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Une interposition prothétique synthétique inter-vésico-vaginale implantée par voie vaginale diminue-t-elle le risque de récidive de cystocèle ? Recommandations pour la pratique clinique. Prog Urol 2016; 26 Suppl 1:S38-46. [DOI: 10.1016/s1166-7087(16)30427-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Lowder JL, Oliphant SS, Shepherd JP, Ghetti C, Sutkin G. Genital hiatus size is associated with and predictive of apical vaginal support loss. Am J Obstet Gynecol 2016; 214:718.e1-8. [PMID: 26719211 DOI: 10.1016/j.ajog.2015.12.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 12/13/2015] [Accepted: 12/16/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recognition and assessment of apical vaginal support defects remains a significant challenge in the evaluation and management of prolapse. There are several reasons that this is likely: (1) Although the Pelvic Organ Prolapse-Quantification examination is the standard prolapse staging system used in the Female Pelvic Medicine and Reconstructive Surgery field for reporting outcomes, this assessment is not used commonly in clinical care outside the subspecialty; (2) no clinically useful and accepted definition of apical support loss exists, and (3) no consensus or guidelines address the degree of apical support loss at which an apical support procedure should be performed routinely. OBJECTIVE The purpose of this study was to identify a simple screening measure for significant loss of apical vaginal support. STUDY DESIGN This was an analysis of women with Pelvic Organ Prolapse-Quantification stage 0-IV prolapse. Women with total vaginal length of ≥7 cm were included to define a population with "normal" vaginal length. Univariable and linear regression analyses were used to identify Pelvic Organ Prolapse-Quantification points that were associated with 3 definitions of apical support loss: the International Consultation on Incontinence, the Pelvic Floor Disorders Network revised eCARE, and a Pelvic Organ Prolapse-Quantification point C cut-point developed by Dietz et al. Linear and logistic regression models were created to assess predictors of overall apical support loss according to these definitions. Receiver operator characteristic curves were generated to determine test characteristics of the predictor variables and the areas under the curves were calculated. RESULTS Of 469 women, 453 women met the inclusion criterion. The median Pelvic Organ Prolapse-Quantification stage was III, and the median leading edge of prolapse was +2 cm (range, -3 to 12 cm). By stage of prolapse (0-IV), mean genital hiatus size (genital hiatus; mid urethra to posterior fourchette) increased: 2.0 ± 0.5, 3.0 ± 0.5, 4.0 ± 1.0, 5.0 ± 1.0, and 6.5 ± 1.5 cm, respectively (P < .01). Pelvic Organ Prolapse-Quantification points B anterior, B posterior, and genital hiatus had moderate-to-strong associations with overall apical support loss and all definitions of apical support loss. Linear regression models that predict overall apical support loss and logistic regression models predict apical support loss as defined by International Continence Society, eCARE, and the point C; cut-point definitions were fit with points B anterior, B posterior, and genital hiatus; these 3 points explained more than one-half of the model variance. Receiver operator characteristic analysis for all definitions of apical support loss found that genital hiatus >3.75 cm was highly predictive of apical support loss (area under the curve, >0.8 in all models). CONCLUSIONS Increasing genital hiatus size is associated highly with and predictive of apical vaginal support loss. Specifically, the Pelvic Organ Prolapse-Quantification measurement genital hiatus of ≥3.75 cm is highly predictive of apical support loss by all study definitions. This simple measurement can be used to screen for apical support loss and the need for further evaluation of apical vaginal support before planning a hysterectomy or prolapse surgery.
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Preoperative Prolapse Stage as Predictor of Failure of Sacrocolpopexy. Female Pelvic Med Reconstr Surg 2016; 22:156-60. [DOI: 10.1097/spv.0000000000000233] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chen Y, Johnson B, Li F, King WC, Connell KA, Guess MK. The Effect of Body Mass Index on Pelvic Floor Support 1 Year Postpartum. Reprod Sci 2015; 23:234-8. [DOI: 10.1177/1933719115602769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yi Chen
- Department of Obstetrics and Gynecology, The Third People’s Hospital, Wenzhou Medical College, Zhejiang, China
| | - Benjamin Johnson
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - William C. King
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Kathleen A. Connell
- Department of Obstetrics and Gynecology, Section of Reconstructive Pelvic Surgery, University of Colorado, Aurora, Colorado, USA
| | - Marsha K. Guess
- Department of Obstetrics and Gynecology, Section of Urogynecology and Reconstructive Pelvic Surgery, Yale School of Medicine, New Haven, CT, USA
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ACR Appropriateness Criteria pelvic floor dysfunction. J Am Coll Radiol 2014; 12:134-42. [PMID: 25652300 DOI: 10.1016/j.jacr.2014.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 01/23/2023]
Abstract
Pelvic floor dysfunction is a common and potentially complex condition. Imaging can complement physical examination by revealing clinically occult abnormalities and clarifying the nature of the pelvic floor defects present. Imaging can add value in preoperative management for patients with a complex clinical presentation, and in postoperative management of patients suspected to have recurrent pelvic floor dysfunction or a surgical complication. Imaging findings are only clinically relevant if the patient is symptomatic. Several imaging modalities have a potential role in evaluating patients; the choice of modality depends on the patient's symptoms, the clinical information desired, and the usefulness of the test. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions; they are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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Abstract
The popularity of imaging in pelvic floor medicine continues to increase. Among the various modalities, ultrasound is superior as it is cheap, safe, easily accesible and simple, resulting in high patient compliance. It is the only technique that allows imaging of modern wide-weave polypropylene sling or mesh implants, and imaging of such implants is commonly required due to the popularity of surgical techniques that involve the placement of slings and meshes. This review article will discuss the role of translabial ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse.
