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This article discusses a study on endometrial polyp-like lesions arising from adenomyosis. Adenomyosis is a common gynecologic disease characterized by the presence of endometrial glands and stroma within the myometrium. The study presents 5 cases of this distinctive lesion and expands their pathologic spectrum. The patients ranged in age from 47 to 75 years and their uteri were resected for various indications. The study describes two patterns of endometrial polyp-like lesions and discusses their histological features. The article concludes by stating that these cases further expand the understanding of endometrial polyp-like lesions arising from adenomyosis. [Extracted from the article]

This study aimed to investigate genetic parameters for sow pelvic organ prolapse in purebred and crossbred herds. Pelvic organ prolapse was recorded as normal or prolapsed on the individual sow level across 32 purebred and 8 crossbred farms. In total, 75,162 purebred Landrace sows from a single maternal line were recorded between 2018 and 2023, while 18,988 commercial two-way crossbred (Landrace x Large White) sows were available between 2020 and 2023. There were 5,122,005 animals included in the pedigree. The prolapse in purebreds and crossbreds was considered two different traits in the model. Pedigrees of the crossbred sows were determined based on genotypes through parentage assignment. The average incidence rates were 1.81% and 3.93% for purebreds and crossbreds, respectively. The bivariate model incorporated fixed effects of parity group and region with random effects of contemporary group (farm and mating year and month at the first parity), additive genetic, and residual. Genetic parameter estimates were obtained using BLUPF90+ with the AIREML option. The estimated additive variance was larger in crossbreds than in purebreds. Estimates of heritability in the observed scale were 0.09 (0.006) for purebreds and 0.11 (0.014) for crossbreds, with a genetic correlation of 0.83 using a linear model. Results suggested that including data from crossbreds with higher incidence rate is beneficial and selection to reduce the prolapse incidence in purebred sow herds would also benefit commercial crossbred sow herds. [ABSTRACT FROM AUTHOR]

This study assesses the efficacy of bilateral mesh sacrospinous ligament suspension (MSSLS) compared to laparoscopic sacrocolpopexy (LSC) in patients with uterine prolapse. Ninety-eight patients with uterine prolapse were evaluated at our hospital from January 2021 to January 2023. Patients were equally divided into two groups: the study group (undergoing MSSLS) and the control group (undergoing LSC) using a random number table. Various parameters including operation time, bleeding volume, indwelling catheter time, exhaust time, hospital stay, pelvic organ prolapse stage, postoperative recurrence rate, pain severity, quality of life, pelvic floor function, impact on sexual life, complications, and recurrence rate were recorded. The study group showed significant reductions in operation time, bleeding volume, indwelling catheter time, exhaust time, and hospital stay compared to the control group (P < 0.05). There were no significant differences in Aa, Ba, Ap, Bp, and C between the two groups before surgery (P > 0.05), but six months postoperatively, these indexes were significantly lower in the study group (P < 0.05). Pain severity did not differ significantly between the two groups before surgery (P > 0.05), but was significantly lower in the study group six months postoperatively (P < 0.05). Quality of life, pelvic floor function, and sexual life quality did not significantly differ before surgery, at 6 months, and at 12 months postoperatively (P > 0.05). All patients were followed up for 12–14 months, with an average follow-up time of (13.02 ± 1.36) months. The incidence of complications was significantly lower in the study group (P < 0.05), but there were no recurrences in either group, thus the difference was not statistically significant (P > 0.05). MSSLS emerges as a safe and efficacious treatment for uterine prolapse, notably reducing both complications and recurrence rates, rendering it suitable for broad clinical application. [ABSTRACT FROM AUTHOR]

