomatic and asymptomatic women except for the domain of sleep/energy (p = 0.108). CONCLUSION: The traditional Chinese language version of the P-QOL is a reliable instrument for the assessment of symptom severity and impact on quality of life in women with pelvic organ prolapse.

Reinforcement of transvaginal repair using polypropylene mesh functionalized with basic fibroblast growth factor.

Numerous modifications have been developed over the past two decades seeking to improve the transvaginal repair in the pelvic organ prolapse (POP) by using polypropylene (PP) mesh implants. The hydrophobicity of PP, however, presents a great hindrance for translating potential technologies into viable clinical applications. In this study, by manipulating self-polymerization and strong adhesive characteristics of dopamine, we developed a facile method to enhance the transvaginal repair by modifying PP meshes with polydopamine (PDA), which allowed easy grafting of basic fibroblast growth factor (bFGF) onto the surface of PP. Such surface modification of PP meshes with bFGF was found to efficiently promote bioactivity without changing the morphology or mechanical properties of the PP meshes. Additionally, bFGF-modified PP meshes significantly promoted cell viability and adhesion compared to the unmodified PP. Ultimately, after three months of implantation, the bFGF-modified PP meshes exhibited improved tissue repair with greater degree of organization of deposited collagen, increased tensile strength and reduced inflammatory response. Overall, the surface-modified PP meshes will be highly practical as templates for transvaginal repair in the POP treatment.

Experiencia en el tratamiento del prolapso de órganos pélvicos con mallas vaginales en el Hospital Universitario de Caracas

Objetivo: Describir la experiencia en el tratamiento del prolapso de órganos pélvicos con materiales protésicos en la Unidad de Patología de Piso Pélvico del Hospital Universitario de Caracas. Métodos: Estudio retrospectivo, descriptivo. Se incluyeron pacientes con diagnóstico de prolapso, intervenidas con mallas transvaginales entre enero de 2010 y diciembre de 2011, con seguimiento durante 12 meses (N = 49). Resultados: La edad promedio fue 57 ± 5 años. El índice de masa corporal promedio fue 27 kg/m². El 50,9 % de los prolapsos fueron grado II, 37,7 % grado III y 9,4 % grado IV. De los grados II, el 90 % fueron anteriores el 7 % posteriores y 3 % apicales. De los grados III el 58 % fueron anteriores, 37 % apicales y 5 % posteriores. Se observó 66,8 % de complicaciones. La complicación más frecuente fue la extrusión (25 %), seguido de la dispareunia y el acortamiento vaginal mayor de 1 cm, (10,4 % en ambos). Se presentó 6,3 % de urgencia de novo y 4,2 % de incontinencia urinaria de esfuerzo de novo. El hematoma, la obstrucción infravesical y la fístula vesico-vaginal se presentaron en 2,1 % de los casos. La cura objetiva fue de 95,7 % al año de seguimiento. Se observó 4,3 % de recidiva y 12,5 % de prolapso de novo. Conclusión: Las mallas vaginales representan una alternativa quirúrgica segura y eficiente para la corrección del prolapso genital. Las complicaciones son frecuentes, pero de poca gravedad. Sin embargo, la alta incidencia de erosiones puede afectar la calidad de vida de las pacientes. Palabras clave: Prolapso de órganos pélvicos. Mallas transvaginales. Erosión vaginal.

Objective: To describe the experience of pelvic organ prolapse treatment with transvaginal mesh in the Pelvic Floor Pathology Unit at the Hospital Universitario de Caracas. Methods: Retrospective and descriptive study. We included patients with pelvic organ prolapse treated with transvagynal mesh between January 2010 and December 2011, and with a follow up of 12 months (N=49). Results: The mean age was 57 ± 5 years, and the mean body mass index was 27 kg/m². A 50,9 % of pelvic organ prolapse were grade II, 37,7 % were grade III, and 9,4 % were grade IV. Among grade II prolapse, 90 % were anterior, 7 % posterior and 3 % apical. Among grade III prolapse, 58 % were anterior, 37.% posterior and 5 % apical. Complications were observed in 66,8 % of the cases. The most common complication was vaginal erosion (25 %), followed by dyspareunia and vaginal shortening (10,4 % both of them). The novo urgency was observed in 6,3 % of the cases, and de novo urinary stress incontinence in 4,2.%. Hematoma, vesicovaginal fistula, and voiding dysfunction were observed in 2,1 %. The objective cure was 95,7 % at 1 year of follow-up. A 4,3 % of recurrence and 12,5 % of de novo prolapse were observed. Conclusion: Vaginal meshes are a safe and effective alternative in pelvic organ prolapse treatment. Complications are frequent, but most of them are mild. However, the high incidence of vaginal erosion can affect the quality of life of most patients.

