scholarly journals Does Dominant Prolapse in Other Compartments Affect the Assessment of Bladder Prolapse on Translabial Ultrasound?

2021 ◽  
Author(s):  
Manli Wu ◽  
Xudong Wang ◽  
Zhijuan Zheng ◽  
Junyan Cao ◽  
Jing Xu ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Chinese Women ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Lower Urinary Tract Dysfunction ◽  
Translabial Ultrasound ◽  
Anterior Compartment ◽  
Stage 1 ◽  
The Impact ◽  
Bladder Prolapse

Objective: To explore the impact of dominant prolapse in other compartments in assessing bladder prolapse, and to establish cutoffs for staging bladder prolapse among Chinese women using translabial ultrasound. Design: Prospective multicentre observational study. Setting: Tertiary referral urogynaecology unit. Population: A total of 741 women with symptoms of lower urinary tract dysfunction and/or pelvic floor dysfunction were included. Methods: Women underwent interview, pelvic organ prolapse quantification (POP-Q) examinations and 4D translabial ultrasounds. Main outcome measures: The ROC statistic was used to assess accuracy and define the optimal cutoffs. Results: The mean patient age was 42.7 years (range, 18-82). There were 456 women without dominant prolapse in the apical/posterior compartments and 285 women with dominant prolapse in the apical/posterior compartments. Among patients without and with dominant prolapse, similar cutoffs (-10.9 mm vs. -9.1 mm) were determined for predicting POP-Q stage ≥ 2 in the anterior compartment, with AUCs of 0.87 and 0.79, respectively. In contrast, significantly different cutoffs (-5.7 mm vs. +3.5 mm) were determined for predicting POP-Q stage ≥ 1 among patients with and without dominant prolapse, with AUCs of 0.85 and 0.77, respectively. Conclusion: Dominant prolapse in the apical/posterior compartments affected the accuracy and cutoffs of translabial ultrasound for staging bladder prolapse. Thus, competition of various organs in women with multi-compartment prolapse should be considered as a potential complicating factor in assessing pelvic organ prolapse. Funding: The study is supported by grants from the National Natural Science Foundation of China (No. 91859115). Key words: Bladder prolapse; translabial ultrasound.

scholarly journals Sexual function in women with pelvic floor disorders

2013 ◽  
Vol 7 (9-10) ◽  
pp. 199 ◽  
Author(s):  
Rebecca G. Rogers
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Stress Urinary Incontinence ◽  
Sexual Function ◽  
Pelvic Floor ◽  
Pelvic Floor Disorders ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
The Impact

Pelvic floor disorders (PFDs) can impact sexual function. This summary provides an overview of the impact of stress urinary incontinence and pelvic organ prolapse and their treatments on sexual function. In general, interventions that successfully address PFDs will generally improve sexual function as well. However, there are patients whose sexual function will remain unchanged despite treatment, and a small but significant minority who will report worsened sexual function following treatment for their pelvic floor dysfunction.

scholarly journals Importance of Translabial Ultrasound for the Diagnosis of Pelvic Organ Prolapse and Its Correlation with the POP-Q Examination: Analysis of 363 Cases

2021 ◽  
Vol 10 (18) ◽  
pp. 4267
Author(s):  
Gina Nam ◽  
Sa-Ra Lee ◽  
Sung-Hoon Kim ◽  
Hee-Dong Chae
Keyword(s):  
Pelvic Organ Prolapse ◽  
Predictive Value ◽  
Pelvic Organ ◽  
Vaginal Wall ◽  
Translabial Ultrasound ◽  
Posterior Compartment ◽  
P Values ◽  
Anterior Compartment ◽  
Aging Society ◽  
Apical Compartment

The incidence of pelvic organ prolapse (POP) is increasing in our aging society. We aimed to evaluate the clinical usefulness of translabial ultrasound (TLUS) by comparing the findings of POP-Q examination and TLUS in advanced POP patients and we also aimed to evaluate the prevalence of rectocele and enterocele on the TLUS. We analyzed the TLUS and POP-Q exam findings of 363 symptomatic POP patients who visited our clinic from March 2019 to April 2021. We excluded three patients who had conditions mimicking POP, as revealed by the TLUS. The most common POP type was anterior compartment POP (68.61%), followed by apical compartment (38.61%) and posterior compartment (16.11%) POP. Agreement between the POP-Q exam and TLUS was tested using Cohen’s kappa (κ). p values < 0.05 were considered statistically significant. The incidence of rectocele or enterocele was only 1.67% (6/360) and there was no rectocele or enterocele in most patients (246/252, 96.63%) when the POP-Q exam revealed posterior compartment POP, suggesting that they only had posterior vaginal wall relaxation. The positive predictive value of the POP-Q exam for detecting rectocele or enterocele (as revealed by TLUS) was only 2.38%, whereas the negative predictive value was 100%. In conclusion, the application of TLUS is useful in the diagnosis of POP, especially for differentiation of true POP from conditions mimicking POP. The correlation between the POP-Q exam and TLUS is low, especially in posterior compartment POP, and therefore, patients with POP-Q exam findings suggesting posterior compartment POP should undergo TLUS to check for rectocele or enterocele. The use of TLUS in the diagnosis of POP patients can improve the accuracy of the diagnosis of POP patients in conjunction with a POP-Q exam.