• The more physiological cervico-vaginal axis and the bilaterality of the anterior sascospinous ligament fixation could render this approach advantageous over the classic Richter's technique. • The use of suture-capturing or anchor-based devices, while optional to access the SSLs through a posterior approach, is obligatory for anterior access. • Limited evidence is available for the more recently introduced, anchor-based device, most of them involving unilateral posterior approach cases. • Our case-control study, involves almost exclusively anterior (paravesical) approach cases, where a device to aid with the fixation is the most indicated. • When comparing perioperative complications and patient reported postoperative pain, the anchor-based device seems to have a comparable safety profile to the traditionally used suture capturing devices. Sacrospinous ligament fixation (SSLF) is a popular surgical technique for treating apical prolapse. The use of suture-capturing devices (SCD), or the more recently introduced anchor-based device (ABD), is useful for a posterior approach but essential for an anterior one. The aim of our study was to assess the safety of the ABD, which was recently introduced to our unit, compared to the traditionally used SCD. This was a pilot case-control study of 40 patients who had a SSLF, 20 of these represented all the patients who had the procedure with the aid of the ABD and 20 patients who had the procedure using the SCD over approximately the same duration. The main safety endpoints of this pilot study were patient reported postoperative pain scores and perioperative complications rate. The population characteristics were similar. The mean postoperative pain scores differed significantly only on postoperative day 1 in favor of the suture capturing device (3.40 [2.60] vs 1.60 [1.64], p = 0.013). The mean highest pain score was similar in both groups. Peri-operative complications rates were low and comparable between both groups. According to POPQ at 6 weeks follow-up the median Ba point was higher in the ABD group and this difference was significant (−3.00 [-3.00; −2.25] vs. −2.00 [-3.00; −1.50]; p = 0.03). The anchor-based device for sacrospinal ligament fixation seems to have comparable safety profile to the traditionally used suture capturing devices. [ABSTRACT FROM AUTHOR]

This paper presents a novel, systematic way to understand the causes of cervical head entrapment in vaginal breech births, and new insights into management. Three different types of cervical head entrapment are described, with detailed illustrations: unpredictable and potentially catastrophic, manageable, and preventable. The first affects preterm and growth-restricted fetuses. The second involves some degree of uterine prolapse. The third may result from prolonged head entrapment at the pelvic inlet, leaving time for cervical contraction or oedematous entrapment. Traditional and innovative strategies to resolve and prevent this complication are described and illustrated, with suggestions for further research. [ABSTRACT FROM AUTHOR]

This case report details the surgical treatment of a rare enlarged cervical leiomyoma with uterine prolapse in a 48-year-old woman. She presented to Konyang University Hospital with a palpable vaginal mass, lower abdominal pain, and urinary incontinence. Despite being nulliparous, she had severe chronic constipation due to schizophrenia medication and lived in a health care facility separated from her family. Pelvic examination revealed stage 3 uterine prolapse with a large necrotic cervical leiomyoma. A robot-assisted vaginal hysterectomy followed by sacrocolpopexy was performed using the Da Vinci Xi Surgical System. Histopathology confirmed cervical leiomyoma with squamous metaplasia. At a three-month follow-up, there were no complications, pelvic anatomy was restored, and urinary incontinence improved. Although the patient had a systemic infection due to the necrotic cervical leiomyoma, raising concerns about the increased risk of infection associated with mesh use, she was high-risk for pelvic organ prolapse (POP) recurrence due to her medical history and living situation. Therefore, she underwent concurrent surgeries with pre- and postoperative antibiotic treatment, and recovered without complications. Given that the risk of developing POP increases after a hysterectomy, in high-risk patients, as demonstrated in this case, the concurrent surgical correction of POP may be an effective strategy. [ABSTRACT FROM AUTHOR]

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

Introduction: The Manchester procedure (MP) and sacrospinous ligament hysteropexy (SSHP) have long been established as effective conservative surgeries for treating uterine prolapse. However, there have been limited studies on outcomes comparing these two techniques. Methodology: This was a prospective cohort study of the British Society of Urogynaecology database between February 2007 and 2023 of MP and SSHP outcomes from 90 centres in the UK. The primary outcome was the Patient Global Impression of Improvement (PGI-I). The other outcomes compared were the absence of pelvic organ prolapse beyond the hymen in any compartment evaluated by the Pelvic Organ Prolapse Quantification (POP-Q), complications, and the incidence of reported symptomatic prolapse within 1 year after the operation. Results: There were 718 women who underwent MP and 2,384 who had SSHP. The PGI-I score was significantly better in the MP group (p value <0.001). The rates of symptomatic prolapse within 1 year (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.18–0.69; p value 0.001), recurrence of prolapse beyond the hymen (OR 0.13, 95% CI 0.03–0.53; p value 0.001) and apical recurrence (OR 0.09, 95% CI 0.01–0.65; p value 0.003) during follow-up examination were lower in the MP group. The combined peri-operative and post-operative complications reported in both groups were comparatively similar. Conclusion: The symptom improvement was better and recurrence was lower with the MP than with SSHP at short-term follow-up. [ABSTRACT FROM AUTHOR]

