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We conducted this study to estimate the rate of, and identify risk factors for, recurrent pelvic organ prolapse (POP) following primary surgical repair. The study consisted of a retrospective cohort study of 142 women who underwent primary surgical management of POP in 1993 and were followed up to 10 years. Prolapse severity was graded using an established classification system of clinical descriptors. Hazard ratios (HR) for recurrent POP were determined using Cox regression. 36 recurrent cases were identified (recurrence rate: 3.7 per 100 woman-years). A cystocele was the most frequent element of primary (87%) and recurrent (72%) prolapse. No predictors of the likelihood of recurrence were identified, though recurrence was somewhat more common among women with a history of two or fewer vaginal deliveries vs three or more (HR = 1.6; 95% confidence interval = 0.81-3.3). Recurrent POP following surgical management is common. Our ability to predict recurrence is limited.

Objective: To determine the prevalence of pelvic organ prolapse (POP) and its impact on the lives of women in Sekyidumasi, a rural Ghanaian community., Methods: A cross-sectional study of 200 women was performed using a questionnaire and pelvic examination to detect symptoms and signs of prolapse. Main outcome measures were the presence of POP and its impact on quality of life., Results: Out of 174 women included in the study, 21 women (12.07%) had POP. Seventeen of these women (81%) were symptomatic, of which only 6 women (35.3%) had sought treatment because of financial constraints. The odds of prolapse increased with increasing parity (P=0.02) and age (P<0.01). The main impacts of prolapse were on emotional well-being (52.4%), the women's relationship with their partner (46.2%), and sex life (25%)., Conclusion: Only about one-third of women with symptomatic prolapse sought treatment because the cost of medical care outweighed the impact of the condition on their lives.

Objective: To investigate whether the nature of the anatomic defects in pelvic organ prolapse (POP) correlates with the character of the symptoms., Methods: This study was a cross-sectional investigation within a population-based sample. Two hundred eighty women who had completed a symptom questionnaire were examined according to POP quantification by two gynecologists blinded to symptom reports., Results: An age- and parity-adjusted logistic regression model, controlling for POP in other compartments, revealed that the feeling of vaginal bulge was specific to prolapse but not to any particular compartment, although the association was strongest with anterior-wall prolapse (odds ratio [OR] for the symptom among women with stage II-IV relative to stage 0 was 5.8, 95% confidence interval [CI] 2.5-13.3). Urge urinary incontinence tended to be linked to POP in either the anterior or posterior wall, but the association was stronger with anterior-wall prolapse. Stress urinary incontinence was strongly linked to posterior-wall prolapse (stage II-IV OR 5.4, 95% CI 1.9-15.2). Self-reports of hard/lumpy stool and difficult or painful defecation tended to be associated with anterior-wall prolapse but without consistent relationships with stage. Painful defecation was the only bowel symptom significantly linked to posterior-wall prolapse (P=.05)., Conclusion: Pelvic floor-related symptoms do not predict the anatomic location of the prolapse in women with mild to moderate prolapse.

The aim of this study is to validate the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) in Portuguese. Two hundred four women (108 symptomatic, 94 asymptomatic, and two with no data) with mean age of 55.4 years received a Portuguese version of the ICIQ-VS. Clinical data and pelvic organ prolapse quantification index (POP-Q) were obtained. Retest was performed 3 weeks later. Responsiveness was assessed after 20 weeks of postsurgical follow-up. Overall, most patients presented POP-Q > 2. ICIQ-VS demonstrated good psychometric properties (validity, reliability and responsiveness). The test-retest reliability was moderate to excellent for all questions. The construct validation distinguished differences in ICIQ-VS scores between symptomatic (ICIQ-VS5a > 0) and asymptomatic (ICIQ-VS5a = 0) women. ICIQ-VS was highly responsive to surgical treatment and discriminated between levels of change in the vaginal symptoms score, sexual matters score, quality-of-life score, and POP-Q. The Portuguese version of ICIQ-VS was successfully validated.

Context: Pelvic floor disorders (urinary incontinence, fecal incontinence, and pelvic organ prolapse) affect many women. No national prevalence estimates derived from the same population-based sample exists for multiple pelvic floor disorders in women in the United States., Objective: To provide national prevalence estimates of symptomatic pelvic floor disorders in US women., Design, Setting, and Participants: A cross-sectional analysis of 1961 nonpregnant women (>or=20 years) who participated in the 2005-2006 National Health and Nutrition Examination Survey, a nationally representative survey of the US noninstitutionalized population. Women were interviewed in their homes and then underwent standardized physical examinations in a mobile examination center. Urinary incontinence (score of >or=3 on a validated incontinence severity index, constituting moderate to severe leakage), fecal incontinence (at least monthly leakage of solid, liquid, or mucous stool), and pelvic organ prolapse (seeing/feeling a bulge in or outside the vagina) symptoms were assessed., Main Outcome Measures: Weighted prevalence estimates of urinary incontinence, fecal incontinence, and pelvic organ prolapse symptoms., Results: The weighted prevalence of at least 1 pelvic floor disorder was 23.7% (95% confidence interval [CI], 21.2%-26.2%), with 15.7% of women (95% CI, 13.2%-18.2%) experiencing urinary incontinence, 9.0% of women (95% CI, 7.3%-10.7%) experiencing fecal incontinence, and 2.9% of women (95% CI, 2.1%-3.7%) experiencing pelvic organ prolapse. The proportion of women reporting at least 1 disorder increased incrementally with age, ranging from 9.7% (95% CI, 7.8%-11.7%) in women between ages 20 and 39 years to 49.7% (95% CI, 40.3%-59.1%) in those aged 80 years or older (P < .001), and parity (12.8% [95% CI, 9.0%-16.6%], 18.4% [95% CI, 12.9%-23.9%], 24.6% [95% CI, 19.5%-29.8%], and 32.4% [95% CI, 27.8%-37.1%] for 0, 1, 2, and 3 or more deliveries, respectively; P < .001). Overweight and obese women were more likely to report at least 1 pelvic floor disorder than normal weight women (26.3% [95% CI, 21.7%-30.9%], 30.4% [95% CI, 25.8%-35.0%], and 15.1% [95% CI, 11.6%-18.7%], respectively; P < .001). We detected no differences in prevalence by racial/ethnic group., Conclusion: Pelvic floor disorders affect a substantial proportion of women and increase with age.

