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Introduction: Pelvic floor disorders (PFD) are more frequently seen in women and impairs quality of life. The aim of this study was to find agreement between the clinical examination and magnetic resonance defecography (MRD) findings of female patients with PFD related symptoms and to discuss the findings of MRDin PFD. Methods: Seventy-six female patients with complaints of PFD and undergone MRD were included in the study. The pubococcygeal line was used as the reference line for pelvic organ prolapse evaluation in MRD. MRD and clinical examination findings were compared. Results: Agreement between the MRD and clinical examination findings concerning the presence of cystoceles, rectoceles, entero/peritoneocele was 75%, 50%, and 60.52% respectively. However, the agreement was weaker in terms of pelvic organ prolapse grading (44% for cystoceles, 32% for rectoceles). Since there was no uterine prolapse detected on clinical examination an agreement test for uterine prolapse could not be performed. Conclusion: MRD is complementary to clinical examination in terms of its ability to comprehensively evaluate all compartments simultaneously. MRD provides additional information to the clinical examination in patients with symptoms related to PFD and should be utilized, in symptomatic cases, if the clinical examination findings are negative or if multicompartmental pathologies are suspected. [ABSTRACT FROM AUTHOR]

Purpose: This study established the prognostic significance of the uroflowmetry flow curve shape in the presence of voiding dysfunction following transvaginal mesh surgery. Methods: This is a retrospective study of 439 symptomatic cystocele patients who underwent anterior wall repair with transvaginal mesh surgery. Uroflowmetry and postvoid residual were used to evaluate voiding function both preoperatively and 12 months postoperatively. The patients were divided into two groups: those with and without postoperative voiding dysfunction, and the predictors of postoperative voiding dysfunction were analyzed. The shape of the urine flow curve was analyzed for its influence on the presence of postoperative voiding dysfunction. Results: Thirty‐five participants were in the voiding dysfunction group, while 404 were in the nonvoiding dysfunction group. Multivariate analysis was conducted by adding an interrupted‐shaped curve to age, Qmax, and postvoid residual, which showed significant differences in univariate analysis, found that age 68 years or older (odds ratio [OR]: 7.68, 95%CI 1.02–58, p = 0.048), postvoid residual ≥110 mL (OR: 2.8, 95%CI 1.25–6.29, p = 0.013) and interrupted‐shaped curve (OR: 2.47, 95%CI 1.07–5.69, p = 0.034) were discovered to be independent risk factors for the presence of voiding dysfunction after transvaginal mesh surgery. Conclusions: Following transvaginal mesh surgery for cystocele, three variables were found to be predictive of voiding dysfunction: the old age, excessive postvoid residual, and an interrupted‐shaped flow curve. The uroflowmetry flow curve shape has the potential to be a new predictor of postoperative voiding dysfunction. [ABSTRACT FROM AUTHOR]

Uterine prolapse is a condition where some or all parts of uterus descended into the introitus vagina. Patients usually present with lump, feeling of discomfort, pain, urinary, and defecating disorders. Uterine prolapse happen to almost half of the women population. Almost half of the women who had given birth suffer from pelvic organ prolapse that is diagnosed through physical examination; however, only 5%–20% of patients present with symptoms. Uterine prolapse with vesicolithiasis is a rare case. Uterine prolapse can cause bladder obstruction, urine stasis, and chronic infection, which become the risk factors to the increase of urine saturation that can lead to vesicolithiasis. We present a case of multiple vesicolithiasis on cystocele and uterine prolapse in a 79-year-old female who has difficulty of urinating, feeling of burning in the end of urinating, and a mass that protrudes from the vagina for 33 years ago. The patient underwent pervaginam hysterectomy, anterior and posterior colporrhaphy, open vesicolithotomy, and cystoscopy biopsy of the bladder mucosa. She evolved with good postoperative condition and was then discharged.

Purpose: To evaluate the changes in clinical outcome and urodynamic parameters after tailored anterior transvaginal mesh (ATVM) surgeries in a mid-term follow-up. Methods: Between November 2011 and December 2015, women with ≥stage II pelvic organ prolapse (POP) who underwent ATVM surgeries were retrospectively reviewed. The data-reviewing timeframe was until December 2021. Clinical and urodynamic diagnoses regarding urinary symptoms were evaluated before and after the operation. Results: A total of 160 women were included. Stress urinary incontinence decreased significantly after the operation (99% (159/160) vs. 43% (68/160), p

Although it is known that hysterectomy (HY) alone cannot resolve apical prolapse, vaginal hysterectomy (VH) remains the most common surgical procedure for this issue. In recent years, various procedures for uterine conservation have been proposed to avoid the surgical risks of HY. Furthermore, most women with symptomatic pelvic organ prolapse (POP) prefer uterine conservation in the absence of considerable benefit in uterine removal. In 2017, we proposed a new technique for hysteropexy and anterior vaginal native tissue repair (NTR) in women with cystocele and apical prolapse. The objective of this study is to assess the efficacy and safety of this new procedure after at least 5 years of follow-up. We included only patients with stage II or greater prolapse of the anterior vaginal wall and a concomitant stage II uterine prolapse in accordance with Pelvic Organ Prolapse Quantification (POP-Q) system. A Patient Global Impression of Improvement (PGI-I) score ≤ 2 in addition with the absence of POP symptoms was defined as subjective success. A descensus with a maximum point of less than −1 in any compartment was considered objective cure. A total of 102 patients who fulfilled the inclusion criteria were enrolled. At 60 months follow-up, 90 out of 102 patients (88%) were subjectively cured, whereas 88 out of the 102 (86%) patients were objectively cured. Subjective and objective cure rates persisted during the entire study period. Uni- and multivariate analysis of possible predictive factors associated with recurrence of prolapse showed that only a preoperative point C > 0 cm and BMI ≥ 25 kg/m2 were risk factors for failure. In conclusion, our study showed that hysteropexy with anterior vaginal native tissue repair may be an effective and safe option for the treatment of anterior vaginal prolapse and concomitant stage II uterine prolapse by at least 5 years of follow-up. [ABSTRACT FROM AUTHOR]