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

Introduction: Pelvic organ prolapse (POP) can be the source of discomfort for women, leading to issues such as urinary incontinence, discomfort from herniated organs, and sexual dysfunction. In this study, our aim is to sh are our experiences with abdominal sacrocolpopexy and colpocleisis. Materials and Methods: In the study, 28 patients who underwent POP surgery between January 1, 2011 and November 1, 2022 were included. All patients had POP-Q stage 3 and above. Age, comorbidities, previous gynecological operations, history of prolapse and urinary incontinence surgery, and quality of life were recorded. In the postoperative period, the patients were followed up i n terms of complications, incontinence and recurrence. Results: A total of 28 patients underwent surgical treatment for POP, with 22 undergoing abdominal sacrocolpopexy and 6 undergoing Le Fort colpocleisis. Since 17 of the patients undergoing sacrocolpopexy had stress urinary incontinence, additional Burch colpo suspension was applied. Two patients who underwent sacrocolpopexy developed de novo urge incontinence. These patients benefited from med ical treatment. No cases of incontinence developed in the colpocleisis group. There were no recurrences observed in any of th e cases. Conclusion: Abdominal sacrocolpopexy and colpocleisis are methods with high success and satisfaction rates. Colpocleisis surgery stands out with shorter hospital stay. These patients should be well informed in terms of sexual life, and if there is concomitant stress urinary incontinence, it is recommended to perform the necessary surgery before colpocleisis. For sacrocolpopexy, the patient should be well informed about mesh and related complications beforehand. [ABSTRACT FROM AUTHOR]

Abstract This study assesses the efficacy of bilateral mesh sacrospinous ligament suspension (MSSLS) compared to laparoscopic sacrocolpopexy (LSC) in patients with uterine prolapse. Ninety-eight patients with uterine prolapse were evaluated at our hospital from January 2021 to January 2023. Patients were equally divided into two groups: the study group (undergoing MSSLS) and the control group (undergoing LSC) using a random number table. Various parameters including operation time, bleeding volume, indwelling catheter time, exhaust time, hospital stay, pelvic organ prolapse stage, postoperative recurrence rate, pain severity, quality of life, pelvic floor function, impact on sexual life, complications, and recurrence rate were recorded. The study group showed significant reductions in operation time, bleeding volume, indwelling catheter time, exhaust time, and hospital stay compared to the control group (P 0.05), but six months postoperatively, these indexes were significantly lower in the study group (P 0.05), but was significantly lower in the study group six months postoperatively (P 0.05). All patients were followed up for 12–14 months, with an average follow-up time of (13.02 ± 1.36) months. The incidence of complications was significantly lower in the study group (P 0.05). MSSLS emerges as a safe and efficacious treatment for uterine prolapse, notably reducing both complications and recurrence rates, rendering it suitable for broad clinical application.

INTRODUCTION: Pelvic organ prolapse (POP) can be the source of discomfort for women, leading to issues such as urinary incontinence, discomfort from herniated organs, and sexual dysfunction. In this study, our aim is to share our experiences with abdominal sacrocolpopexy and colpocleisis. METHODS: In the study, 28 patients who underwent POP surgery between January 1, 2011 and November 1, 2022 were included. All patients had POP-Q stage 3 and above. Age, comorbidities, previous gynecological operations, history of prolapse and urinary incontinence surgery, and quality of life were recorded. In the postoperative period, the patients were followed up in terms of complications, incontinence and recurrence. RESULTS: A total of 28 patients underwent surgical treatment for POP, with 22 undergoing abdominal sacrocolpopexy and 6 undergoing Le Fort colpocleisis.Since 17 of the patients undergoing sacrocolpopexy had stress urinary incontinence, additional Burch colposuspension was applied. Two patients who underwent sacrocolpopexy developed de novo urge incontinence. These patients benefited from medical treatment. No cases of incontinence developed in the colpocleisis group. There were no recurrences observed in any of the cases. DISCUSSION AND CONCLUSION: Abdominal sacrocolpopexy and colpocleisis are methods with high success and satisfaction rates. Colpocleisis surgery stands out with shorter hospital stay. These patients should be well informed in terms of sexual life, and if there is concomitant stress urinary incontinence, it is recommended to perform the necessary surgery before colpocleisis. For sacrocolpopexy, the patient should be well informed about mesh and related complications beforehand.