To describe trends in the utilization of surgical procedures for pelvic organ prolapse among women in Olmsted County, MN, we retrospectively identified all county residents undergoing pelvic organ prolapse repair from January 1, 1965 through December 31, 2002. From 1965 to 2002, 3,813 women had pelvic organ prolapse surgeries: 3,126 had hysterectomy combined with pelvic floor repair (PFR) procedures and 687 had PFR alone. The age-adjusted utilization of hysterectomy plus PFR and of PFR alone decreased by 62% (P < 0.001) and 32% (P = 0.02), respectively. In both groups, utilization decreased in all age groups over time except in women aged 80 years and older undergoing hysterectomy plus PFR and women aged 70 years and older undergoing PFR only. The most common indication for PFR was uterovaginal prolapse. Among women in the community, the rate of utilization and age distribution of pelvic organ prolapse surgery changed substantially between 1965 and 2002.

The aim of this study was to evaluate clinical and urodynamic observations on women with fibromyalgia (FM) and lower urinary tract symptoms (LUTS). Fifty-one patients with FM and LUTS and 50 patients with LUTS without FM answered questions about urinary symptoms and also two questionnaires about quality of life measures: "Medical Outcomes Study 36-Item Short-Form Health Survey" and "King's Health Questionnaire". The urodynamic parameters evaluated were the following: maximum cystometric capacity, urine loss due to cough, Valsalva leak point pressure, and detrusor overactivity (DO). The groups were homogeneous concerning age, parity, body mass index, and genital prolapse. Symptoms such as increase of urinary frequency (p=0.007) and urge urinary incontinence (p=0.004) were statistically more common in the FM group. DO was the statistically most common urodynamic observation in patients with FM (p=0.02). Regarding the questionnaires about quality of life, the patients with fibromyalgia and LUTS had the worst results in all fields. In conclusion, patients with FM and LUTS have detrusor overactivity more often as well as an increase of urinary frequency, contributing to the quality of life worsening.

Objective: The purpose of this study was to determine if there is any difference between AM and PM POPQ exam results., Study Design: Prospective, IRB approved study of women presenting with pelvic organ prolapse symptoms. Initial POPQ exams were performed in the morning or afternoon; a second exam was performed within 4 weeks at the opposite time of day. Statistical analysis included Wilcoxon signed rank test, paired t test, Spearman correlation, and Stuart-Maxwell test., Results: The study consisted of 32 subjects. Mean age was 58.8 years, mean BMI 28.6, median parity 2.0, 75% white, 22% black, and 3% Hispanic. The POPQ exam stages were 47% stage II, 50% stage III, and 3.0% stage IV. There was no significant difference for the 9 POPQ exam measures between morning and afternoon exams. There was good agreement between AM and PM POPQ ordinal stages (Stewart Maxwell P = 1.0, kappa 0.76)., Conclusion: There is no difference between AM and PM POPQ exam results.

Objective: To review the current literature and summarize the effect of obesity on outcomes of surgical treatment of pelvic floor disorders as well as the effect of weight loss on pelvic floor disorder symptoms., Data Sources: Relevant sources were identified by a MEDLINE search from 1966 to 2007 using the key words obesity, pelvic floor disorders, urinary incontinence (UI), fecal incontinence, and pelvic organ prolapse (POP). References of relevant studies were hand searched., Methods of Study Selection: Relevant human observational studies, randomized trials, and review articles were included. A total of 246 articles were identified; 20 were used in reporting and analyzing the data. Meta-analyses were performed for topics meeting the appropriate criteria., Tabulation, Integration, and Results: There is good evidence that surgery for stress UI in obese women is as safe as in their nonobese counterparts, but cure rates may be lower in the obese patient. Meta-analysis revealed cure rates of 81% and 85% for the obese and nonobese groups, respectively (P<.001; odds ratio [OR] 0.576, 95% confidence interval [CI] 0.426-0.779). Combined bladder perforation rates were 1.2% in the obese and 6.6% in the nonobese (P=.015; OR 0.277, 95% CI 0.098-0.782). There is little evidence on which to base clinical decisions regarding the treatment of fecal incontinence and POP in obese women, because few comparative studies were identified addressing the outcomes of prolapse surgery in obese patients compared with healthy-weight patients. Weight loss studies indicate that both bariatric and nonsurgical weight loss lead to significant improvements in pelvic floor disorder symptoms., Conclusion: Surgery for UI in obese women is safe, but more trials are needed to evaluate its long-term effectiveness as well as treatments for both fecal incontinence and POP. Weight loss, both surgical and nonsurgical, should be considered in the treatment of pelvic floor disorders in the obese woman.

The aim of this study was to determine whether a family history of prolapse and/or hernia is a risk factor for prolapse. A cohort of 458 women seeking gynecological care was classified as exposed (family history) or unexposed (without family history). We used chi2 to assess confounding and logistic regression to determine risk. Nearly half (47.3%) of the 458 participants reported a positive family history. Of these, 52.5% had prolapse. This was significantly higher than the 28.9% rate of prolapse in women without a family history (p<0.001). The crude risk ratio for family history of prolapse and/or hernia and prolapse was 1.8 (95% CI 1.4-2.3). After adjusting for vaginal deliveries, incontinence, and hysterectomy, the risk of prolapse was 1.4 (95% CI 1.2-1.8) times higher in women with a family history of prolapse and/or hernia. Heredity is a risk factor for prolapse. History taking should include both male and female family members.

Estrogen and estrogen receptors are known to play important roles in the pathophysiology of pelvic organ prolapse (POP). We investigated whether estrogen receptor alpha (ERalpha) gene polymorphisms were associated with POP risk by conducting a case-control association study in 88 women with POP and 153 women without POP. Genotypes of the ERalpha (ESR1) gene polymorphisms (rs17847075, rs2207647, rs2234693, rs3798577, and rs2228480) were determined by polymerase chain reaction, followed by restriction fragment length polymorphism analysis. There was significant difference between women with and those without POP in the distribution of the ESR1 rs2228480 genotypes evaluated. By using multivariable logistic regression, age and ESR1 rs2228480 genotype GA were significantly associated with POP risk. Although the sample size of women with POP studied is small, the present study shows that ERalpha genotype may be associated with POP risk.

Urinary incontinence (UI) is defined as uncontrolled urine leakage through an urethra. At present, the following types of UI can be specified: stress incontinence (SI), urge incontinence (UI), mixed incontinence (MI), overflow incontinence (OI) in which the bladder becomes too full because it cannot be fully emptied, and functional incontinence (FI). Incontinence is one of the most common chronic diseases in women and is found in 17-60% of the whole population. In most patients, SI is combined with pelvic organ prolapse. The basic risk factors mentioned as contributing to these two conditions are obstetrical past and gynaecological history and atrophic changes in the urogenital area. There are also a number of diseases related to the increase in intra-abdominal pressure, such as obesity chronic constipation and diseases associated with persistent cough. Other factors leading to pelvic organ prolapse include hard physical work, some professional sports, connective tissue disorders, neuropathy and disturbed innervation of the pelvic floor. To deal with stress incontinence (SI), conservative and surgical treatment is employed. In the first degree intensity, it is mainly physiotherapy, electrical stimulation of the pelvic floor muscles, lifestyle modification and reduction of body mass. When the SI symptoms are more severe, surgical treatment is usually preferred. From among many methods, these presently used are Burch and sling operations. On the other hand, surgical treatment for pelvic organ prolapse involves colpoperineoplasty with the use of polypropylene mesh (Prolift), colporrhaphy by double TOT approach method, median colporrhaphy, Cooper's ligament or sacrospinous ligament colpopexy, and attachment of the uterus to the sacrum. The results of surgical treatment depend on co-occurrence of risk factors, the surgical method chosen, the lapse of time from the surgery and the type of the applied biomedical material.

