scholarly journals Clinical Risk Factors for Uterine Cervical Elongation among Women with Pelvic Organ Prolapse

2021 ◽  
Vol 18 (17) ◽  
pp. 9255
Author(s):  
Yi-Yin Liu ◽  
Chiu-Lin Wang ◽  
Zi-Xi Loo ◽  
Kun-Ling Lin ◽  
Cheng-Yu Long
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Cervical Length ◽  
Uterine Weight ◽  
Cervical Elongation ◽  
Vaginal Length ◽  
Independent Risk Factors ◽  
Cervical Amputation ◽  
Total Vaginal Length

Background: Cervical elongation is commonly associated with pelvic organ prolapse (POP). It was an identified risk for recurrent prolapse after hysteropexy, requiring additional surgeries. The aim of the study is to investigate the risk factors for uterine cervical elongation among women with POP. Methods: In this single-center retrospective cohort study, women who underwent vaginal total hysterectomy for POP between 2014 and 2016 were collected. The cervical and total uterine lengths were measured by pathologists, while the ratio of cervical length to total uterine length were calculated. The cervical elongation is defined as corpus/cervix ratio ≤ 1.5. Results: A total of 133 patients were enrolled in this study. Among these patients, 43 women had cervical elongation and 90 women had normal length of uterine cervix. We found that age > 65 years old (67.4% vs. 42.2%, p = 0.007), total vaginal length ≥ 9.5 cm (65.1% vs. 45.6%, p = 0.035), uterine weight < 51 gm (72.1% vs. 52.2%, p = 0.03), and Pelvic Organ Prolapse Distress Inventory 6 (POPDI-6) ≥ 12 (30.2% vs. 14.4%, p = 0.032) were associated with the risk of cervical elongation. There were no significant differences on preoperative urodynamic parameters in the two groups. Conclusion: The patient age > 65 years old, the total vaginal length of POP-Q system ≥ 9.5 cm, uterine weight < 51 g, and POPDI-6 ≥ 12 are independent risk factors of cervical elongation in women with POP. For women scheduled for pelvic reconstructive hysteropexy, concomitant cervical amputation should be considered.

scholarly journals Perineal Body Length and Pelvic Organ Prolapse in Menopausal Women

2019 ◽  
pp. 193-195
Author(s):  
Chairun Nisa ◽  
David Lotisna ◽  
Deviana Soraya Riu ◽  
St. Maisuri T Chalid
Keyword(s):  
Pelvic Organ Prolapse ◽  
Body Length ◽  
Pelvic Organ ◽  
Cross Sectional Study ◽  
Perineal Body ◽  
Cross Sectional ◽  
Genital Hiatus ◽  
Vaginal Length ◽  
Menopausal Women ◽  
Total Vaginal Length

Abstract Objective: To determine the correlation between the perineal body length and the pelvic organ prolapse (POP) in menopausal women. Methods: The total vaginal length (TVL), genital hiatus (GH), and perineal body (PB) length as the POP-Q component were measured at 60 menopausal women enrolled in a cross-sectional study. Results: Menopausal women with POP have the shorter perineal body (63.3%; <3 cm) compared with menopausal women without POP (36.7%; ≥3 cm). The mean length of the perineal body in menopausal women who suffer POP 2.81 ± 0.26 cm while in women without POP is 3.23±0.17 cm. POP risk was 25 times in menopausal women with a perineal body length <3 cm compared with longer perineal body (p = 0.01; OR = 25.4; 95% CI 3.1-209.1).Conclusion: Perineal body length is a risk factor for pelvic organ prolapse in menopausal women.Keywords: perineal body, prolapse, pelvic organ prolapsed Abstrak Tujuan: Menentukan korelasi panjang perineal body dengan kejadian prolaps organ panggul (POP) pada perempuan menopause. Metode: Pengukuran komponen POP-Q meliputi total vaginal length (TVL), genital hiatus (GH), dan panjang perineal body (PB) dilakukan pada 60 perempuan menopause yang dilibatkan dalam penelitian potong lintang. Hasil:    Perempuan menopause dengan POP memiliki perineal body yang lebih pendek (63,3%; <3 cm) dibandingkan dengan perempuan menopause tanpa POP (36,7%; ≥3 cm). Panjang rata-rata perineal body pada perempuan menopasue yang menderita POP 2,81 ± 0,26 cm sedangkan pada perempuan tanpa POP adalah 3,23 ± 0,17 cm. Risiko POP 25 kali pada perempuan menopause dengan panjang perineal body <3 cm dibandingkan dengan tubuh perineum yang lebih panjang (p = 0,01; OR = 25,4; 95% CI 3,1-209,1). Kesimpulan: Panjang perineal body merupakan faktor risiko prolaps organ panggul pada perempuan menopause. Kata kunci : perineal body, prolapsed, prolaps organ panggul