Straining to void is the need to make a muscular effort in order to initiate, maintain or improve the urinary stream, through an increase in abdominal pressure. This pattern of bladder emptying is frequently observed in women with pelvic organ prolapse causing urinary obstruction, to overcome the increased resistance to urine flow. However, frequent increases in abdominal pressure are a risk factor for developing pelvic organ prolapse, and might play a role in its recurrence after surgery. The aim of this study was to investigate the role of straining identified at urodynamic study in prolapse recurrence after surgical repair. This was a retrospective study on women submitted to prolapse repair by vaginal hysterectomy with modified McCall culdoplasty and anterior colporraphy. All patients underwent a preoperative urodynamic evaluation including a pressure-flow study performed after prolapse reduction by means of a vaginal pessary; straining was defined by a simultaneous and similar increase in intravesical and abdominal pressures of at least 10 cmH 2 O over the baseline during bladder emptying, corresponding to intermittent peaks of urine flow. Patients were divided into two groups according to the presence or absence of straining, and they were compared for surgical results at 12 months and for the rate of anterior or central recurrence over time. Women with straining (n = 16), compared to women with normal voiding (n = 43), showed a higher risk of anterior recurrence over time at Kaplan-Meier curves, for both stage II (p = 0.02) and stage III prolapse (p = 0.02). No difference was seen for central recurrence during the follow up period. POP-Q staging at 12 months was similar for the two groups, except for the location of the Aa point which was significantly better for women without straining (−1.6 ± 0.1 cm vs −0.8 ± 0.3 cm, p = 0.03). Straining to void identified in preoperative urodynamic study seems to increase the risk of anterior recurrence after surgical repair of pelvic organ prolapse. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate whether cystocele type varies with vaginal parity. Methods: Retrospective analysis of 464 vaginally nulliparous women seen at 2 urogynecology units between November 2006 and November 2019. A control group consisted of 871 vaginally parous women seen between July 2017 and November 2019. Patients underwent a standardized interview, POPQ, urodynamic testing, and translabial ultrasound. On imaging, significant cystocele was defined as bladder descent to ≥10 mm below symphysis pubis. Volume datasets were analyzed offline and blinded against clinical data. Results: Of 5266 women seen during the inclusion period, 464 were vaginally nulliparous. Three were excluded due to missing data, leaving 461. A control group of 871 parous women was generated from patients seen during the last 2.5 years of the inclusion period. Vaginally nulliparous women were presented at a younger age compared to vaginally parous women (P <.001). Symptoms of prolapse were reported in 104 (22%) nulliparae and 489 (56%) parous women (P <.0001). Vaginally parous women demonstrated more bladder descent (P <.0001) and more cystocele (418/871 versus 43/461, P <.0001), with a higher proportion of type III cystocele (cystocele with intact retrovesical angle) (20/43 versus 273/ 418, P <.0001). Cystourethrocele (Green type II) was more common in nulliparae and cystocele type III in parous women (P =.015). On multivariate analysis, these differences in proportions remained significant (P =.049). Conclusions: Nulliparity was associated with a higher proportion of Green type II cystoceles. Green type III cystocele was more common in vaginally parous women, suggesting that the latter may be more likely to be due to childbirth‐related pelvic floor trauma. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the presence of defects in the pelvic muscles, muscle configuration, and the relationship of pelvic organs using magnetic resonance imaging (MRI) in women with apical pelvic organ prolapse (POP), and compare these findings with measurements from women without POP. Materials and Methods: The study analyzed computer-based medical records of patients diagnosed with POP prolapse at İzmir Bakırçay University Çiğli Training and Research Hospital between March 2022 and May 2023. Forty-five patients diagnosed with apical POP were matched with 45 patients of the same age group without prolapse. Pelvic MRI images of all patients were examined, and the pubococcygeal line, H line, and M line were marked. Additionally, measurements of the uterocervical angle, genital hiatus width, obturator internus muscle area, and levator ani defect were assessed. Results: The demographic characteristics of patients with POP were similar to those in the control group. There were no statistical differences in the POP group regarding pubococcygeal distance, genital hiatus length, vaginal length, uterocervical length, and puborectal distance (H). The presence of unilateral and bilateral levator ani muscle defects was more common in the POP group (p=0.02 and p=0.03). The obturator internus muscle area was lower in the POP group compared to the control group (1770±293.4 mm² vs. 2104±303.5 mm², p=0.02). M length was higher in women with POP (27.3±5.8 mm vs. 15±4.2 mm, p=0.02). Conclusion: MR images revealed defects in pelvic floor muscles and descent of pelvic organs in patients with POP. MRI has the potential to become a standard preoperative examination for pelvic floor abnormalities, assisting in surgical planning. [ABSTRACT FROM AUTHOR]