Objective: To investigate the hypothesis that pelvic floor disorders are associated with female sexual problems, independently of other related factors., Methods: The study population included 301 adult women seeking outpatient gynecologic and urogynecologic care. Pelvic floor disorders were assessed with the Pelvic Floor Disorders Inventory-20 (PFDI-20) and the pelvic organ prolapse quantification examination. Sexual function was assessed with the Personal Experiences Questionnaire. Using ordinal regression analysis, we identified characteristics and conditions associated with decreased libido, infrequent orgasm, decreased arousal, and dyspareunia., Results: Sexual function was poorer among 78 women (26%) without a current sexual partner than among 223 with a partner (P<.01). Among the 223 with a current partner, women with a high Pelvic Floor Disorders Inventory score were significantly more likely to report decreased arousal (P<.01), infrequent orgasm (P<.01), and increased dyspareunia (P<.01). A similar pattern was observed for the urinary, colorectal-anal, and prolapse scales of the Pelvic Floor Disorders Inventory, although some associations were marginally significant. Stage III-IV prolapse was significantly associated with infrequent orgasm (P=.02), but other sexual complaints were not more common with increasing prolapse stage., Conclusion: Pelvic floor symptoms are significantly associated with reduced sexual arousal, infrequent orgasm, and dyspareunia. We conclude that sexual function is worse in women with symptomatic prolapse but not in women with asymptomatic prolapse., Level of Evidence: II.

Objective: This study measured the 10-year risk of reoperation for surgically treated pelvic organ prolapse and urinary incontinence (POPUI) in a community population., Study Design: We conducted a prospective cohort analysis of 374 women who were > 20 years old and who underwent surgery for POPUI in 1995., Results: The 10-year reoperation rate was 17% by Kaplan Meier analysis. Previous POPUI surgery at the time of index surgery conferred a hazard ratio of 1.9 (95% CI, 1.1-3.2; P = .018). The abdominal approach was protective against reoperation compared with the vaginal approach (hazard ratio, 0.37; 95% CI, 0.17-0.83; P = .02) With the use of Cox regression, no association was observed for age, vaginal parity, previous hysterectomy, body mass index, prolapse severity, ethnicity, chronic lung disease, smoking, estrogen status, surgical indication, or anatomic compartment., Conclusion: A reoperation rate of 17% is unacceptably high and likely represents an underestimate of the true rate. Most of the factors that influence reoperation have not yet been identified.

Objective: The primary objective was to estimate the effect of body mass index on the risk of anal incontinence and defecatory dysfunction in a tertiary referral urogynecologic population., Study Design: This was a cross-sectional study, including 519 new patients. Exposure was defined as body mass index. The primary outcome was any reported anal incontinence. The secondary outcome was any defecatory dysfunction. We used multiple logistic regression to estimate odds ratios and 95% confidence intervals for the effect of body mass index on anal incontinence and defecatory dysfunction., Results: After adjusting for confounders, every 5 unit increase in body mass index was associated with a significantly increased odds of anal incontinence (odds ratio 1.25; 95% confidence interval, 1.09 to 1.44) and a trend toward an increased odds of defecatory dysfunction (odds ratio 1.13; 95% confidence interval, 0.98 to 1.31), although this was not statistically significant., Conclusion: Increasing body mass index is significantly associated with anal incontinence, but not defecatory dysfunction in women.

Objective: The purpose of this study was to develop a validated self-administered questionnaire to measure fluid intake, output, behavior, and urinary symptoms., Study Design: Factor analysis identified 4 subscales in the new questionnaire. Ninety-two women completed the questionnaire, comprised of a 48-hour voiding diary and the Bristol Female Lower Urinary Tract Symptom-Scored form. The questionnaire was readministered after a 2-week period with no change in treatment and 2-3 months later after treatment of urinary symptoms., Results: Correlation of items of the questionnaire with the 48-hour voiding diary in the 4 subscales was high (r = 0.55, 0.74. 0.68, and 0.47; P < .01). Subscale scores also correlated with the Bristol Lower Urinary Tract Symptom score (r = 0.68 and =0.87; P < .001). Comparisons of scores before and after treatment showed the ability of the questionnaire to respond to change., Conclusion: The new questionnaire is a valid and reliable means to assess fluid intake, output, behavior, and urinary symptoms.

Objective: To determine whether vaginal descent changes are associated with pelvic floor symptoms in postmenopausal women., Methods: This 4-year prospective study included 260 postmenopausal women with an intact uterus enrolled at one Women's Health Initiative (WHI) clinical trial site. All completed at least two annual pelvic organ prolapse quantification (POP-Q) examinations and symptom questionnaires (30 bladder, bowel, and prolapse symptom items, modified from the Pelvic Floor Distress Inventory). Symptoms were grouped, and group scores categorized into two or three evenly distributed levels. Year 4 data collection was incomplete because the overall WHI study halted. Generalized logistic linear models and generalized estimating equation methods were used to measure associations between vaginal descent and a symptom or symptom score, controlling for time, age, and body mass index (BMI)., Results: Mean age was 68+/-5 years, BMI 30+/-6 kg/m(2), and median parity 4. Ninety-five percent of women had POP-Q stages I-II prolapse. Increasing maximal vaginal descent was associated with "see/feel a bulge" and "sensation of protrusion or bulging," and with obstructive bladder, prolapse, and obstructive bowel scores. Increasing apical descent (POP-Q point C) was associated with "see/feel a bulge," increasing anterior descent (POP-Q point Ba) with bladder pain and obstructive bladder scores, and increasing posterior descent (POP-Q point Bp) with the bowel incontinence score., Conclusion: Although previous work showed that most pelvic floor symptoms correlated poorly with levels of early prolapse, longitudinal analysis suggests that vaginal descent progression over time is positively associated with various bladder, bowel, and prolapse symptoms in postmenopausal women with stages I-II prolapse., Level of Evidence: II.

