Influence of Toileting Behaviour on Anterior Vaginal Wall Prolapse Natural Course

Background: Many risk factors have been proposed for POP, and the cause seems most plausible to be multifactorial. This study aimed to investigate the effect of toileting behaviors on the anterior vaginal wall prolapse (AVWP) natural course.Methods: The data of 75 women who had been operated for symptomatic AVWP were recorded. The patients with grade ³II AVWP were included in this study, and they were divided into two groups according to voiding and defecation position. The volunteers who were voiding in the sitting position defined as Group 1, and Group 2 included the volunteers who were voiding in squatting position. The Colo-Rectal-Anal Impact Questionnaire (CRAIQ), Pelvic Floor Impact Questionnaire (PFIQ), Pelvic Organ Prolapse Impact Questionnaire (POPIQ), Urinary Impact Questionnaire (UIQ) and visual analog pain scores were used for evaluation of patients’ symptoms. Results: 44 patients enrolled in group 1 (sitting position) and 31 patients enrolled in group 2 (squatting position). BMI, number of parity, menopause duration, topical estrogen using, comorbidities, presence of constipation and urinary incontinence, and ped count for incontinence were similar in both groups. The time from initial symptoms to surgery was demonstrated shorter in group 2, 12 (3-73) and 24 (2-182) months, respectively (p=0.001). The PFIQ and POPIQ scores and the POP-related VAS score were statistically higher in patients who were voiding and defecating in squatting positions. Conclusion: Questioning the toileting position of patients with AVWP may be effective on the treatment option of the patient and may be beneficial on symptom control.

Native-Tissue Anterior Colporrhaphy Versus Transvaginal Mesh for Anterior Pelvic Organ Prolapse

This article provides a summary of a landmark study in the management of pelvic organ prolapse. This study sought to evaluate if patients with anterior vaginal wall prolapse should be managed with a traditional native tissue colporrhaphy or with transvaginal mesh. This article briefly reviews other relevant studies related to vaginal prolapse and concludes with a relevant clinical case.

The first experience of using tissue-engineered constructs for surgical correction of anterior vaginal wall prolapse

Objective. To study the effectiveness and safety of new surgical method for correcting the anterior vaginal wall prolapse using tissue-engineered constructs. Patients and methods. After preliminary experimental work on the creation and evaluation of the biocompatibility of tissueengineered constructs based on non-biodegradable (polypropylene and titanium endoprostheses) mesh implants with an autologous cellular component (rat and human dermal fibroblasts), 4 patients aged 44, 54, 70 and 75 years were examined. Inclusion criteria: anterior vaginal wall prolapse (stage II – III); consent to the installation of tissue-engineered construct. A fourstage surgical program providing for the correction of stage II-III anterior vaginal wall prolapse using tissue-engineered constructs of individual size was used. Results. In the early postoperative period, one patient was diagnosed with a small hematoma of the anterior vaginal wall. During the first month after surgery, one patient complained of gradual perineal pain, another patient – of frequent urination. Subsequently, these symptoms stopped. After 3, 6, 9, 12, 15 months after surgery, during the pelvic examination at rest, the Valsalva maneuver and transperineal ultrasound, no displacement of organs was detected, ultrasound clearly visualized a tissueengineered construct without displacement and deformation. Conclusion. We have developed an original method for correcting the prolapse of the anterior vaginal wall using tissueengineered constructs based on polypropylene and titanium with an autologous cellular component, which helps to optimize the results of surgical treatment, reduce the frequency of disease recurrence and the risk of developing mesh-related complications. Key words: pelvic organ prolapse, tissue-engineered constructs, surgical correction

Non-absorbable versus absorbable sutures for anterior colporrhaphy: study protocol for a randomised controlled trial in South Korea

IntroductionThe anterior vaginal wall is the segment most commonly affected by prolapse. Traditionally, anterior vaginal wall prolapse is repaired via anterior colporrhaphy, which is known to have a high recurrence rate. Several factors might affect the outcome of anterior colporrhaphy, and the use of absorbable sutures might also be associated with the high recurrence rate because the sutures might not be able to retain adequate strength until the plicated pubocervical fascia remodels and regains maximum tensile strength. Nonetheless, no comparative data exist about the relative efficacy and safety of anterior colporrhaphy using non-absorbable versus absorbable sutures. The objective of this study is to compare the surgical outcomes of anterior colporrhaphy using non-absorbable sutures with those of anterior colporrhaphy using absorbable sutures.Methods and analysisThis is a randomised, multicentre, superiority trial. Anterior colporrhaphy will be performed in a traditional manner with midline plication of the fibromuscular layer using either non-absorbable or absorbable sutures. The primary outcome is composite surgical success 1 year after surgery defined as the absence of all of the following: (1) anterior vaginal descent beyond the hymen, (2) the presence of vaginal bulge symptoms and (3) retreatment for recurrent anterior vaginal wall prolapse with either surgery or pessary. The secondary outcomes include the individual components of the composite primary end point, anatomical outcomes, condition-specific quality of life and adverse events related to anterior colporrhaphy. The planned number of participants is 192.Ethics and disseminationThis study was approved by the Institutional Review Board of Seoul National University Hospital (H-1810-037-977). The results of the study will be published in peer-reviewed journals, and the findings will be presented at scientific meetings.Trial registration numberNCT03736811