Aim of the study: The aim of this study was to evaluate the anatomical results after an anterior sacrospinous ligament fixation (ASSLF) with native tissue repair (anterior colporraphy and apical suspension with prolene) compared to mesh repair for the correction of anterior prolapse at 12 months after surgery. Materials and methods: A monocentric prospective study comparing two similar cohorts who underwent ASSLF was conducted. The primary endpoint was the gain in the position of the Ba point relative to its position before surgery and twelve months after surgery. The secondary endpoints consisted of objective results, which were assessed using validated questionnaires. Results: Fifty-three women were included in the native tissue repair group between June 2019 and March 2020. They were compared to 53 women operated on with anterior and apical mesh. There was no difference with respect to the Ba point after 1 year between the two groups (−2 [−3; 1.5]; −2 [−3; 1], p = 0.9789). The apex was significantly better corrected in the native tissue repair group (−7 vs. −6, p = 0.0007). There was also a better correction on the rectocele in the native tissue repair group (−3 vs. −2, p = 0.0178). The rate of Stage 2 anterior vaginal prolapse at one year was approximately 30% in both groups (no statistical difference). Conclusions: ASSFL without mesh does not increase the risk of cystocele recurrence at 1 year after surgery. A future prospective comparison of this native tissue repair technique with mesh suspension is necessary to explore these preliminary findings. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Prolapse is a common condition seen in women and its therapeutical management consists first and foremost of surgery. Postoperative pain is one of the most common side effects seen after surgery. The objective of this study was to identify risk factors for postoperative pain after cystocele repair with mesh. Methods: This is a secondary analysis of the multicenter randomized trial PROSPERE, which compared cystocele repair with mesh according to the vaginal or laparoscopic approach. The presence of postoperative pain was assessed by a pain-specific self-reported questionnaire (Questionnaire de Baudelocque). The statistical analysis is based on the Wilcoxon, Chi-squared, and Fisher's tests. Results: The prevalence of postoperative pain (pain persisting more than 6 months) was 39% (80 out of 205, 95% CI 32.4–46.1), with 6.3% (13 out of 205) of chronic pain reports. Preoperative pain was the only statistically significant risk factor OR = 2.32 (p = 0,007; 95% CI 1.24–4.36). Conclusions: Surgeons must be careful with preoperative painful prolapse and should inform their patient of the risk of developing postoperative chronic pain. [ABSTRACT FROM AUTHOR]

Background: To assess the contemporary trends in the types and incidence of pelvic organ prolapse (POP) surgery in Australia after the removal of transvaginal mesh from the Australian market. Methods: This was a retrospective Australian cohort study utilizing three large Governmental databases covering all private and public POP procedures in Australia. All females ≥25 years old undergoing POP procedures between 2005 and 2021 were included. Results: From 2005–2006 to 2020–2021 there have been a total of 408 881 POP procedures in Australia. The total number of procedures peaked in 2005–2006 at 537.8 procedures per 100 000 age‐standardized female population, decreasing by an average of 3.5% per year to 329.0 procedures per 100 000 in 2018–2019, an overall 38.8% decrease (P < 0.001). A sudden growth in private operative procedures was noted between 2019–2020 and 2020–2021, from 218.2 to 268.6 procedures per 100 000 population, a 23.1% increase (P < 0.001). Laparoscopic and abdominal POP repair has seen a 115.8% increase from 13.7 procedures to 29.6 per 100 000 between 2005–2006 and 2020–2021. Over the last 15 years, the most common age group to undergo a procedure has changed from the 55 to 64 years demographic to a later decade of 65 to 74 years. Conclusion: Over the last 15 years, the total number of POP procedures performed has significantly decreased. There has however been a recent rise in interventions seen in the private sector and the utilization of laparoscopic or abdominal POP repair has increased, which has implications for procedural credentialing to ensure patient safety. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to evaluate the impact of cystocele repair on urinary urge symptoms and to determine the likelihood that urge symptoms are caused by cystocele and therefore cured by cystocele repair. The secondary aim was to assess the impact of baseline cystocele stage POP on the improvement of urge symptoms following surgical treatment of POP. Material and methods: A total of 321 female patients with cystocele stages II, III or IV (POP), who underwent repair surgery for pelvic organ prolapse, were included. A retrospective analysis was performed to determine the presence of urge symptoms in patients with cystocele and to evaluate how many patients were cured from urge symptoms by the cystocele repair. Postoperative data were obtained by interview during a follow-up examination six weeks after surgery. Results: Preoperatively, 52.02% of all patients diagnosed with cystocele stages II, III or IV POP experienced urge symptoms. Urge symptoms were cured in 88.62% of patients with cystocele stages II after POP repair (p < 0.005). 88.60% of patients with cystocele stage II POP and 88.68% of patients with cystocele stages III to IV POP reported improvement in urge symptoms (p < 0.005). Despite cystocele repair, 11.4% of patients with preoperative cystocele stage II POP and 11.32% with preoperative cystocele stages III and IV POP reported persistent urge symptoms. 5.84% of the study group who showed no urge symptoms preoperatively, experienced de novo urge symptoms after following surgery (p < 0.005). Conclusions: Cystocele repair cured urge symptoms in the majority of patients. Therefore, repair of bladder prolapse may help to differentiate urge symptoms from other urinary tract dysfunctions and assist in determining a proper diagnosis and treatment. However, the severity of POP had no significant influence on the improvement in urge symptoms following cystocele repair. Risk of de novo urge symptoms after anatomical repair still needs to be explored. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) is a common pelvic floor disorder (PFD) that affects quality of life (QoL) in millions of women in the United States and around the world. The normal position of pelvic organs relies on both the pelvic floor muscles/levator ani muscle and the connective tissue support for the uterus and vagina. Known risk factors for POP include age, parity, family history, genetic predisposition, and chronic straining. The diagnosis of POP depends mainly on history and clinical examination. After diagnosis, progression is slow, and regression is more common than expected. Treatment starts with patient education about the disorder and available treatments. It is important to note that "doing nothing" is always an option. If patient has troublesome symptoms, there are nonsurgical and surgical options. Nonsurgical options include pelvic floor muscle training and pessary therapy. Surgery is an option for patients with POP who decline nonsurgical options or for whom those options fail. Management of women with POP and other PFDs requires a multidisciplinary team to evaluate and formulate individualized plans to address the specific health and QoL issues facing each patient. (J GYNECOL SURG 39:3) [ABSTRACT FROM AUTHOR]

