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Introduction: The study aimed to compare the short‐term outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for uterosacral ligament suspension (USLS) versus nonendoscopic USLS in patients with subtotal uterine prolapse who had a concomitant vaginal hysterectomy. Methods: There were 51 patients who underwent vNOTES USLS, whereas the nonendoscopic conventional USLS group had 49 patients. The information about patient demographics, and perioperative data including the operative duration, blood loss, intraoperative and postoperative complications, and length of postoperative hospital stay were determined from the patients' files. Postoperative follow‐up visits were scheduled at the first week and 1 month after surgery. Results: The demographic variables including age, body mass index, menopausal status, and parity were comparable, and no significant differences were found. A total of 90.2% of the patients in the vNOTES group and 69.4% of the patients in the shull group were at menopause (p =.09). Operation time was significantly shorter in the shull group (p <.001), and the hospitalization period (p =.029) was significantly shorter in the vNOTES group. Ba, Bp, and D points and total vaginal length (TVL) were significantly behind the hymenal ring in patients who had vNOTES USLS procedure (p <.001). None of the patients who had intraoperative significant blood loss required transfusion. One patient in the vNOTES and two patients in the shull group had a postoperative cuff hematoma. Conclusion: vNOTES USLS has a good safety profile, higher percentage of adnexal surgeries with better improvement on POP‐Q points Ba, Bp, D, and TVL compared with classic USLS in patients with subtotal uterine prolapse. Studies evaluating short‐ and long‐term results of vNOTES versus conventional USLS are needed. [ABSTRACT FROM AUTHOR]

Background: Previous reviews on hysterectomy versus uterine‐sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned. Objectives: To provide up‐to‐date evidence by examining only studies investigating techniques currently in use for POP repair. Search Strategy: MEDLINE and Embase databases were searched from inception to January 2023. Selection Criteria: We included randomized and non‐randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded. Data Collection and Analysis: A random effect meta‐analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI). Main Results: Thirty‐eight studies were included. Hysterectomy and uterine‐sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74–1.17), intraoperative major (OR 1.34; 95% CI 0.79–2.26) and minor (OR 1.38; 95% CI 0.79–2.4) complications, postoperative major (OR 1.42; 95% CI 0.85–2.37) and minor (OR 1.18; 95% CI 0.9–1.53) complications, and objective (OR 1.38; 95% CI 0.92–2.07) or subjective (OR 1.23; 95% CI 0.8–1.88) success. Uterine preservation was associated with a shorter operative time (−22.7 min; 95% CI –16.92 to −28.51 min), shorter hospital stay (−0.35 days, 95% CI –0.04 to −0.65 days), and less blood loss (−61.7 mL; 95% CI –31.3 to −92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups. Conclusions: No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors. Synopsis: In women with indication for surgical management of pelvic organ prolapse, the decision to preserve or remove the uterus should be tailored on individual factors. [ABSTRACT FROM AUTHOR]

Objectives: The changes of the extracellular matrix of the connective tissue have significantly contributed to the incidence of pelvic organ prolapse (POP). It seems reasonable that sonoelastography could be a useful tool to evaluate the elasticity of pelvic floor tissue in patients with POP and compare it to those without POP. The main aim of this pilot study was to determine if there are differences in the elasticity of the levator ani muscle (LAM) and vaginal tissue between patients with and without POP. Methods: Prospective observation study, including 60 patients (30 with POP and 30 without POP). Sonoelastography was performed to evaluate the elasticity (in kilopascals, kPa) of the following regions of interest: vagina at the level of middle third of the urethra; vagina at the level of the bladder trigone; vagina in the anterior and posterior fornix; vagina at the level of middle third of the anorectal canal; posterior third of the LAM. Results: A total of 60 patients completed the study (30 with POP, 30 without POP). In the POP group, 18/30 (60%) had an anterior vaginal wall prolapse, 3/30 (10%) a uterine prolapse, 15/30 (50%) a rectocele, and 6/30 (20%) a enterocele. Patients with POP had higher elasticity in all anatomical study areas, with statistically significant differences in the anterior fornix (13.6 vs 11.2 kPa; P:.012). A multiple regression (controlling age, menopausal stage, and parity) allowed to detect statistically significant differences in the elasticity of the middle third of the urethra (P:.03) and the middle third of the anorectal canal (P:.019). Conclusion: It is possible to evaluate the elasticity of the LAM and vaginal tissue using sonoelastography, detecting a higher elasticity in patients with POP than in those without POP. [ABSTRACT FROM AUTHOR]

Objectives: To compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and transvaginal endoscopic hysterectomy (TVEH) for benign uterine diseases. Methods: This retrospective, cohort, interrupted time‐series study included patients who underwent TLH between January 2013 and September 2016 and TVEH between October 2016 and June 2020. Median difference regression was used to compare the hospital length of stay (LOS) and operative time between the groups. Risk difference regression was used to analyze the proportion of patients who developed postoperative fever or vaginal stump infection. Results: Of the total 171 patients enrolled, 101 and 70 underwent TVEH and TLH, respectively. The mean ages of patients in the TVEH and TLH groups were 46.49 and 46.17 years, respectively. No conversion was observed. Ureteric injury occurred in one patient in the TVEH group, whereas there was no organ injury in any of the patients in the TLH group. Compared with those in the TLH group, patients in the TVEH group had a significantly shorter median operative time, shorter hospital LOS, lower morphine use, and lower postoperative febrile morbidity rates. However, no significant difference was observed in the rate of vaginal stump infection between the groups. Conclusion: Given the shorter operative time, shorter hospital LOS, less febrile morbidity, and lower morphine use in patients with TVEH than in those with TLH, TVEH should be considered as an alternative hysterectomy procedure for benign uterine diseases. Synopsis: TVEH was associated with better surgical outcomes than TLH, and showed similar organ injury and conversion rates to those in TLH. [ABSTRACT FROM AUTHOR]

A 2‐year‐old Pomeranian‐Spitz dog (5.8 kg) was admitted with symptoms of uterine prolapse and lethargy 1 day after whelping three puppies. The prolapsed uterus was corrected, but the next day, prolapse reoccurred. To fix the cervix to the abdominal wall, the dog underwent a surgery operation where intussusception in the left horn of the uterus was found. Ovariohysterectomy was performed as the treatment of choice. The diagnosis of intussusception is challenging, and exploratory laparotomy is the reliable diagnostic approach. Although uterine intussusception is rare, it should be one of the important considerations in dogs within the post‐partum period. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether there is a difference in pelvic organ prolapse (POP) stage at time of presentation after lifting coronavirus disease (COVID‐19) lockdown restrictions, as compared to before the lockdown. Enhancing our understanding of how healthcare utilization for pelvic floor disorders may be affected by limited accessibility, such as the COVID‐19 pandemic, could prove invaluable for similar future circumstances. Methods: This is a retrospective study of women with POP at their initial visit. Patients were grouped into two cohorts based on their initial presentation time: pre‐COVID‐19 lockdown (before March 2020) and post‐COVID‐19 lockdown (after December 2020). The cohorts were compared using demographic, clinical, and surgical variables. A logistic regression controlling for confounders was used to evaluate the influence of the COVID‐19 lockdown on prolapse stage. Results: There were 656 (50.3%) patients in the pre‐COVID‐19 lockdown cohort and 648 (49.7%) in the post‐COVID‐19 lockdown cohort. All baseline characteristics were similar between both cohorts except for race (p = 0.015). Treatment choices differed with the post‐COVID‐19 lockdown cohort having a lower proportion (26.5%) opting for surgery and a higher proportion (50.5%) of patients opting for nonsurgical interventions compared to the pre‐COVID‐19 lockdown cohort (p = 0.0005). A higher proportion of women presented with stages I and II prolapse in the post‐COVID‐19 lockdown (70.4%) cohort as compared to the pre‐COVID‐19 lockdown (62.5%) cohort (p = 0.002). Conclusions: Women in the post‐COVID‐19 lockdown cohort presented with early stage prolapse with preference for more conservative treatment options. [ABSTRACT FROM AUTHOR]

