Relationship of Decubitus Ulcer on Cervix in Pelvic Organ Prolapse with POP-Q Staging

Study of the Relationship Between Pelvic Organ Prolapse Quantification (POP-Q) Staging and Decubitus Ulcer in Pelvic Organ Prolapse

Introduction

The protrusion of pelvic organs and their associated vaginal segments into or through the vagina is called pelvic organ prolapse (POP). One of the worrisome complications of POP is decubitus ulcer.It is a feature of old, long-standing prolapse. The standardized pelvic organ prolapse quantification (POP-Q) system of classification was proposed by the International Incontinence Society (ICS) for staging pelvic organ prolapse in 1996. This system is a clear and reproducible quantification method and has more inter-observer and intra-observer reliability. This study was designed to determine the relationship of the POP-Q stage with the presence and size of decubitus ulcer.

Methods

A total of 92 cases with pelvic organ prolapse were included in the study. We examined our patients by the POP-Q method and measured the dimension of the decubitus ulcer if present.

Results

Out of the 92 patients included in the study, 32 cases had a decubitus ulcer. As the POP-Q stage increased, the number of patients with a decubitus ulcer also increased. We also observed that larger dimension (>6 cm²) decubitus ulcers are present in stage 3 and stage 4 POP. A statistically significant correlation was observed between the POP-Q stage and the size of the decubitus ulcer, r_s=0.607, p<0.001.

Conclusion

A decubitus ulcer becomes more common as the POP-Q stage increases. The size of the ulcer also increases with the advancing stage of POP-Q.

Fractional Pixel CO2 laser treatment for decubitus ulcer in advanced pelvic organ prolapse: a case report

OBJECTIVE

Cervicovaginal decubitus ulceration is a complication of advanced pelvic organ prolapse that is very difficult to manage. Here, we report on the effectiveness of fractional CO2 laser treatment for a wide decubitus ulcer over an apical vaginal vault prolapse.

METHODS

We report a case of a postmenopausal woman with a wide decubitus ulcer over a vaginal vault prolapse. A fractional microablative CO2 Pixel laser system (Alma Lasers, Cesarea, Israel), equipped with an appropriate probe for the vulva, was used to treat the ulceration of a 78-year-old patient across three laser sessions with 30-day intervals.

RESULTS

A significant improvement in the decubitus ulcer was noted in a check-up held 2 months after the final laser session, with approximately 95% wound healing observed. No side effects were reported during or after the laser therapy.

CONCLUSIONS

This case demonstrates that fractional Pixel CO2 laser treatment is a viable option for managing decubitus ulcers before definitive surgery in postmenopausal women with advanced pelvic organ prolapse.

Total colpocleisis technique in huge neglected ulcerated uterovaginal prolapse

INTRODUCTION AND HYPOTHESIS

We present a video describing the technical considerations for performing a total colpocleisis in the management of significant, neglected, ulcerated, and symptomatic complete uterovaginal prolapse.

METHODS

A 79-year-old debilitated woman presented with a large, ulcerated pelvic bulge. A previous attempt at pessary treatment failed because of a disproportion of the pessary with the prolapse size. She had a history of liver insufficiency and hypertension. Obliterative colpocleisis surgery was selected because the healing of a large ulcerated vagina was not likely within a short timeframe. Sharp dissection with scissors and de-epithelialisation of the remaining non-eroded vaginal mucosa with the friction of a sharp-edged surgical knife were performed. Closely located purse strings were used to obliterate potential spaces. Two mirror image triangles in the anterior and posterior vaginal walls were removed. After the formation of a new perineal body, the diamond-shaped vaginal incision was closed vertically to narrow introitus.

RESULTS

The patient was discharged on the first postoperative day and an uncomplicated postoperative course ensued. At the 4-week follow-up, there was no evidence of infection, recurrent prolapse, de novo stress incontinence, or voiding with difficulty.

CONCLUSIONS

Total colpocleisis is an excellent surgical option in women with multiple, large cervicovaginal ulcers and multiple comorbidities with no desire for penetrative vaginal function.