Endometrial cancer after the Manchester procedure: a nationwide cohort study

Objectives To investigate whether the Manchester procedure affects the risk and prognosis of endometrial cancer. Design Nationwide historical cohort. Setting The nationwide Danish registers including all residents with lifelong follow-up. Population All Danish women born 1947–2000, living in Denmark at one point during 1977–2018 undergoing the Manchester procedure (N = 23,935) or anterior colporrhaphy (reference group N = 51,008) during 1977–2018. Methods We conducted a nationwide cohort with full follow-up. Chi-Square test for trend to compare the diagnostic stage for the two groups of women. Cox Regression to analyse the risk of endometrial cancer and mortality. The models were adjusted for age, calendar year, income level, and parity. Main outcome measures Number of women diagnosed with endometrial cancer, the stage of endometrial cancer at the time of diagnosis and the cancer specific and overall mortality. Results During the follow up (median 13 years), 271 (1.13%) women were diagnosed with endometrial cancer after the Manchester procedure and 520 (1.05%) after anterior colporrhaphy. The adjusted hazard ratio (HR) for endometrial cancer was 1.00 (95% confidence interval (CI) 0.86 to 1.16). No difference in stage of cancer was found (p=0.18), nor when stratifying for calendar year. The HR for cancer specific mortality and overall mortality after the Manchester procedure was 0.86 (95% CI 0.65 to 1.15) and 0.93 (95% CI 0.77 to 1.12) respectively. Conclusions The Manchester procedure does not affect the risk or prognosis of endometrial cancer. Keywords Epidemiology, endometrial cancer, Manchester procedure, uterine prolapse, pelvic organ prolapse, vaginal hysterectomy

Risk Factor Characteristics Of Patients With Uterine Prolapse In Gynecology Outpatient Clinic In Dr. Soetomo Hospital, Surabaya

Introduction: Uterine prolapse can occurs due to the failure of the ligamentous and fascial supports of the uterus. It causes inconvenience to the patients because of genital tract dysfunction and decrease quality of life. The risk factor are multifactorial. Advancing age, increasing parity, vaginal delivery, and menopause is associated with the uterine risk factors. The aim of this study is to describe the stage, treatment, age, parity, vaginal delivery, and menopause status of women with uterine prolapse in Dr. Soetomo General Academic Hospital, Surabaya. Methods: This research is a descriptive study. The sample is included all women with complaints of uterine prolapse diagnosed and treated at Dr. Soetomo General Academic Hospital, Surabaya from January – December 2017. Statistical was analysed descriptively.Results: From total 82 patients of uterine prolapse in Gynecology Outpatient Clinic Dr. Soetomo General Academic Hospital, Surabaya in 2017, most of the uterine prolapse patients were older than 65 years old (45.1%) and multiparous (62.2%). More than half of the patients (61%) have had more than three vaginal deliveries and have gone through menopause (91.5%). Stage IV prolapse, 33 cases (40.2%) has the highest percentage. Mostly, 47 cases (57.3%) received conservative treatment. Conclusion: Uterine prolapse is most likely to be found in women with older age, came from those in the age group of >65 years old. The incidence of uterine prolapse might increase in multiparous women, have more than three vaginal deliveries, and have gone through menopause. Most of them is on stage IV and received conservative treatment. It is important for women to be educated about uterine prolapse risk factor as an uterine prolapse prevention.

Anatomical and Symptomatic Outcomes in Patients With Le Fort Colpocleisis

Background: We aimed to evaluate the short term anatomical and symptomatic results of elderly patients on whom Le Fort colpocleisis operation was performed due to pelvic organ prolapse (POP) in our clinic. Methods: Medical records of fifty-nine sexually inactive and ≥65 aged women with stage 2 or higher vaginal or uterine prolapse who underwent Le Fort colpocleisis operation were prospectively analysed. Pre-operative and 12 months post-operative data were recorded. Turkish validated Global Pelvic Floor Bother Questionnaire (GPFBQ) were also evaluated at pre-operative and 12 months post-operative period in all patients. Anatomical success was determined as no prolapse of any POP-Q point at or below 1 cm above the hymen. Results: A total of 59 patients were conducted in this study. The average age of the patients was 71.67±7.01 (years). The mean BMI was 27.1±9.52 kg/m2. POP-Q point C as well as, Gh and TVL measurements were significantly higher after surgery than those at preoperative period (p<0.01, p<0.01, p<0.01, respectively). There was no recurrence in any case. Evaluation of complications at the pre-operative and post-operative 12th month revealed significant differences for SUI, urinary frequency, nocturia, and pelvic pain symptoms during post-operative period (p:0.007, p<0.001, p:0.01, p<0.001; respectively). Conclusions: Le Fort colpocleisis is a simple and effective procedure that has been found to provide successful anatomical and symptomatic outcomes in sexually inactive and elderly women for POP. However long-term results of this procedure needs further investigation.

