scholarly journals Changes of Pelvic Organ Prolapse Symptoms and Quality of Life One Year After Pessary Fitting

2021 ◽  
Author(s):  
Tahereh Eftekhar ◽  
Zinat Ghanbari ◽  
Leila Pourali ◽  
Maryam Deldar Pesikhani ◽  
Soodabeh Darvish ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Significant Proportion ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Sexually Active ◽  
Sexual Symptoms ◽  
Before And After ◽  
Prolapse Symptoms ◽  
One Year

Pelvic organ prolapse (POP) is the descend of pelvic organs, including the uterus, bladder, and rectum, to the vaginal wall. Patients with POP may present with symptoms such as vaginal bulging with other symptoms like urinary, defecatory, or sexual dysfunction. This study was conducted to evaluate the changes of POP symptoms one year after pessary fitting. Patients with symptomatic pelvic organ prolapse who presented to the pelvic floor clinic of an academic hospital between August 2016 and April 2019 were considered. Pelvic organ prolapse symptoms, including urinary, defecatory, sexual, and bulging symptoms, were recorded before and one year after pessary fitting. Pelvic floor distress inventory (PFDI)-20 and pelvic floor impact questionnaire-7 (PFIQ-7) were evaluated before and after treatment for all subjects. We analyzed the characteristics of 110 patients who used the pessary for 12 months. At the baseline, the most common prolapse symptoms were vaginal bulging and pelvic pressure. All urinary, defecatory, and sexual symptoms significantly improved one year after regular pessary use (P<0.001). Changes in PFDI-20 and PFIQ-7 before and after pessary use showed a significant improvement in both frequency and satisfaction of sexual function (P<0.001). The study showed significant improvement in bulging, urinary, and defecatory symptoms. Although the majority of patients were not sexually active, a significant proportion of sexually active patients reported an increase in sexual satisfaction.

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.

scholarly journals Atypical vaginal location of endometriosis following repeated urogynaecological surgery

2021 ◽  
Vol 14 (8) ◽  
pp. e244186
Author(s):  
Anna Elisabet Christensen ◽  
Jens Jorgen Kjer ◽  
Dorthe Hartwell ◽  
Signe Perlman
Keyword(s):  
Vaginal Surgery ◽  
Surgical Excision ◽  
Scar Tissue ◽  
Pelvic Organ ◽  
Urethral Diverticulum ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Urinary Flow ◽  
Prolapse Symptoms ◽  
One Year

We outline a case of vaginal endometriosis in scar tissue located in the distal part of the anterior vaginal wall close to the urethra following repeated urogynaecological surgery. Our case presents a 45-year-old woman diagnosed with pelvic endometriosis in her youth. She underwent several vaginal surgeries due to pelvic organ prolapse, symptoms of stress incontinence and decreased urinary flow. One year after her most recent vaginal surgery, she developed a tender lump in the lower part of the anterior vaginal wall. A urethral diverticulum was suspected, but a diagnostic puncture and biopsy unexpectedly showed histologically verified endometriosis. As the cyst recurred, surgical excision of all visible endometriosis tissue was performed. After 3 years of follow-up, the patient remained without recurrence. This case illustrates the risk of atypical implantation of endometriosis related to repeated urogynaecological surgery and that treatment requires surgery with thorough removal of all visible tissues.

Evaluation of implant-associated complications after mesh-implants setting in pelvic floor reconstruction

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 69-73
Author(s):  
Alfiya G Yashchuk ◽  
Ilnur I Musin ◽  
Raisa A Naftulovich ◽  
Elena M Popova ◽  
Irina B Fatkullina ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Blood Circulation ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Pelvic Floor Muscles ◽  
Reproductive Age ◽  
Doppler Flowmetry ◽  
Mesh Implant

