scholarly journals Ultrasound evaluation of anterior transvaginal mesh for pelvic organ prolapse: correlation to 5-year clinical outcomes

2021 ◽  
Author(s):  
Georgios Poutakidis ◽  
Anna Marsk ◽  
Daniel Altman ◽  
Christian Falconer ◽  
Edward Morcos
Keyword(s):  
Pelvic Organ Prolapse ◽  
Clinical Outcomes ◽  
Pelvic Organ ◽  
Horizontal Line ◽  
Midsagittal Plane ◽  
Inferior Margin ◽  
Bladder Emptying ◽  
Ultrasound Evaluation ◽  
Patient Reported ◽  
Mesh Length

Abstract Introduction and hypothesis Vaginal prolapse mesh may effectively restore vaginal anatomy. The aim of this study was to investigate how the in vivo mesh position correlates to clinical outcomes. Methods Seventy-one women operated on using Uphold mesh for apical pelvic organ prolapse (POP-Q, C ≥ stage II) were examined 5 years after surgery by introital-perineal 2D ultrasound in a midsagittal plane at rest and Valsalva. The horizontal line and pubis symphysis were considered the reference for all measures. Ultrasound measures were statistically compared to clinical outcomes: POP-Q, Pelvic Floor Distress Inventory (PFDI-20) and subscales [Pelvic Organ Distress Inventory (PODI-6), and Urinary Distress Inventory (UDI-6)] and the VAS scale for pain. Results Original mesh length was preserved by 86% and correlated to improved pain as estimated by VAS scale (r 0.321). Valsalva was associated with a lowering of the superior and inferior mesh margins by 7.3 and 6.1 mm, respectively (p < 0.001) but a reduction of total mesh length by only 1 mm (30.2 ± 5.2 to 29.2 ± 4.7 mm, p < 0.001). Mobility of the anterior vaginal wall (bladder neck and midurethra) at Valsalva was parallel to downward movement of the mesh inferior margin (r 0.346 and 0.314) but inversely correlated to total UDI-6 (r − 0.254 and − 0.263). Mobility of the midurethra was inversely correlated to bladder emptying (PFDI-20 Question 19, r − 0.245). Conclusions Five years after surgery, preserved original length of the mesh with apical support was correlated to improved anatomical and patient-reported outcomes. Mesh support to the vaginal apex was associated with improved bladder emptying and total urinary distress outcomes but not stress urinary incontinence.

scholarly journals Pelvic floor muscle training for women with pelvic organ prolapse: the PROPEL realist evaluation

2020 ◽  
Vol 8 (47) ◽  
pp. 1-104
Author(s):  
Margaret Maxwell ◽  
Karen Berry ◽  
Sarah Wane ◽  
Suzanne Hagen ◽  
Doreen McClurg ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Symptom Score ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Organ ◽  
Realist Evaluation ◽  
Muscle Training ◽  
Patient Reported ◽  
Study Sites

Background Pelvic organ prolapse is estimated to affect 41–50% of women aged > 40 years. A multicentre randomised controlled trial of individualised pelvic floor muscle training found that pelvic floor muscle training was effective in reducing symptoms of prolapse, improved quality of life and showed clear potential to be cost-effective. Provision of pelvic floor muscle training for prolapse has continued to vary across the UK, with limited availability of specialist physiotherapists to deliver it. Objectives This project aimed to study the implementation and outcomes of different models of delivery to increase the service provision of pelvic floor muscle training, and to follow up treatment outcomes for the original trial participants. Design A realist evaluation of pelvic floor muscle training implementation conducted within three full case study sites and two partial case study sites; an observational prospective cohort study comparing patient-reported outcomes pre and post intervention in all five sites; and a long-term follow-up study linking previous trial participants to routine NHS hospital data. Setting The setting for the realist evaluation was pelvic floor muscle training service delivery models in three NHS sites. The setting for the patient-reported outcome measures study was pelvic floor muscle training services in five NHS sites. Methods Realist evaluation qualitative data were collected at four time points in three case study sites to understand the implementation models, uptake, adherence and impact. Interviews involved service managers/leads, consultants, staff delivering pelvic floor muscle training and women receiving pelvic floor muscle training. Main outcomes measures Patient-reported outcomes were collected at baseline and at 6 and 12 months across five sites, including the Pelvic Organ Prolapse Symptom Score, health-related quality of life (measured using the EuroQol-5 Dimensions, five-level version, questionnaire), prolapse severity (measured using the Pelvic Organ Prolapse Quantification System), urinary incontinence (measured using International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form) and need for further treatment. Results A total of 102 women were recruited to the patient-reported outcome measures cohort study (target, n = 120), and 65 women had matched baseline and 6-month Pelvic Organ Prolapse Symptom Scores. The mean Pelvic Organ Prolapse Symptom Score was 10.18 (standard deviation 5.63) at baseline and 6.98 (standard deviation 5.23) at 6 months, representing a statistically significant and clinically meaningful difference. There was no statistically significant difference between the outcomes obtained from delivery by specialist physiotherapists and the outcomes obtained from delivery by other health-care professionals (mean change in Pelvic Organ Prolapse Symptom Score: –3.95 vs. –2.81, respectively). Services delivered using higher-band physiotherapists only were more costly than services delivered using other staff mixes. The effect of the original pelvic floor muscle training intervention, over a post-intervention period of > 10 years, was a reduction in the odds of any treatment during follow-up (odds ratio 0.61, 95% confidence interval 0.37 to 0.99). The realist evaluation revealed stark differences in implementation. The site with a specialist physiotherapy service resisted change because of perceived threats to the specialist role and concerns about care quality. Pelvic floor muscle training delivery by other health-care staff was easier when there was a lack of any existing specialist service; staff had prior training and interest in pelvic health; staff had support, autonomy, time and resources to deliver pelvic floor muscle training as part of their core role; and surrounding services supported a flow of pelvic floor muscle training referrals. Limitations The number of available matched pre and post outcomes for women and the lack of Pelvic Organ Prolapse Quantification System examinations were limitations of this study. Conclusions It is possible to train different staff to effectively deliver pelvic floor muscle training to women. Women’s self-reported outcomes significantly improved across all service models. Training should be adequately tailored to differential skill mix needs. Future work Future work should include further implementation of pelvic floor muscle training and should include pre- and post-outcome data collection using the Pelvic Organ Prolapse Symptom Score. Study registration This study is registered as Research Registry 4919. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 47. See the NIHR Journals Library website for further project information.