Objective: To determine if the addition of the assessment of levator ani muscle (LAM) avulsion to the measurement of the difference in the pubis‐uterine fundus distance between rest and with the Valsalva maneuver could increase the diagnostic capacity of ultrasound for uterine prolapse (UP). Methods: This multicenter, observational and prospective study included 145 patients. Ultrasound assessment was performed, establishing the diagnosis of UP as a difference between the pubic‐uterine fundus distance at rest and during the Valsalva maneuver ≥15 mm (standard technique), while LAM avulsion was defined as an abnormal LAM insertion in three central slices using multislice ultrasound. A binary multivariate logistic regression model was made using nonautomated methods to predict surgical UP (general population, premenopausal, and postmenopausal patients), including the difference between the pubis‐uterine fundus distance at rest and with the Valsalva maneuver as well as LAM avulsion. Results: A total of 143 patients completed the study. The addition of LAM avulsion criteria to the standard dynamic distance‐based protocol for the diagnosis of UP resulted in a higher sensitivity for the general population (79.7 vs 68.1%) as well as for premenopausal (89.3 vs 79.9%) and postmenopausal patients (76 vs 66.1%). In contrast, the standard technique showed a higher specificity than the model based on the standard technique associated with LAM avulsion for the general population (89.2 vs 74.3%) and premenopausal women (91.7 vs 63.2%). For postmenopausal patients, the model based on the standard technique associated with LAM avulsion had a higher sensitivity (76 vs 66.1%) and specificity (91.7 vs 86.8%) than the ultrasound diagnosis of UP. Conclusion: The implementation of the assessment of LAM avulsion in the ultrasound diagnosis of UP is useful in postmenopausal patients, increasing sensitivity and specificity relative to the ultrasound assessment based only on the difference between the pubis‐uterine fundus distance at rest and with the Valsalva maneuver. [ABSTRACT FROM AUTHOR]

The assumption is that a number of controlled trials have been conducted to assess the impact of uterus retaining or hysterectomy on wound and haemorrhage, but there is no indication as to which method would be more beneficial for wound healing. This research is intended to provide a comprehensive overview of the availability of wound healing in case studies of both operative methods. From inception to October 2023, four databases were reviewed. The odds ratio (OR) and the mean difference (MD) for both groups were computed with a random effect model, as well as the corresponding 95% confidence intervals. A total of five studies were carried out in the overall design and enrolled 16 972 patients. No statistical significance was found in the rate of postoperative wound infection among the two treatments (OR,1.46; 95% CI,0.66,3.22 p = 0.35); The rates of bleeding after surgery did not differ significantly from one procedure to another (OR,1.41; 95% CI,0.91,2.17 p = 0.12); two studies demonstrated no statistical significance for the rate of incisional hernia after surgery (OR,2.58; 95% CI,0.37,18.05 p = 0.34). Our findings indicate that there is a similar risk between uterine preservation and hysterectomies for the incidence of wound infection, haemorrhage and protrusion of incision. [ABSTRACT FROM AUTHOR]

The article discusses the importance of a healthy and well-functioning pelvic floor in preventing pelvic floor disorders, such as urinary incontinence, anal incontinence, pelvic organ prolapse, pelvic floor pain, and sexual dysfunction. Pregnancy and vaginal delivery are identified as the main risk factors for these disorders. Pelvic floor muscle training (PFMT) during pregnancy is suggested as a potential preventive measure, with studies showing a significant reduction in the risk of urinary incontinence and perineal tears for women who undergo PFMT. The article also highlights the need for further research on the prevention of anal incontinence and the role of pelvic floor ultrasound in preventing birth trauma. [Extracted from the article]

A ten‐year‐old mixed breed bitch was presented for a tissue prolapse protruding from her vulva. Following detailed examination and stabilization, the ovaries and uterine horns were removed by laparotomy, whereas the prolapsed tissue identified as uterus including cervix was removed vaginally. Histology confirmed uterine prolapse, a rare condition in bitches usually found shortly after birth especially due to dystocia. In contrast, the present case was found in a nulliparous non‐pregnant bitch. Diagnostic and therapeutic approaches, including microbiological and histological findings, are described and discussed critically. [ABSTRACT FROM AUTHOR]

Objective: To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP‐Q stage ≥2 vaginal vault prolapse (VVP). Design: Multicentre randomised controlled trial (RCT) and prospective cohort study alongside. Setting: Seven non‐university teaching hospitals and two university hospitals in the Netherlands. Population: Patients with symptomatic post‐hysterectomy vaginal vault prolapse, requiring surgical treatment. Methods: Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP‐Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively. Main outcome measures: Primary outcome was disease‐specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri‐operative data, complications and sexual function. Results: A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease‐specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129). Conclusions: LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow‐up period of 12 months. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the usefulness of transabdominal sonographic confirmation of placental detachment in preventing uterine inversion. Methods: This was 14‐year retrospective cohort study that included women who had transvaginal deliveries in our hospital. We introduced routine transabdominal ultrasonography during placental delivery to prevent uterine inversion. Followed by the confirmation of placental detachment by ultrasonography, we started placental delivery procedure. The frequency of uterine inversion during placental delivery was compared before and after the ultrasonography was introduced. Moreover, the duration of the third stage of labor and bleeding volume during labor were compared between the ultrasonography performing group (USG group) and the non‐performing group (non‐USG groups). Results: Five thousand and eighty‐one women, including 1724 and 3357 women who delivered before and after the ultrasonography was introduced, respectively. The frequency of uterine inversion after the introduction of the ultrasonography system was significantly reduced compared to that before the introduction (0.03% vs. 0.23%, p = 0.03). Even after the introduction of ultrasonography, the actual rate of performing ultrasonography remained 54.1% due to various restrictions. The mean duration of the third stage of labor in the USG group was slightly longer than that in the non‐USG group (8.4 ± 5.0 vs. 6.8 ± 3.6, p < 0.01). The mean bleeding volume during labor in the USG group was higher compared with the non‐USG group (457 ± 329 vs. 418 ± 285, p < 0.01). Conclusions: Transabdominal sonographic confirmation of placental detachment may be useful in preventing uterine inversion. [ABSTRACT FROM AUTHOR]

Objective: The EnPlace® device is a novel minimally invasive tool allowing transvaginal sacrospinous ligament (SSL) fixation of apical pelvic organ prolapse (POP). The study aimed to investigate the safety and short–term efficacy of the EnPlace® SSL fixation for significant apical POP repair. Methods: A retrospective cohort study of 123 consecutive patients (mean age 64.4 ± 11.1 years) with stage III or IV apical POP who underwent SSL fixation by the EnPlace® device. Safety and 6‐month outcome results were analyzed and compared between 91 (74%) patients with uterine prolapse versus 32 (26%) patients with vaginal vault prolapse. Results: There were no intraoperative or early postoperative complications. The mean (± standard deviation) duration of surgery was 30 ± 6.9 min and mean blood loss was 30.5 ± 18.5 mL. The average position of point C by POP‐Quantification measurements before surgery and at 6 months postoperatively was 4.5 ± 2.8 cm and −3.1 ± 3.3 cm, respectively. Of 91 patients with preoperative uterine prolapse, eight (8.8%) patients developed a recurrent uterine prolapse within 6 months postoperatively. Of 32 patients with preoperative vault prolapse, two patients (6.3%) had recurrent vault prolapse. Conclusion: Short‐term outcome results of EnPlace® SSL fixation suggest that it is a safe and effective minimally invasive transvaginal procedure for significant apical POP repair. Synopsis: Short‐term outcome results of EnPlace® sacrospinous ligament fixation suggest that it is a safe and effective minimally invasive transvaginal procedure for significant apical POP repair. [ABSTRACT FROM AUTHOR]

