Evaluation of intersystem agreement between standard pelvic organ prolapse quantification system and simplified pelvic organ prolapse scoring system

2017 ◽  
Vol 6 (5) ◽  
pp. 2031
Author(s):  
Archana G. Singh ◽  
Varsha Rani Choudhary ◽  
Vineeta Ghanghoria ◽  
Kirti Patel
Keyword(s):  
Pelvic Organ Prolapse ◽  
Coming Out ◽  
Classification System ◽  
Staging System ◽  
Weighted Kappa ◽  
Pelvic Organ ◽  
Home Delivery ◽  
Vaginal Wall ◽  
Classification Systems ◽  
Kappa Statistics

Background: Pelvic organ prolapse (POP) is one of the most common gynaecological problem encountered worldwide. The POPQ has become the most commonly used prolapse staging system since its introduction (1996). In spite of having merits to it, POP-Q has not acquired a widespread acceptance. International Urogynaecological Association (IUGA) Standardization of Terminology Committee has devised a simplified version S-POP classification system based on the ordinal stages of the POPQ. The objectives of present study are to determine the intersystem agreement between the standard POPQ and S-POP classification system of pelvic organ prolapse and to propose a user-friendly classification system.Methods: This prospective observational blinded study was conducted in the department of Obstetrics and Gynaecology, NSCB Medical College and Hospital, Jabalpur (M.P.) from March 2015-August 2016. 125 women underwent two separate pelvic examinations POPQ and S-POP, by two groups of gynaecologists at each site. Results were compared and analysed using appropriate statistics.Results: Out of 125 women 54 (43.2%) were in age group 41-50 years. 79 (63.2%) were post-menopausal. 102 (81.4%) were more than third parity. 107 (85.6%) had home delivery. 119 (95.2%) had symptom of something coming out of vagina. The weighted Kappa statistics for the intersystem agreement of S-POP system with POPQ system for overall stage was 0.82, 0.61 for both anterior and posterior vaginal wall, 0.9 for cervix and 0.87 for posterior fornix/cuff.Conclusions: There is significant agreement between the POPQ and S-POP classification systems of POP.

Tissue Composition of the Vaginal Wall in Women with Pelvic Organ Prolapse

2013 ◽  
Vol 75 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Aukje M. Meijerink ◽  
Reinier H. van Rijssel ◽  
Paul J.Q. van der Linden
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Tissue Composition

scholarly journals Changes in muscularis propria of anterior vaginal wall in women with pelvic organ prolapse

2016 ◽  
Vol 60 (1) ◽  
Author(s):  
A. Vetuschi ◽  
A. D'Alfonso ◽  
R. Sferra ◽  
D. Zanelli ◽  
S. Pompili ◽  
...  
Keyword(s):  
Risk Factors ◽  
Smooth Muscle ◽  
Pelvic Organ Prolapse ◽  
Smooth Muscle Cells ◽  
Muscularis Propria ◽  
Muscle Cells ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Collagen Iii

<p>The objective<strong> </strong>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.</p><p><strong> </strong></p>

scholarly journals To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse

2017 ◽  
Vol 5 (2) ◽  
pp. 81-86
Author(s):  
Krutika Bhalerao ◽  
Anuja V Bhalerao ◽  
Richa Garg
Keyword(s):  
Pelvic Organ Prolapse ◽  
Coming Out ◽  
Vaginal Hysterectomy ◽  
Pelvic Organ ◽  
Uterosacral Ligament ◽  
Vaginal Vault ◽  
Care Hospital ◽  
Uterosacral Ligament Suspension ◽  
Vaginal Length ◽  
Vault Suspension

ABSTRACT Introduction Vaginal vault prolapse can be prevented by supporting the vaginal cuff, which is an essential part of hysterectomy, whether done abdominally or vaginally. The American Association of Gynecologic Laparoscopists (AAGL) has recommended for future research, specifically, a randomized trial comparing McCall's culdoplasty (with uterosacral ligament plication) with vaginal high uterosacral ligament suspension (HUSLS) (without plication), since both procedures are accessible to gynecological surgeons without urologic background. Hence, this study was carried out. Aim To compare both anatomic and functional outcomes of patients undergoing vaginal HUSLS or McCall's culdoplasty at the time of vaginal hysterectomy. Materials and methods This hospital-based prospective comparative study was carried out at a tertiary care hospital from January 1, 2013 to December 31, 2015 over a period of 3 years after obtaining Ethical Committee approval. All women attending gynecological outpatient department having symptom of mass coming out of vagina were subjected to detailed history, examination, and later underwent either HUSLS (43) or McCall's culdoplasty (42), for vault suspension with concomitant hysterectomy. The effectiveness of both the procedures was assessed by preoperative and postoperative pelvic organ prolapse quantification (POP-Q) and both were compared. Observations There was statistically significant improvement in all the sites of POP-Q points by HUSLS and McCall's culdoplasty as a method of vault suspension except in total vaginal length (TVL). Vault suspension by HUSLS is better than McCall's culdoplasty. All the points of POP-Q showed better results but the point C was significantly placed at a higher level by HUSLS (p = 0.000) as compared with McCall's culdoplasty. The time required for HUSLS was statistically more as compared with repair by McCall's culdoplasty (81.55/74.53 minutes, T: 1.981, p: 0.05). Complications, such as hemorrhage and ureteric injuries were more in HUSLS (2/43, 4.8%) as compared with McCall's culdoplasty (0/42); this is statistically significant. Conclusion High uterosacral ligament suspension provides excellent suspensory support to vaginal vault. Vagina is suspended over the levator ani with normal axis toward sacrum. By doing HUSLS, the vagina is symmetrically supported directed toward the hollow of sacrum. High uterosacral ligament suspension is highly recommended for young women with POP as vaginal length is not altered at all and so is the quality of life. How to cite this article Bhalerao AV, Bhalerao K, Garg R. To Compare the Effectiveness of Vaginal High Uterosacral Ligament Suspension and McCall's Culdoplasty during Vaginal Hysterectomy for Pelvic Organ Prolapse. J South Asian Feder Menopause Soc 2017;5(2):81-86.