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Affiliation(s)
- Ka Lai Shek
- Liverpool Hospital University of Western Sydney Liverpool New South Wales Australia
| | - Hans Peter Dietz
- Nepean Clinical School University of Sydney Sydney New South Wales Australia
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Svabik K, Martan A, Masata J, El-Haddad R, Hubka P. Comparison of vaginal mesh repair with sacrospinous vaginal colpopexy in the management of vaginal vault prolapse after hysterectomy in patients with levator ani avulsion: a randomized controlled trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:365-371. [PMID: 24615948 DOI: 10.1002/uog.13305] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 12/13/2013] [Accepted: 12/18/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the efficacy of two standard surgical procedures for post-hysterectomy vaginal vault prolapse in patients with levator ani avulsion. METHODS This was a single-center, randomized interventional trial, of two standard surgical procedures for post-hysterectomy vaginal vault prolapse: Prolift Total vs unilateral vaginal sacrospinous colpopexy with native tissue vaginal repair (sacrospinous fixation, SSF), during the period from 2008 to 2011. Entry criteria included at least two-compartment prolapse, as well as complete unilateral or bilateral levator ani avulsion injury. The primary outcome was anatomical failure based on clinical and ultrasound assessment. Failure was defined clinically, according to the Pelvic Organ Prolapse Quantification system, as Ba, C or Bp at the hymen or below, and on translabial ultrasound as bladder descent to 10 mm or more below the lower margin of the symphysis pubis on maximum Valsalva maneuver. Secondary outcomes were evaluation of continence, sexual function and prolapse symptoms based on validated questionnaires. RESULTS During the study period, 142 patients who were post-hysterectomy underwent surgery for prolapse in our unit; 72 of these were diagnosed with an avulsion injury and were offered participation in the study. Seventy patients were randomized into two groups: 36 in the Prolift group and 34 in the SSF group. On clinical examination at 1-year follow-up, we observed one (3%) case of anatomical failure in the Prolift group and 22 (65%) in the SSF group (P < 0.001). Using ultrasound criteria, there was one (2.8%) failure in the Prolift group compared with 21 (61.8%) in the SSF group (P < 0.001). The postoperative POPDI (Pelvic Organ Prolapse Distress Inventory) score for subjective outcome was 15.3 in the Prolift group vs 21.7 in the SSF group (P = 0.16). CONCLUSION In patients with prolapse after hysterectomy and levator ani avulsion injury, SSF has a higher anatomical failure rate than does the Prolift Total procedure at 1-year follow-up.
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Affiliation(s)
- K Svabik
- Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
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Barber MD, Brubaker L, Burgio KL, Richter HE, Nygaard I, Weidner AC, Menefee SA, Lukacz ES, Norton P, Schaffer J, Nguyen JN, Borello-France D, Goode PS, Jakus-Waldman S, Spino C, Warren LK, Gantz MG, Meikle SF. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA 2014; 311:1023-34. [PMID: 24618964 PMCID: PMC4083455 DOI: 10.1001/jama.2014.1719] [Citation(s) in RCA: 283] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE More than 300,000 surgeries are performed annually in the United States for pelvic organ prolapse. Sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) are commonly performed transvaginal surgeries to correct apical prolapse. Little is known about their comparative efficacy and safety, and it is unknown whether perioperative behavioral therapy with pelvic floor muscle training (BPMT) improves outcomes of prolapse surgery. OBJECTIVE To compare outcomes between (1) SSLF and ULS and (2) perioperative BPMT and usual care in women undergoing surgery for vaginal prolapse and stress urinary incontinence. DESIGN, SETTING, AND PARTICIPANTS Multicenter, 2 × 2 factorial, randomized trial of 374 women undergoing surgery to treat both apical vaginal prolapse and stress urinary incontinence was conducted between 2008 and 2013 at 9 US medical centers. Two-year follow-up rate was 84.5%. INTERVENTIONS The surgical intervention was transvaginal surgery including midurethral sling with randomization to SSLF (n = 186) or ULS (n = 188); the behavioral intervention was randomization to receive perioperative BPMT (n = 186) or usual care (n = 188). MAIN OUTCOMES AND MEASURES The primary outcome for the surgical intervention (surgical success) was defined as (1) no apical descent greater than one-third into vaginal canal or anterior or posterior vaginal wall beyond the hymen (anatomic success), (2) no bothersome vaginal bulge symptoms, and (3) no re-treatment for prolapse at 2 years. For the behavioral intervention, primary outcome at 6 months was urinary symptom scores (Urinary Distress Inventory; range 0-300, higher scores worse), and primary outcomes at 2 years were prolapse symptom scores (Pelvic Organ Prolapse Distress Inventory; range 0-300, higher scores worse) and anatomic success. RESULTS At 2 years, surgical group was not significantly associated with surgical success rates (ULS, 59.2% [93/157] vs SSLF, 60.5% [92/152]; unadjusted difference, -1.3%; 95% CI, -12.2% to 9.6%; adjusted odds ratio [OR], 0.9; 95% CI, 0.6 to 1.5) or serious adverse event rates (ULS, 16.5% [31/188] vs SSLF, 16.7% [31/186]; unadjusted difference, -0.2%; 95% CI, -7.7% to 7.4%; adjusted OR, 0.9; 95% CI, 0.5 to 1.6). Perioperative BPMT was not associated with greater improvements in urinary scores at 6 months (adjusted treatment difference, -6.7; 95% CI, -19.7 to 6.2), prolapse scores at 24 months (adjusted treatment difference, -8.0; 95% CI, -22.1 to 6.1), or anatomic success at 24 months. CONCLUSIONS AND RELEVANCE Two years after vaginal surgery for prolapse and stress urinary incontinence, neither ULS nor SSLF was significantly superior to the other for anatomic, functional, or adverse event outcomes. Perioperative BPMT did not improve urinary symptoms at 6 months or prolapse outcomes at 2 years. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00597935.