The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study.

OBJECTIVE: To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI). METHODS: The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS. RESULTS: In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO. CONCLUSION: In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

Incidence of unanticipated uterine pathology at the time of minimally invasive abdominal sacrocolpopexy.

STUDY OBJECTIVE: To determine the incidence of unanticipated uterine pathologic findings in women undergoing hysterectomy concomitant with minimally invasive sacrocolpopexy. DESIGN: Retrospective case series (Canadian Task Force classification III). SETTING: Four institutions in the United States. PATIENTS: Women undergoing laparoscopic or robotically assisted sacrocolpopexy with hysterectomy. INTERVENTIONS: Concurrent hysterectomy and minimally invasive sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS: We measured the incidence of clinically important uterine disease at minimally invasive sacrocolpopexy. A total of 324 women underwent concurrent hysterectomy and minimally invasive sacrocolpopexy. Their mean age was 56.1 years, and body mass index was 26.9 kg/m(2). Sixty-four percent were postmenopausal. Only 3 patients (0.92%) had abnormal uterine pathologic findings. No significant differences were noted in age, body mass index, or parity between the women with normal and abnormal uterine pathologic findings. None of the 3 women reported abnormal uterine bleeding before surgery. All lesions were premalignant and focal. No invasive carcinomas were identified. No patients required further follow-up or treatment of abnormal pathologic findings. CONCLUSION: The risk of unanticipated uterine pathologic findings during minimally invasive sacrocolpopexy to treat pelvic organ prolapse is low.

The significance and factors related to bladder outlet obstruction in pelvic floor dysfunction in preoperative urodynamic studies: A retrospective cohort study

OBJECTIVE: To demonstrate the significance of bladder outlet obstruction (BOO) in preoperative urodynamic studies (UDS) in women who have been diagnosed with pelvic floor dysfunction including pelvic organ prolapsed (POP) and stress urinary incontinence (SUI). METHODS: The medical records of 150 patients with pelvic floor dysfunction who underwent preoperative UDS at Yonsei University Health System from 2006 to 2012 were reviewed. Under the criteria of BOO, as a maximal flow rate in free-flow study (Qmax) less than 12 mL/sec and a detrusor pressure at Qmax in pressure-flow study (PdetQmax) higher than 20 cmH2O in UDS, they were divided into two groups: a group of 50 patients with BOO and a group of 100 patients without BOO. Comparisons were made between the patients with and without BOO in preoperative UDS. RESULTS: In the POP-with-SUI group, 25 patients with BOO had lower mean Qmax (10.0 vs. 25.4 mL/sec, P < 0.001), higher PdetQmax (49.6 vs. 21.5 cmH2O, P < 0.001), lower maximum cystometric capacity (422.7 vs. 454.0 mL, P = 0.007), and higher postvoidal residual volume (44.3 vs. 21.1 mL, P = 0.021) than the patients without BOO. In the SUI-only group, the mean Qmax was significantly lower in the 25 patients with BOO (9.4 vs. 25.4 mL/sec, P < 0.001). The mean PdetQmax was significantly higher with BOO (39.6 vs. 25.4 cmH2O, P = 0.004). In the univariate analyses, menopause, maximum cystometric capacity, and cystoscopic bladder trabeculation were associated with BOO. CONCLUSION: In the univariate analysis, menopause, MCC and cystoscopic bladder trabeculation were associated with BOO. In the multivariate model, however, no significant association with BOO was found.