A 43-year-old woman with a history of uterine fibroids, anemia, and deep vein thrombosis presented with a chief symptom of prolapse of tumor from the perineum, complicated by infection. The case was further complicated by bilateral pulmonary multiple embolism, deep vein thrombosis, acute cardiac insufficiency, acute renal insufficiency, and shock. The patient was treated with preoperative placement of an inferior vena cava filter, open hysterectomy, and perioperative anticoagulation with low-molecular-weight heparin. She smoothly navigated the perioperative period and recovered completely. [ABSTRACT FROM AUTHOR]

Objective: This study compared the outcomes of the bulking agent polyacrylamide hydrogel (PAHG) with a single-incision sling (SIS) for treating occult stress urinary incontinence (SUI) in association with vaginal prolapse surgery. Methods: This was a retrospective study of patients who underwent transvaginal surgical correction of pelvic organ prolapse and received either SIS or urethral bulking with PAHG for occult SUI. Demographic and perioperative data were extracted from the charts. The primary outcomes were Urinary Distress Inventory–6 (UDI-6) scores, Incontinence Impact Questionnaire–7 (IIQ-7) scores, and incontinence episodes documented by 3-day bladder diaries collected 24 months after surgery. Secondary outcomes included complications such as adverse events, rates of urine retention with prolonged catheterization, and urinary-tract infections. Results: Thirty patients had the bulking agent using PAHG with the prolapse surgery for occult incontinence and 23 patients has SIS. Twenty-two patients from each group completed the postoperative questionnaires. UDI-6 scores were low in both groups with bulking versus SIS value (19 versus 11; p = 0.096). The stress subscale median value for bulking versus SIS was 33 versus 0; p = 0.009. IIQ-7 median value was 0 for both groups. The median Foley catheter duration for the bulking group versus the SIS group was 1 versus 5 days (p = 0.015). Conclusions: SIS and PAHG were equally satisfactory for treating occult SUI with similar total UDI-6 and IIQ-7 scores; yet, the UDI-6 stress subscale was significantly better for the SIS group, but with more short-term voiding dysfunction. (J GYNECOL SURG 20XX:000) [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Continuation of using a pessary for the treatment of pelvic organ prolapse (POP) is important for improving symptoms but the data on long-term compliance is very limited. Therefore, we conducted this study aimed at evaluating the compliance of patients in the long-term use of a pessary. Methods: The medical records of women with symptomatic POP were retrospectively reviewed to recruit cases opting for pessary use. The inclusion criteria were women who had a successful pessary fitting and completed at least 5 years of follow-up. Exclusion criteria were pregnancy, death during the follow-up period, and loss to follow-up. Demographic data, pelvic organ prolapse stage, associated symptoms, type and size of pessary, and reason for discontinuation were reviewed. Results: A total of 261 patients opted for pessary use. Of them, 88.9% (231 out of 261) were successful in initial pessary fitting and 54 were excluded for various reasons. The remaining 178 patients were available for analysis. The continuation rate of self-care pessary at the 5-year follow-up was 53.93% (96). The discontinuation rate was 46.07% (82). The main reasons for discontinuation were desire for surgery (39.1%) and discomfort (31.7%). The highest rate of discontinuation (46.63%) was found in the 1st year of follow-up. The significant risk factors of discontinuation included digitation symptoms on univariate analysis and prior hysterectomy on multivariate analysis, with an odds ratio (95% CI) of 5.98 (1.56–22.88). Conclusions: Among Thai women, the adherence to self-care pessary in symptomatic pelvic organ prolapse at the 5-year follow-up was 53.93%. The main reason for discontinuation was a prior hysterectomy. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse (POP) significantly affects women's quality of life, occurring in 20–30% of females aged over 20 globally. With aging populations, demand for pelvic reconstructive surgery is rising. Patients seek anatomical restoration while preserving uterus and sexual function. Sacrohysteropexy is the gold standard for apical prolapse, but carries risks. Lateral suspension, offers safer apical and anterior correction especially for obese, sexually active women. Our prospective study compares laparoscopic sacrohysteropexy and lateral suspension objectively and subjectively. The study included patients who had laparoscopic lateral suspension (n = 22) or laparoscopic sacrohysteropexy (n = 22) for symptomatic stage 2 apical prolapse. Groups randomized with using block design. Anatomical cure was based on measurements taken by the same physician, unaware of intervention, before and at 12 months using POP-Q score. Pelvic floor ultrasound also used for objective rates. Subjective comparison used Prolapse Quality of Life (P-QoL), Pelvic Organ Prolapse-Symptom Score (POP-SS), Female Sexual Function Index (FSFI), Visual Analog Score (VAS), and Michigan Incontinence Severity Index (M-ISI). Age, BMI, parity, menopause, sexual activity, complications, showed no significant difference between groups (p > 0.05). Surgical procedure duration significantly varied between groups lateral suspension group was shorter. There was no significant difference in post operative complications. No significant differences in posterior/enterocele stages.) Anterior staging showed no significant difference in sacrouteropexy (p = 0.130), but significant difference in lateral suspension group (p < 0.001). No significant differences in pre-op and post-op PQOL, POP-SS, FSFI, and M-ISI scores between the two groups. Both methods effectively managed apical prolapse with similar outcomes. Objective measurements showed lateral suspension's superiority in reducing bladder descent. [ABSTRACT FROM AUTHOR]