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Affiliation(s)
- Matthew D Barber
- Obstetrics/Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Linda Brubaker
- Departments of Obstetrics and Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Kathryn L Burgio
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham4Department of Veterans Affairs, Birmingham, Alabama
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Ingrid Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Medical Center, Salt Lake City
| | - Alison C Weidner
- Department of Obstetrics and Gynecology, Duke University, Medical Center, Durham, North Carolina
| | - Shawn A Menefee
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, San Diego
| | - Emily S Lukacz
- Department of Reproductive Medicine, University of California San Diego Health Systems
| | - Peggy Norton
- Department of Obstetrics and Gynecology, University of Utah, Medical Center, Salt Lake City
| | - Joseph Schaffer
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - John N Nguyen
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, Downey
| | | | - Patricia S Goode
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham4Department of Veterans Affairs, Birmingham, Alabama
| | - Sharon Jakus-Waldman
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, Downey
| | - Cathie Spino
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Lauren Klein Warren
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Marie G Gantz
- Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Susan F Meikle
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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Dietz HP, Hankins KJ, Wong V. The natural history of cystocele recurrence. Int Urogynecol J 2014; 25:1053-7. [PMID: 24556972 DOI: 10.1007/s00192-014-2339-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/26/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Female pelvic organ prolapse is a common condition, and recurrence after surgery is considered a significant clinical issue, especially in the anterior compartment. To the best of our knowledge, there are currently no published data in the literature on the timing of recurrence. We used data obtained in clinical audit projects and a prospective surgical trial to define the natural history of cystocele recurrence. METHODS This is an observational retrospective study utilising data of 166 patients seen at least twice after anterior colporrhaphy, obtained from four clinical audit projects and one prospective surgical trial. RESULTS We identified a total of 481 postoperative visits at a mean follow-up of 1.11 years in 166 individuals. At last available follow-up, 80 (48%) had evidence of cystocele recurrence (ICS POP-Q stage 2+), and 44 (27%) reported symptoms of prolapse. Ultrasound evidence of cystocele recurrence was seen in 74 women (45%). Regression modelling demonstrated that the likelihood of recurrence was highest between 1 and 2 years' follow-up. CONCLUSIONS Cystocele recurrence after anterior colporrhaphy seems to be a relatively early phenomenon, with maximum prevalence reached at 18-24 months.
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Affiliation(s)
- H P Dietz
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, 2750, Australia,
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Rodrigo N, Wong V, Shek KL, Martin A, Dietz HP. The use of 3-dimensional ultrasound of the pelvic floor to predict recurrence risk after pelvic reconstructive surgery. Aust N Z J Obstet Gynaecol 2014; 54:206-11. [PMID: 24576013 DOI: 10.1111/ajo.12171] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 11/19/2013] [Indexed: 01/26/2023]
Abstract
AIMS Female pelvic organ prolapse is a common condition. Prolapse recurrence following surgical treatment is a significant clinical issue. The aim of this study was to determine risk factors for recurrence, attempting to improve clinical practice by allowing better patient selection prior to surgery. METHODS This was a retrospective study utilising patient records and ultrasound volume imaging data sets obtained in four clinical audits following anterior colporrhaphy ± mesh. Prolapse recurrence was diagnosed clinically and by ultrasound; findings were analysed against potential predictors. RESULTS Symptomatic prolapse recurrence was demonstrated in 86 (26%), on clinical examination in 141 (42%) and on ultrasound in 113/334 women (34%). None of the tested predictors were predictive of recurrent symptoms, likely due to a lack of power. However, both levator avulsion and hiatal area on Valsalva were shown to be highly significant predictors of objective prolapse recurrence on clinical examination and ultrasound. CONCLUSIONS Prolapse recurrence following surgery is a common complaint. The state of the patient's pelvic floor muscle seems to be the strongest determinant.
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Affiliation(s)
- Natassia Rodrigo
- Sydney Medical School Nepean, Penrith, New South Wales, Australia
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Wong V, Shek KL, Goh J, Krause H, Martin A, Dietz HP. Cystocele recurrence after anterior colporrhaphy with and without mesh use. Eur J Obstet Gynecol Reprod Biol 2014; 172:131-5. [DOI: 10.1016/j.ejogrb.2013.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 08/17/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
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Deffieux X, Sentilhes L, Savary D, Letouzey V, Marcelli M, Mares P, Pierre F, Brun JL, Boukerrou M, Daraï É, Fauconnier A, Fritel X, Herry M, Hocke C, Tardif D, Villefranque V, Cosson M, Debodinance P, Fernandez H, Ferry P, Graesslin O, Hermieu JF, Jacquetin B, Jourdain O, Lenormand L, Marpeau L, Michaud P, Rabischong B, Salet-Lizée D, Sergent F, de Tayrac R. Indications de la cure du prolapsus génital par voie vaginale avec prothèse : consensus d’experts du Collège national des gynécologues et obstétriciens français (CNGOF). ACTA ACUST UNITED AC 2013; 42:628-38. [DOI: 10.1016/j.jgyn.2013.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Ghafar MA, Chesson RR, Velasco C, Slocum P, Winters JC. Size of Urogenital Hiatus as a Potential Risk Factor for Emptying Disorders After Pelvic Prolapse Repair. J Urol 2013; 190:603-7. [DOI: 10.1016/j.juro.2013.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Mohamed A. Ghafar
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Ralph R. Chesson
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Cruz Velasco
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Paul Slocum
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - J. Christian Winters
- Department of Urology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Wong V, Shek K, Rane A, Goh J, Krause H, Dietz HP. Is levator avulsion a predictor of cystocele recurrence following anterior vaginal mesh placement? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:230-234. [PMID: 23404827 DOI: 10.1002/uog.12433] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 01/31/2013] [Accepted: 02/01/2013] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Levator avulsion has been shown to be a predictor of cystocele recurrence following anterior colporrhaphy. The aim of this study was to determine if levator avulsion is a risk factor for prolapse recurrence following anterior colporrhaphy with mesh. METHODS This was a retrospective analysis of data obtained from three surgical audits for subjective and objective outcomes following anterior colporrhaphy with mesh. Recurrence was defined as cystocele ≥ Stage 2 on the prolapse quantification system of the International Continence Society; symptoms of vaginal lump/bulge; or cystocele on ultrasound, defined as maximum bladder descent to ≥ 10 mm below the symphysis pubis. Levator avulsion was diagnosed using tomographic ultrasound imaging. RESULTS Two hundred and nine patients were followed up at a mean of 2.2 years (range, 3 months to 5.6 years) after anterior vaginal mesh placement. 24% (51/209) had recurrent prolapse symptoms, 33% (68/209) clinical cystocele recurrence ≥ Stage 2, and 26% (54/209) a recurrent cystocele on ultrasound. Twenty-eight out of 80 (35%) women with levator avulsion had significant sonographic cystocele recurrence (odds ratio (OR), 2.24 (95% confidence interval (CI), 1.13-4.43)). This finding was confirmed after adjusting for potential predictors of prolapse recurrence on multivariate logistic regression (OR, 2.13 (95% CI, 1.04-4.39); P = 0.04). CONCLUSION Levator avulsion doubles the risk of cystocele recurrence after anterior colporrhaphy with transobturator mesh.