Objectives: To validate an ultrasound software that uses transperineal ultrasound to diagnose uterine prolapse (UP). Methods: Multicenter, observational and prospective study with 155 patients that had indications for surgical intervention for dysfunctional pelvic floor pathology. Each patient underwent an examination with Pozzi tenaculum forceps was performed in the operating room with the patient anesthetized, followed by surgical correction of stages II–IV UP. Transperineal ultrasound was used to assess the difference in the pubis–uterine fundus measurement. With a multivariate logistic regression binary model (with the measurement ultrasound at rest, the Valsalva maneuver and age) using nonautomated methods to predict UP. With the purpose of evaluating the model, a table with coordinates of the receiver operating characteristic (ROC) curve, after which sensitivity and specificity were assessed. Results: A total of 153 patients were included (73 with a diagnosis of surgical UP). It was obtained from the AUC (0.89) of the probabilities predicted by the model (95% confidence interval, 0.84–0.95; P <.0005). Based on the ROC curve for the model, obtaining a sensitivity of 91.8% and a specificity of 72.7%, values that were superior to those for the clinical exam for surgical UP (sensitivity: 80.8%; specificity: 71.3%). Conclusions: We validated software that uses transperineal ultrasound of the pelvic floor and patient age to generate a more reliable diagnosis of surgical UP than that obtained from clinical examinations. [ABSTRACT FROM AUTHOR]

Objectives: We herein evaluated the effects of gestational weight gain (GWG) on postpartum pelvic floor function using transperineal ultrasound (TPUS). Methods: We analyzed retrospectively the data from 228 primiparous women with singleton pregnancies who were evaluated for postpartum pelvic floor function between February 2022 and October 2022. According to the 2009 Institute of Medicine guidelines regarding GWG, subjects were separated into three groups: inadequate GWG, recommended GWG, and excessive GWG. All underwent TPUS 6–10 weeks postpartum to assess bladder neck descent between rest and Valsalva (BND), retrovesical angle at Valsalva (RVA), urethral rotation angle between rest and Valsalva (URA), the area of levator hiatus at Valsalva (LHA), and abnormal pelvic floor function. Univariate and multivariate regression analyses were applied to explore the association measures between GWG and the pelvic floor. A P‐value <.05 was considered statistically significant. Results: Of the 228 primiparous women, 113 (49.6%) showed excessive GWG. Univariate analysis revealed that there were no statistical differences in ultrasonic parameters of the pelvic floor among the three groups (P >.05). After adjusting for potential confounders and using the recommended GWG group as a reference group, inadequate GWG was significantly associated with BND ≥25 mm (OR = 0.36, 95% CI = 0.14–0.93), and excessive GWG was significantly associated with uterine prolapse (OR = 2.79, 95% CI = 1.13–6.92). Conclusions: GWG was associated with the ultrasonic parameters of the female pelvic floor in the early postpartum period. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: It is unknown whether diagnosing uterine prolapse (UP) via ultrasound or surgical criteria is superior. Our objective is to determine whether the diagnostic capacity of ultrasound with surgical criteria differs from that of surgical criteria only. Methods: This was a multicenter prospective observational study with 54 premenopausal patients with surgical criteria for a dysfunctional pelvic floor pathology who were consecutively recruited for 1 year. Clinical UP with surgical criteria was defined when UP stage II–IV was identified (during pelvic floor consultation), and UP diagnosed by ultrasound with surgical criteria was established when a difference ≥15 mm was found between rest and Valsalva applied to the pubis‐uterine fundus. The sensitivity, specificity and positive and negative predictive values were determined to evaluate clinical and ultrasound methodologies as diagnostic tests. Results: UP diagnosed by ultrasound with surgical criteria presented better sensitivity (78.57 vs 35.71%), specificity (92.11 vs 81.58%), positive predictive value (61.83 vs 23.99%), and negative predictive value (96.35 vs 11.37%) than UP diagnosed by surgical criteria only. Conclusion: Ultrasound with surgical criteria is superior to surgical criteria alone when diagnosing UP. [ABSTRACT FROM AUTHOR]

The article discusses the importance of a life course approach in addressing the unmet health needs of women. It emphasizes the need for collaboration among various stakeholders, including men, to achieve maximum impact. The article highlights several studies published in BJOG that explore different aspects of women's health, such as fetal health indicators, prevention of preterm preeclampsia, interventions to reduce neurodisability in preterm infants, prevention of maternal and neonatal sepsis, management of post-partum hemorrhage, and the impact of vulval lichen sclerosis on pregnancy and postpartum. The article also covers topics like uterine transplantation, medical management of missed miscarriage, cost-effectiveness of treatments for pelvic organ prolapse, triage alternatives for cervical cancer screening, the association between paracetamol use and ovarian cancer risk, and the use of artificial intelligence in medical education. The author emphasizes the importance of prioritizing women's health and involving all stakeholders in research and healthcare services. [Extracted from the article]

The placenta accreta spectrum without previa is difficult to diagnose before delivery and sometimes requires hysterectomy. A fertility preservation procedure is useful when placenta accreta spectrum is unexpectedly encountered. A 38‐year‐old woman, conceived by in vitro fertilization (IVF), was not diagnosed of placenta accreta spectrum until delivery. A cesarean section was performed for fetal breech presentation. The placenta could not be detached from the uterine fundus and marked bleeding started. We conducted the "TURIP" procedure: ensured hemostasis with tourniquet of uterine isthmus, uterus inversion to expose the adhesion site with intra‐venous nitroglycerin administration, placental detachment by sharp dissection under direct visualization. The detached areas were sutured for hemostasis. The patient recovered uneventfully and achieved the second pregnancy by IVF 1 year later. The TURIP procedure is useful to preserve fertility in unpredicted placenta accreta spectrum without previa, even in undiagnosed cases before delivery. [ABSTRACT FROM AUTHOR]

Aims: To study the non‐recurrent prolapse rate after vaginal hysterectomy colpoperineorrhaphy and sacrospinous ligament fixation (SSLF) with or without anterior colporrhaphy, with or without posterior colpoperineorrhaphy. Materials and Methods: A retrospective cohort study was carried out at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, during January 1, 2012—December 31, 2021. The inclusion criteria were Thai women diagnosed with uterovaginal prolapse and undergone vaginal hysterectomy, with or without anterior colporrhaphy, with or without posterior colpoperineorrhaphy, with SSLF and had the complete pelvic organ prolapse quantification (POP‐Q) information at the 12 months follow up. The recurrent case was defined as any compartment prolapse ≥ stage II by POP‐Q classification at 1, 3, 6, 12 months follow up. Results: Of 71 cases included, 20 cases had recurrent prolapse at 12 months. The incidences of non‐recurrent prolapse rate at 1, 3, 6, and 12 months were 70/71 (98.59%), 65/70 (92.86%), 58/65 (89.23%), and 51/58 (87.93%). The overall PHVP prevalence at 12 months was 2/71 (2.81%). The anterior compartment prolapse were 18/71 (25.35%) at 12 months. The most common postoperative complications were the urinary tract infection (4.23%). There were one case of nerve entrapment and one case of stitches exposure that required stitches removal. Conclusion: SSLF at the time of vaginal hysterectomy is safe and effective in post hysterectomy vaginal vault prolapse prevention. But there are high recurrence rate of anterior compartment prolapse at 12 months. Preoperative counseling and long‐term follow up after SSLF is advocated. [ABSTRACT FROM AUTHOR]

This letter to the editor responds to a systematic review and meta-analysis comparing hysterectomy with uterine preservation in pelvic organ prolapse surgery. The authors argue that it is misleading to pool all uterus-sparing procedures together in the comparison with hysterectomy. They highlight the differences between the Manchester-Fothergill procedure and the sacrospinous hysteropexy, emphasizing that studies have shown significant differences in efficacy and safety outcomes between the two techniques. The authors suggest that if the systematic review had distinguished between these procedures, the Manchester procedure would likely have been found to be superior to hysterectomy. They conclude that the Manchester procedure deserves more attention as a first-line treatment for pelvic organ prolapse. [Extracted from the article]