Clinical analysis on pelvic organ prolapse treated by pelvic floor reconstruction surgery with Prolift system and routine transvaginal surgery / 重庆医学

Objective To investigate the clinical effectiveness of pelvic floor reconstruction surgery with Prolift system and rou‐tine transvaginal surgery in treating pelvic organ prolapse (POP) .Methods We analyzed an retrospective study of 64 patients with POP patients from June 2009 to March 2011 .All patients were divided into two groups ,32 cases of the reconstruction group were treated with pelvic floor reconstruction surgery with Prolift system ,as reconstruction group ,the other 32 cases in routine treatment group with routine transvaginal surgery ,which inclouded transvaginal hysterectomy ,repair of anterior and posterior vaginal wall ,as routine treatment group ,the pre operative ,peri operative data and follow up results were compared between the two groups and to evaluate the outcomes of the two groups after surgery .Results The age ,body mass index ,menopause age ,pregnant times and the degree of uterus prolapse were no significant difference between the two groups (P>0 .05) .The operation of all the patients were successful .No patient were infected after surgery ,no vascular injury ,or urinary system injury ,or rectal injury occurred .Reconstruc‐tion group showed more significant in the amounts of blood loss ,average operation time ,anal exsufflation time ,mean of highest postoperative body temperature ,the urinary canal indwelling time and the postoperative hospitalization time compared with routine treatment group(P0 .05) ,but the objective cure rate at 12 months after operation was significantly different between the two groups (P<0 .05) .The objective curative rate in reconstruction group was significantly higher than that in routine treatment group .Conclusion Pelvic floor reconstruction surgery with Prolift system is a safe and effective methods of minimally invasive surgery ,patients had better regain integrity of anatomical structure and functions of pelvic floor in short term for POP when compared with routine transvaginal sur‐gery ,but its long term study is still needed .

Sacrocolpopexia laparoscópica para el tratamiento del prolapso apical: resultados y seguimiento a largo plazo / Laparoscopic sacrocolpopexy for apical prolapse

Objetivos: Evaluar los resultados subjetivos, anatómicos y funcionales a largo plazo de las pacientes sometidas a sacrocolpopexia laparoscópica para manejo de prolapso apical. Métodos: Estudio observacional con pacientes a quienes se les hizo sacrocolpopexia laparoscópica entre febrero de 2006 y diciembre de 2012, en tres centros. El nivel de soporte del piso pélvico se midió mediante la escala de cuantificación del prolapso de órganos pélvicos (POP-Q). Los resultados funcionales se evaluaron mediante un cuestionario de síntomas intestinales, urinarios, sexuales y de molestias físicas. También se estimó la satisfacción global de las pacientes con una escala de uno a diez. Resultados: Se realizó sacrocolpopexia laparoscópica a 68 pacientes, pero el seguimiento fue posible sólo en 24. Ninguna paciente tuvo prolapso apical postoperatorio. El punto C medio del POP-Q fue -6,8 cm. Se observó mejoría importante con respecto a los síntomas subjetivos de prolapso con reducciones significativas en las puntuaciones del cuestionario en el seguimiento postoperatorio. La satisfacción fue en promedio de 9,1. La incontinencia urinaria preoperatoria se resolvió en el 35 por ciento de las que la reportaron, sin necesidad de cirugía de continencia concomitante. No hubo complicaciones a corto plazo. A largo plazo hubo una hernia incisional en el sitio del trocar y una obstrucción intestinal por la malla. Conclusión: La sacrocolpopexia laparoscópica es un tratamiento quirúrgico seguro y eficaz para el prolapso apical post-histerectomía. Proporciona un excelente soporte apical y buen nivel de satisfacción, con una mejoría general de los síntomas de prolapso.