A Rare Case of Pregnancy Complicated by Bladder Exstrophy and Uterine Prolapse

Uterine prolapse and bladder exstrophy (BE) during pregnancy is a rare condition. The aim of this study was to present a rare case of pregnancy complicated by both bladder exstrophy and uterine prolapse. A 39-year-old pregnant woman (gravida 2, para 1) presented to the maternity department at 39 weeks of gestation with labor pain. Physical examination showed regular uterine contractions; the cervix was completely out of the vaginal opening with dilatation of 3 cm and effacement of 30%. She had a history of multiple surgeries for correction of bladder exstrophy and also suffered from uterine prolapse. In active labor, abnormal fetal heart rate tracing happened, so an emergent cesarean section was planned, and a healthy neonate with the normal Apgar score was born. At regular follow-up until four months after delivery, there was no sign or symptom of uterine proplase. Multidisciplinary management of patients with BE and uterine prolapse may result in optimal perinatal outcomes. Uterine prolapse may disappear after delivery, even in the complicated case of bladder exstrophy.

Gynaecological Problems among Elderly Women Living in Old Age Homes of Kathmandu Valley

Ageing is a natural process. The elderly population is increasing in Nepal.When there is presence of diseases, physical inability, and financial harshness, the elderly in Nepal have to face many problems. This study was thus conducted to assess the socio-economic milieu and spectrum of gynaecological problems among women living in old age homes of Kathmandu valley. For this a cross sectional study was conducted in 21old age homes of three districts of Kathmandu valley. In this study, they were 234 particants. Privacy and confidentiality of information about the individual were strictly maintained. One-third of the aged women living in the old age homes belonged to 70-80 years.50.9% were from outside Kathmandu valley, while 49.1% were from the valley. The elderly were mostly not visited by their relatives and friends. Most of them (74.4%) were interested in praying than other activities. Out of the total Urine samples (190), 68.4% were normal, and 9.4% had a urinary tract infection. There were only 15.6% uterine prolapse cases. Out of total, 70.9% of Pap smear report was normal, while 25.1% had inflammatory smear. This study revealed that the old age homes have become a shelter for most of elderly women. The socio-economic condition was poor. Gynaecological probems like UTI, Urinary incontinence were not high but the prolapse cases (uterine proplase, cystocele, rectocele) were remarkably high. Cervical cancer screening through Pap smear showed negative results.

508 Late-Breaking: Heritability and Validation of Sow Uterine Prolapse in the United States

Uterine prolapse impacts animal welfare and reduces sow farm profitability. In general, the incidence of uterine prolapse is higher in the United States than in other countries. Some suspected causes of uterine prolapse include water quality, vitamin deficiency, mycotoxins, and genetics. The objectives of this study were to: 1.) estimate the heritability of uterine prolapse; and 2.) to validate estimated breeding values (EBVs) for uterine prolapse in an independent, related population. Prolapse records collected from purebred females at a commercial multiplier (n = 16,434) and nucleus farm (n = 4,096) were used for training and validation, respectively. Phenotypes were recorded as the presence/absence of uterine prolapse at the sow level. Heritability estimates were derived from the training dataset by fitting year-season of insemination and parity at removal of the sow as fixed effects and animal as a random effect. Using the same model, validation was performed by regressing corrected offspring performance on sire EBV in the validation dataset. A pedigree- and a genomics-based relationship matrix were used for parameter estimation and the validation analysis, respectively. Incidence of uterine prolapse was heritable at 0.15 ± 0.02 and 0.22 ± 0.02 when analyzed using a linear vs. threshold model, respectively. Regression of corrected offspring performance on sire EBV resulted in a slope parameter of 0.40 (95%-CI; 0.27 - 0.54, including the expected value of 0.5), indicating that sire EBV is predictive of uterine prolapse among his offspring. In conclusion, these results show that uterine prolapse is lowly-to-moderately heritable, and therefore, mainly due to environmental factors. Higher incidence of uterine prolapse within the United States vs. other geographic locations confirms the existence of a strong environmental component. Genetic selection can be used to address genetic factors, but identifying/mitigating environmental triggers remains critical to reducing the incidence of uterine prolapse within the U.S. swine industry.