Detection of oncological diseases in patients with pelvic organ prolapse. Case report

GYNECOLOGY ◽  
2021 ◽  
Vol 23 (2) ◽  
pp. 193-197
Author(s):  
Dmitrii V. Baibuz ◽  
Oleg L. Molchanov ◽  
Zhanna V. Glushchenko ◽  
Yanina A. Lebedeva ◽  
Sergei V. Utkin ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Preoperative Diagnosis ◽  
Abdominal Cavity ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Benign Disease ◽  
Pelvic Tumor ◽  
Planning Treatment ◽  
Oncological Diseases ◽  
Anterior Posterior

Pelvic organ prolapse is a common benign disease among women that is characterized by an isolated or combined descent of the anterior, posterior vaginal wall, uterus, and vaginal dome after hysterectomy. Given the fact that most of the operations are performed among middle-aged and elderly patients, the probability of detecting previously undiagnosed tumor of the abdominal cavity and pelvic region increases, which may be due to the limited volume of basic preoperative diagnosis. The purpose of our report is to draw the attention of clinicians to the problem of insufficient examination of women when planning treatment of pelvic organ prolapse on the example of our experience in managing a patient with this pathology in combination with pelvic tumor.

Is pelvic organ prolapse associated with altered microcirculation of the vaginal wall?

2015 ◽  
Vol 35 (7) ◽  
pp. 764-770 ◽  
Author(s):  
M.A. Weber ◽  
D.M.J. Milstein ◽  
C. Ince ◽  
J.P.W.R. Roovers
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Vaginal Wall

Computational Modeling of Anterior and Posterior Pelvic Organ Prolapse (POP)

2016 ◽  
Author(s):  
Arnab Chanda ◽  
Vinu Unnikrishnan ◽  
Holly E. Richter ◽  
Mark E. Lockhart
Keyword(s):  
Pelvic Organ Prolapse ◽  
Urinary Bladder ◽  
High Stress ◽  
Significant Proportion ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Vaginal Tissue ◽  
Bladder Filling ◽  
Vaginal Length ◽  
Vaginal Canal

Pelvic Organ Prolapse (POP) is a condition of the female pelvic system suffered by a significant proportion of women in the U.S. and more across the globe, every year. POP is caused by the weakening of the pelvic floor muscles and musculo-connective tissues due to child birth, menopause and morbid obesity. Prolapse of the pelvic organs namely the urinary bladder, uterus, and rectum into the vaginal canal can cause vaginal discomfort, strained urination or defecation, and sexual dysfunction. To date, success rates of native tissue POP surgeries vary from 50–70% depending on the definition of cure and time-point of assessment. A better understanding of the mechanics of prolapse may lead to improvement in surgical outcomes. In the current work, the mechanics of progression of anterior and posterior vaginal prolapse were modeled to understand the effect of bladder fill and posterior vaginal stresses using computational approaches. A realistic and full-scale female pelvic system model, comprised of the urinary bladder, vaginal canal, uterus, rectum, and fascial connective tissue, was developed using image segmentation methods. All of the relevant loads and boundary conditions were applied based on a comprehensive study of the anatomy and functional morphology of the female pelvis. Hyperelastic material models were adopted to characterize all pelvic tissues, and a non-linear analysis was invoked. In the first set of simulations, a realistic bladder filling and vaginal tissue stiffening in prolapse were modeled and their effects on the anterior vaginal wall (AVW) were estimated in terms of the induced stresses, strains and displacements. The degree of bladder filling was found to be a strong indicator of stress build-up on the AVW. Also, vaginal tissue stiffening was found to increase the size of the high stress zone on the AVW. The second simulation consisted of modeling the different degrees of posterior vaginal wall (PVW) prolapse, in the presence of an average abdominal pressure. The vaginal length was segmented into four sections to study the localized stresses and strains. Also, a clinically well-known phenomena known as the kneeling effect was observed with the PVW in which the vaginal wall displaces away from the rectum and downward towards the vaginal hiatus. All of these results have relevant clinical implications and may provide important perspective for better understanding the mechanics of POP pathophysiology.

Morphometric analysis of smooth muscle in the anterior vaginal wall of women with pelvic organ prolapse

2002 ◽  
Vol 187 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Muriel K. Boreham ◽  
Clifford Y. Wai ◽  
Rodney T. Miller ◽  
Joseph I. Schaffer ◽  
R.Ann Word
Keyword(s):  
Smooth Muscle ◽  
Pelvic Organ Prolapse ◽  
Morphometric Analysis ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall
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