Objective: This study uses the unique properties of twin research design to evaluate whether hysterectomy impacts stress urinary incontinence (SUI)., Study Design: As part of the Evanston Twins Sister Study, we performed bivariate and multivariate analyses on 83 identical twin pairs discordant for hysterectomy., Results: In bivariate analysis, SUI was less common in women who had prior hysterectomy (P =0.028). Multivariate analysis suggested that SUI was significantly less common after hysterectomy (odds ratio [OR], 0.55, confidence interval [CI], 0.30 to 1.00). Exclusion of twin pairs with a history of pelvic floor defect surgery eliminated the statistical relationship between hysterectomy and SUI (OR, 0.79, CI, 0.4 to 1.40)., Conclusion: Hysterectomy, when analyzed with all cases, was associated with reduced SUI. When concurrent pelvic floor defect surgeries were excluded from the analysis, we found no relationship between hysterectomy and the risk of SUI afterward.

Objective: The objective of the study was to determine the risk for pelvic organ prolapse surgery attributed to hysterectomy on benign indications, Study Design: In a nationwide longitudinal study, 162,488 women with hysterectomy from 1973 through 2003 were matched to 470,519 population-based control women. Hazard ratios (HR) with 95% confidence interval (CI) were calculated using Cox regression analyses., Results: In all, 3.2% (n = 5270) of women with hysterectomy had pelvic organ prolapse surgery, compared with 2.0% (n = 9437) in nonhysterectomized controls. Compared with nonhysterectomized controls, the overall HR for prolapse surgery was 1.7 (95% CI, 1.6 to 1.7) with the highest risks observed in women having had a vaginal hysterectomy (HR 3.8; 95% CI, 3.1 to 4.8). Compared with hysterectomized women with no vaginal births, the HR for prolapse surgery was 2.0 (95% CI, 0.9 to 4.1) among women with 1 vaginal childbirth and 11.3 (95 % CI, 6.0. to 21.1) among women with at least 4 vaginal births., Conclusion: Hysterectomy is associated with an increased risk for subsequent pelvic organ prolapse surgery with multiparous women at particular risk.

Objective: To examine the effect of high-fiber diet on constipation in women with pelvic floor disorders., Methods: This was a study of a prospective cohort of 41 consecutive women presenting to a tertiary care facility for pelvic floor disorders with a complaint of constipation from March 2005 to September of 2005. Patient Assessment of Constipation Symptoms and Rome II criteria administered as a questionnaire were obtained through telephone interviews every 14 days and were evaluated at the end of the 42-day study period. Each patient was instructed to supplement her diet with a high-fiber cereal (14 g of fiber per one-half cup). Women gradually increased their cereal intake with a goal of reaching 28 g of fiber daily. Patients with adverse reactions, abdominal bloating or pain, and surgery during the study period were withdrawn., Results: Median age and body mass index were 60 years (range 33-77 years), and 29.9 kg/m(2) (range 21.6-59.8), respectively. Thirty patients (73%) completed the study. Average Rome II scores improved from day 1 to day 42 (P<.05). The total, abdominal, rectal, and stool symptoms of the Patient Assessment of Constipation Symptoms improved significantly during the study period (P<.001). Weekly laxative use and vaginal splinting were decreased from 2.8, 1.5 to 1.4, 0.67 (P<.05), respectively., Conclusion: Increasing fiber intake gradually to the amount recommended by the National Academy of Sciences Institute of Medicine improves constipation and its associated symptoms. Reducing the incidence and severity of straining in constipated women may help a risk factor for the onset, progression, or recurrence of prolapse.

The objective of our study was to estimate the age-specific incidence and lifetime risk of surgically managed pelvic organ prolapse (POP) and urinary incontinence (UI). Women aged 20 and older who underwent primary surgical management of POP or UI in 1993 were identified from the database of a health maintenance organization using ICD-9 codes and confirmed through chart abstraction. From a population of 147,719 women, 135 were identified who underwent prolapse surgery only, 82 incontinence only, and 34 surgery for both conditions. From the age-specific incidence, we estimated the lifetime risk of undergoing an operation by age 80 to be 11.8%. Our findings agree with a previous estimate that approximately 11% of women will undergo surgery for POP or UI by age 80. POP and UI appear to be common problems, undoubtedly affecting an even larger proportion of the women than suggested by this high cumulative incidence of surgery.

Objective: To assess the effect of age on prevalence of pelvic floor disorders and report the co-occurrence of these conditions in community-dwelling women., Methods: Stress urinary incontinence (SUI), overactive bladder (OAB), pelvic organ prolapse (POP), and anal incontinence were assessed using a validated questionnaire among 25- to 84-year-old women. Women screened positive for each disorder based on reported symptoms and their degree of bother. Covariates were assessed through self-report. Prevalence of each disorder was compared across four 15-year age groups using chi(2) tests. Multiple logistic regression was used to adjust for confounders., Results: Among 4,103 women (mean age 56.5+/-15.8 years), the prevalence of SUI was 15%, OAB 13%, POP 6%, anal incontinence 25%, and 37% for any one or more disorder. Although the unadjusted prevalence of SUI, OAB, and anal incontinence increased with increasing age category, age was no longer significantly associated with the prevalence of any condition in most categories after adjustment for confounders, including obesity, birth history, menopause, and hormones. Co-occurrence of the disorders was high; roughly 80% of women with SUI or OAB, 69% with POP, and 48% with anal incontinence reported at least one other disorder., Conclusion: Although the prevalence of pelvic floor disorders in a community-dwelling population is high, age was not a significant contributor after adjustment for confounders. The high co-occurrence of pelvic floor disorders suggests that physicians seeing women seeking care for one condition should inquire about symptoms of other disorders.

The objective of this study was to describe the distribution of pelvic organ prolapse (POP) surgery across age groups in the USA in 2003. Patients were grouped into four age categories: Reproductive age, perimenopausal, postmenopausal, and elderly. Data from the 2003 National Hospital Discharge Survey and National Census were used to estimate surgical rates by age group. In 2003, 199,698 women underwent a total of 311,587 surgical procedures for POP. Prolapse surgical rates (per 10,000 women) were 7, 24, 31, and 17 in reproductive age, perimenopausal, postmenopausal, and elderly age groups, respectively. Surgical complications occurred in 28.8, 19.6, 18.6, and 22.1% of women in these age groups, respectively. Mortality was uncommon. Although often considered a condition of the elderly, this study suggests that pelvic organ prolapse is a condition affecting women across the reproductive life cycle and for which women of all ages seek surgical treatment.