Acute uterine inversion is a rare and potentially life‐threatening obstetric emergency. Its occurrence as a result of a mid‐trimester abortion is an even rarer consequence. We report a case of a 32‐year‐old woman who presented with complete acute uterine inversion and hemorrhagic shock following an incomplete medical abortion at 14 weeks of gestation. Our attempts at non‐operative reversal of the inversion failed. Therefore, we resorted to the manual replacement of the uterus via laparotomy without using surgical instruments or an incision in the cervical ring. The laparotomic manual replacement served as a successful alternative with minimal immediate or long‐term morbidity that may have resulted from trauma and scarring of the uterus. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to evaluate the outcomes of the Manchester procedure (MP) with or without concomitant high uterosacral ligament suspension (HUSLS) for treating uterine prolapse. The primary outcomes were to compare the two methods for differences in perioperative complications and recurrence rates, and to explore whether MP combined with concomitant HUSLS is beneficial in reducing recurrence rates. Methods: A total of 98 uterine prolapse patients underwent MP or MP‐HUSLS during the study period. Demographic data, perioperative, and follow‐up outcomes were analyzed retrospectively. Univariate and multivariate cox proportional hazards regression analysis was used to explore the effect of surgical methods on recurrence. Results: The MP‐HUSLS group had a higher degree of apical compartment prolapse before the operation, but the pelvic organ prolapse quantification (POP‐Q) values of points Ba and C in the MP‐HUSLS group improved significantly compared with the MP group (p < 0.05). The operation time in the MP group was shorter than that in the MP‐HUSLS group. There were no differences in baseline characteristics or perioperative complications between the two groups. Twelve patients had subjective recurrence during follow‐up, although 20 developed anatomical recurrence. After controlling for confounding factors, the MP group had a higher risk of recurrence in the anterior compartment than the MP‐HUSLS (adjusted hazard ratio: 4.191, confidence interval: 1.195–14.701, p = 0.025). There was no significant difference in the recurrence rate of the two groups' total, apical, and posterior compartments. Conclusion: Compared with MP, MP‐HUSLS seems more effective in treating uterine prolapse, with a higher location of the points C and Ba. However, further studies with large samples and long follow‐up times need to confirm this result. [ABSTRACT FROM AUTHOR]

Objective: To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse. Design: Labelled discrete choice experiment (DCE). Setting: Eight Dutch hospitals. Population: Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation. Methods: DCEs are attribute‐based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatment success (levels SH: 84%, 89%, 94%; levels MM: 89%, 93%, 96%), dyspareunia (levels: 0%, 5%, 10%), cervical stenosis (levels: 1%, 6%, 11%) and severe buttock pain (levels: 0%, 1%). A different combination of attribute levels was used in each choice set. Women completed nine choice sets, making a choice based on attribute levels. Data were analysed in multinomial logit models. Main outcome measures: Women's preference for MM or SH. Results: 137 DCEs were completed (1233 choice sets). SH was chosen in 49% of the choice sets, MM in 51%. Of all women, 39 (28%) always chose the same surgery. After exclusion of this group, 882 choice sets were analysed, in which women preferred MM, likely associated with a labelling effect, i.e. description of the procedure, rather than the tested attributes. In that group, MM was chosen in 53% of the choice sets and SH in 47%. When choosing MM, next to the label, dyspareunia was relevant for decision‐making. For SH, all attributes were relevant for decision‐making. Conclusions: The preference of women for MM or SH seems almost equally divided. The variety in preference supports the importance of individualised healthcare. This article includes Author Insights, a video abstract available at: https://vimeo.com/736147808 [ABSTRACT FROM AUTHOR]

Objective: To perform a multicenter study of muscle recovery in levator ani muscle (LAM) avulsion during the first 12 months postpartum according to the type of LAM avulsion suffered. Methods: This was a multicenter prospective observational study including 242 primiparas. Transperineal ultrasound was performed at 6 months and 12 months after delivery. Type I LAM avulsion was present when most of the lateral fibers of the pubovisceral muscle were observed at the muscle's insertion at the pubic level. Type II LAM avulsion was defined as complete detachment of the pubovisceral muscle from its insertion at the pubic level. Results: Among the 56 patients who completed the study (with ultrasound at 6 and 12 months after delivery), 76 avulsions (10 cases of bilateral avulsion) were identified at 6 months after delivery, and the total number of avulsions had decreased to 58 at 12 months after delivery (P < 0.001; 95% confidence interval [CI] 13.9%–33.5%). This decrease was due to the disappearance of 69.2% of the cases of Type I LAM avulsions (P < 0.001; 95% CI: 50.2%–88.2%). However, the number of Type II LAM avulsions remained constant at 6 months and 12 months after delivery. Conclusion: The spontaneous resolution of LAM avulsion during the first 12 months postpartum occurs in cases of Type I LAM avulsion but is not observed in Type II LAM avulsion. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of repair of uterovaginal prolapse using sacrospinous hysteropexy on female sexual function. Methods: A cross‐sectional study was conducted at the Urogynecology Clinic of the Suez Canal University Hospital from May 2014 to April 2019. Twenty‐seven women with a diagnosis of uterovaginal prolapse and wishing to preserve their uteri were recruited. Sacrospinous ligament fixation was done. Sexual symptoms were assessed using the female sexual function index (FSFI) questionnaire just before and 6 months after the operation. Results: The mean age of the participants was 36.5 ± 4 years. Sacrospinous hysteropexy only was performed for three women. Additional procedures included anterior colporrhaphy (12), posterior colporrhaphy (9), and perineorrhaphy (15). There was a significant improvement in pre‐ and postoperative patients' orgasm (3.1 ± [0.8] vs. 3.7 ± [1.1]; p value = 0.03) and satisfaction (3.4 ± [0.6] vs. 4.2 ± [0.8]; p value < 0.001) while there was worsening of pain (4.3 ± [1.5] vs. 3.2 ± [1.6]; p value = 0.017). There was insignificant improvement in the other three domains as well as total score of FSFI, with all patients having sexual dysfunction. Conclusion: Sacrospinous hysteropexy was associated with significant improvement orgasm and satisfaction domains of FSFI and significant worsening of pain. [ABSTRACT FROM AUTHOR]

Background: Primary vaginal cancer is a rare gynecologic malignancy. Few cases describing the concurrence of a vaginal tumor with advanced genital prolapse are reported in the literature and there is no consensus on optimal treatment. Objectives: To investigate available evidence on presentation, treatment, and outcomes of these concurrent conditions. Search Strategy: We performed a systematic search of literature indexed on PubMed, Scopus, ISI Web of Science, and Cochrane using a combination of keywords and text words represented by "pelvic organ prolapse", "genital prolapse", and "vaginal cancer", "vaginal carcinoma". Selection Criteria: No article type restrictions were applied. Data Collection and Analysis: Twenty‐one studies (case reports and two small case series) were incorporated into the review process, for a total of 27 patients. Main Results: Management usually involved surgery or primary external beam radiation therapy. External beam radiation therapy was reported to be highly associated with the development of vesicovaginal fistula. A surgical approach was the treatment of choice in most cases. Exclusive interstitial brachytherapy was rarely performed. Conclusion: A multidisciplinary approach considering risks and benefits is of the utmost importance to provide counseling and tailor treatment strategy in these complex cases. Management of vaginal cancer with genital prolapse usually involves surgical or radiation therapy. Surgery may concomitantly treat malignancy and prolapse, and improve bladder/kidney function. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and childbirth are thought to be the strongest environmental risk factors for pelvic organ prolapse, but prolapse does occur in nulliparae. Aim: To characterise prolapse in vaginal nulliparae. Material and methods: This was a retrospective study using archived clinical and imaging data of 368 vaginally nulliparous women seen between 2006 and 2017 at two tertiary urogynaecological centres. Patients underwent a standardised interview, clinical examination and 3D/4D translabial ultrasound. Volume datasets were analysed by the second author, blinded against all clinical data, using post‐processing software on a personal computer. Significant prolapse was defined as Pelvic Organ Prolapse Quantification system stage ≥2 for the anterior and posterior compartment, and stage ≥1 for the central compartment. On imaging, significant prolapse was defined as previously described. Results: Of 4297 women seen during the inclusion period, 409 were vaginally nulliparous, for whom 368 volume data sets could be retrieved. Mean age was 50 years (17–89) and mean body mass index 29 (16–64). Eighty‐one (22%) presented with prolapse symptoms. On clinical examination, 106 women (29%) had significant prolapse, mostly of the posterior compartment (n = 70, 19%). On imaging 64 women showed evidence of significant prolapse (17%), again mostly posterior (n = 47, 13%). Rectovaginal septal defects were even more common in 69 (19%). On multivariate analysis we found no differences between true nulliparae (n = 184) and women delivered exclusively by caesarean section (n = 184). Conclusions: Prolapse occurs in vaginal nulliparae, but it has distinct characteristics. Rectocele predominates, while cystocele and uterine prolapse are uncommon. Pregnancy and caesarean delivery seem to have little effect. [ABSTRACT FROM AUTHOR]

