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

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.

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Pelvic organ prolapse surgery and overactive bladder symptoms—a population-based cohort (FINPOP)

International Urogynecology Journal ◽

10.1007/s00192-021-04920-w ◽

2021 ◽

Author(s):

Päivi K. Karjalainen ◽

Anna-Maija Tolppanen ◽

Nina K. Mattsson ◽

Olga A.E. Wihersaari ◽

Jyrki T. Jalkanen ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Overactive Bladder ◽

Symptom Severity ◽

Pelvic Organ ◽

Population Based ◽

Urinary Frequency ◽

Posterior Compartment ◽

Posterior Repair ◽

Apical Compartment ◽

Bothersome Symptom

Abstract Introduction and hypothesis It is unclear how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after POP surgery. We hypothesized that anterior and apical prolapse are more strongly associated with OAB symptoms than posterior compartment prolapse. Methods A total of 2933 POP surgeries from a prospective population-based cohort were divided into two groups: (1) anterior and/or apical compartment surgery (± posterior repair), N = 2091; (2) posterior repair only, N = 478. Urinary frequency and urgency urinary incontinence (UUI) were evaluated using PFDI-20 (bothersome symptom: score 3–4) at baseline, 6, and 24 months. Association between degree of POP in specific compartments and symptoms at baseline was estimated with generalized linear models and between compartment of surgery and symptom improvement with generalized estimating equations. Results At least one bothersome symptom was reported by 40% at baseline, 14% at 6, and 19% at 24 months. At baseline, urinary frequency was associated with degree of anterior and apical and UUI with anterior compartment prolapse. Women undergoing surgery for anterior/apical compartment started with worse symptoms and experienced greater improvement than women undergoing posterior compartment surgery. Bothersome frequency resolved in 82% after anterior/apical and in 63% after posterior compartment surgery. Bothersome UUI resolved in 75% after anterior/apical and in 61% after posterior compartment surgery. After surgery, symptom severity was comparable between groups. Bothersome de novo symptoms occurred in 1–3%. Conclusions OAB symptoms are more strongly related to anterior and apical than to posterior compartment prolapse, but improvement is seen after surgery for any vaginal compartment.

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

BMC Women s Health ◽

10.1186/s12905-021-01388-0 ◽

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.

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

10.22541/au.161735657.71843341/v1 ◽

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.

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The distribution of pelvic organ support defects in women undergoing pelvic organ prolapse surgery and compartment specific risk factors

International Urogynecology Journal ◽

10.1007/s00192-021-04826-7 ◽

2021 ◽

Author(s):

Emmanuel Payebto Zoua ◽

Michel Boulvain ◽

Patrick Dällenbach

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Pelvic Organ Prolapse ◽

Reconstructive Surgery ◽

Significant Risk ◽

Significant Risk Factor ◽

Pelvic Organ ◽

Posterior Compartment ◽

Anterior Compartment ◽

Specific Risk

Abstract Introduction and hypothesis The objective of our study was to describe the distribution of pelvic organ prolapse (POP) in a population of women undergoing POP reconstructive surgery and to identify compartment-specific risk factors. Methods We conducted a retrospective observational study in a cohort of 326 women who underwent POP repair and had a standardized preoperative POP assessment using the Baden-Walker classification. The distribution of POP grade was described for each vaginal compartment. The association between the involvement of each specific compartment and predictors was evaluated with a logistic regression model. Results The frequency of significant POP (grade ≥ 2) was 79% in the anterior compartment, 49% in the middle/apical compartment and 31% in the posterior compartment. Combined significant anterior and apical defects were present in 25% of women. Increasing age was a significant risk factor for apical defect (between 60 and 70 years OR = 2.4, 95% CI 1.2–4.6; > 70 years OR = 3.4, 95% CI 1.7–6.6). Previous hysterectomy (OR = 2.2, 95% CI 1.0–4.6) was a significant risk factor for posterior defect. Conclusions In a population undergoing POP surgery, anterior compartment involvement is the most common and serious defect and can often be associated with an apical defect, especially in older women. In case of previous hysterectomy, the posterior compartment may be weakened. These findings may help surgeons to select the appropriate POP reconstructive surgery, which often should address both anterior and apical defects.

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Modified Laparoscopic Lateral Suspension with A 5 Arm Mesh in Pelvic Organ Prolapse Surgery.

10.21203/rs.3.rs-271886/v1 ◽

2021 ◽

Author(s):

Eren Akbaba

Keyword(s):

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Synthetic Mesh ◽

Advanced Stage ◽

Posterior Compartment ◽

Anterior Compartment ◽

Mesh Graft ◽

Laparoscopic Lateral Suspension ◽

The Mean ◽

Pop Repair

Abstract Background: The LLS procedure is a laparoscopic technique used to treat pelvic organ prolapse (POP), performed with a T-shaped synthetic mesh graft. The posterior compartment is repaired by using a second mesh or a second procedure like posterior colporrhaphy in the LLS procedure. In laparoscopic lateral suspension (LLS) surgery, we want to repair the defect of the posterior compartment in addition to the apical and anterior compartment by using a 5-arm mesh instead of a T-shaped synthetic mesh graft. In this study, we aim to report clinical results of surgeries performed POP repair with a 5-arm mesh.Method: Data from 37 patients who underwent LLS surgery by using a 5-arm mesh with a diagnosis of advanced stage (≥ stage 3) POP and the defect of the posterior compartment were retrospectively analyzed. The postoperative examination included grading and measurement of the POP-Q stage. Surgical outcomes were reported in pursuance of the International Urogynecological Association recommendations. The results of measurements and examinations, the reoperation rates, the erosion rates, lower urinary tract symptoms (LUTS), and complications were recorded. A p-value of < 0.05 was considered to be statistically significant.Results: There was a significant improvement in POP-Q ≤ −1 score in all treated compartments with an overall objective cure rate of 95.3% for the apical compartment, 86.1% for the anterior compartment, and 91.1% for the posterior compartment. The mean operative time was 96.27±15.81 minutes. The mean length of hospitalization was 2±0.82 days. A significant improvement was observed in symptoms of the vaginal bulge, urinary urgency, incomplete voiding, urinary frequency after surgery. Also, an improvement occurred in defecation symptoms of patients after POP repair. While 13 of the patients (35.1%) were sexually active preoperatively, this rate was determined to be 59.4% (n=22) postoperatively. De novo stress urinary incontinence developed in 7 patients (18.9%) postoperatively. The POP-related quality-of-life score (PQOL) improved significantly after surgery.Conclusion: İn advanced stage POP patients undergoing laparoscopic lateral suspension procedure using a 5-arm mesh, damaged compartments including the posterior compartment can be repaired without the need for an additional procedure and the recurrence rate can be reduced.

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

BMC Women s Health ◽

10.1186/s12905-021-01304-6 ◽

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.

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

Gynecologic and Obstetric Investigation ◽

10.1159/000341709 ◽

2013 ◽

Vol 75 (1) ◽

pp. 21-27 ◽

Cited By ~ 16

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

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

European Journal of Histochemistry ◽

10.4081/ejh.2016.2604 ◽

2016 ◽

Vol 60 (1) ◽

Cited By ~ 6

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

The objective 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.

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