Female sexual dysfunction is a common problem with detrimental effects on woman's quality of life. It also has an economical and societal impact. It is defined as disorders of sexual desire, arousal, orgasm, and sexual pain, which lead to personal distress. The etiology of sexual dysfunction is frequently multifactorial as it relates to general physical and mental well-being, quality of relationship, past sexual functioning, social class, education, employment, life stressors, personality factors, the presence of a sexual partner, and partner's age and health. It is very important to adopt the most efficient approach to gather information, and this may be achieved via standardized questionnaires or open-ended questions. Therapy should be tailored according to the patient's needs and may involve a multidisciplinary team approach including psychosexual counselor/sexologist/therapist and the physician. There is still more work needed to optimize the care of women with this problem. Priority should be given to international standardization and training of health care professionals.

The objective of this study is to evaluate the effect of anatomic urethral length on the relationship between descent at point Aa of the pelvic organ prolapse quantification (POP-Q) system and the Q-tip straining angle. The records of 323 patients who were evaluated for urinary incontinence were reviewed. Prolapse staging was performed using the POP-Q system. Urethrovesical junction hypermobility defined as a maximal straining angle > or =30 degrees was assessed with the Q-tip test. Urethral length was measured with a urethral profilometer. A substantial correlation was found between descent at point Aa and the straining Q-tip angle (r = 0.65, p < 0.0001). There was no correlation between the anatomic urethral length and straining Q-tip angle (r = -0.01, p = 0.8). Urethral length does not affect the straining Q-tip angle. Point Aa is a strong predictor of an abnormal straining Q-tip angle in women with stage I anterior vaginal wall prolapse or greater.

Restoration of apical vaginal support remains a challenging problem for the pelvic reconstructive surgeon. The transvaginal use of the uterosacral-cardinal ligament complex is gaining increasing popularity in the surgical treatment of uterovaginal and posthysterectomy vault prolapse. We describe an extraperitoneal surgical approach using this ligamentous complex to reattach the vaginal apex in women with posthysterectomy vault prolapse and report our surgical experience with this procedure in 123 women over 5 years. The relevant anatomy related to the procedure and risk of ureteric injury with uterosacral suspension is also reviewed. Extraperitoneal vault suspension can be combined with the use of polypropylene mesh if required. The extraperitoneal approach is an alternative procedure in women with vault prolapse with or without concomitant enterocele or where access to the Pouch of Douglas is difficult particularly after previous pelvic surgery. We believe this procedure to have less risk of ureteral injury than the intraperitoneal approach.

Objective: Testing a hypothesis that pelvic organ prolapse (POP) is a focal manifestation of disordered connective tissue, we evaluated whether there is an association between POP and history of fracture., Design: This was a case-control study. Baseline data were from postmenopausal women aged 60 years or older enrolled in the Women's Health Initiative Estrogen Plus Progestin trial. Distinct variants (cystocele, rectocele, and uterovaginal) and severity (mild, moderate, or severe) of POP were recognized. A history of "fracture after age 55" was considered as the event of interest., Results: Moderate to severe POP was identified in 9% of 11,096 participants aged 60 years or older. Women with moderate to severe rectocele were significantly more likely to report fracture (odds ratio: 1.37, 95% CI: 1.06-1.77, P = 0.02) compared with those with absent to mild prolapse. Of the subset of participants who underwent bone mineral density assessment, those with moderate to severe prolapse demonstrated significantly lower whole-body bone mineral density ([beta] = -0.03, SE 0.02); this difference was of borderline significance (P = 0.05) compared with that for participants with absent to mild POP. Multivariate logistic regression analysis confirmed an independent association between moderate to severe rectocele and fracture (odds ratio: 1.45, 95% CI: 1.08-1.95, P = 0.01)., Conclusions: We demonstrate a relationship between moderate to severe POP and low bone mineral density in postmenopausal women enrolled in the Women's Health Initiative Estrogen Plus Progestin trial. Our findings of an association between clinically significant (moderate to severe) POP, specifically rectocele, and a history of fracture suggest that suboptimal collagen status purported to associate with POP may also involve bone collagen and hence translate into skeletal compromise.

Objective: To determine whether the shift in treatment tradition of genital prolapse surgery was followed by a change in the occurrence of subsequent prolapse surgery, and to analyze the complementary and recurrent surgery with respect to the size of the prolapse and the extent of the primary surgery., Methods: A retrospective study of patients consecutively operated with primary prolapse surgery in three Swedish hospitals in two time periods: 261 patients in 1983 (Period I) and 281 patients in 1993 (Period II). Clinical data were obtained from the patient records. A follow-up period of 6 years was used for both periods., Results: Subsequent prolapse surgery was seen significantly more often in Period II than in Period I (7.7 versus 2.7%), and after selective repairs compared with complete repairs (7.7 versus 3.2%). Despite a significant reduction in the use of posterior repair between the time periods, no significant increase was seen in complementary posterior repairs compared with complementary repair in any of the other compartments. Size of the prolapse at the primary surgery or hysterectomy did not seem to influence the occurrence of subsequent prolapse surgery. The postoperative complication rate was significantly higher after complete repairs than after selective repair, and especially when posterior repair was included in the operation., Conclusion: Subsequent prolapse surgery is slightly more common after selective repair than after complete repair. However, selective repairs are encumbered with a lower complication rate. The results of this study appear to be in favor of a restrictive use of 'prophylactic' posterior repair.

Background: Levator trauma is common in parous women. We have recently found a relationship with age at first vaginal delivery in women seen before and after childbirth., Aims: To examine women presenting with symptoms of pelvic floor disorders for such an association., Methods: Eight hundred and one women were prospectively seen for an interview, clinical examination (including for levator integrity and function in 789 cases), multichannel urodynamic testing and pelvic floor ultrasound (including 3D imaging in 350 cases). Findings were tested for association with maternal age at first vaginal delivery, parity and operative vaginal delivery using logistic regression., Results: Mean age was 55.3 years (range 17-90), with 79% complaining of stress urinary incontinence and 28% of symptoms of prolapse. Median vaginal parity was 2 (range 0-12); mean age at first vaginal delivery was 24 (range 14-39). Levator defects were found in 170 women (21.6%), 24% of the vaginally parous. Defects were more common on the right (86%) than left (45%) (P<0.0001). Women with levator trauma had a higher mean age (25.5 (SD 5.2) vs 23.5 (SD 4.5) years, P<0.0001). Regression modelling confirmed findings, demonstrating an increase in the odds of levator trauma of approximately 10% for every year of delay in child-bearing. Vaginal operative delivery was associated with a near-doubling of the odds of trauma., Conclusions: Increased maternal age is a risk factor for intrapartum pelvic floor trauma. The global trend towards delayed child-bearing may result in an increased prevalence of pelvic floor disorders in coming decades.