A female domestic shorthair cat of unknown age, weighing 2.9 kg, was presented with a single horn of the uterus protruding through the vulva. The cat had a history of recent parturition, delivering four kittens, and was mildly dehydrated and generally stable. The exposed uterine tissue was congested and oedematous, with areas of devitalization and necrosis. Manual reduction of the prolapsed uterus was unsuccessful because of severe oedema. The protruding uterus was amputated, and a midline laparotomy was performed for staged ovariohysterectomy. Postoperatively, the cat appeared healthy with no vulval discharge and no recurrence of clinical signs. This case report demonstrates the different methods involved in the correction of a uterine prolapse. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to verify the safety and efficacy of transvaginal mesh by analyzing the 2‐year follow‐up data of patients performed by a surgeon with a high volume of procedures. Methods: A total of 617 patients with pelvic organ prolapse underwent transvaginal mesh by a single surgeon. Complications and anatomical status of each patient were examined up to 24 months after surgery. Risk factors for the recurrence were also analyzed. Results: Regarding complications, we experienced 10 patients (3.8%) of bladder injuries in anterior transvaginal mesh and eight (3.4%) in anterior and posterior transvaginal mesh. Massive blood loss was observed in four patients, but there was no case of blood transfusion. Mesh exposures were seen in seven patients (1.2%). A total of 100 patients (16.2%) had prolapse recurrence, defined as the Pelvic Organ Prolapse Quantification System stage ≥II. As to recurrences on the operated compartments, we observed five patients (2.0%) for anterior transvaginal mesh, three (6.5%) for posterior transvaginal mesh, five (7.4%) for combined transvaginal mesh, and 31 (14.2%) in anterior and posterior transvaginal mesh. Regarding Point C before operation in the anterior and posterior transvaginal mesh, the recurrence rates were more than 23% in patients with a Point C of 4 or more. Binominal regression analyses showed that higher body mass index, younger age, and higher stage of uterine prolapse were significant risk factors. Conclusions: The transvaginal mesh surgery is safe when conducted by experts. However, the recurrence rate may exceed 20% for high‐stage uterine prolapse even when conducted by experts. [ABSTRACT FROM AUTHOR]

Introduction: One in three women with pelvic organ prolapse (POP) undergoing surgery have a relapse. Currently, no optimal surgical treatment has been identified for correcting a uterine prolapse. This population‐based register study aims to compare the relapse rate in patients with uterine prolapse undergoing hysterectomy with suspension or uterine‐sparing surgical procedures. Material and methods: All women with uterine prolapse undergoing prolapse surgery in Sweden from January 1, 2015 to December 31, 2018, were identified from the Gynecological Operation Register (GynOp). The primary outcome was the number of recurrent POP surgeries up to December 31, 2020. Results: Sacrospinous hysteropexy (SSHP) without graft and sacrohysteropexy (SHP) were associated with a significantly higher rate of recurrent POP surgery (SSHP without graft: adjusted odds ratio [aOR] 2.6, 95% CI 2.0–3.5; SHP aOR 2.6, 95% CI 1.8–3.7) and patients describing a sense of globe (SSHP without graft, aOR 2.0, 95% CI 1.6–2.6; SHP, aOR 1.8, 95% CI 1.1–3.1) compared with cervical amputation with uterosacral ligament fixation (Manchester procedure). There was no difference in the reoperation rate or sense of a globe between SSHP with graft and Manchester procedure. Patients undergoing SSHP without graft had a higher frequency of 1‐year postoperative complications compared with Manchester procedure (aOR 2.0, 95% CI 1.6–2.6) and SHP (aOR 2.4, 95% CI 1.4–3.9). Moreover, the frequency of 1‐year postoperative complications was higher in SSHP with graft (aOR 1.6, 95% CI 1.1–2.2) than in Manchester procedure. Conclusions: The Manchester procedure was associated with a low rate of recurrent POP surgery, symptomatic recurrence and low surgical morbidity compared with other surgical methods in women with uterine prolapse. [ABSTRACT FROM AUTHOR]

Aims: A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). Materials: Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ2 and Fisher's exact tests. Results: Forty‐six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). Conclusions: After hydrodissection, less bleeding was noted without compromise the surgical planes. [ABSTRACT FROM AUTHOR]

A 37‐year‐old multiparous woman complained of uterine prolapse at 14 weeks of gestation. A silicone ring‐shaped middle‐size vaginal pessary (# 62 mm) was placed into the vagina to reduce prolapsed uterus. Because the cervical length became shortened at 25 weeks of gestation, we decided to start intramuscular administration of progesterone (250 mg) weekly. At 33 weeks of gestation, she complained of the vaginal pessary spontaneous falling out, so we inserted a vaginal pessary of the same size again. The uterocervical angle became acute, going from 100° to 60° after placing the vaginal pessary into the vagina. We took the vaginal pessary out at 37 weeks of gestation. The patient gave birth at 39 weeks by spontaneous vaginal delivery to a healthy baby. A vaginal pessary may help continue a pregnancy via the same mechanism as a cervical pessary, which sharpens the uterocervical angle. [ABSTRACT FROM AUTHOR]