Background: Pelvic organ prolapse is one of the elements increasing the prevalence of Female Sexual Dysfunction which influences the lifestyles of women and their marital relationships. One of the critical desires of surgical remedies of those women, further than enhancing signs and symptoms and restoring regular anatomy, is to preserve and enhance sexual function. The effect of perineorrhaphy and anterior-posterior vaginal repair on body image, sexual function, and quality of life in postoperative women is one of the objectives of this study. Methods: The present study is a clinical trial without a control group. 119 women referred to Shahid Beheshti and Al-Zahra hospitals in Isfahan, aged 28-49 years, with rectocele and cystocele, uterine prolapse and a candidate for perineal surgery and anterior-posterior vaginal repair, entered the study from October 2020 to August 2021. Data collection tools were three questionnaires on Female Sexual Function Index (FSFI), Multidimensional Body–Self Relations Questionnaire (MBSRQ), and Short-Form Health Survey (SF-36) that were completed before and 6 months after surgery by interviewing individuals. All surgeries were performed by a Fellowship in pelvic floor disorder, and the type of surgery was the same in all patients. Data were analyzed using a dependent t-test. Results: Data of 119 women with rectocele, second and third-degree cystocele with maximal grade 1 apex prolapse, and candidates for perineorrhaphy and anterior-posterior vaginal repair were evaluated. The mean age of the study samples was 36.40±6.39 years and the age range was 28 to 49 years (before menopause). In the postoperative stage; perineorrhaphy and anterior-posterior vaginal repair affect body image, improvement of sexual function, and quality of life in women (P

Objective This study aimed to evaluate the current surgical techniques for anterior and posterior vaginal wall prolapse repair in South Korea. Methods A web-based questionnaire survey was sent to 780 members of the Korean Society of Obstetrics and Gynecology. The items assessed in the questionnaire were the demographic characteristics and current surgical techniques used for the correction of anterior and posterior vaginal wall prolapse. Results The response rate was 16%. There were variations in the suture materials and methods used for anterior and posterior colporrhaphy. Most respondents used only rapid absorbable suture materials to plicate the fibromuscular layer and close the mucosal layer of the anterior and posterior vaginal wall. Simple interrupted sutures are the most popular suture method for both the fibromuscular and mucosal layers. Thirty-one and eleven percent of the respondents used mesh for surgical correction of anterior and posterior vaginal wall prolapse, respectively. Concomitant perineorrhaphy was routinely performed with posterior vaginal wall repair by 42% of the respondents, whereas 58% performed perineorrhaphy only in cases with perineal defects. Conclusion There is considerable diversity in the current surgical techniques for anterior and posterior vaginal wall prolapse repair in Korea. Further research is required to standardize the surgical techniques.

Introduction and hypothesis: Pelvic organ prolapse (POP) is a defect of the female pelvic floor. Stress urinary incontinence (SUI), urge urinary incontinence (UUI), and obstructive symptoms may occur in these patients. The objective of surgical treatment is to restore the anatomy and function of the pelvic floor; however, it may prompt urinary symptoms not present previously. We performed a systematic review and meta-analysis to determine urodynamic changes in patients undergoing surgical correction for POP. Methods: PubMed and Cochrane databases were searched for studies that contained data from urodynamic evaluation before and after vaginal surgery for POP. The main urodynamic data collected were free uroflowmetry (maximum flow [Qmax], voided volume, and post-void residual volume [PVR]), cystometry (bladder capacity, presence of detrusor overactivity [DO], SUI or UUI, and Valsalva leak point pressure), and pressure × flow study (detrusor pressure at maximum flow [PdetQmax], Qmax, and PVR). Results: A total of 22 studies were included (1,549 women). Patients had a significantly higher prevalence of DO before surgery (OR = 1.56; 95% CI = 1.06–2.29), and surgeries without sling placement demonstrated a tendency to ameliorate DO. Patients who did not receive a sling were more incontinent after surgery. Bladder-emptying parameters improved after surgery, with higher PdetQmax before surgery (IV = 3.23; 95% CI = 0.45–1.18). Patients who did not receive MUS presented a lower Qmax (IV = −3.19; 95%CI = −4.09 to −2.30) and a higher PVR (IV = 27.89; 95%CI = 15.68–40.1) before surgery. Conclusion: Correction surgery for POP yields better urodynamic emptying parameters, with a reduction in the prevalence of DO. In contrast, sling placement enhances obstructive parameters. [ABSTRACT FROM AUTHOR]