Objective: The purpose of this study was to quantify the risk for anal incontinence and difficult defecation among women with prolapse by comparing them with women without prolapse of similar age, body mass index, race, and hysterectomy status, and to determine whether there are characteristics or findings in women with prolapse that are associated with greater symptom severity., Study Design: Women with primary pelvic organ prolapse (n = 151) were compared with women without prolapse (n = 135). All subjects underwent pelvic examination and completed symptom questionnaires regarding how frequently anal incontinence and difficult defecation were experienced. Incontinence of flatus was considered to be present if it occurred on "most" or "every" day; difficult defecation was considered to be present if it was experienced with "most" or "every" bowel movement. Symptoms that occurred "on occasion" or "never" were considered to be absent., Results: Incontinence of flatus was reported by 23.1% of cases vs 8.3% of control subjects (P = .006). Incontinence of liquid or solid stool was present in 4.7% and 3.5%, respectively, and was not reported by control subjects (P < .001 and .009, respectively). Difficult defecation, which was characterized by pushing on the vaginal walls to complete defecation, was present in 19.7% vs 4.4% of control subjects (P = .001). Cases that reported symptoms were compared with those that did not report symptoms. Among those reporting difficult defecation, the length of the perineal body length was greater when straining (4.0 vs 3.4 cm; P = .020). Among those reporting incontinence of flatus, mean parity was higher (3.3 vs 2.5; P = .012), and a positive standing cough stress test was more likely (39.3% vs 18.5%; P = .025). Symptoms of anal incontinence and/or difficult defecation were present in 35.3% of subjects (52/147)., Conclusion: Women with prolapse are more likely than control subjects to have symptoms of anal incontinence or difficult defecation; approximately one-third of these women will have symptoms.

Uterine prolapse is a significant public health problem in Nepal. The aim of this study was to determine the prevalence of uterine prolapse and to define possible risk factors for this disease in the Kathmandu Valley of Nepal. This clinical report consists of an analysis of data from Dr. Iwamura Memorial Hospital and Research Center (IMHARC) in Bhaktapur, between July 1 and September 30, 2006. This analysis was restricted to a sample that included all women with complaints of uterine prolapse (second- or third-degree prolapse) diagnosed and treated at the IMHARC. During a 3-month period, 96 women were diagnosed and treated with uterine prolapse. The median age at the time of clinical presentation was 50 years, and the median maternal weight was 45 kg. In average, the women gave birth to four children vaginally. Most of the affected women were smoking, and most of them were postmenopausal. Thirty-five percent of the affected patients had a chronic obstructive pulmonary disease (COPD), 16% suffered from hypertension and 5% had diabetes mellitus. The majority of the women with uterine prolapse were of Newari origin (84%), and nearly all patients reported that they were working heavily during pregnancy as well as in the postpartum period (87%). We found several risk factors for uterine prolapse in Nepal. Especially extensive physical labor during pregnancy and immediately after delivery, low availability of skilled birth attendants, smoking while having COPD and low maternal weight due to lack of nutritious food are mainly responsible for this common disease. In our opinion, extensive information, prevention programs and early management of genital prolapse should be the first steps to reduce this significant social and public health problem in Nepal.

The objective of this study was to determine the factors associated with the anatomic and functional recurrence of prolapse. An examination was performed in 134 of the 228 patients who underwent primary vaginal surgery for prolapse of the pelvic organs (POP) between 2000 and 2001. Anatomical recurrence of the prolapse was established by pelvic examination using the pelvic organ prolapse quantification (POPQ) staging system. Functional results were obtained by interview with the patients. Descriptive statistical analyses and multivariate logistic regression were performed to determine the factors associated with recurrence. Five years after surgery, 42 women (31.3%) presented anatomical recurrence of the prolapse (grade > or = II), and only 10 of the 134 (7.4%) had prolapse-related symptoms. Those with high body weight (>65 kg) and younger women (<60 years) were associated with an increase in the risk for both anatomical and functional recurrence. Advanced preoperative prolapse (grade III-IV) of any compartment was associated with anatomical failure but not with symptomatic recurrence. There was a poor correlation between anatomical and symptomatic recurrence. Younger women and those with a higher body weight are more likely to experience recurrent prolapse after vaginal repair.

Purpose: Numerous studies have documented a relationship between provider specialty and outcomes for surgical procedures. In this study we sought to determine the effect of surgeon specialty on outcomes of sling surgery for women with stress urinary incontinence., Materials and Methods: We analyzed the 1999 to 2001 Medicare claims data from a 5% national random sample of Medicare beneficiaries. Women 65 years or older who underwent a sling procedure between July 1, 1999 and December 31, 2000 were identified on the basis of CPT-4 codes and tracked for 12 months. Key complications were identified using CPT-4 and ICD-9 revision codes for relevant procedures and diagnoses. Outcomes were compared between urologists and gynecologists., Results: A total of 1,356 sling procedures were performed. Of them 1,063 (78.4%) were performed by urologists, while 246 (18.1%) were performed by gynecologists. Urologists performed concomitant prolapse repairs in 29.1% of cases, and gynecologists performed prolapse repairs in 55.7% (p <0.0001). In the 12 months following sling surgery, urologists were more likely than gynecologists to perform a repeat incontinence procedure (9.3% vs 4.9%, p = 0.024) and prolapse repair (26.0% vs 12.2%, p <0.0001). The 2 surgical specialties did not differ in postoperative outlet obstruction, urological complications, or nonurological complications., Conclusions: Early prolapse management by gynecologists corresponded to fewer prolapse repairs in the year following the sling. Our findings suggest that gynecologists are more likely to identify and manage prolapse at the time of the evaluation of urinary incontinence, a strategy that appears to avoid the morbidity and cost of repeat surgery.

Objectives: To evaluate the risk factors for pelvic organ prolapse (POP) and to determine the relationship between these risk factors and stage or other components of POP., Methods: 244 patients with primary POP and 314 women without POP were included. Age, parity, smoking, body mass index (BMI), menopause, and hormone replacement therapy (HRT) were investigated., Result: Independent risk factors for POP included age over 70, parity higher than 3, and menopause. Age, parity, menopause, and HRT were significantly associated with stage of POP. Genital hiatus (GH) and perineal body (PB) showed a significant positive and negative correlation with age and parity, respectively. Menopause and HRT were also associated with them., Conclusion: Age, parity and menopause are possible risk factors of POP and associated with the lengths of GH and PB in POP women. Further, these risk factors and HRT are significantly correlated with the severity of the disease.