Objective: Voiding Dysfunction (VD) is one of the most common disorders among women, which is characterized by a disorder in urination. Pelvic organ prolapse is one of the factors that can affect VD. In this study, the relationship between prolapse in the anterior, posterior, and apical areas and VD has been evaluated. Materials and methods: This is a cohort retrospective study. The participants in this study were women with VD, who referred to the pelvic floor disorders clinic of Imam Khomeini Hospital in Tehran in 2018-2020. Clinical information was obtained retrospectively from the hospital's electronic data system, also symptoms (intermittent stream, incomplete voiding, poor flow, post void dribble, straining to void, stage anterior, posterior and apical) and urodynamic parameters (including EMG, PVR100, Qmax12, and pdet20) were evaluated, which included detailed questionnaires (Urinary Distress Inventory 6 (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7)), pelvic examination, and complete urodynamic evaluation. Results: There was a direct relationship between the age of the patients and the stage of prolapse (p<0.001). So that, the stage increased with age. In addition, it was found that the severity of urinary symptoms is related to the stage of prolapse in the apical area (p=0.001). Also, the results showed that intermittent stream symptoms and the symptoms of staining to void had a significant relationship with the stage of prolapse (III and IV) in the apical and anterior areas. Also, it was shown that only PVR > 100 had a significant relationship with the stage of prolapse in the apical area (p=0.001). Conclusion: Intermittent stream and straining to void were related to the stages of prolapse in the apical and anterior regions. It was also concluded that the greater the prolapse, the higher the value of PVR > 100. [ABSTRACT FROM AUTHOR]

Background: While suture anchors are widely used in medical procedures for their advantages, they can sometimes lead to complications, including anchor prolapse. This article presents a unique case of suture anchor prolapse at the base of the distal phalanx of the little finger after extensor tendon rupture reconstruction surgery. Case presentation: A 35-year-old male, underwent extensor tendon rupture reconstruction using a non-absorbable suture anchor. After seven years the patient visited our outpatients complaining of stiffness, pain, and protrusion at the surgical site. Initial X-ray imaging suggested suggesting either a fracture of the distal phalanx or tendon adhesion but lacked a definitive diagnosis. Subsequent magnetic resonance imaging (MRI) revealed bone connectivity between the middle and distal phalanges with irregular signal shadow and unclear boundaries while maintaining a regular finger shape. MRI proved superior in diagnosing prolapsed suture anchors, marking the first reported case of its kind. Surgical intervention confirmed MRI findings. Conclusions: Suture anchor complications, such as prolapse, are a concern in medical practice. This case underscores the significance of MRI for accurate diagnosis and the importance of tailored surgical management in addressing this uncommon complication. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to examine the impact of structured pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) contraction and the treatment of pelvic organ prolapse (POP) in postpartum women. Methods: Sixty patients who volunteered for a PFMT assessment at 6–8 weeks after delivery were included in this retrospective analysis. For 5 weeks, all patients had structured PFMT, which included supervised daily pelvic muscle contractions, biofeedback therapy, and electrical stimulation. The main outcomes were POP stage assessed by POP quantification (POP-Q), pelvic organ position and hiatus area (HA) assessed by transperineal ultrasound, PFM contraction assessed by Modified Oxford scale (MOS), surface electromyography (EMG), and sensation of PFM graded using visual analog scale (VAS). Results: Structured PFMT was associated with better POP-Q scores in Aa, Ba, C, and D (p values were 0.01, 0.001, 0.017, and 0.001 separately). The bladder neck at rest and maximum Valsalva, the cervix position and HA at maximum Valsalva in transperineal ultrasound were significantly better than before (p values were 0.031, < 0.001, 0.043, and < 0.001 separately). PFM contraction assessed by MOS, EMG, and PFM VAS score were significantly improved (all p values were < 0.001). However, no significant improvement was observed in POP-Q stage. Conclusions: Structured PFMT can increase PFM function in postpartum women but cannot modify the POP-Q stage. Transperineal ultrasonography is a useful method for evaluating therapy efficacy objectively. More randomized controlled trials are needed before definitive conclusions can be drawn about the effect of structured PFMT on POP in postpartum women. [ABSTRACT FROM AUTHOR]