Uterine prolapse is a condition where some or all parts of uterus descended into the introitus vagina. Patients usually present with lump, feeling of discomfort, pain, urinary, and defecating disorders. Uterine prolapse happen to almost half of the women population. Almost half of the women who had given birth suffer from pelvic organ prolapse that is diagnosed through physical examination; however, only 5%–20% of patients present with symptoms. Uterine prolapse with vesicolithiasis is a rare case. Uterine prolapse can cause bladder obstruction, urine stasis, and chronic infection, which become the risk factors to the increase of urine saturation that can lead to vesicolithiasis. We present a case of multiple vesicolithiasis on cystocele and uterine prolapse in a 79-year-old female who has difficulty of urinating, feeling of burning in the end of urinating, and a mass that protrudes from the vagina for 33 years ago. The patient underwent pervaginam hysterectomy, anterior and posterior colporrhaphy, open vesicolithotomy, and cystoscopy biopsy of the bladder mucosa. She evolved with good postoperative condition and was then discharged. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in clinical outcome and urodynamic parameters after tailored anterior transvaginal mesh (ATVM) surgeries in a mid-term follow-up.Methods: Between November 2011 and December 2015, women with ≥stage II pelvic organ prolapse (POP) who underwent ATVM surgeries were retrospectively reviewed. The data-reviewing timeframe was until December 2021. Clinical and urodynamic diagnoses regarding urinary symptoms were evaluated before and after the operation.Results: A total of 160 women were included. Stress urinary incontinence decreased significantly after the operation (99% (159/160) vs. 43% (68/160), p < 0.01), as well as the pad weight (20.5 ± 2.7 vs. 9.4 ± 2.0, p < 0.001) and diagnosis of urodynamic stress incontinence (83% (132/160) vs. 51% (82/160), p < 0.01). Overactive bladder syndrome increased significantly after the operation (18% (29/160) vs. 28% (45/160), p = 0.03), even though the objective parameters, such as first and strong desire to void, bladder oversensitivity, and detrusor overactivity, were all improved after the operation. The pad weight was mostly improved significantly within the first postoperative 2 years. Eighteen (11%) women had global recurrent POP, and only one (0.6%) woman had true recurrence of cystocele. Twenty-four (15%) women had mesh extrusion, and two-thirds of them could be managed in an office setting.Conclusion: In women with advanced cystocele, the ATVM surgery provides a favorable anatomic reduction outcome with an acceptable mesh extrusion rate. The ATVM provides an anti-incontinence effect, both in subjective symptoms and objective parameters, but this effect might decline after postoperative 2 years. [ABSTRACT FROM AUTHOR]

Background: this study aims to compare the efficacy and safety of vaginal patch plastron (VPP) associated to anterior sacrospinous ligament fixation (SSLF-A) with SSLF-A associated or not to the anterior colporrhaphy (AC) for cystocele treatment. Methods: single-center retrospective study in women with cystocele ≥ III stage submitted to surgery. The primary outcome was to compare objective and subjective cystocele relapse and reoperation rate at follow-up > 6 months. The secondary outcome was to describe peri- and postoperative complications and risk factors for cystocele objective relapse. Results: 75 women were submitted to SSLF-A and 61 women to VPP. VPP objective and subjective relapse (6.5%, 4/61 and 1.1%, 1/61) were lower than SSLF-A (26.7%, 20/75 and 20%, 15/75; p = 0.002 and p = 0.001, respectively). SSLF-A had a higher reintervention rate, but not significantly (6.6%, 5/75 vs. 0%, 0/61; p = 0.06). Previous hysterectomy was a risk factor (HR 4; 1.3–12.1) while VPP was protective factor (HR 0.2; 0.1–0.9) for cystocele anatomical relapse. Postoperative buttock pain was more prevalent in VPP (57.4%, 35/75 vs. 34.7%, 26/61; p = 0.01). Conclusions: VPP is effective and safe for advanced cystocele treatment, with lower objective and subjective relapse rates in comparison to isolated SSLF-A or associated with the AC. [ABSTRACT FROM AUTHOR]

Objective: To define associations between partial levator trauma and symptoms and signs of pelvic organ prolapse (POP).Methods: This was a retrospective study of 3484 women attending a tertiary urogynecology unit for symptoms of pelvic floor dysfunction between January 2012 and February 2020. All women underwent a standardized interview, clinical pelvic organ prolapse quantification (POP-Q) examination and tomographic ultrasound imaging of the pelvic floor. Women with full levator avulsion were excluded from analysis. Partial levator avulsion was quantified using the tomographic trauma score (TTS), in which slices 3-8 are scored bilaterally for abnormal insertions. Binomial multiple logistic regression was analyzed independently for the outcome variables prolapse symptoms, symptom bother and objective prolapse on clinical examination and imaging, with age and body mass index as covariates. Two continuous outcome variables, prolapse bother score and hiatal area on Valsalva, were analyzed using multiple linear regression.Results: Of the 3484 women, ultrasound data were missing or incomplete in 164 due to lack of equipment, clerical error and/or inadequate image quality. Full levator avulsion was diagnosed in 807 women, leaving 2513 for analysis. TTS ranged from 0-10, with a median of 0. Partial trauma (TTS > 0) was observed in 667/2513 (26.5%) women. All subjective and objective measures of POP were associated significantly with TTS, most strongly for cystocele. Associations were broadly linear and similar for all slice locations but disappeared after accounting for hiatal area on Valsalva.Conclusion: Partial avulsion is associated with POP and prolapse symptoms. This association was strongest for cystocele, both on POP-Q and ultrasound imaging. The effect of partial avulsion on POP and prolapse symptoms is explained fully by its effect on hiatal area. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

The aim of the present systematic review and meta-analysis was to compare native tissue repair (NTR) against transvaginal mesh augmentation for the repair of anterior vaginal prolapse. A total of 2289 articles were found but only 27 (24.8 %) were included in the review. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were followed to guide the process of the systematic review and meta-analysis. The quality of the observational studies was evaluated according to the Scottish Intercollegiate Guidelines Network, whereas the quality of randomized control trials (RCT) was assessed by the Cochrane risk-of-bias scale. The mesh repair intervention was associated with a higher anatomical cure rate in comparison with NTR repair when the follow-up was ≤24 months [pooled risk difference (95 % CI): -0.18 % (-0.22 %; 0.13 %); p-value: <0.0001; I2: 36.0 %]. Studies reporting anatomical failure had similar findings [pooled risk difference (95 % CI): 0.17 % (0.01 %; 0.33 %); p-value: 0.03; I2: 88.6 %]. No differences in the risk of re-operation were observed between NTR repair and mesh augmentation. Pooled risk differences in the incidence of post-surgical and late complications were higher for the mesh repair intervention [-0.05 % (95 % CI: -0.10 %; 0.00 %) p-value: 0.05; I2: 68.3 %] [-0.05 % (95 % CI: -0.14 %; 0.03 %) p-value: 0.25; I2: 82.0 %]. Women who underwent mesh repair reported greater satisfaction than women who underwent NTR [pooled risk difference (95 % CI): -0.07 % (-0.16 %; 0.02 %); p-value: 0.15; I2: 65.3 %]. In conclusion, mesh repair surgery had higher anatomical cure and satisfaction rates, with no differences in re-operation rate, but had higher post-surgical and late complications in comparison with NTR. [ABSTRACT FROM AUTHOR]