Aims: To evaluate differences in the curvature of the urethral‐vaginal interface in women with and without stress urinary incontinence (SUI) using geometric morphometric analysis techniques. Methods: We conducted a pilot case–control study using magnetic resonance imaging (MRI) scans of 18 women with and without SUI. The urethral‐vaginal interface at the level of the mid‐urethra was fitted with a second‐order polynomial regression. The chord length and chord‐to‐vertex length of the resulting parabolic curve were used to calculate the arc length and radius of a circular arc fitted to the interface curvature. Demographic characteristics and Pelvic Organ Prolapse Quantification (POP‐Q) parameters were collected. Subjects were stratified by those with and without SUI, as well as by those with and without anterior wall prolapse beyond 2 cm proximal to the hymen (Aa > −2 cm). Results: The radius of the urethral‐vaginal interface curvature was not found to be different between subjects with and without SUI (8.8 vs. 9.2 mm, p = 0.53); however, this value was smaller in subjects with Aa > −2 (8.4 vs. 11.9 mm, p = 0.03). The chord length, chord‐to‐vertex length, and arc length comprising the urethral‐vaginal interface curvature were similar between subjects with and without SUI, and between subjects with and without Aa > −2 cm (p > 0.05 for all). Conclusions: In this pilot study population, the radius of the urethral‐vaginal interface curvature at the mid‐urethra was smaller among women with anterior vaginal wall prolapse beyond 2 cm proximal to the hymen. A difference in the urethral‐vaginal interface curvature among women with and without SUI was not found. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether locally applied vaginal estrogen affects prolapse‐associated complaints compared with placebo treatment in postmenopausal women prior to surgical prolapse repair. Design: Randomised, double‐masked, placebo‐controlled, multicentre study. Setting: Urogynaecology unit at the Medical University of Vienna and University Hospital of Tulln. Population: Postmenopausal women with symptomatic pelvic organ prolapse and planned surgical prolapse repair. Methods: Women were randomly assigned local estrogen cream or placebo cream 6 weeks preoperatively. Main outcome measures: The primary outcome was differences in subjective prolapse‐associated complaints after 6 weeks of treatment prior to surgery, assessed with the comprehensive German pelvic floor questionnaire. Secondary outcomes included differences in other pelvic floor‐associated complaints (bladder, bowel or sexual function). Results: Out of 120 women randomised, 103 (86%) remained for the final analysis. After 6 weeks of treatment the prolapse domain score did not differ between the estrogen and the placebo groups (4.4 ± 0.19 versus 4.6 ± 0.19; mean difference, −0.21; 95% CI −0.74 to 0.33; P = 0.445). Multivariate analysis, including only women receiving the intervention, showed that none of the confounding factors modified the response to estradiol. Conclusions: These results demonstrate that preoperative locally applied estrogen does not ameliorate prolapse‐associated symptoms in postmenopausal women with symptomatic pelvic organ prolapse. Preoperative local estrogen does not ameliorate prolapse‐associated symptoms in postmenopausal women with pelvic organ prolapse. Preoperative local estrogen does not ameliorate prolapse‐associated symptoms in postmenopausal women with pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

Introduction: Hysterectomy has been one of the most common surgical procedures in women in Finland. We studied the population‐based trends of hysterectomy and its indications from 1986 to 2017. Material and methods: A retrospective population‐based cohort was created from the Care Register for Health Care by identifying women who had a hysterectomy from 1986 to 2017 and calculating the number of women from the Digital and Population Data Services Agency. We estimated the number and incidence of hysterectomy by period and age as well as by indication. We considered the primary diagnosis at the time of surgery as the indication of hysterectomy. Results: The number of hysterectomies increased from 7492 procedures in 1986 to 12 404 procedures in 1998, and reduced substantially after that to 5971 procedures in 2017, the turning point being in 1999. The incidence rate of hysterectomy has decreased on average by 2.5% annually from 432.6 per 100 000 women in 1998–2001 to 224.5 per 100 000 women in 2014–2017. The median age at the time of hysterectomy has increased from 51 years in 1998–2001 to 55 years in 2014–2017. The cumulative burden of hysterectomy by age of 60 years has nearly halved from the first 4‐year period (23%) to the last (12%). After 2010, the most common indication has been genital prolapse and incontinence, whereas earlier it was uterine fibroids. Conclusions: The number and incidence of hysterectomies have fluctuated during the observation period 1986–2017 and decreased considerably during the past 17 years in Finland. This is probably a result of the availability of hormonal and other conservative treatment options for bleeding disorders and uterine fibroids. As hysterectomy practically removes the risk for endometrial cancer, the change in hysterectomy incidence over time emphasizes the importance of correcting endometrial cancer incidence according to hysterectomy incidence. [ABSTRACT FROM AUTHOR]

Caesarean delivery, PPH and tranexamic acid Rates of caesarean delivery (CD) continue to rise with the highest figures generally found in high-income situations. Specifically, this involves the use of tools such as a vaginal/vulvar delivery system for the administration of anaesthetic and/or neurolytic therapy/therapies to block the pain signals and the use of ultrasound energy and electrical energy which can be used separately or in combination. In particular, the 2021 edition includes updated information about medicines, methods of family planning, treatment information regarding HIV during pregnancy, and new links to training resources. The income of medical practitioners (physicians) working in the United States are reported on annually. [Extracted from the article]

Aims: This systematic review aimed to assess the completeness of exercise reporting in randomized controlled trials (RCTs) on pelvic floor muscle training (PFMT) for women with pelvic organ prolapse (POP). Methods: MEDLINE, Cochrane Central, CINHAL, Embase, SCOPUS, and PEDro databases were searched up to October 2020. Full‐text RCTs comparing PFMT to any type of intervention among women with any type and stage of POP were eligible for inclusion. Completeness of intervention was evaluated with t20he template for intervention description and replication (TIDieR) and the consensus on exercise reporting template (CERT). Inter‐rater agreement for each item of the tools was calculated. Results: Twenty‐six RCTs were included. None of the studies completely reported all intervention descriptors. On average 57.1% (6.8 ± 2.4; out of 12) of the overall TIDieR items and 35.3% (6.7 ± 2.9; out of 19) of the CERT were well described. In particular, 7 and 5 items were completely reported more than 50% of the time for the TIDieR and CERT, respectively. Frequent shortcomings were the undetailed reporting of information regarding tailoring and modifications of exercises and their adherence. Detailed descriptions of exercise repetitions to enable replication were missing in 53.8%. According to the CERT, only 11.5% of the RCTs sufficiently described the main providers' characteristics. Conclusion: The completeness of PFMT reporting for women with POP is still below desirable standards and it is insufficient to ensure transferability into practice. The present results may add relevant knowledge and contribute to improving adequate reporting of exercise. [ABSTRACT FROM AUTHOR]

Aim: Tension‐free vaginal mesh (TVM) surgery using synthetic polypropylene (PP) soft mesh had spread rapidly. However, the frequency of mesh‐related postoperative complications had increased, and PP was banned in April 2019. In Japan, however, transvaginal surgery using polytetrafluoroethylene (PTFE) mesh had been approved. In this study, we evaluated the clinical outcome and quality of life (QOL) of the postoperative course using PP mesh and PTFE mesh (named "ORIHIME™") in a combination surgery for utero‐sacral ligament suspension and anterior vaginal support using anterior TVM. Methods: The vaginal hysterectomy and utero‐sacral ligament colpopexy augmented by anterior vaginal mesh implants using PP mesh and PTFE mesh were performed on patients with stage III to IV cystocele and uterine prolapse. The clinical outcome and QOL changes in their postoperative course were evaluated by comparing 15 cases of PP mesh and 13 cases of PTFE mesh. Results: There was no difference between the PP group and PTFE group in characteristics. No mesh‐related complications occurred during the follow‐up period. With regard to the pelvic organ prolapse quantification (POP‐Q) score, no significant difference was found between the two groups. Comparing the postoperative QOL of both groups, the PTFE group had significantly higher values in two domains than PP group (SF‐12v2 questionnaire). Conclusions: We used the world's first PTFE mesh to compare PP mesh with postoperative POP‐Q and QOL after the same surgery, with the same operator, and at the same institution. The results showed no significant difference between both mesh materials in the short‐term. [ABSTRACT FROM AUTHOR]