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Affiliation(s)
- V Wong
- Sydney Medical School Nepean, University of Sydney, Penrith, New South Wales, Australia.
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66
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STEWARD MJ, TAYLOR SA, BRUNELL C. Advances in MRI assessment of pelvic floor structure and function: a review. IMAGING 2013. [DOI: 10.1259/imaging.20100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Andrew BP, Shek KL, Chantarasorn V, Dietz HP. Enlargement of the levator hiatus in female pelvic organ prolapse: Cause or effect? Aust N Z J Obstet Gynaecol 2012; 53:74-8. [DOI: 10.1111/ajo.12026] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 11/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Bronwyn P. Andrew
- Sydney Medical School Nepean, Nepean Hospital; Sydney; New South Wales; Australia
| | - Ka L. Shek
- Sydney Medical School Nepean, Nepean Hospital; Sydney; New South Wales; Australia
| | | | - Hans P. Dietz
- Sydney Medical School Nepean, Nepean Hospital; Sydney; New South Wales; Australia
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Bartuzi A, Futyma K, Kulik-Rechberger B, Skorupski P, Rechberger T. Transvaginal Prolift® mesh surgery due to advanced pelvic organ prolapse does not impair female sexual function: a prospective study. Eur J Obstet Gynecol Reprod Biol 2012; 165:295-8. [DOI: 10.1016/j.ejogrb.2012.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 06/28/2012] [Accepted: 07/21/2012] [Indexed: 10/28/2022]
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Lakeman MME, Koops SES, Berghmans BC, Roovers JPWR. Peri-operative physiotherapy to prevent recurrent symptoms and treatment following prolapse surgery: supported by evidence or not? Int Urogynecol J 2012; 24:371-5. [PMID: 23152045 DOI: 10.1007/s00192-012-1973-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/08/2012] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To provide a clinical opinion based on current literature reporting on the effects of peri-operative pelvic floor muscle training (PFMT) on postoperative pelvic floor symptoms, recurrent treatment after pelvic organ prolapse (POP) surgery and current clinical practice in the Netherlands. METHODS The PubMed database was searched, with dates from 1966 to May 2012, for all types of studies reporting on the effects of peri-operative PFMT on recurrent treatment and/or pelvic floor symptoms after POP surgery. Also, current clinical practice in the Netherlands was evaluated. RESULTS Two small randomised controlled trials (RCTs), with differences in the population included, were identified. The first RCT concluded that peri-operative PFMT reduced the risk of pelvic floor symptoms 12 weeks after surgery and improved the quality of life. The second trial concluded that there is no significant beneficial effect 12 months after surgery. However, when looking at the reported outcomes in this trial micturition symptoms and quality of life improved more in the treatment group too. Studies evaluating whether peri-operative PFMT reduced the rate of recurrent treatment for POP-related symptoms, were not identified. This lack of evidence reflects the current clinical practice, as most gynaecologists do not offer peri-operative PFMT to their patients. CONCLUSIONS Peri-operative PFMT may reduce the risk of pelvic floor symptoms and improve the quality of life after POP surgery, although evidence is insufficient to implement this in current clinical practice. Since the results of the two RCTs on this topic are promising, there is an urgent need for robust, well-designed trials to evaluate the efficacy and (cost-)effectiveness of peri-operative PFMT.
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Affiliation(s)
- Marielle M E Lakeman
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-205, PO Box 22700, 1105 DE Amsterdam, The Netherlands.
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Dietz HP. Mesh in prolapse surgery: an imaging perspective. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 40:495-503. [PMID: 22847883 DOI: 10.1002/uog.12272] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 06/01/2023]
Affiliation(s)
- H P Dietz
- Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School Nepean, Penrith, New South Wales, Australia.
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71
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Johnson P, Larson KA, Hsu Y, Fenner DE, Morgan D, Delancey JOL. Self-reported natural history of recurrent prolapse among women presenting to a tertiary care center. Int J Gynaecol Obstet 2012; 120:53-6. [PMID: 23073228 DOI: 10.1016/j.ijgo.2012.07.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 07/06/2012] [Accepted: 09/25/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the characteristics of recurrent pelvic organ prolapse (POP). METHODS A convenience sample of patients presenting with recurrent POP symptoms between October 2007 and February 2010 completed questionnaires. The survey focused on timing of recurrence(s), symptoms, and demographics. RESULTS Ninety-seven women completed questionnaires. Thirty-four (35.1%) had undergone multiple prior treatments. Overall, 23 of 76 (30.3%) women had not informed their surgeon of the recurrence. Twenty-seven of 59 (45.8%) women reported that their symptoms were the same as before treatment, whereas 23 of 59 (39.0%) reported more severe symptoms. POP was considered to be persistent if symptoms returned within 3 months, and recurrent if symptom relief exceeded 3 months. After primary surgery, 28 of 79 (35.4%) cases were considered to be persistent, whereas 51 (64.6%) cases were recurrent. Similar percentages were seen after second and third treatments. CONCLUSION Overall, 35% of participants experienced early return of symptoms. Almost one-third of participants had not informed their surgeon of the recurrence, indicating that there may not be an accurate self-assessment of outcome in the absence of careful follow-up.