scholarly journals Minimal important difference and patient acceptable symptom state for PFDI-20 and POPDI-6 in POP surgery

2020 ◽  
Author(s):  
Päivi K. Karjalainen ◽  
Nina K. Mattsson ◽  
Jyrki T. Jalkanen ◽  
Kari Nieminen ◽  
Anna-Maija Tolppanen
Keyword(s):  
Pelvic Organ Prolapse ◽  
Roc Curve ◽  
Minimal Important Difference ◽  
Patient Reported Outcome Measures ◽  
Pelvic Organ ◽  
Population Based ◽  
Patient Reported Outcome ◽  
Pop Surgery ◽  
Patient Reported ◽  
Patient Acceptable Symptom State

Abstract Introduction and hypothesis Patient-reported outcome measures are fundamental tools when assessing effectiveness of treatments. The challenge lies in the interpretation: which magnitude of change in score is meaningful for the patients? The minimal important difference (MID) is defined as the smallest difference in score that patients perceive as important. The Patient Acceptable Symptom State (PASS) represents the value of score beyond which patients consider themselves well. We aimed to determine the MID and PASS for Pelvic Floor Distress Inventory-20 (PFDI-20) and Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6) in pelvic organ prolapse (POP) surgery. Methods We used data from 2704 POP surgeries from a prospective, population-based cohort. MID was determined with three anchor-based and one distribution-based method. PASS was defined using two different methods. Medians of the estimates were identified. Results The MID estimates with (1) mean change, (2) receiver-operating characteristic (ROC) curve, (3) 75th percentile, and (4) distribution-based method varied between 22.9–25.0 (median 24.2) points for PFDI-20 and 9.0–12.5 (median 11.3) for POPDI-6. The PASS cutoffs with (1) 75th percentile and (2) ROC curve method varied between 57.7–62.5 (median 60.0) for PFDI-20 and 16.7–17.7 (median 17.2) for POPDI-6. Conclusion A mean difference of 24 points in the PFDI-20 or 11 points in the POPDI-6 can be used as a clinically relevant difference between groups. Postoperative scores ≤ 60 for PFDI-20 and ≤ 17 for POPDI-6 signify acceptable symptom state.

scholarly journals CLINICAL OUTCOMES OF LAPAROSCOPIC SACROCOLPOPEXY FOR PELVIC ORGAN PROLAPSE: A RETROSPECTIVE ANALYSIS OF 500 CASES FROM A SINGLE INSTITUTION

2017 ◽  
Vol 108 (3) ◽  
pp. 137-144
Author(s):  
Shingo Moriyama ◽  
Ting-wen Huang ◽  
Kriengkrai Sittidilokratna ◽  
Bahiyah Abdullah ◽  
Shino Tokiwa ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Retrospective Analysis ◽  
Clinical Outcomes ◽  
Pelvic Organ ◽  
Laparoscopic Sacrocolpopexy ◽  
Single Institution

Patient-Reported Impact of Pelvic Organ Prolapse on Continence and Sexual Function in Women With Exstrophy-Epispadias Complex

2017 ◽  
Vol 23 (6) ◽  
pp. 377-381 ◽  
Author(s):  
Ross G. Everett ◽  
Kathy M. Lue ◽  
Sunil S. Reddy ◽  
Daniel A. Friedlander ◽  
Cameron E. Alexander ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Sexual Function ◽  
Pelvic Organ ◽  
Patient Reported

scholarly journals A New Angle Measurement in Translabial Ultrasound as an Adjunct for the Diagnosis of Pelvic Organ Prolapse

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 98
Author(s):  
Gina Nam ◽  
Jae-Yen Song ◽  
Sa-Ra Lee
Keyword(s):  
Pelvic Organ Prolapse ◽  
Valsalva Maneuver ◽  
Pelvic Organ ◽  
Angle Measurement ◽  
Symphysis Pubis ◽  
Clinical Staging ◽  
Translabial Ultrasound ◽  
Inferior Margin ◽  
The Difference ◽  
Spearman’S Correlation

The aim of this study was to compare the data obtained by a pelvic organ prolapse quantification (POP-Q) examination with the translabial ultrasound (TLUS) quantification of prolapse, using a new method of angle measurement. We analyzed the TLUS and POP-Q exam findings of 452 patients with symptoms of POP. The POP-Q system was used for clinical staging. TLUS was performed both at rest, and during the Valsalva maneuver after proper preparation. A horizontal reference line was drawn through the inferior margin of the symphysis pubis and the levator plate connected to the rectal ampulla, and the difference was calculated between the rest and the Valsalva maneuver. The Spearman’s correlation coefficient of agreement between the TLUS and the clinical POP-Q staging was used for statistical analysis. There was a weak degree of correlation between the POP-Q findings for the Ap parameter and our new angle measurement (rho = 0.17, p < 0.001). Thus, POP staging in conjunction with TLUS with this new angle measurement shows better agreement for the diagnosis of POP than POP-Q staging alone.

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