Objective: To compare the prevalence of genital prolapse stratified by Asian American, black and white ethnic groups in women presenting for routine gynecologic examinations and to screen them for symptoms of pelvic floor problems., Study Design: This was a descriptive study of women presenting for annual examinations. Demographic information on age, weight, gravidity, parity, weight of largest vaginally delivered infant, gynecologic surgery, medical problems (including hypertension, diabetes, pulmonary disease, smoking) and menopausal status were obtained from the patient and chart. Pelvic organ prolapse was assessed using the quantitative pelvic organ prolapse system. Subjects completed the Pelvic Floor Distress Inventory, which was graded along the 3 scales of Urinary Distress Inventory, Pelvic Organ Prolapse Distress Inventory and Colorectal-Anal Distress Inventory., Results: One hundred sixty-seven women completed the study, including 73 whites, 60 Asian Americans and 34 blacks. The populations differed in that black women had higher body weight and were more likely to smoke, while white patients had lower parity and more use of hormone replacement therapy. Sixty-seven percent of Asian American patients had stage 2 or higher prolapse as compared to 26% of black and 28% of white patients. Multiple logistic regression showed that Asian American ethnicity independently correlated with higher rates of pelvic organ prolapse. There was no difference in survey results by race., Conclusion: There may be significant racial differences in the incidence of pelvic floor prolapse, with higher rates of stage 2 prolapse in asymptomatic Asian American women.

Objective: To estimate the incidence and identify the risk factors for pelvic organ prolapse repair after hysterectomy., Methods: We conducted a case-control study. We identified 6,214 women who underwent hysterectomy in our gynecology department from 1982 to 2002. Cases (n=114) were women who required pelvic organ prolapse surgery after hysterectomy from January 1982 through December 2005. Controls (n=236) were women randomly selected from the same cohort who did not require pelvic organ surgery during the same period. We performed a univariable and a multivariable analysis among 104 cases and 190 controls to identify the variables associated with prolapse repair after hysterectomy., Results: The incidence of pelvic organ prolapse that required surgical correction after hysterectomy was 1.3 per 1,000 women-years. The risk of prolapse repair was 4.7 times higher in women whose initial hysterectomy was indicated by prolapse and 8.0 times higher if preoperative prolapse grade 2 or more was present. Risk factors included preoperative prolapse grade 2 or more (adjusted odds ratio [OR] 12.6, 95% confidence interval [CI] 4.6-34.7), previous pelvic organ prolapse or urinary incontinence surgery (adjusted OR 7.9, 95% CI 1.3-48.2), history of vaginal delivery (adjusted OR 5.0, 95% CI 1.3-19.7), and sexual activity (adjusted OR 6.2, 95% CI 2.7-14.5). Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (adjusted OR 0.7, 95% CI 0.4-1.1)., Conclusion: Preoperative pelvic organ prolapse and other factors related to pelvic floor weakness were significantly associated with subsequent pelvic floor repair after hysterectomy. Vaginal hysterectomy was not a risk factor., Level of Evidence: II.

Uterine torsion and vaginal prolapse are accidents of gestation; this paper first reviews the predisposition, symptoms, diagnosis, and treatment of uterine torsion, and the predisposition, pathogenesis, symptoms, treatment, and prognosis of vaginal prolapse during late gestation in the cow. Other noninfectious complications of gestation are either fetal or placental in origin. Two relatively unusual fetal problems, mummification and maceration, are also discussed, followed by a comparison of two hydropic conditions (hydrallantois and hydramnios). Hydrops allantois, primarily a placental problem, occurs about nine times more frequently than hydrops amnii, which is a result of fetal anomalies. Abnormal offspring syndrome is a more recent phenomenon associated with the transfer of IVF or SCNT embryos. Finally, reference is made to teratology in general and a website of illustrations is cited.

Objective: This study was undertaken to compare the prevalence, demographics, and complications of pelvic organ prolapse surgery across races in the United States., Study Design: Data from the 2003 National Census and the 2003 National Hospital Discharge Survey were used to determine rates of prolapse surgery, demographic characteristics, morbidity, and mortality across races., Results: In 2003, 199,698 women underwent prolapse surgery. Rates of prolapse surgery per 10,000 women were 14.8, 5.6, and 8.7 in women of white, black, and other races. By geographic region, surgical rates per 10,000 white vs black women differed most in the West (16.0 vs 0.8). Of black women, 27% were on public assistance, compared with 5.9% and 9.6% women of white and other races. Complications occurred in 19.4%, 34.1%, and 27.4% of women of white, black, other races. Mortality was uncommon for all races., Conclusion: Racial disparities between white and black women undergoing prolapse surgery appear to exist.

The aim of this study was to investigate the prevalence of pelvic organ prolapse in urban and rural women and to identify possible related factors. They were 1749 participants; one thousand four hundred seventeen (81%) urban women and 332 rural residents (19%). The urban and rural women were congruently regarding to age, parity, using oral contraceptives and postmenopausal status. The urban women were more often obese (p < 0.01), estrogen replacement users (p < 0.001), smokers (p < 0.001), with mild (p < 0.001) and high (p < 0.001) education, and they were often divorced (p < 0.05) than rural women. Rural women were more often alcohol consumers (p < 0.001), with low level of education (p < 0.001) and more often married (p < 0.05) than rural examinees. There were no association between the presence of prolapse and: weight, menopausal status, oral contraceptives and estrogen replacement using, smoking, alcohol consuming and marital status. There were not observed differences in prevalence of prior hysterectomy, urinary incontinence, uroinfectio, sexual and bowel dysfunction between both groups. The prevalence of cystocele, rectocele and uterine prolapse were similar among urban and rural participants. In conclusion, a more complete picture of factors associated with genital prolapse would include in investigation, such as molecular and genetic ones.

Objective: To estimate the prevalence of and identify risk factors associated with symptomatic pelvic organ prolapse and level of distress in racially diverse women aged older than 40 years., Methods: The Reproductive Risks for Incontinence Study at Kaiser is a population-based study of 2,001 randomly selected women. Symptomatic prolapse was determined by self-report of a feeling of bulge, pressure, or protrusion or a visible bulge from the vagina. Risk factors were assessed by self-report, interview, physical examination, and record review. Distress was assessed by self-report. Multivariable logistic regression analysis was used to identify independent risk factors., Results: Symptomatic prolapse was reported by 118 (6%) women. Almost 50% of these women reported moderate or great distress, and 35% reported that the symptoms affected at least one physical, social or sexual activity. In multivariable analysis, the risk of prolapse was significantly increased in women with one (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.1-7.2), two (OR 4.1, 95% CI 1.8-9.5), and three or more (OR 5.3, 95% CI 2.3-12.3) vaginal deliveries compared with nulliparous women. Irritable bowel syndrome, constipation, and self-reported fair or poor health status were strongly associated with prolapse, with ORs of 2.8 (95% CI 1.7-4.6), 2.5 (95% CI 1.7-3.7), and 2.3 (95% CI 1.1-4.9), respectively. African-American women were significantly less likely to report symptomatic prolapse compared with white women (OR 0.4, 95% CI 0.2-0.8)., Conclusion: Symptomatic prolapse is less common among African-American women and more common among women with a prior vaginal delivery, poor health status, constipation, or irritable bowel syndrome. Nearly one half of women with symptomatic prolapse are substantially bothered by their symptoms.