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Affiliation(s)
- Payton Johnson
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan, USA
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72
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Dietz HP. What's wrong with the debate on mesh surgery? Aust N Z J Obstet Gynaecol 2012; 52:313-5. [DOI: 10.1111/j.1479-828x.2012.01467.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/18/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Hans P. Dietz
- Sydney Medical School Nepean, University of Sydney, Penrith NSW Australia
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73
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Dietz HP. Clinical consequences of levator trauma. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2012; 39:367-371. [PMID: 22457009 DOI: 10.1002/uog.11141] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- H P Dietz
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, 2750, Australia.
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74
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Khunda A, Shek KL, Dietz HP. Can ballooning of the levator hiatus be determined clinically? Am J Obstet Gynecol 2012; 206:246.e1-4. [PMID: 22133801 DOI: 10.1016/j.ajog.2011.10.876] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 10/03/2011] [Accepted: 10/31/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether genital hiatus (gh) and perineal body (pb), measured using the pelvic organ prolapse quantification system of the International Continence Society, are predictive of an abnormally distensible levator hiatus on ultrasound and of objective prolapse and/or prolapse symptoms. STUDY DESIGN The design of the study included datasets of 188 urogynecology patients assessed in a cross-sectional retrospective study. RESULTS Gh and pb, as well as gh plus pb, were strongly associated with symptoms and signs of prolapse and with hiatal area on ultrasound. The sum of gh and pb was superior in predictive performance to individual measures for symptoms (P < .001) and signs of prolapse (P < .001). Gh plus pb equaled the hiatal area on ultrasound (area under the curve, 0.886; 95% confidence interval, 0.828-0.945 vs 0.867; 95% confidence interval, 0.808-0.926) for predicting objective prolapse. Optimal sensitivity (80%) and specificity (81%) was reached with a cutoff of 7 cm for gh plus pb. CONCLUSION A cutoff of 7 cm for gh plus pb measured on Valsalva is proposed as a clinical definition of excessive levator hiatal distensibility.
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Affiliation(s)
- Azar Khunda
- Urogynecology and Pelvic Floor Reconstruction Unit, University College London Hospitals, London, England, UK
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75
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Ying T, Li Q, Xu L, Liu F, Hu B. Three-dimensional ultrasound appearance of pelvic floor in nulliparous women and pelvic organ prolapse women. Int J Med Sci 2012; 9:894-900. [PMID: 23155363 PMCID: PMC3498754 DOI: 10.7150/ijms.4829] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 10/25/2012] [Indexed: 11/18/2022] Open
Abstract
The present study investigated the morphology and structure of pelvic floor in 50 nulliparous and 50 pelvic organ prolapse (POP) women using translabial three-dimensional (3D) ultrasound. The levator hiatus in POP women was significantly different from that in nullipara women. In POP women, the size of pelvic floor increased, with a circular shape, and the axis of levator hiatus departed from the normal position in 36 (72%) cases. The puborectalis was avulsed in 18 (36%) cases and the pelvic organs arranged abnormally in 23 (46%) cases. In summary, 3D ultrasound is an effective tool to detect the pelvic floor in POP women who presented with abnormalities in the morphology and structure of pelvic floor.
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Affiliation(s)
- Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, People's Republic of China.
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76
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Morgan DM, Larson K, Lewicky-Gaupp C, Fenner DE, DeLancey JOL. Vaginal support as determined by levator ani defect status 6 weeks after primary surgery for pelvic organ prolapse. Int J Gynaecol Obstet 2011; 114:141-4. [PMID: 21669431 DOI: 10.1016/j.ijgo.2011.02.020] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/14/2011] [Accepted: 04/27/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether major levator ani muscle defects were associated with differences in postoperative vaginal support after primary surgery for pelvic organ prolapse (POP). METHODS A retrospective chart review of a subgroup of patients in the Organ Prolapse and Levator (OPAL) study. Of the 247 women recruited into OPAL, 107 underwent surgery for prolapse and were the cohort for the present analysis. Major levator ani defects were diagnosed when more than 50% of the pubovisceral muscle was missing on MRI. Postoperative vaginal support was assessed via POP-quantification system. Postoperative anatomic outcome was analyzed according to levator ani defect status, as determined by MRI. RESULTS Support of the anterior vaginal wall 2 cm above the hymen occurred among 62% of women with normal levator ani muscles/minor defects and 35% of those with major defects. Support of the anterior wall 1cm above the hymen occurred among 32% women with normal muscles /minor defects and 59% of those with major defects. Levator ani defects were not associated with differences in postoperative apical/posterior vaginal support. CONCLUSION Six weeks after primary surgery for prolapse, women with normal levator ani muscles/minor defects had better anterior vaginal support than those with major levator defects.
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Affiliation(s)
- Daniel M Morgan
- Department of Obstetrics and Gynecology, Division of Gynecology, Pelvic Floor Research Group, University of Michigan Medical School, Ann Arbor, USA.
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77
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Nemeth Z, Ott J. Complete recovery of severe postpartum genital prolapse after conservative treatment--a case report. Int Urogynecol J 2011; 22:1467-9. [PMID: 21614441 DOI: 10.1007/s00192-011-1452-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/03/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Zoltan Nemeth
- Department of Gynecology, Saint John of God Hospital, Johannes Gott Platz 1, 1020 Vienna, Austria.