Introduction. Transvaginal mesh-reconstruction of urogenital prolapse remains a controversial trend in modern urogynecology. We have seen growth in transvaginal mesh surgery since 2004, followed by a sharp decline after 2011 due to FDA restrictions related to imperfections in previously available prostheses and implantation techniques. Improving the efficacy and minimizing complications of transvaginal mesh-surgery is at the forefront of research in the field of modern urogynecology.Purpose of the study. To optimize the indications for transvaginal mesh-reconstruction of anterior apical prolapse.Materials and methods. The study enrolled 375 patients with anterior apical prolapse. The grade of prolapse was assessed using POP-Q. In patients with endopelvic pelvic fascia insufficiency, severe cystocele (Aa ≥ +1) and hysteroptosis grade II – IV, the correction was carried out using the six-arm OPUR® («ABISS», Saint-Étienne, France). lightweight polypropylene monofilament implant (n = 290). When the cystocele was not prominent (Aa ≤ -1) and grade III – IV hysteroptosis, posterior sacrospinal hysteropexy was preferred with the CYRENE® («ABISS», Saint-Étienne, France) tape (n = 85). In 35 patients, the operation was combined with anterior colporrhaphy. In 5 patients, a simultaneous conization/amputation of the cervix was performed. The examination was performed 1 month after surgery and then annually. Prolapse ≥ grade II was as recurrent. The follow-up period of 67 patients was more than 4 years.Results. After OPUR® prosthesis implantation, recurrent hysteroptosis was detected in 6 women with cervical hypertrophy / elongation within a period of 1 mo to 3.5 yr and cystocele in 4 patients. The efficacy was 96%. In 9 patients, an postoperative ischuria was found associated with extensive dissection and hypotension of the bladder wall due to chronic urinary retention in severe cystocele. Urination improved in 88% of cases. In the remaining cases, long-term mediator and hormone replacement therapy were continued., One recurrent hysteroptosis was observed during the implantation of the CYRENE® prosthesis. No damage to the bladder was observed. Acute urinary retention was detected in 1 case, which resolved after intermittent catheterization. Conclusion. The availability of 2 types of transvaginal prostheses for various degrees and configurations of urogenital prolapses allows a differentiated approach to their choice. Both prostheses suggest reliable «reconstruction-imitation» of the sacroiliac ligament by sacrospinal hysteropexy. If necessary, the operation can be supplemented with anterior colporrhaphy. The prevalence of anterior prolapse with endopelvic fascia insufficiency requires more extensive reconstruction, which can be performed relatively safely and effectively by implantation of a 6-arm OPUR® prosthesis.

Pessaries are an effective treatment for pelvic organ prolapse, yet currently available pessaries can cause discomfort during removal and insertion. An early feasibility trial of an investigational, collapsible pessary previously demonstrated mechanical feasibility during a brief 15-minute office trial. Longer-term, patient-centered safety and efficacy data are needed. This study aimed to assess the effectiveness and safety of the investigational vaginal pessary for pelvic organ prolapse at 3 months. This was a prospective, 7-center, open-label equivalence study with participants serving as their own controls. Subjects were current users of a Gellhorn or ring pessary with ≥stage 2 prolapse. Subjective and objective data were collected at baseline for 1 month while subjects used their current pessary. Data were then collected throughout a 3-month treatment phase with the study pessary. The primary outcome was change in Pelvic Floor Distress Inventory-20 score. Secondary outcome measures included objective assessment of prolapse support, changes in the Pelvic Floor Impact Questionnaire-7, and pain with insertion and removal, measured using a visual analog scale. Data from subjects fitted with the study pessary were analyzed using an intention-to-treat approach, and those who dropped out were assigned scores at the upper limit of the predefined equivalence limits. Secondary per protocol analyses included subjects who completed treatment. The study was powered to 80% with a minimal important change equivalence limit of 18.3 points on the Pelvic Floor Distress Inventory-20 scale. Square root transformations were used for nonparametric data, and P values were adjusted for multiple comparisons. A total of 78 subjects were enrolled, however, 16 withdrew before study pessary placement. The study pessary was fitted in 62 subjects (50 ring and 12 Gellhorn pessary users), and 48 (62%) completed the 3-month intervention. The change in Pelvic Floor Distress Inventory-20 scores at 3 months demonstrated equivalence when compared with the subjects' baseline scores (mean difference, −3.96 [improvement]; 90% confidence interval, −11.99 to 4.08; P =.002). Among those completing study, the Pelvic Floor Distress Inventory-20 scores, equivalence was not demonstrated and scores favored the study pessary (mean difference, −10.45; 90% confidence interval, −20.35 to 0.54; P =.095). Secondary outcomes included objective measures of support, which were similar (mean difference: Ba, 0.54 cm; Bp, 0.04 cm, favoring study pessary; improvement in mean Pelvic Floor Impact Questionnaire-7 scores for those who completed the trial: before, 32.23; after, 16.86; P =.019), and pain with insertion and removal, which was lower with the study pessary than with the subject's own pessary (mean difference visual analog scale score insertion, 9.91 mm; P =.019; removal, 11.23 mm; P =.019). No serious adverse events related to the pessary were reported. Equivalence was demonstrated in the primary outcome of the study pessary when compared with current, noncollapsible pessaries in terms of change in severity and bother of pelvic floor symptoms. Among participants who completed the trial, the Pelvic Floor Impact Questionnaire-7 improved with study pessary use and change in Pelvic Floor Distress Inventory-20 scores were nonequivalent, favoring the study pessary. Subjects reported significantly lower pain scores with both pessary insertion and removal with the novel collapsible pessary when compared with their standard pessary. [Display omitted] [ABSTRACT FROM AUTHOR]