Objective: To investigate the effect of long-term treatment with raloxifene on pelvic organ prolapse and urinary incontinence., Methods: This was a case-control study in patients attending the Centre for Metabolic Bone Disease. Eighty-two women were included. The average age was 69 years (range 60-85 years). Thirty-nine women had taken raloxifene for an average of 55 +/- 25 months and 43 had taken bisphosphonates for an average of 41.96 +/- 15.93 months. The Prolapse Quality of Life (P-QOL), version 4 and Incontinence Impact questionnaire (IIQ-7) and Urogenital Distress Inventory, short form (UDI-6) were used to evaluate presence of pelvic organ prolapse and urinary incontinence. Women symptomatic with prolapse were offered a pelvic examination to define the type and severity of the prolapse. Women giving a history of urinary incontinence were offered urodynamic evaluation to establish the cause of the incontinence. The main outcome measures were prevalence and severity of pelvic organ prolapse and urinary incontinence and its impact on quality of life., Results: Over 50% of the women complained of incontinence in both groups, 51% (22) of women taking raloxifene and 53% (28) of the controls. Prolapse was present in two women in the raloxifene group (5%) and six women (11%) in the control group. Urge incontinence was similar in both prevalence (15 vs. 21 women) and severity between cases and controls. Stress incontinence, on the contrary, had a similar prevalence (20 vs. 19 women) but was more severe in the controls (p = 0.004). There was no difference in mean scores of IIQ-7 and P-QOL for quality of life between cases and controls., Conclusions: Raloxifene taken long-term does not appear to adversely affect urinary incontinence or prolapse.

Genital prolapses usually occurs in the post-menopausal period. Patients under 50 years of age with genital prolapse represent about 25% of candidates for surgical reconstruction in our center. Some of these patients wish to conserve their child-bearing potential and most want to be able to have a normal sex life. Five per cent of these women, all under 35, have isolated hysterocele and a hypertrophic uterine cervix. This article focuses on the etiology, prevention and new surgical treatments of genital prolapse in young women. Etiologies include late age at first pregnancy, chronic lung disease, and perineal damage during delivery. Connective-tissue and collagen disorders predominate before 35 years of age. New surgical procedures include vaginal repair with synthetic mesh. Laparoscopic sacropexy is still the gold standard. Prevention includes non traumatic delivery (Caeseran section), while pelvic floor exercises are mandatory after vaginal delivery.

Objectives: To study the prevalence of occult stress urinary incontinence (SUI) among Indian women with genitourinary prolapse, and determine the risk of developing SUI after vaginal hysterectomy and pelvic floor repair in Indian women with occult SUI., Methods: A prospective cohort study of 78 women with significant genitourinary prolapse without symptoms of SUI was conducted at Christian Medical College, Vellore, India. Before the surgical intervention, the prolapse was repositioned using a pessary and a Pyridium (Parke Davis, Morris Plains, NJ, USA) pad test was performed to detect occult SUI. The primary outcome studied was the risk of developing postoperative urinary incontinence., Results: Preoperatively, 67.9% of women were found to have occult SUI. The prevalence of SUI was 43.6% postoperatively, and 64.2% of the women with a positive result to the preoperative Pyridium pad test after pessary insertion were found to have urinary incontinence postoperatively. Postmenopausal women had twice the risk of developing occult SUI., Conclusion: Preoperative testing is useful to identify women with genitourinary prolapse who have occult SUI. Women with a positive result may need a systematic clinical evaluation and urodynamic studies to characterize the incontinence. They can be then counseled preoperatively regarding concomitant anti-incontinence procedures.

Aim: To evaluate the outcomes of 90 Burch colposuspension procedures with or without concomitant surgery after a 6-year follow-up period., Methods: The study was carried out in the urogynecology department of Ankara Etlik Women's and Maternity Teaching Hospital, Turkey. Ninety women who were diagnosed as having genuine stress urinary incontinence (GSI) were enrolled in this study. The Burch colposuspension procedure was performed for the treatment of genuine stress urinary incontinence with or without a concomitant surgery, Results: After a 6-year follow-up, it has been noted that concomitant surgeries have no effect on the outcome of continence (P>0.05). Pelvic prolapse incidence was 7%. No voiding difficulty was observed., Conclusion: The study shows that concomitant surgeries have no effect on the outcome of continence. However, concomitant surgery can increase operational morbidity. Modified McCall culdoplasty does not seem to be a preventive measure for pelvic organ prolapse.

This study looked at the subjective and objective long-term outcome of abdominal sacrocolpopexy for post-hysterectomy vaginal vault prolapse, with emphasis on recurrent prolapse. It included 42 patients who had abdominal sacrocolpopexy for post-hysterectomy vaginal vault prolapse from 1994 to 2004. Patients were invited for a follow-up visit to assess the objective and subjective outcome. The notes of 35 patients (83.3%) were available and 22 attended for follow-up (52.4%). None of them had a recurrent vault prolapse (0% direct failure rate). However, 20 cases (20%) had a repair operation by the time they were invited for follow-up and 18 of those attending for follow-up had anterior and/or posterior vaginal wall prolapse (81.8% indirect failure rate). Nonetheless, only eight of these (44.4%) were symptomatic, bringing the rate of indirect recurrences requiring management to 50%. Concomitant or prior repair operation was associated with a lower incidence of indirect recurrence. The incidence of urodynamic stress incontinence and detrusor overactivity was 13.6% and bowel emptying dysfunction was 4.5%.

A urogynecologist's examination typically includes assessment of the abdominal musculature, including the determination of whether a diastasis recti abdominis (DRA) is present. The purposes of the current study were to examine the (1) prevalence of DRA in a urogynecological population, (2) differences in select characteristics of patients with and without DRA, and (3) relationship of DRA to support-related pelvic floor dysfunction diagnoses. A retrospective chart review was conducted by an independent examiner. Fifty-two percent of the patients examined presented with DRA. Patients with DRA were older, reported higher gravity and parity, and had weaker pelvic floor muscles than patients without DRA. Sixty-six percent of all the patients with DRA had at least one support-related pelvic floor dysfunction (SPFD) diagnosis. There was a relationship between the presence of DRA and the SPFD diagnoses of stress urinary incontinence, fecal incontinence, and pelvic organ prolapse.