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78
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Prospective evaluation of outcome of vaginal pessaries versus surgery in women with symptomatic pelvic organ prolapse. Int Urogynecol J 2010; 22:273-8. [DOI: 10.1007/s00192-010-1340-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 11/18/2010] [Indexed: 10/18/2022]
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Levator defects are associated with prolapse after pelvic floor surgery. Eur J Obstet Gynecol Reprod Biol 2010; 153:220-3. [DOI: 10.1016/j.ejogrb.2010.07.046] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 07/28/2010] [Accepted: 07/30/2010] [Indexed: 11/18/2022]
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Clark NA, Brincat CA, Yousuf AA, Delancey JOL. Levator defects affect perineal position independently of prolapse status. Am J Obstet Gynecol 2010; 203:595.e17-22. [PMID: 20869037 PMCID: PMC3360540 DOI: 10.1016/j.ajog.2010.07.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 06/26/2010] [Accepted: 07/27/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the effect of levator defects on perineal position and movement irrespective of prolapse status. STUDY DESIGN Forty women from an ongoing study were divided into 2 groups of 20 women with and without severe levator defects. Prolapse status was matched between groups, with 50% of the women having stage III or greater anterior wall prolapse. Perineal structure locations were measured against standard axes on magnetic resonance scans at rest, maximum contraction (Kegel), and maximum Valsalva maneuver. Differences in location were calculated and compared. RESULTS In women with levator defects, independently of prolapse status: (1) At rest, the perineal body was 1.3 cm, and the anal sphincter was 1.0 cm more caudal (P ≤ .01); at maximum contraction, the perineal body and the anal sphincter were both 1.2 cm more caudal (P ≤ .01); with maximum Valsalva maneuver, the perineal body was 1.3 cm more caudal, and the anal sphincter was 1.2 cm more caudal (P ≤ .01). (2) At rest, the levator hiatus was 0.8 cm larger, and the urogenital hiatus was 1.0 cm larger (P ≤ .01). (3) At rest, the bladder was 0.07 cm more posterior (P ≤ .02); with maximum contraction, it was 1.9 cm lower (P ≤ .02). (4) With maximum Valsalva maneuver, the bladder was 1.5 cm lower and displaced further caudally (P ≤ .03). CONCLUSION When we controlled for prolapse, the women with levator defects had a more caudal location of their perineal structures and larger hiatuses at rest, maximum contraction, and maximum Valsalva maneuver.
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Affiliation(s)
- Natalie A Clark
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA.
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81
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Dietz HP, Chantarasorn V, Shek KL. Levator avulsion is a risk factor for cystocele recurrence. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:76-80. [PMID: 20499408 DOI: 10.1002/uog.7678] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine whether levator avulsion is a risk factor for recurrence after cystocele repair. METHODS This was an audit of women who underwent anterior colporrhaphy at a tertiary hospital between 2002 and 2005, who were followed up by interview, clinical examination and four-dimensional translabial ultrasound examination 3-6 years later. RESULTS Of 242 patients identified through theater records we were able to contact 171 (71%). Of 83 who agreed to attend, 24 (29%) reported symptoms of recurrent prolapse. There were 33 (40%) recurrent cystoceles (ICS POP-Q ≥ 0), [corrected] and 34 (41%) had a significant cystocele on ultrasound examination. On pelvic floor tomographic ultrasound examination, a levator avulsion was detected in 29 (35%) patients. The relative risk of recurrence in women with avulsion was 3.9 (95% CI, 2.4-5.8) when ultrasound criteria of recurrent cystocele were used, and 2.9 (95% CI, 1.7-4.5) when using clinical staging. CONCLUSION Levator avulsion is associated with a relative risk of 3-4 for cystocele recurrence after anterior colporrhaphy.
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Affiliation(s)
- H P Dietz
- Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, Australia.
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82
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Pelvic floor muscle function in a general population of women with and without pelvic organ prolapse. Int Urogynecol J 2010; 21:311-9. [PMID: 19936592 PMCID: PMC2815803 DOI: 10.1007/s00192-009-1037-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 10/08/2009] [Accepted: 10/21/2009] [Indexed: 11/17/2022]
Abstract
Introduction and hypothesis This study aims to examine the relationship between pelvic floor muscle function (PFMF) and pelvic organ prolapse (POP) in a general female population. Methods Cross-sectional study on women aged 45–85 years. Validated questionnaires were used to assess pelvic floor muscle function. POP and PFMF were evaluated with vaginal examination. For statistical analysis chi-squared test for trend and analysis of variance were used. Results Response rate to the questionnaire was 62.7% (1,869/2,979). No significant differences were found in muscle strength and endurance during voluntary muscle contraction between the POP stages. Women with POP stages I and II were significantly less able to achieve effective involuntary muscle contraction during coughing (38.3% and 37.7%) than women without POP (75.2%). Conclusion Involuntary contraction of the PFM during coughing (that resulted in stabilization of the perineum) was significantly weaker in the women with POP stage I and II than in the women without POP.
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83
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Perioperative Physiotherapy as an Adjunct to Prolapse Surgery: An In-Depth Analysis of a Study With a Negative Result. CURRENT BLADDER DYSFUNCTION REPORTS 2010. [DOI: 10.1007/s11884-010-0039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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84
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Abstract
Pelvic floor function and structure are complex, and imaging (integrated with an understanding of physiology) is central to guiding the clinician in managing patients with incontinence, constipation, difficult rectal evacuation and pelvic organ prolapse. Multimodal imaging techniques such as static and dynamic imaging techniques (sometimes combined in a single sitting) have revolutionised our understanding of functional anatomy. The advent of endo-luminal imaging has increased our spatial resolution by its closer proximity to the area of interest. Dynamic imaging gives us a near physiological data set which helps us to simulate what is likely to happen in real life and gives us a better understanding of the multifactorial causes, and consequences, of pelvic floor dysfunction.