(1) Background: Treating female pelvic organ prolapse (POP) is challenging. Surgical meshes have been used in transvaginal surgeries since the 1990s, but complications such as mesh exposure and infection have been reported. Polyvinylidene fluoride (PVDF) mesh, known for its stability and non-reactive properties, has shown promise in urogynecological surgeries. (2) Methods: A retrospective analysis was conducted on 27 patients who underwent a modified PVDF vaginal mesh repair procedure using DynaMesh®-PR4 and combined trans-obturator and sacrospinous fixation techniques. Additional surgeries were performed as needed. (3) Results: The mean operation time was 56.7 min, and the mean blood loss was 66.7 mL. The average hospitalization period was 4.2 days with Foley catheter removal after 2 days. Patients experienced lower pain scores from the day of the operation to the following day. Postoperative follow-up revealed that 85.2% of patients achieved anatomic success, with 14.8% experiencing recurrent stage II cystocele. No recurrence of apical prolapse was observed. Complications were rare, with one case (3.7%) of asymptomatic mesh protrusion. (4) Conclusions: The modified vaginal mesh procedure using DynaMesh®-PR4 showed favorable outcomes with a short operation time, low recurrence rate, rare complications, and improved functional outcomes. This surgical option could be considered for anterior and apical pelvic organ prolapse in women.

Objectives: Knowledge on the severity of cystocele and incidence of postoperative stress urinary incontinence (SUI) after prolapse repair is lacking. This study investigated the incidence and risk factors of postoperative SUI following laparoscopic sacrocolpopexy (LSC). Materials and Methods: We retrospectively reviewed the charts of 83 women without occult SUI who underwent LSC for pelvic organ prolapse and developed SUI over 3 months postoperatively. We used Fisher's exact test, the Mann–Whitney U-test, and logistic regression for statistical data analyses. Results: After 3 months, the incidences of postoperative SUI were 50% and 24% in those who did and did not report preoperative SUI, respectively. Eventually, postoperative SUI was reported by 39% and 9% of the women with and without preoperative SUI, respectively. Increased Ba (point of maximal anterior vaginal wall prolapse) measurement (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.0–2.06; P = 0.04) and preoperative SUI (OR, 3.95; 95% CI, 1.14–13.7; P = 0.03) were the risk factors for postoperative SUI. Conclusion: Our findings suggest that counseling regarding the risk of postoperative SUI should be conducted for women with preoperative advanced cystocele or bothersome SUI.

Introduction: Sexual dissatisfaction is a common problem in women with pelvic organ prolapse which affects the quality of life. This study was performed with aim to evaluate the effect of cosmetic reconstructive surgery (colporrhaphy) on improving sexual satisfaction in married women.Methods: This randomized controlled clinical trial study was carried out on 30 women before and after undergoing cosmetic reconstructive surgery in terms of sexual satisfaction between 2015 and 2016 in Sarakhs. The Larson Sexual Satisfaction Questionnaire was used to collect data related to the patients' sexual satisfaction after surgery. Data were analyzed by SPSS statistical software (version 16) and independent t-tests. P

This review is addressed to the specialists who treat and correct pathologies of the perianal area and pelvic floor. The pelvic floor area is a space in which the organs of different systems have a common origin and a common framework, therefore they are located in close contact with each other. In view of these features, all specialists working with pelvic floor dysfunction should be aware of the possible combination with disorders from neighboring organs and systems. The article discusses the most urgent and common proctological and urological problems of pregnant women and maternity women, including perineal damage during vaginal childbirth with the development of anal incontinence and urinary incontinence, rectocele, prolapse and prolapse of pelvic organs. The paper presents a detailed description of all anatomical structures involved in the pathological process, as well as their gradual embryonic development. The article presented in details the disorders, which are lying in the base of pelvic organ dysfunctions, from the point of view of modern anatomical data, and discussed different diagnostic protocols and tactical approaches to the choice of treatment. Special attention is paid to the points of interaction of related specialists (urologists and proctologists) and the need for their joint participation in the medical and diagnostic process. Colorectal surgeons should be aware of the frequently associated gynecological pathologies described in this article. The cooperation of related specialists in the field of working with pelvic floor pathology is necessary to exchange experience and improve the quality of care for this category of patients. The article is illustrated with original drawings and clinical examples before and after.

Background and aimsThe present study aimed to analyze the effects of factors on cystocele and the Green classification.Materials and methodsWe conducted a cross-sectional study on 357 primiparous women examined at our hospital from January 2019 to May 2021. The following data were recorded: maternal characteristics, neonatal characteristics, and factors of childbirth. It was added to the multivariate logistic regression model to determine the independent predictors of the cystocele and the Green classification.ResultsA total of 242 women had cystocele, including 71 women with Green type I cystocele, 134 women with Green type II cystocele, and 37 women with Green type III cystocele. In multivariate logistic regression analysis, body mass index (BMI) at delivery was associated with cystocele, while BMI at delivery and the second stage of labor (SSL) > 1 h were independently with the distance from the symphysis pubis to the bladder neck (SPBN) abnormal (P < 0.05). BMI at examination was associated with the large retrovesical angle (RVA) (P < 0.05). BMI at delivery and the fetal right occiput anterior position (ROA) were independently associated with the distance from the symphysis pubis to the posterior wall of the bladder (SPBP) abnormal (P < 0.05), while epidural anesthesia (EDA) was the protective factor (P < 0.05).ConclusionPrimipara women should strive to avoid exposure to modifiable risk factors such as controlling weight during pregnancy, reducing weight after delivery, and shortening SSL to reduce the occurrence of cystocele.