Objective: Transperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine descent on ultrasound in Chinese women is still poorly defined. We aimed to determine the optimal cut-off to define abnormal uterine descent on transperineal ultrasound in Chinese women.Methods: This prospective multicenter study recruited women who were examined in tertiary-level gynecological centers, due to symptoms of lower urinary tract and/or pelvic floor dysfunction, between February 2017 and September 2018. All recruited women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) examination, and four-dimensional transperineal ultrasound examination. On ultrasound, uterine descent was measured relative to the posteroinferior margin of the symphysis pubis during maximum Valsalva maneuver. The optimal cut-off value for definition of abnormal uterine descent was selected as the value with the highest Youden index and the diagnostic performance of this cut-off for the prediction of prolapse symptoms and POP-Q stage was assessed and compared by means of the area under the receiver-operating-characteristics curve (AUC).Results: In total, 538 Chinese women, with a mean age of 39.4 (range, 18-81) years, were enrolled into the study. Both uterine descent on transperineal ultrasound (P < 0.001) and POP-Q stage (P < 0.001) were associated strongly with presence of prolapse symptoms. Uterine descent on ultrasound was associated significantly with POP-Q stage for apical compartment prolapse (P < 0.001). The optimal cut-off value for the definition of abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver in the prediction of prolapse symptoms was 4.79 mm above the symphysis pubis (AUC, 0.75 (95% CI, 0.71-0.78)), while the optimal cut-off values in the prediction of prolapse of POP-Q Stage ≥ 1 and POP-Q Stage ≥ 2 were 6.63 mm above the symphysis pubis (AUC, 0.83 (95% CI, 0.80-0.86)) and 8.42 mm below the symphysis pubis (AUC, 0.85 (95% CI, 0.82-0.88)), respectively.Conclusions: The optimal cut-off value to define abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver for the prediction of prolapse symptoms in this population of Chinese women was 4.79 mm above the symphysis pubis, close to that for predicting apical compartment prolapse of POP-Q Stage ≥ 1 (6.63 mm above the symphysis pubis). These are somewhat different from values described previously in mainly Caucasian populations. Ethnic differences should be taken into account in the evaluation of pelvic organ prolapse using transperineal ultrasound. © 2020 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Introduction: Fetal bradycardia due to sentinel events such as placental abruption, cord prolapse or uterine rupture is associated with an increased risk of acidemia at birth. In the absence of a sentinel event, data regarding neonatal prognosis are scarce, and it seems plausible that the depth of bradycardia might be associated with an increased risk of acidosis at birth. The objective was to determine whether the depth of bradycardia is associated with a higher risk of umbilical artery acidemia at birth in term singleton pregnancies requiring cesarean delivery during labor.Material and Methods: A retrospective comparative study of all cesarean deliveries for bradycardia in an academic tertiary center in the 6-year period of 2013-2018, among term singleton pregnancies. Bradycardia associated with a sentinel event such as placental abruption, cord prolapse or uterine rupture, were excluded. The nadir of the bradycardia was defined as the lowest fetal heart rate baseline lasting at least 3 minutes during bradycardia. Women who delivered an infant with an umbilical pH at birth <7.00 (acidosis group) were compared with women who delivered an infant with an umbilical pH at birth ≥7.00 (non-acidosis group).Results: Among 111 eligible cases, 32 women in the acidosis group were compared with 79 in the non-acidosis group. The median nadir of the bradycardia was lower in the acidosis than in the non-acidosis group (60 bpm, interquartile range [56-65] vs 70 [60-76], P < .01). A bradycardia nadir <60 bpm emerged as the optimal threshold for predicting acidemia and was more frequently observed in the acidosis than in the non-acidosis group (10 [31%] vs 10 [13%], P = .02). In the multivariable analysis, a nadir <60 bpm was independently associated with an umbilical artery pH <7.00 (adjusted OR 3.16, 95% CI 1.10-9.04).Conclusions: A bradycardia nadir <60 bpm was associated with a tripled risk of umbilical artery acidemia at birth. [ABSTRACT FROM AUTHOR]

Background: Women with high‐grade uterovaginal prolapse have a greater risk of recurrent prolapse after pelvic organ prolapse surgery. Royal College of Obstetricians and Gynaecologists guidelines have recommended sacrospinous suspension (sacrospinous fixation) at the time of vaginal hysterectomy, whenever there is a marked uterovaginal prolapse. We have modified the McCall culdoplasty by placing sutures extraperitoneally, higher and more lateral into the uterosacral/cardinal ligaments to re‐support the vaginal cuff at the time of a vaginal hysterectomy. Aims: To evaluate the results of a modified technique of McCall high culdoplasty and native tissue repair at time of vaginal hysterectomy in women with advanced uterovaginal prolapse. Material and methods: Longitudinal clinical follow‐up conducted between 2000–2018, in a tertiary urogynaecology centre for patients presenting with stage 3–4 uterovaginal prolapse, who underwent vaginal hysterectomy and modified McCall vault suspension. Results: There were 176 cases meeting the inclusion criteria. Mean follow‐up was 19.35 months. There were 25 recurrences (14%) of ≥ stage 2 (76% not symptomatic). Twelve of these recurrences (48%) occurred in anterior compartment, six (25%) posterior, three (12%) combined anterior/posterior, two (8%) combined posterior/central and one case had recurrence in all compartments. Only six cases (3%) required another surgical procedure for symptomatic prolapse, all with an enterocele recurrence. Conclusions: Our described modified McCall technique incorporates high extraperitoneal approach to apical resuspension along with closure of any existing large hiatal defects of the levator plate at the time of vaginal hysterectomy for advanced uterine prolapse has excellent outcomes and extremely low complication rates and avoids the need for sacrospinous fixation. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated the effectiveness of sacrospinous ligament fixation (SSLF) and whether uterine preservation reduces the anatomical recurrence rate. Methods: The medical records of 82 patients who received SSLF in a single medical center were reviewed retrospectively. Anatomical recurrence was defined as Pelvic Organ Prolapse‐Quantification stage 2 or higher in any compartment. The primary outcome was intergroup analysis for uterine preservation and concomitant hysterectomy patients. The secondary outcomes were anatomical recurrence risk factors and the incidence of adverse events. Propensity score matching (PSM) was used to adjust for demographic differences between groups. Results: The anatomical recurrence rate was 19.5%, and the retreatment rate was 11.0% (mean follow‐up duration: 22.9 months). Cystocele was the most common recurrent compartment (17.1%). The uterine preservation group (n = 66) was younger, had lower parity, and had fewer stage 3 to 4 cystoceles and uterine prolapses than the concomitant hysterectomy group (n = 16). Shorter operation times (99.4 minutes vs 153.7 minutes, P =.002) and lower anatomical recurrence rates (11.5% vs 45.5%, P =.039) were found in the uterine preservation group before and after PSM. Previous pelvic organ prolapse surgery (hazard ratio 3.14) and concomitant hysterectomy (hazard ratio 4.08) were identified as risk factors for anatomical recurrence. The most common adverse event was buttock pain (14.6%), which resolved spontaneously within 4 weeks. Conclusions: SSLF is an effective surgical method using native tissue for pelvic reconstruction. Compared with concomitant hysterectomy, SSLF with uterine preservation reduces the anatomical recurrence rate. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have shown that anterior vaginal wall prolapse (AVWP) results in reduction of pressure in the proximal urethra. However, the effect of severity of AVWP on urethral pressure is controversial. This study aimed to evaluate parameters of the urethral pressure profile in different stages of AVWP. Materials and methods: From 2016 to 2017, 286 consecutive patients with urogynecologic complaints who were referred to our urodynamic unit were enrolled in this study to analyze their urethral pressure profiles. Stages of AVWP were regrouped into three groups ranging from mild to severe stages (groups 1‐3). Maximal urethral pressure, urethral closure pressure, functional urethral length, length of continence zone, as well as area of continence zone were compared among these three groups. Results: Distribution of age, parity, and menopausal women were significantly different among these three groups. Maximal urethral pressure (pressures for groups 1, 2, and 3 were 74.6∼75.9cmH2O, 69.7∼73.4cmH2O, and 58.3∼60.5cmH2O, respectively; all P<.05) and stress urethral closure pressure (pressures for groups 1, 2, and 3 were 69.3cmH2O, 62.3cmH2O, and 52.2cmH2O, respectively; all P<.05) gradually and significantly decreased, consistent with the severity of AVWP. However, the attenuated maximal urethral pressure and stress urethral closure pressure in accordance with severity did not show any significant difference after controlling for age, body mass index, parity, menopause, and stress urinary incontinence symptoms. Conclusion: Our results showed that AVWP significantly attenuated urethral pressure. However, patient age, menopausal status, and number of parities seem to be more influential in compromising urethral function than just AVWP alone. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate whether the number of vaginal births a woman has alters the association between symptoms and signs of pelvic organ prolapse. Methods: In this retrospective study, we investigated data on 1748 women seen between April 2012 and January 2016. To elucidate whether the number of vaginal births is a confounder of this relationship, we used receiver operating characteristic statistics to investigate the association between symptoms and signs of prolapse in women of different vaginal parity. Results: A higher number of vaginal births was associated with a higher likelihood of symptoms of prolapse for any given degree of prolapse. Multivariate modeling, however, showed this confounding effect to be due to higher vaginal parity in older women (P <.001). Receiver operating characteristic curves obtained for the association between symptoms and signs of prolapse were near identical regardless of whether vaginal parity was included in the modeling. This was true for both clinical and imaging assessments of prolapse. Conclusions: Although vaginal childbirth is associated with symptoms of prolapse, the number of vaginal births does not alter the relationship between symptoms and signs of prolapse among individuals presenting to a tertiary care center for evaluation. Previously published limits for "normal" pelvic organ mobility can be used irrespective of vaginal parity. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