Objective: To evaluate the long-term subjective, anatomical and functional outcomes after laparoscopic sacrocolpopexy for apical prolapse. Methods: An observational study of women undergoing laparoscopic sacrocolpopexy between February 2006 and December 2012 was undertaken, at three centers. Pelvic organ support was assessed objectively using the pelvic organ prolapse quantification scale (POP-Q). Functional outcomes were assessed using a questionnaire of bowel, urinary, sexual and physical discomfort symptoms postoperatively. Also was assessed the overall satisfaction of surgery with a scale of one to ten. Results: During the period of the study, sacrocolpopexy was done in 68 patients, but follow-up was possible only in 24. At a mean follow up of 34 months, all 24 women had stage 0 vault support with point C of the POP-Q score averaging -6.8 cm. Subjective improvements in prolapse symptoms were observed with significant reductions in the questionnaire scores. The satisfaction measured with visual scale averaged 9.1. Fifteen women reported stress urinary incontinence before sacrocolpopexy, and it was resolved in 35 percent without concomitant continence surgery. New onset incontinence was reported in two women. There were no intraoperative and perioperative complications. The long term complications were an incisional hernia on the trocar port site and bowel obstruction caused by the mesh that needed intestinal resection. Conclusions: Laparoscopic sacrocolpopexy is a safe and effective surgical treatment for post-hysterectomy apical prolapse. It provides excellent apical support and good level of satisfaction, with overall improvement in prolapse symptoms.

Ultrasound Characteristics of Patients with Urinary Stress Incontinence with or without Genital Prolapse.

PURPOSE: The study purpose was to evaluate the clinical and ultrasound characteristics of women with urinary stress incontinence (USI) with or without genital prolapse (GP). MATERIALS AND METHODS: A total of 268 patients who underwent ultrasound perineal evaluation were divided into two groups: isolated USI (n=132) and USIGP (n=136) with USI/GP stage I/II. The latter group was additionally divided into two subgroups: USIGP(A) (n=78) with USI/GP stage I and USIGP(B) (n=58) with USI/GP stage II. RESULTS: Point Aa (pelvic organ prolapse quantification system), which is the projection of the bladder neck (BN) on the anterior vaginal wall, was situated higher in the rest position (RP) but moved lower during a Valsalva maneuver (VM) in the USI group than in the USIGP group (p<0.05). The ultrasound parameters α-angle and the distance Sy-BN (symphisis-bladder neck) decreased, whereas distance H increased, in the USIGP group during VM. The ultrasound parameters that gave the best insight into the range of BN movements were as follows: distance R→V and angle of rotation (ρ), which were significantly higher in the USI group than in the USIGP group during VM. CONCLUSIONS: According to the clinical and ultrasound findings, we can conclude that the BN is situated higher during the RP but moved lower during a VM in patients with isolated USI compared with those with concomitant USI/GP, which could be explained by the cystocele-immobilizing effect on the BN during the VM in the latter group but also by the deteriorated pubo-urethral ligaments in the former group.

Ultrasound Characteristics of Patients with Urinary Stress Incontinence with or without Genital Prolapse

PURPOSE: The study purpose was to evaluate the clinical and ultrasound characteristics of women with urinary stress incontinence (USI) with or without genital prolapse (GP). MATERIALS AND METHODS: A total of 268 patients who underwent ultrasound perineal evaluation were divided into two groups: isolated USI (n=132) and USIGP (n=136) with USI/GP stage I/II. The latter group was additionally divided into two subgroups: USIGP(A) (n=78) with USI/GP stage I and USIGP(B) (n=58) with USI/GP stage II. RESULTS: Point Aa (pelvic organ prolapse quantification system), which is the projection of the bladder neck (BN) on the anterior vaginal wall, was situated higher in the rest position (RP) but moved lower during a Valsalva maneuver (VM) in the USI group than in the USIGP group (pV and angle of rotation (rho), which were significantly higher in the USI group than in the USIGP group during VM. CONCLUSIONS: According to the clinical and ultrasound findings, we can conclude that the BN is situated higher during the RP but moved lower during a VM in patients with isolated USI compared with those with concomitant USI/GP, which could be explained by the cystocele-immobilizing effect on the BN during the VM in the latter group but also by the deteriorated pubo-urethral ligaments in the former group.