scholarly journals Quo Vadis Urogynecology 2020 – Innovative Treatment Concepts for Urinary Incontinence and Pelvic Organ Prolapse

2021 ◽  
Vol 81 (02) ◽  
pp. 183-190
Author(s):  
Gert Naumann
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Professional Training ◽  
Pelvic Floor Dysfunction ◽  
Estrogen Therapy ◽  
Pelvic Organ ◽  
Alloplastic Materials ◽  
Wide Range ◽  
Quo Vadis

AbstractThe current treatment for urinary incontinence and pelvic organ prolapse includes a wide range of innovative options for conservative and surgical therapies. Initial treatment for pelvic floor dysfunction consists of individualized topical estrogen therapy and professional training in passive and active pelvic floor exercises with biofeedback, vibration plates, and a number of vaginal devices. The method of choice for the surgical repair of stress urinary incontinence consists of placement of a suburethral sling. A number of different methods are available for the surgical treatment of pelvic organ prolapse using either a vaginal or an abdominal/endoscopic approach and autologous tissue or alloplastic materials for reconstruction. This makes it possible to achieve optimal reconstruction both in younger women, many of them affected by postpartum trauma, and in older women later in their lives. Treatment includes assessing the patientʼs state of health and anesthetic risk profile. It is important to determine a realistically achievable patient preference after explaining the individualized concept and presenting the alternative surgical options.

scholarly journals Rectal–vaginal pressure gradient in patients with pelvic organ prolapse and symptomatic rectocele

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cheng Tan ◽  
Man Tan ◽  
Jing Geng ◽  
Jun Tang ◽  
Xin Yang
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pressure Gradient ◽  
Obstructed Defecation ◽  
Elevated Pressure ◽  
Pelvic Organ ◽  
Lower Grade ◽  
Translabial Ultrasound ◽  
Rectal Ampulla ◽  
The Relationship ◽  
Posterior Vaginal Prolapse

Abstract Objective The aim of this study is to examine the relationship between rectal–vaginal pressure and symptomatic rectocele in patients with pelvic organ prolapse (POP). Method Patients with posterior vaginal prolapse staged III or IV in accordance with the POP Quantitation classification method who were scheduled for pelvic floor reconstructive surgery in the years 2016–2019 were included in the study. Rectocele was diagnosed using translabial ultrasound, and obstructed defecation (OD) was diagnosed in accordance with the Roma IV diagnostic criteria. Both rectal and vaginal pressure were measured using peritron manometers at maximum Vasalva. To ensure stability, the test was performed three times with each patient. Results A total of 217 patients were enrolled in this study. True rectocele was diagnosed in 68 patients at a main rectal ampulla depth of 19 mm. Furthermore, 36 patients were diagnosed with OD. Symptomatic rectocele was significantly associated with older age (p < 0.01), a higher OD symptom score (p < 0.001), and a lower grade of apical prolapse (p < 0.001). The rectal–vaginal pressure gradient was higher in patients with symptomatic rectocele (37.4 ± 11.7 cm H2O) compared with patients with asymptomatic rectocele (16.9 ± 8.4 cm H2O, p < 0.001), and patients without rectocele (17.1 ± 9.2 cm H2O, p < 0.001). Conclusion The rectal–vaginal pressure gradient was found to be a risk factor for symptomatic rectocele in patients with POP. A rectal–vaginal pressure gradient of > 27.5 cm H2O was suggested as the cut-off point of the elevated pressure gradient.

scholarly journals Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eren Akbaba ◽  
Burak Sezgin
Keyword(s):  
Pelvic Organ Prolapse ◽  
De Novo ◽  
Pelvic Organ ◽  
Laparoscopic Technique ◽  
Life Questionnaire ◽  
Advanced Stage ◽  
Posterior Compartment ◽  
Anterior Compartment ◽  
Mesh Graft ◽  
Laparoscopic Lateral Suspension

Abstract Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments. Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

scholarly journals Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 387
Author(s):  
Karolina Eva Romeikienė ◽  
Daiva Bartkevičienė
Keyword(s):  
Clinical Trials ◽  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Randomized Clinical Trials ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Cochrane Library ◽  
Muscle Training