Stress urinary incontinence and pelvic organ prolapse are common conditions affecting women with many different conservative and surgical treatment options available for women. Our primary aim was to determine patient views and preferences surrounding theoretical potential future treatment options for pelvic floor dysfunction (PFD): pelvic organ prolapse/SUI and determine what level of success patients would find acceptable and see if their choice was dependent on severity of their symptoms. All patients had either just completed or were about to start a course of 3 months physiotherapy. All patients with overactive bladder symptoms were excluded. We conducted an service evaluation study of 100 consecutive women attending our urogynaecology clinic. Patients attending clinic completed a questionnaire. They were asked to choose a preferred treatment between "Option A": A surgical procedure which had an 80% success rate in curing symptoms but would require 1–2 day hospital stay and carry a small risk of complications. Or "Option B": A hypothetical course of outpatient, non-surgical treatments which would have a variable chance of improving (but not curing) symptoms (ranging from 70%, 50% or 25% chance of improvement) but would require no "down-time" and have no long term safety issues. Our results showed 100% of women with severe PFD would chose a surgical procedure. However those with mild/moderate symptoms would prefer a non-surgical treatment (if one were available) which may only improve their symptoms but had no long-term complications. There was a moderate correlation (r = 0.46) between severity of symptoms and chance of success. This study is important as it highlights a change in patient demand from one of highest efficacy to possibly one with the greatest safety profile and quickest recovery time. Newer treatment technologies such as energy-based devices (radiofrequency, laser and magnetic therapy) have shown to have lower success rates but may be favourable for some women. This supports the need for further research in these areas. [ABSTRACT FROM AUTHOR]

Aim: In this study, we retrospectively analyzed the medium‐term efficacy and safety of surgery with transobturator two‐arm transvaginal mesh for cystocele and to verify whether the anterior arms are necessary for Japanese‐style transvaginal mesh surgery. Methods: The study included 203 patients with cystocele who underwent transobturator two‐arm transvaginal mesh at our hospital between August 2015 and June 2017 and received appropriate follow‐up care for at least 48 months after surgery. Results: The Pelvic Organ Prolapse Quantification stage was III in all the patients. Intraoperative complications included two cases of bladder injury and one case of more than 200 mL of blood loss. The mean observation period was 51.9 months, and prolapse recurred in the operated compartment in nine patients (4.4%). No cases of mesh exposure were observed. In comparing the preoperative characteristics of the 9 patients with prolapse recurrence at the surgical site with those of the other 194 patients, we found that the recurrence rate was significantly higher among patients in whom point Ba being 3.5 cm or more and among patients younger than 66 years. Conclusions: Transobturator two‐arm transvaginal mesh for cystocele was as good and safe as the procedure previously reported with four‐arm mesh; thus, it was possible to omit the anterior mesh arms in Japanese‐style transvaginal mesh surgery. Patients should be informed preoperatively that prolapse recurs at a significantly higher rate among younger patients and in those whose point Ba being 3.5 cm or more. [ABSTRACT FROM AUTHOR]

POP affected 40% of participants in the WHI trial. Risk factors include parity, vaginal delivery, large babies, advancing age, obesity, hysterectomy and lifting. Data suggest African-American women have a lower prevalence of symptomatic POP than other racial groups. Literature review did not show a study of risk factors and symptoms in a black population. Cross-sectional study of women with POP attending urogynaecology clinic at the UHWI from May to October 2013, using an interviewer administered questionnaire was performed and analysed using SPSS version 19 program (SPSS Inc., Chicago, IL). One hundred and eight participants were included: 94.7% postmenopausal (mean 65.08 years) and 94.5% parous (mean 4). Risk factors included obesity (mean BMI 28.82 kg/m2), hysterectomy (28.7%), heavy lifting (51.9%) and chronic cough (13.9%). Symptoms included stress incontinence (40.7%), stranguria (16.7%), faecal incontinence (13.9%), constipation (31.5%), coital urinary and faecal incontinence (6.3%, 12.6%). We concluded risk factors for POP in this population correlates with other studies. Stress urinary incontinence and constipation most frequently reported symptoms in this population.Impact StatementWhat is already known on this subject? Pelvic organ prolapse (POP) is a common condition with multifactorial aetiology. As seen in systematic reviews (Vergeldt TFM, Weemhoff M, IntHout J, Kluivers KB. 2015. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. International Urogynecology Journal 26(11):1559-1573). Study shows white women appeared to have more overall symptoms both from prolapse, as well as urinary symptoms, as compared with black women (Ford AT, Eto CU, Smith M, Northington GM. 2019. Racial differences in pelvic organ prolapse symptoms among women undergoing pelvic reconstructive surgery for prolapse. Female Pelvic Medicine & Reconstructive Surgery 25:130-133).What do the resultsof this study add? The result highlights the fact that Black women are exposed to similar risk factors and have similar symptoms to other racial groups for POP.What are the implications of these findings for clinical practice and/or further research? These findings can be used to educate women with risk factors about the possibility of developing symptomatic POP. Further research is needed to ascertain the prevalence of POP and to assess knowledge and attitude in this population as we hypothesise that there is generalised assumption in that being black is protective from POP. [ABSTRACT FROM AUTHOR]