scholarly journals Pelvic Organ Prolapse Quantifi cation Accuracy for Elongasio Cervix Diagnose in Pelvic Organ Prolapse Patients

2020 ◽  
pp. 52-60
Author(s):  
Tyas Priyatini ◽  
Finish Fernando ◽  
Lucky S. Widyakusuma ◽  
Shirley T. Anggraeni ◽  
Kukuh W. Kustarto
Keyword(s):  
Body Mass Index ◽  
Pelvic Organ Prolapse ◽  
Gold Standard ◽  
Pelvic Organ ◽  
Cervical Length ◽  
Pelvic Organ Prolapse Quantification ◽  
Cross Sectional ◽  
Cervical Elongation ◽  
Consecutive Sampling ◽  
Sensitivity Specificity

Abstract Objective: To know sensitivity, specificity and accuracy of Pelvic Organ Prolapse Quantification (POP-Q) to measure cervical length for cervical elongation diagnose in Pelvic Organ Prolapse (POP) patients with gold standard was the anatomical cervical length from hysterectomy result. Methods: Diagnosis research, cross-sectional, consecutive sampling. POP-Q was taken before the operation and the anatomical cervical length was from hysterectomy result Results: Sixty six subject, 1.5% 2nd stage POP, 45.5% 3rd stage POP, and 53.0 % 4th stage POP. Mean (± sd) age and body mass index consecutively59.88 years (± 9.347) and 24.41 (± 3.67) kg/m2. Median (min-max) cervical length POP-Q and anatomy consecutively 4 cm (1-12) and 5 cm (3-10). Sensitivity, Specificity dan Accuracy POP-Q consecutively 79%, 58% dan 68% Conclusion: POP-Q has good specificity (79%) but with less sensitivity (58%) with accuracy 68% to diagnose cervical elongation in POP Keywords: accuracy, cervical elongation, cervical length,  pelvic organ prolapse,  pelvic organ prolapse quantification (POP-Q), sensitivity, specificity.   Abstrak Tujuan: Untuk mengetahui nilai sensitivitas, spesifisitas dan akurasi Pelvic Organ Prolapse Quantification (POP-Q) untuk menilai panjang serviks sebagai diagnosis elongasio serviks pada pasien POP dengan baku emas pengukuran anatomi serviks dari hasil histerektomi. Metode: Uji diagnosis, potong lintang, consecutive sampling. Data diambil dari pemeriksaan POP-Q dan pengukuran anatomi serviks dari hasil histerektomi. Hasil : Enam puluh enam subjek, 1,5% POP derajat 2, 45,5% POP derajat 3 dan 53,0 % POP derajat 4. Rerata(± sb)usia dan Indeks Massa Tubuh (IMT) berturut – turut 59,88 tahun (± 9,347) dan 24,41 (± 3,67) kg/m2. Median (min-maks) panjang serviks POP-Q dan anatomi berturut – turut 4 cm (1-12) dan 5 cm (3-10).  Sensitivitas, spesifisitas, dan akurasi POP-Q berturut – turut 79%, 58% dan 68% Kesimpulan : Pemeriksaan POP-Q memiliki spesifitas yang baik (79%) tetapi dengan sensitivitas yang kurang baik (58%) dan akurasi 68% untuk diagnosis elongasio serviks pada prolaps organ panggul. Kata kunci: akurasi, elongasio serviks, panjang serviks,  prolaps organ panggul, pelvic organ prolapse quantification (POP-Q), sensitivitas, spesifisitas

scholarly journals Assessment of Metalloproteinase Matrix 9 (MMP9) Gene Polymorphisms Risk Factors for Pelvic Organ Prolapse in the Brazilian Population