Every woman needs to know about the importance of the function of pelvic-floor muscles and pelvic organ prolapse prevention, especially pregnant women because parity and labor are the factors which have the biggest influence on having pelvic organ prolapse in the future. In this article, we searched for methods of training and rehabilitation in prepartum and postpartum periods and their effectiveness. The search for publications in English was made in two databases during the period from August 2020 to October 2020 in Cochrane Library and PubMed. 77 articles were left in total after selection—9 systematic reviews and 68 clinical trials. Existing full-text papers were reviewed after this selection. Unfinished randomized clinical trials, those which were designed as strategies for national health systems, and those which were not pelvic-floor muscle-training-specified were excluded after this step. Most trials were high to moderate overall risk of bias. Many of reviews had low quality of evidence. Despite clinical heterogeneity among the clinical trials, pelvic-floor muscle training shows promising results. Most of the studies demonstrate the positive effect of pelvic-floor muscle training in prepartum and postpartum periods on pelvic-floor dysfunction prevention, in particular in urinary incontinence symptoms. However more high-quality, standardized, long-follow-up-period studies are needed.

scholarly journals bFGF Activates Integrin β1 and Subsequently Upregulates Collagens via the p-MEK1/2/p-ERK1/2 Signaling Pathway in L929 Cells

2021 ◽  
Author(s):  
Lian Yang ◽  
Shasha Hong ◽  
Yang Li ◽  
Tingting Wang ◽  
Li Hong
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Floor ◽  
Signaling Pathway ◽  
Pelvic Floor Dysfunction ◽  
Underlying Mechanism ◽  
Pelvic Organ ◽  
Integrin Β1 ◽  
L929 Cells ◽  
Signal Transduction Protein ◽  
Special Project

Abstract The substantial loss of collagen in the supporting tissues of the pelvic floor is characteristic of pelvic organ prolapse (POP). A bFGF-induced collagen increase has been widely recognized by scholars, but the role of bFGF in pelvic floor dysfunction and the mechanism by which bFGF promotes collagen have not been reported. Here, we elucidated this mechanism. After bFGF stimulation, L929 cells showed significantly increased expression of collagen, integrin β1, and MEK1/2 signaling proteins. Our previous studies showed that integrin β1 plays an important role in electric stimulation-induced collagen expression, which suggests an underlying mechanism. By overexpressing and silencing integrin β1, we proved that integrin β1 is also an important signal transduction protein of bFGF that promotes collagen through the MEK1/2 pathway, which is a classic collagen-promoting pathway. In summary, these findings suggest that bFGF can stimulate the expression of collagen through the integrin β1/p-MEK1/2/p-ERK/1/2 signaling pathway in L929 cells. Keyword Pelvic organ prolapse; bFGF; integrinβ1; ERK1/2; Collagen Special project for Chinese women's pelvic floor dysfunction prevention and treatment (no. 201817092) and the Natural Science Foundation of Hubei Province（no.2019CFB149）.

scholarly journals Role of Magnetic Resonance defecography in assessment of pelvic floor dysfunction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M S Moussa ◽  
Y I Abdelkhaleq ◽  
S M Botros ◽  
A A Montasser
Keyword(s):  
Pelvic Organ Prolapse ◽  
Physical Examination ◽  
Pelvic Floor ◽  
Pelvic Floor Dysfunction ◽  
Pelvic Organ ◽  
Magnetic Resonance Defecography ◽  
Facial Defect ◽  
Floor Failure ◽  
Muscle Tear

Abstract Purpose to assess the role of the role of MR defecography in assessment of pelvic floor failure . Methods and Material Thirty-six patients (twenty-seven female and nine male) with female and male patients, complaining of stress urinary incontinence, constipation, fecal incontinence or pelvic organ prolapse. Results MRI revealed 18 cystocele (50%), compared to physical examination 2 cases(5.6%),MRI revealed 28 rectocele ( 77.8%) compared to physical examination that showed 13 (36.1%) , MRI revealed 10 uterine descent (40.7%), compared to physical examination 6 (22.2%) I, MRI revealed 7 enterocele (19.4%) compared to physical examination that was negative. MRI revealed level I/II facial defect in and level III facial defect in, 19 cases of Intussusception (52.8%), urethral hypermobility in 14 (38.9%), sphincteric defect 7 (19.4%), levator angle weakness in 30 cases (83.3%), iliococcygeaus muscle tear in 5 cases (13.9%), puborectalis tear in 3 cases (8.3%),anorectal decent in 26 cases (72.2%), genital hiatus width in 23 (63.9%) Conclusion Dynamic MR imaging is a necessary tool in the diagnosis of multicompartment pelvic organ prolapse and it provides good concordance with clinical examination

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