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Affiliation(s)
- Stuart A Taylor
- Clinical Radiology, University College London, 235 Euston Road, London NW1 2BU, UK.
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85
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Salvatore S, Athanasiou S, Digesu GA, Soligo M, Sotiropoulou M, Serati M, Antsaklis A, Milani R. Identification of risk factors for genital prolapse recurrence. Neurourol Urodyn 2009; 28:301-4. [PMID: 19214994 DOI: 10.1002/nau.20639] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS To assess the relationship between prolapse recurrence and some risk factors in a group of women submitted to reconstructive pelvic surgery. METHODS Women referred to our Urogynaecological Units complaining of prolapse symptoms were prospectively included. We excluded women who were affected by apical vaginal prolapse >stage I after a previous hysterectomy. All women had pelvic surgery with traditional techniques without using grafts. Each woman was reassessed at 1, 6, and 12 months and then yearly postoperatively. We defined as prolapse recurrence a vaginal descent >or=II stage involving the operated compartments. RESULTS A total of 360 consecutive women were recruited and submitted to vaginal reconstructive pelvic surgery. At a mean follow-up of 26 months, 36 women (10%) had a recurrent prolapse. A preoperative vaginal descent >or=III stage was the only significant risk factor for recurrence (P = 0.02, OR 2.4, 1.1-5.1 95% CI). CONCLUSIONS Women with prolapse >or=III stage had a significant higher risk of developing prolapse recurrence after surgical repair without grafts.
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Affiliation(s)
- Stefano Salvatore
- Department of Obstetrics & Gynecology, Insubria University, Varese, Italy.
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86
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87
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Yang SH, Huang WC, Yang SY, Yang E, Yang JM. Validation of new ultrasound parameters for quantifying pelvic floor muscle contraction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:465-471. [PMID: 19306473 DOI: 10.1002/uog.6338] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine the reliability and validity of new ultrasound parameters, measured in the polar coordinate system, for quantifying pelvic floor muscle action. METHODS This was a prospective study, from January 2005 to December 2007, in 209 women with urodynamic stress incontinence, to validate new ultrasound parameters for quantifying pelvic floor muscle contraction. The examination of each patient included intravaginal digital palpation of voluntary pelvic floor muscle contractility and an ultrasound assessment of the positions of the bladder neck and anorectal junction at rest and during pelvic floor muscle contraction. The position of the bladder neck was expressed by bladder neck angle and bladder neck distance from the lower border of the pubic symphysis, and the position of the anorectal junction was expressed by the levator hiatal angle and sagittal hiatal diameter. The vector lengths of the motion of the bladder neck and anorectal junction during pelvic floor muscle contraction were calculated from the positions at rest and during pelvic floor muscle contraction by mathematical formulae. RESULTS There was good inter- and intraobserver reliability of measurement of ultrasound parameters on stored volumes. During pelvic floor muscle contraction, elevated bladder neck distance and shortened sagittal hiatal diameter were valid parameters representing stronger pelvic floor muscle contractility, with shortened sagittal hiatal diameter having the best correlation (r = - 0.348, P < 0.001). CONCLUSION The methods used in this study appear to be reliable for quantifying pelvic floor muscle action. The bladder neck distance with respect to the lower border of the pubic symphysis and the sagittal hiatal diameter were both valid parameters reflecting PFM contractility.
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Affiliation(s)
- S-H Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
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88
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Abramowitch SD, Feola A, Jallah Z, Moalli PA. Tissue mechanics, animal models, and pelvic organ prolapse: a review. Eur J Obstet Gynecol Reprod Biol 2009; 144 Suppl 1:S146-58. [PMID: 19285776 DOI: 10.1016/j.ejogrb.2009.02.022] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pelvic floor disorders such as pelvic organ prolapse, urinary incontinence, and fecal incontinence affect a large number of women each year. The pelvic floor can be thought of as a biomechanical structure due to the complex interaction between the vagina and its supportive structures that are designed to withstand the downward descent of the pelvic organs in response to increases in abdominal pressure. Although previous work has highlighted the biochemical changes that are associated with specific risk factors (i.e. parity, menopause, and genetics), little work has been done to understand the biomechanical changes that occur within the vagina and its supportive structures to prevent the onset of these pelvic floor disorders. Human studies are often limited due to the challenges of obtaining large tissue samples and ethical concerns. Therefore, it is necessary to investigate the use of animal models and their importance in understanding how different risk factors affect the biomechanical properties of the vagina and its supportive structures. In this review paper, we will discuss the different animal models that have been previously used to characterize the biomechanical properties of the vagina: including non-human primates, rodents, rabbits, and sheep. The anatomy and preliminary biomechanical findings are discussed along with the importance of considering experimental conditions, tissue anisotropy, and viscoelasticity when characterizing the biomechanical properties of vaginal tissue. Although there is not a lot of biomechanics research related to the vagina and pelvic floor, the future is exciting due to the significant potential for scientific findings that will improve our understanding of these conditions and hopefully lead to improvements in the prevention and treatment of pelvic disorders.
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Affiliation(s)
- Steven D Abramowitch
- Department of Bioengineering, Musculoskeletal Research Center, University of Pittsburgh, PA 15219, USA.