The Neurourology & Urodynamics journal has published abstracts that were accepted for presentation at the 2024 winter meeting of the Society for Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU). The meeting will take place from February 21-24 at the Marriott Resort Fort Harbor Beach in Fort Lauderdale, FL. The abstracts represent cutting-edge research in the field of Urogynecology and Reconstructive Pelvic Surgery (URPS). The meeting will include podium presentations, video abstracts, posters, and videos. The first 1 ½ days of the meeting will focus on basic science, while the following days will cover clinical topics. The meeting aims to provide an opportunity for clinicians and basic science colleagues to share ideas and knowledge. [Extracted from the article]

Aims: The Elevate™ Anterior mesh was designed to correct anterior vaginal wall defects by providing level 1 and 2 support via a single incision and transvaginal approach. This study aimed to examine the objective and subjective outcomes following prolapse repair using the Elevate™ Anterior mesh kit. Methods: A retrospective case series review of 270 patients with Baden–Walker Grades 3 or 4 anterior compartment prolapse who underwent the Elevate™ Anterior mesh kit was undertaken. Operative complications were recorded with follow‐up intervals arranged at 1, 6, 12, 24, 36, 48 and 60 months. A standardized questionnaire directed at urinary, pain and recurrence symptoms was used at each follow‐up visit. Pelvic examinations were performed at each follow‐up visit to assess for objective cure and for detection of complications. The primary outcome was to assess the cure rate defined as anterior vaginal wall prolapse ≤ Grade 1. Results: The follow‐up rate was 28.9%. Subjective and objective cure rates at 60 months were 100% and 96.2%, respectively. Ten (3.7%) intraoperative complications were recorded. At 60 months, three (3.8%) patients complained of de novo stress/urge urinary incontinence. One patient had dyspareunia at 6 months postsurgery which resolved by the end of 1 year. Prolapse recurrences in the anterior compartment was 3.8% at the end of 5 years. Mesh exposure into the vagina occurred in three patients. Conclusions: In conclusion, our experience with the Elevate™ Anterior mesh kit had promising subjective and objective outcomes with high patient satisfaction rates. [ABSTRACT FROM AUTHOR]

This report describes a surgical technique for resolution of uterine prolapse in rabbits. Three pet rabbits presented within 24 hours of parturition with a red mass protruding from the vagina, which was diagnosed as uterine prolapse. In the first case, an attempt to reduce the prolapse by manual compression was ineffective. A laparotomy was used to apply internal uterine traction while simultaneously using gentle external pressure with cotton‐tip applicators and resulted in successful resolution. After repositioning, an ovariohysterovaginectomy was performed in all three rabbits. All rabbits recovered uneventfully. Laparotomic repositioning of the uterus and ovariohysterovaginectomy, not previously described in rabbits, was easy to perform and permitted resolution of uterine prolapse. [ABSTRACT FROM AUTHOR]

Various methods have been described to treat neovaginal prolapse in patients with Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. In this case report, we describe neovaginal prolapse of a 21‐year‐old patient with MRKH syndrome which had been created by sexual intercourse dilation. Herein, the laparoscopic lateral suspension was performed for the surgical correction of neovaginal prolapse which is not available in the literature as far as we search. Prolapse was successfully corrected and vaginal length was provided at a sufficient length of 7 cm. Since after 1‐year of operation, she has remained satisfied with her surgical outcome anatomically, sexually and psychologically. Laparoscopic lateral suspension is a safe and effective treatment in a patient who has neovaginal prolapse with MRKH syndrome and also can be used as a potentially alternative management in the treatment of neovaginal prolapse in patients with MRKH syndrome. [ABSTRACT FROM AUTHOR]

Clinical records of all 212 ewes undergoing emergency caesarean surgery at a veterinary teaching hospital between January 2008 and December 2019 were evaluated retrospectively. Their age ranged from 1 to 10 years (median = 4 years), with German merino the predominant breed (48.1% of cases). The most frequently diagnosed indications were insufficient cervical dilatation (n = 94, 44.3%), uterine torsion (n = 50, 23.6%), foetopelvic disproportion (n = 31, 14.6%) and vaginal prolapse intra partum (n = 11, 5.2%). Fifty‐four (25.5%) of the 212 ewes additionally suffered from one or more concurrent, pre‐existing conditions. Overall ewe mortality until hospital discharge was 10.8% (23/212), and 3.8% (n = 6) for the 158 ewes without a history of concurrent disorders. Mortality during hospitalization increased to 31.5% (17/54) for those with pre‐existing conditions. Total lamb mortality was 49.1% (173/352) until hospital discharge. Pre‐existing conditions (p =.001) and the presence of post‐surgical complications (p =.025) were identified as significant factors influencing dam mortality, while delayed presentation for veterinary attention with an observed duration of labour of >12 hr was identified as the most influential factor on total lamb mortality (p =.010). The presence of dead or emphysematous foetuses was not significant for ewe mortality. Follow‐up information on further outcomes was available for 156 (82.5%) of the 189 discharged ewes. Eighty‐nine animals (57.1%) were re‐bred in the following season and achieved a 93.3% (83/89) pregnancy rate, while the remainder had either been slaughtered (n = 56, 35.9%), sold (n = 5, 3.2%) or had died of unknown causes (n = 3, 1.9%). The subsequent incidence of dystocia was 15.6% (n = 12) in the 77 ewes with available information on lambing ease. Adequate management of underlying conditions and timely intervention are important factors for best possible short‐term outcomes. In the long term, the subsequent pregnancy rate was good and the incidence of subsequent dystocia was within the normal range. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the correlation between pre‐existing conditions and worsening of Stage I untreated posterior vaginal wall prolapse (PVWP) after vaginal hysterectomy and anterior repair at 12‐month follow‐up. Methods: This is a multicenter retrospective study. Women with symptomatic (vaginal bulging and low back pain) anterior and/or apical pelvic organ prolapse (POP) and I stage PVWP were enrolled. Patients were submitted to vaginal hysterectomy and native‐tissue anterior vaginal wall repair. Risk factors for POP development were collected for each woman before surgery. At 12 month‐follow‐up after surgery, women were evaluated and divided into two groups depending on the anatomical finding of the posterior vaginal wall according to the Pelvic Organ Prolapse Quantification System: women with Persistent I stage PVWP and patients with worsened PVWP more than or equal to II stage. Difference of distribution of risk factors for POP between the two groups was evaluated. Correlation between risk factors and development of PVWP more than I stage was assessed. Results: Seventy women were submitted to POP surgery. Significant difference in constipation before surgery and degree of anterior and central vaginal compartments descent was observed (p <.01) between the two groups. Constipation before surgery resulted as an independent factor in worsening of PVWP at 12‐month follow‐up (p value =.01; odds ratio 1.99 [1.49–2.33]). Conclusion: Untreated Stage I PVWP, not included in the first surgical repair, can significantly get worse in women complaining of constipation at 12‐month follow‐up. [ABSTRACT FROM AUTHOR]