Relevance. According to world data, nowadays prevalence of pelvic floor dysfunction and pelvic organ prolapsed reaches 28%. Most specialists relate pregnancy and delivery to main factors of pelvic prolapse development. Due to lifespan growth frequency of pelvic organ prolapse development increases. According to FDA data annually in the world is made more than 100 000 surgeries with synthetic implants, herewith heavy complications occur in 3.4% and mild complications occur in 14.8% of all cases. About 58% of surgeries are made to women under the age of 60, 13% of patients needs re-intervention during next 5 years. It should be noted that in cases of relapse more than 30% of women need re-intervention. Aim. Evaluate implant-associated complications after mesh-implants setting. Materials and methods. We have made retrospective analysis of mesh-implant use in 458 patients with pelvic organ prolapse in 2018-2018 yy. on the base of Bashkir State Medical University clinic. In order to assess quality of life after mesh-implant setting, we used the following questionnaires: Incontinence Questionnaire Short Form (ICIQ-SF), and also Female Sexual Function Index (FSFI). In order to assess blood microcirculation indices after surgery, we used laser Doppler flowmetry evaluation from anterior vaginal wall. Results. All in all, there were revealed 13 (2.84%) implant-associated complications. In 4 patients ICIQ-SF points were from 3 to 15, which indicates manifestation of urgent urine incontinence signs. According to FSFI questionnaire, sexually active women have 31.5 points. Basic factor, which provokes pelvic floor muscles dysfunction is delivery. Besides, in group of women of reproductive age, pelvic floor muscles dysfunction (PFMD) is associated with the presence of concomitant gynecologic diseases (uterine myoma, endometriosis, ovarian tumors). In the group of women older than 45 years with the presence of somatic pathology - obesity and impaired blood circulation. According to LDF data from anterior vaginal wall women with PFMD have low blood circulation indices, herewith the lowest indices are registered in the group of women older than 45 years.

scholarly journals Identifying the Pathway to Conservative Pelvic Floor Physiotherapy in a Tertiary Public Hospital in Australia: A Retrospective Audit

2017 ◽  
Author(s):  
Tara Beaumont ◽  
Kate Goode
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Healthcare Provider ◽  
Best Practice ◽  
Conservative Therapy ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Prolapse Symptoms ◽  
Tertiary Healthcare ◽  
Local Healthcare

Introduction: Incontinence and/or pelvic organ prolapse symptoms are prevalent in women in Australia and the estimated healthcare cost is considerable. Internationally accepted best practice evidence supports a trial of conservative Physiotherapy treatment with a Physiotherapist trained in the management of pelvic floor dysfunction before surgical options should be considered. Existing referral pathways in the tertiary healthcare system to access conservative Physiotherapy treatment require direct referral from Gynaecology staff. Objective: To identify the pathway to conservative pelvic floor physiotherapy for women referred to a tertiary hospital in Australia with incontinence and/or pelvic organ prolapse symptoms following existing referral pathways. Results: Attendance data for the period January to June 2015 identified 63 women as being primarily referred for incontinence and/or pelvic organ prolapse by their local healthcare provider. Half of these 63 women (n = 31) were referred on to Physiotherapy for conservative management; the other half were not. The time between local healthcare provider referral to specialist Gynaecology appointment ranged from 49 days to 351 days (average 169.6 days). Of the 31 women referred to Physiotherapy, the majority (n = 22, 70.9%) were referred on the day of their initial Gynaecology consultation, the 9 remaining women waited between 2 to 126 days for Physiotherapy referral. The shortest pathway from local healthcare provider referral to Physiotherapy consultation was 64 days; the longest pathway was 402 days. Of the 31 women who were not referred to Physiotherapy, 18 (58%) proceeded directly to surgery. Conclusion: This audit demonstrates that existing referral pathways for women referred with incontinence and/or pelvic organ prolapse create lengthy delays between local healthcare provider referral and access to Physiotherapy services. Only half of those women who would be appropriate for a trial of conservative therapy are being referred to Physiotherapy which is in direct contrast to the widely accepted best practice guidelines for the management of pelvic floor dysfunction mandating conservative therapy as a first line approach for these conditions. The opportunity to implement an advanced scope model of care that promotes more timely access and earlier commencement of conservative Physiotherapy for these women would significantly improve the clinical care pathway for this cohort of patients in the tertiary healthcare setting.

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