Incidence and risk factors for reoperation of surgically treated pelvic organ prolapse

The objective of this study was to evaluate the morphological and immunohistochemical alterations of tissue removed from the upper third of anterior vaginal wall in a sample group of the female population presenting homogenous risk factors associated with Pelvic Organ Prolapse (POP). The case study consisted of 14 patients with POP and there were 10 patients in the control group. Patient selection was carried on the basis of specific criteria and all of the patients involved in the study presented one or more of the recognized POP risk factors. Samples were taken from POP patients during vaginal plastic surgery following colpohysterectomy, and from control patients during closure of the posterior fornix following hysterectomy. Samples were processed for histological and immunohistochemical analyses for Collagen I and Collagen III, α-Smooth Muscle Actin (α-SMA), Platelet-Derived-Growth-Factor (PDGF), matrix metalloproteinase 3 (MMP3), Caspase3. Immunofluorescence analyses for Collagen I and III and PDGF were also carried out. In prolapsed specimens our results show a disorganization of smooth muscle cells that appeared to have been displaced by an increased collagen III deposition resulting in rearrangement of the muscularis propria architecture. These findings suggest that the increase in the expression of collagen fibers in muscularis could probably due to a phenotypic switch resulting in the dedifferentiation of smooth muscle cells into myofibroblasts. These alterations could be responsible for the compromising of the dynamic functionality of the pelvic floor.

Download Full-text

Long-term observation on postoperative recurrence and complications of transvaginal mesh surgery for pelvic organ prolapse

Gynecologic and Obstetric Investigation ◽

10.1159/000520979 ◽

2021 ◽

Author(s):

Junfang Yang ◽

Kun Zhang ◽

Jinsong Han ◽

Yiting Wang ◽

Ying Yao ◽

...

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Protective Factor ◽

Pelvic Organ ◽

Vaginal Mesh ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Surgery ◽

Post Menopause

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. Conclusion: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

Download Full-text

Pelvic Organ Prolapse in Countries of Different Economy: A Systematic Review

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v14i2.28436 ◽

2019 ◽

Vol 14 (2) ◽

pp. 7-21

Author(s):

Shishir Paudel ◽

Anisha Chalise ◽

Ganesh Dangal ◽

Tulsi Ram Bhandari ◽

Gehanath Baral

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Pelvic Organ Prolapse ◽

Uterine Prolapse ◽

National Income ◽

Significant Risk ◽

Pelvic Organ ◽

Reference List ◽

Medical Subject Headings ◽

Pubmed Database

Aims: This review was done to identify the reported prevalence rate of pelvic organ prolapse among the different world populations. Methods: Systematic review of Pelvic Organ Prolapse (POP) using the PRISMA checklist; PubMed database was searched on reportingthe prevalence of POP and its management measures in January 2020. Medical Subject Headings (MeSH) like "Pelvic Organ Prolapse"OR "Uterine Prolapse" OR “Vaginal Wall Prolapse” OR "Cystocele"AND "Prevalence [key word/s]" were used. Additional articles were identified through the reference list of the retrieved articles. Results: Out of 91 screened articles, 46 full articles were eligible and only 15 satisfied by selection criteria for the systematic review.The methodological score rated for the quality of studies is 4.5±1.7 (range=2-7) out of 8 points. The mean prevalence of POP diagnosis was 40%; with 42.44% in low and lower-middle-income countries,and 35.56%in upper-middle and high-income countries. Increasing age and parity, body mass indexand fetal macrosomia were found to be the significant risk factors irrespective of the country’s economy. Conclusions:The low and lower-income countries have almost twice the burden of prolapse than the countries of the higher economy. The major risk factors associated with prolapse remain common in all countries irrespective of national income or development.

Download Full-text

Metabolic risk factors and recurrence of pelvic organ prolapse after primary repair in post-menopausal women

Maturitas ◽

10.1016/j.maturitas.2019.04.092 ◽

2019 ◽

Vol 124 ◽

pp. 140-141

Author(s):

Giulia Gava ◽

Renato Seracchioli ◽

Maria Cristina Meriggiola

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Primary Repair ◽

Pelvic Organ ◽

Metabolic Risk Factors ◽

Metabolic Risk ◽

Menopausal Women ◽

Post Menopausal

Download Full-text

Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors

International Urogynecology Journal ◽

10.1007/s00192-005-0003-8 ◽

2005 ◽

Vol 17 (4) ◽

pp. 315-320 ◽

Cited By ~ 183

Author(s):

Pierre Collinet ◽

Franck Belot ◽

Philippe Debodinance ◽

Edouard Ha Duc ◽

Jean-Philippe Lucot ◽

...

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Prolapse Repair ◽

Pelvic Organ Prolapse Repair ◽

Mesh Technique

Download Full-text

Clinical epidemiological study of uterine prolapse

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20185287 ◽

2018 ◽

Vol 8 (1) ◽

pp. 79

Author(s):

Parvathavarthini K. ◽

Vanusha A.

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Social Issues ◽

Uterine Prolapse ◽

Epidemiological Data ◽

Pelvic Organ ◽

Life Threatening ◽

The Mean ◽

Awareness Programme

Background: Pelvic organ prolapse is one of the common gynaecological problem in India among the parous and aged women. Though the pelvic organ prolapse is not life threatening if left untreated it can lead to many social issues and also it reduces the quality of life of a woman. Thus, this study aims at generating epidemiological data on uterine prolapse in a clinical setting and identifying its risk factors so that appropriate measures can be taken to prevent the same.Methods: It was a descriptive case control study. Using a study proforma the required information was collected from the patients admitted with uterine prolapse (case) and from amongst the patient’s attendees of Gynaecology ward (control). Obtained data were compared and analyzed using appropriate statistical methods.Results: Uterine prolapse contributes to about 5.9% of the total gynecological patients admitted during the study period. The mean age of presentation with uterine prolapse was 50.1years the mean number of deliveries was higher in case compared to the control with the mean of 4 deliveries. Out of 130 patients, only 13.9% of them had institutional delivery while the others had home delivery.Conclusions: Uterine prolapse is strongly associated with age, parity and place of delivery. As the risk factors for uterine prolapse are easily preventable public health awareness programme must be conducted on its risk factors there by reducing the incidence of prolapse and decreasing the morbidity caused by it.

Download Full-text