• The modifiable risk factors with levator ani muscle avulsion include forceps and vacuum delivery. • The non-modifiable risk factors with levator ani muscle avulsion include obstetric anal sphincter injuries and maternal age. • This is the first meta-analysis of both modifiable and non-modifiable risk factors associated with LAM avulsion. Women have a 11% lifetime risk of undergoing surgery for vaginal prolapse. Levator ani muscle (LAM) avulsion is one etiological factor associated with primary and recurrent pelvic organ prolapse. Pelvic organ prolapse has been shown to greatly affect the quality of life and well-being of women. Conduct a meta-analysis identifying risk factors associated with LAM avulsion recognised on transperineal ultrasound (TPUS) or magnetic resonance imaging (MRI) in primiparous women after vaginal birth. OVID Medline, Embase and the Cochrane Library from inception to January 2021 were searched. Review Manager 5.3 (The Cochrane Collaboration) was used to analyse data. Odds ratios (OR) with 95% confidence intervals (95% CIs) were calculated. The heterogeneity among studies was calculated using the I2 statistic. Twenty-five studies were eligible for inclusion (n = 9333 women). Major LAM avulsion was diagnosed in an average of 22 % (range 12.7–39.5 %) of cases. Twenty-two studies used TPUS and three used MRI to diagnose avulsion. Modifiable and non-modifiable risk factors were identified. Significant predictors identified were forceps (OR 6.25 [4.33 – 9.0]), obstetric anal sphincter injuries (OR 3.93 [2.85–5.42]), vacuum (OR 2.41 [1.40–4.16]), and maternal age (OR 1.06 [1.02–1.10]). This is the first meta-analysis of both modifiable and non-modifiable risk factors associated with LAM avulsion. This information could be used to develop a clinically applicable risk prediction model to target postnatal women at risk of LAM avulsion with a view to prevent the onset of pelvic floor organ prolapse. [ABSTRACT FROM AUTHOR]

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

Background: Conflicts of interest inherent in industry funding can bias medical research methods, outcomes, reporting and clinical applications. This study explored the extent of funding provided to American physician researchers studying surgical mesh used to treat uterine prolapse or stress urinary incontinence, and whether that funding was declared by researchers or influenced the ethical integrity of resulting publications in peer reviewed journals. Methods: Publications identified via a Pubmed search (2014–2021) of the terms mesh and pelvic organ prolapse or stress urinary incontinence and with at least one US physician author were reviewed. Using the CMS Open Payments database industry funding received by those MDs in the year before, of and after publication was recorded, as were each study's declarations of funding and 14 quality measures. Results: Fifty-three of the 56 studies reviewed had at least one American MD author who received industry funding in the year of, or one year before or after publication. For 47 articles this funding was not declared. Of 247 physician authors, 60% received > $100 while 13% received $100,000-$1,000,000 of which approximately 60% was undeclared. While 57% of the studies reviewed explicitly concluded that mesh was safe, only 39% of outcomes supported this. Neither the quality indicator of follow-up duration nor overall statements as to mesh safety varied with declaration status. Conclusions: Journal editors' guidelines re declaring conflicts of interest are not being followed. Financial involvement of industry in mesh research is extensive, often undeclared, and may shape the quality of, and conclusions drawn, resulting in overstated benefit and overuse of pelvic mesh in clinical practice. [ABSTRACT FROM AUTHOR]