2019 ◽  
Vol 41 (03) ◽  
pp. 164-169 ◽  
Author(s):  
Frederico Ghersel ◽  
Ricardo Souto ◽  
Ester Gonzales ◽  
Denise Paulo ◽  
César Fernandes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Gene Polymorphisms ◽  
Home Birth ◽  
Epidemiological Studies ◽  
Pelvic Organ ◽  
Venous Puncture ◽  
Nulliparous Women ◽  
Independent Risk Factors ◽  
Mmp9 Gene

Objective To evaluate the C-1562T matrix metalloproteinase 9 (MMP9) gene polymorphisms as risk factors related to the occurrence of pelvic organ prolapse (POP) and to identify the clinical variables associated with the occurrence of the disease. Epidemiological studies of risk factors for POP do not explain why nulliparous women with no known risk factors also develop POP. Therefore, genetic factors may be involved. Methods Cohort study with 86 women with symptomatic POP (cases), and 158 women without a prior or current diagnosis of this disorder (controls). The groups were analyzed for the presence of MMP9 gene polymorphisms. Genotyping was performed using polymerase chain reaction (PCR) with DNA obtained from a peripheral venous puncture of both groups. Results There were no differences between the cases and controls even when we grouped the mutant homozygous and heterozygous genotypes. The analysis of patients with a complete absence of POP versus patients with total POP also showed no statistically significant differences. Age and home birth were found to be independent risk factors for POP. Conclusions There were no statistically significant differences in the C-1562T MMP9 polymorphisms between the cases and controls in Brazilian women.

scholarly journals Excision of elongated cervix during reconstructive surgery in patients with pelvic organ prolapse – pro et contra

2019 ◽  
Vol 4 (3) ◽  
pp. 34-40
Author(s):  
I. A. Eizenach ◽  
V. V. Vlasova ◽  
V. G. Mozes
Keyword(s):  
Pelvic Organ Prolapse ◽  
Reconstructive Surgery ◽  
Primary Outcome ◽  
Pelvic Organ ◽  
Cervical Length ◽  
Long Term Outcomes ◽  
Cervical Elongation ◽  
Mesh Surgery

Aim. To determine whether the cervical elongation affects long-term outcomes of reconstructive surgery of pelvic organ prolapse.Materials and Methods. We consecutively enrolled 99 patients with grade 2-3 pelvic organ prolapse (Pelvic Organ Prolapse Quantification System) who underwent vaginal mesh surgery. Volume and length of the cervix were measured using vaginal ultrasonography immediately before the surgery. Cervical elongation was defined as cervix > 6 cm in length (n = 55). Upon 1 year of follow-up, we evaluated the primary outcome (pelvic organ prolapse) and secondary outcomes (cervical length and volume).Results. After 1 year of follow-up, cervical elongation was still detected in 18.1% of patients with cervical elongation before the surgery but not in those without (p = 0.008). Dyspareunia was documented in 14.5% and 2.2% of women with and without cervical elongation, respectively (p = 0.034). In patients with cervical elongation, the length of the cervix before the surgery and after 1 year of follow-up was 7.6 (7; 7.9) cm and 8.4 (7.9; 8.9) cm, respectively (p = 0.001); the respective values of cervical volume were 23.7 (23.4; 24.4) cm3 and 26.9 (25.7; 31.9) cm3 , respectively (p = 0.001); however, these differences were insignificant in patients without cervical elongation.Conclusion. Cervical excision may be recommended for the patients with pelvic organ prolapse and concurrent cervical elongation (length of the cervix > 6 cm). Cervical preservation in such patients may lead to progression of the elongation even after the correction of pelvic organ prolapse. 

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

2011 ◽  
Vol 23 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Patrick Dällenbach ◽  
Carol Jungo Nancoz ◽  
Isabelle Eperon ◽  
Jean-Bernard Dubuisson ◽  
Michel Boulvain
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Pelvic Organ

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.

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