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89
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Operations and pelvic muscle training in the management of apical support loss (OPTIMAL) trial: design and methods. Contemp Clin Trials 2008; 30:178-89. [PMID: 19130903 DOI: 10.1016/j.cct.2008.12.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 12/08/2008] [Accepted: 12/10/2008] [Indexed: 11/20/2022]
Abstract
The primary aims of this trial are: 1) to compare surgical outcomes following sacrospinous ligament fixation to uterosacral vaginal vault suspension in women undergoing vaginal surgery for apical or uterine pelvic organ prolapse and stress urinary incontinence and 2) to examine the effects of a structured perioperative program consisting of behavioral techniques and pelvic floor muscle training compared to usual care. This trial is performed through the Pelvic Floor Disorders Network (PFDN), which is funded by National Institute of Child Health and Human Development. Subjects will be enrolled from hospitals associated with seven PFDN clinical centers across the United States. A centralized biostatistical coordinating center will oversee data collection and analysis. Two approaches will be investigated simultaneously using a 2x2 randomized factorial design: a surgical intervention (sacrospinous ligament fixation versus uterosacral vaginal vault suspension) and a perioperative behavioral intervention (behavioral and pelvic floor muscle training versus usual care). Surgeons have standardized essential components of each surgical procedure and have met specific standards of expertise. Providers of the behavioral intervention have undergone standardized training. Anatomic, functional, and health-related quality of life outcomes will be assessed using validated measures by researchers blinded to all randomization assignments. Cost-effectiveness analysis will be performed using prospectively collected data on health care costs and resource utilization. The primary surgical endpoint is a composite outcome defined by anatomic recurrence, recurrence of bothersome vaginal prolapse symptoms and/or retreatment and will be assessed 2 years after the index surgery. Endpoints for the behavioral intervention include both short-term (6-month) improvement in urinary symptoms and long-term (2-year) improvement in anatomic outcomes and prolapse symptoms. This article describes the rationale and design of this randomized trial, focusing on several key design features of potential interest to researchers in the field of female pelvic floor disorders and others conducting randomized surgical trials.
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90
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91
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Biomaterials in the treatment of pelvic organ prolapse and stress urinary incontinence: An update. CURRENT BLADDER DYSFUNCTION REPORTS 2008. [DOI: 10.1007/s11884-008-0023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Fialkow MF, Newton KM, Weiss NS. Incidence of recurrent pelvic organ prolapse 10 years following primary surgical management: a retrospective cohort study. Int Urogynecol J 2008; 19:1483-7. [DOI: 10.1007/s00192-008-0678-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 06/10/2008] [Indexed: 11/28/2022]
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Medina CA, Candiotti K, Takacs P. Wide genital hiatus is a risk factor for recurrence following anterior vaginal repair. Int J Gynaecol Obstet 2008; 101:184-7. [PMID: 18215663 DOI: 10.1016/j.ijgo.2007.11.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 11/08/2007] [Accepted: 11/08/2007] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if a wide genital hiatus is a risk factor for recurrence of anterior vaginal wall prolapse following anterior vaginal repair. METHODS A retrospective cohort study was performed on patients who had undergone an anterior vaginal wall repair. Patients were placed into 1 of 2 groups: wide genital hiatus (> or =5 cm) or normal genital hiatus (<5 cm). The wide genital hiatus group (n=35) was compared with the normal genital hiatus group (n=30) for surgical failure. RESULTS There were no significant differences between the 2 groups in demographic data, additional operative procedures, or apical suspensions. The rate of postoperative anterior vaginal wall prolapse was greater in patients with a wide genital hiatus compared with those with a normal genital hiatus (34.3% vs 10% respectively; odds ratio 4.7 [95% confidence interval, 1.0-24.1]; P=0.02). CONCLUSION The rate of recurrent anterior vaginal wall prolapse is higher in patients with a wide genital hiatus.
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Affiliation(s)
- Carlos A Medina
- Department of Obstetrics and Gynecology, University of Miami, Miller School of Medicine, Miami, FL, USA.
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Kim CM, Jeon MJ, Chung DJ, Kim SK, Kim JW, Bai SW. Risk factors for pelvic organ prolapse. Int J Gynaecol Obstet 2007; 98:248-51. [PMID: 17408669 DOI: 10.1016/j.ijgo.2007.02.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Revised: 02/22/2007] [Accepted: 02/22/2007] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- C M Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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Borello-France DF, Handa VL, Brown MB, Goode P, Kreder K, Scheufele LL, Weber AM. Pelvic-floor muscle function in women with pelvic organ prolapse. Phys Ther 2007; 87:399-407. [PMID: 17341510 DOI: 10.2522/ptj.20060160] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine whether pelvic organ prolapse severity, pelvic symptoms, quality of life, and sexual function differ based on pelvic-floor muscle function in women planning to have prolapse surgery. SUBJECTS AND METHODS Three hundred seventeen women without urinary stress incontinence who were enrolled in a multicenter surgical trial were examined to determine pelvic-floor muscle function (by Brink scale score). The subjects were 61.6+/-10.2 (X+/-SD) years of age. Thirteen percent of the subjects had stage II (to the hymen) pelvic organ prolapse, 68% had stage III (beyond the hymen) prolapse, and 19% had stage IV (complete vaginal eversion) prolapse. Subjects with lowest (3-6) and highest (10-12) Brink scale scores were compared on prolapse severity, pelvic symptoms and bother, quality of life, and sexual function. RESULTS Subjects with the highest Brink scores (n=75) had less advanced prolapse, smaller genital hiatus measurements, and less urinary symptom burden compared with those with the lowest Brink scores (n=56). The results indicated that pelvic-floor muscle function was not associated with condition-specific quality of life or sexual function. DISCUSSION AND CONCLUSION Although modestly clinically significant, better pelvic-floor muscle function was associated with less severe prolapse and urinary symptoms.
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Affiliation(s)
- Diane F Borello-France
- Department of Physical Therapy, 111 Health Sciences Bldg, Duquesne University, Pittsburgh, PA 15282, USA.
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Diez-Itza I, Aizpitarte I, Becerro A. Risk factors for the recurrence of pelvic organ prolapse after vaginal surgery: a review at 5 years after surgery. Int Urogynecol J 2007; 18:1317-24. [PMID: 17333439 DOI: 10.1007/s00192-007-0321-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Accepted: 01/25/2007] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- I Diez-Itza
- Departamento de Obstetricia y Ginecología Secretaria Ginecología, Planta no.4, Edificio Materno-Infantil, Hospital Donostia, Paseo Beguiristain, 107-115, 20014 San Sebastian, Guipuzcoa, Spain.
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