Cow is the national animal of Nepal, yet it is one of the most abused animal species here. Under realized utilities of cow that is nonlactating or pregnant is the reason for demonic cruelty. Since the Vedic period, gaushalas have been caring for cows. At present, most gaushalas have responsibility to rescue, offer refuge, and treat poorly treated or confiscated cattle from smuggling rackets in Nepal. It is no surprise that these abused animals suffer from many health issues and compromised reproductive ability. This study was conducted to know about husbandry practice and to determine prevalence of reproductive disorders in cows of Gaushala from Nepal. Altogether, 27 gaushalas were visited throughout the study period and cows (≥2 years) (n = 2959) were included for the study. From the study, respondents from 14.81% Gaushala admitted indigenous cattle only, 11.11% admitted any breed (indigenous and crossbreed), 44.44% admitted stray animals only, and 29.63% admitted all types (indigenous, crossbreed, and stray animals). The study revealed that among (n = 2959) animals examined, 5.54% (n = 164) were affected by either one or more reproductive problems. The major reproductive disorders identified in study area were repeat breeding 0.47%, cervico-vaginal and uterine prolapse 0.34%, retention of placenta 2.13%, dystocia 0.61%, and abortion 1.66%. Herd size of Gaushala had a significant difference (P < 0.05) on the overall prevalence of reproductive problems in cows of Gaushala. The main issues with gaushalas included a lack of resources like adequate fund, feeds, fodder, and water, shortage of grazing acreage, veterinary services, and difficulties in managing male cattle. To mitigate the issues and welfare related to gaushalas strict adherence to disease surveillance and biosecurity rules, avoidance of unlimited reproduction in cows, and separation of males and females, fund raising and resource management, collaboration with local government and NGOs, veterinary hospital, clinics, research, and innovation with veterinary institution and universities. [ABSTRACT FROM AUTHOR]

The article focuses on uterine inversion, a condition where the placenta remains attached to the uterine wall and pulls the uterus inside out during delivery. It is discussed that treatment options vary depending on the severity of the inversion and may involve manual reinsertion of the uterus, abdominal surgery, or emergency hysterectomy.

Background and Objectives: Pelvic floor muscles (PFM) play a core role in defecation and micturition. Weakening of PFM underlies urogynecological disorders such as pelvic organ prolapse and stress urinary incontinence. Vaginal delivery damages PFM. Muscle trauma implies an inflammatory response mediated by myeloid cells, essential for subsequent recovery. Molecular signaling characterizing the pro-inflammatory phase shifts M1 macrophages to M2 macrophages, which modulate muscle repair. The present study aimed to evaluate histological characteristics and the presence of M1 and M2 macrophages in bulbospongiosus (Bsm) and pubococcygeus muscles (Pcm). Materials and Methods: Muscles from young nulliparous (N) and multiparous rabbits on postpartum days three (M3) and twenty (M20) were excised and histologically processed to measure the myofiber cross-sectional area (CSA) and count the centralized myonuclei in hematoxylin-eosinstained sections. Using immunohistochemistry, M1 and M2 macrophages were estimated in muscle sections. Kruskal–Wallis or one-way ANOVA testing, followed by post hoc tests, were conducted to identify significant differences (p < 0.05). Results: The myofiber CSA of both the Bsm and Pcm of the M3 group were more extensive than those of the N and M20 groups. Centralized myonuclei estimated in sections from both muscles of M20 rabbits were higher than those of N rabbits. Such histological outcomes matched significant increases in HLA-DR immunostaining in M3 rabbits with the CD206 immunostaining in muscle sections from M20 rabbits. Conclusions: A shift from the pro- to anti-inflammatory phase in the bulbospongiosus and pubococcygeus muscles of multiparous rabbits matches with centralized myonuclei, suggesting the ongoing regeneration of muscles. [ABSTRACT FROM AUTHOR]

Rectal prolapse is characterized by a full-thickness intussusception of the rectal wall and is associated with a spectrum of coexisting anatomic abnormalities. We developed the transabdominal levatorplasty technique for laparoscopic rectopexy, inspired by Altemeier's procedure. In this method, following posterior mesorectum dissection, we expose the levator ani muscle just behind the anorectal junction. Horizontal sutures, using nonabsorbable material, are applied to close levator diastasis associated with rectal prolapse. The aim of the transabdominal levatorplasty is to (i) reinforce the pelvic floor, (ii) narrow the anorectal hiatus, and (iii) reconstruct the anorectal angle. We report a novel transabdominal levatorplasty technique during laparoscopic rectopexy for rectal prolapse. The laparoscopic mesh rectopexy with levatorplasty technique was performed in eight cases: six underwent unilateral Orr–Loygue procedure, one modified Wells procedure, and one unilateral Orr–Loygue procedure combined with sacrocolpopexy for uterine prolapse. The median follow-up period was 178 (33–368) days, with no observed recurrences. Six out of seven patients with fecal incontinence experienced symptomatic improvement. Although the sample size is small and the follow-up period is short, this technique has the potential to reduce the recurrence rate and improve functional outcomes, as with levatorplasty of Altemeier's procedure. We believe that this technique may have the potential to become an option for rectal prolapse surgery. [ABSTRACT FROM AUTHOR]

Pelvic organ prolapse refers to the descent of pelvic floor organs resulting from the weakening of pelvic muscles, fascia and connective tissue. The overall prevalence of pelvic organ prolapse is approximately 41%, including bladder prolapse (25%–34%), uterine prolapse (4%–14%) and rectal prolapse (13%–19%). Various methods are currently employed to repair damaged structures and improve patient symptoms, consequently enhancing their quality of life. This report focuses on a 94-year-old female diagnosed with pelvic organ prolapse, specifically Grade 3 bladder prolapse, Grade 3 uterine prolapse and complete rectal prolapse. A comprehensive surgical treatment was carried out to repair the pelvic organs on all three levels (rectum, uterus and bladder) by combining the Delorme procedure with synthetic graft implants. The surgical outcomes were good, illustrating immediate improvement in symptoms without early complications. A multispeciality approach helps functionally repair pelvic organ prolapse while preserving structural integrity.

Objective: Herniation of the pelvic organs into or outside the vagina is what is known as pelvic organ prolapse (POP). This paper was prepared in order to offer a case report of our pregnant patient who reached term after undergoing this operation, as well as to conduct a literature review on the vaginally assisted laparoscopic sacrohysteropexy (VALSH) procedure, which is a new method in the surgical treatment of POP. Both of these goals were accomplished through the writing of this article. Methods: A patient who 32 years old was admitted to our hospital with a palpable mass in the vagina. Because our patient was planned to get pregnant in the future, we suggested that she undergo a procedure known as VALSH, which is a uterus-preserving operation. The patient, who became pregnant spontaneously one year after the operation, had a healthy baby by cesarean section on at 38 weeks of gestation. Results: We conducted a literature review on the vaginally assisted laparoscopic sacrohysteropexy procedure, which is a new method in the surgical treatment of POP. It is unknown what kind of surgical procedure should be used to treat POP in young women who are still of childbearing age. Studies have shown that young women have an increased chance of POP recurrence following surgical treatment; however, no studies have been conducted to investigate the effect of surgical POP repair on subsequent pregnancies and the kind of delivery that occurs during those pregnancies. Conclusion: No signs of prolapse returning were detected during the tests conducted at the 6th week, 6th month of pregnancy, and the 12th month postpartum. We believe that the surgical procedure we utilized is an appropriate treatment for women of childbearing age who plan to become pregnant. The lack of prolapse recurrence indicates that the pregnancy can progress to full term without complications. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sacrocolpopexy (LSC) is the gold standard for the treatment of apical prolapse, although dissection of the promontory may be challenging. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical repair with similar anatomical and functional outcomes, according to recent studies. The purpose of this study was to compare these operative techniques. Methods: Women with uterine Pelvic Organ Prolapse Quantification (POP-Q) stage 2 were enrolled in this prospective study and were randomly allocated to the LLS or LSC group. At the 12-month follow-up, primary measures included both anatomical and functional outcomes. Perioperative parameters and complications were recorded. Results: A total of 93 women were randomized, 48 in the LLS group and 45 in the LSC group, with 2 women lost to follow-up in both groups. LSC anatomic success rates were 81.82% for the apical compartment and 95.22% for the anterior compartment. LLS anatomic success rates for the apical and anterior compartments were 90% and 92.30%, respectively. The mean operative time for LLS was 160.3 min, while for LSC it was 168.3 min. The mean blood loss was 100 mL in both procedures. Conversion to laparotomy was necessary in three women. Mesh erosion was not observed in any of the cases. In terms of the complication, Clavien–Dindo grade 1 was observed in two patients in the LLS group and a complication rated grade 3b was observed in one patient in LSC group. Conclusions: LLS is a good alternative to LSC, with promising anatomical and quality-of-life results. [ABSTRACT FROM AUTHOR]

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