Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019

Mental illness and sleep disorders among women with gynecological problems

This retrospective cohort study identifies differences between rates of selected mental illnesses and sleep disorders according to eight gynecological problems. Analyses utilize medical claims data for adult employees of a large corporation during 2017-2021. Women with a gynecological problem (most notably pain, endometriosis, pelvic inflammation and bleeding) are significantly more likely to experience mental illness. Several gynecological problems are also significantly associated with sleep disorders. Women with a gynecological problem (vs. none) are 50% more likely to have a mental health problem and 44% more likely to have a sleep disorder after adjusting for age, marital status, dependent children and year. The largest differences between higher (%) mental illness and sleep disorders appear for hyperplasia (6% vs. 45%), cancer (11% vs. 68%), pelvic inflammation (46% vs. 79%) and pain (79% vs. 43%), respectively. On the other hand, the rate of having one or more gynecological problems ranges from 7.1% for women with no mental illness or sleep disorder to 20.6% for women with schizophrenia. Understanding the association between gynecological problems, mental illness and sleep disorders can help clinicians more effectively identify and treat patients.

Building a pelvic organ prolapse diagnostic model using vision transformer on multi-sequence MRI

BACKGROUND

Although the uterus, bladder, and rectum are distinct organs, their muscular fasciae are often interconnected. Clinical experience suggests that they may share common risk factors and associations. When one organ experiences prolapse, it can potentially affect the neighboring organs. However, the current assessment of disease severity still relies on manual measurements, which can yield varying results depending on the physician, thereby leading to diagnostic inaccuracies.

PURPOSE

This study aims to develop a multilabel grading model based on deep learning to classify the degree of prolapse of three organs in the female pelvis using stress magnetic resonance imaging (MRI) and provide interpretable result analysis.

METHODS

We utilized sagittal MRI sequences taken at rest and during maximum Valsalva maneuver from 662 subjects. The training set included 464 subjects, the validation set included 98 subjects, and the test set included 100 subjects (training set n = 464, validation set n = 98, test set n = 100). We designed a feature extraction module specifically for pelvic floor MRI using the vision transformer architecture and employed label masking training strategy and pre-training methods to enhance model convergence. The grading results were evaluated using Precision, Kappa, Recall, and Area Under the Curve (AUC). To validate the effectiveness of the model, the designed model was compared with classic grading methods. Finally, we provided interpretability charts illustrating the model's operational principles on the grading task.

RESULTS

In terms of POP grading detection, the model achieved an average Precision, Kappa coefficient, Recall, and AUC of 0.86, 0.77, 0.76, and 0.86, respectively. Compared to existing studies, our model achieved the highest performance metrics. The average time taken to diagnose a patient was 0.38 s.

CONCLUSIONS

The proposed model achieved detection accuracy that is comparable to or even exceeds that of physicians, demonstrating the effectiveness of the vision transformer architecture and label masking training strategy for assisting in the grading of POP under static and maximum Valsalva conditions. This offers a promising option for computer-aided diagnosis and treatment planning of POP.

Effect of Body Mass Index on Complications After Vaginal and Laparoscopic Apical Prolapse Surgery

INTRODUCTION AND HYPOTHESIS

Obesity is increasing worldwide, and data are limited on how body mass index (BMI) affects surgical risk in pelvic organ prolapse. This study is aimed at evaluating the impact of obesity on outcomes after apical pelvic organ prolapse surgery. We hypothesize that obese patients have higher rates of postoperative complications.

METHODS

This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program database from 2014 to 2018. Current Procedural Terminology codes identified subjects aged 18-89 who underwent apical prolapse repair, including vaginal colpopexy and laparoscopic or robotic sacrocolpopexy. Minor and major complications were analyzed using the World Health Organization BMI category. Regression analysis was performed to adjust for confounders.

RESULTS

The total cohort was 24,718 with 15,137 vaginal colpopexy and 9,581 laparoscopic/robotic sacrocolpopexy. The average age was 60.1, 76.5% were white, 24.2% were American Society of Anesthesiologists (ASA) class 3 or 4, and 44.7% had a major medical comorbidity. Eight hundred and eighty-five patients (5.4%) experienced a minor complication, 324 (2.0%) a major complication, and 1,167 (7.2%) any complication. There was no difference in any, major, or minor complication by BMI and this persisted after adjusting for age, race, ASA class, smoking, and surgical approach.

CONCLUSIONS

There is no difference in complication rates after apical prolapse surgery by BMI regardless of age, race, ASA class, smoking use, and surgical approach. Patients and surgeons should be reassured that minimally invasive apical prolapse surgery is safe, with low complication rates. Randomized controlled trials are needed to verify these findings.

Risk Factors of Pelvic Floor Disorders Among Women in Rural Nepal: A Case-Control Study

INTRODUCTION AND HYPOTHESIS

Risk factors for pelvic floor disorders (PFDs) are not well understood in lower resource settings. The objective of this study is to determine the risk factors associated with stress urinary incontinence (SUI), urge urinary incontinence (UUI), and pelvic organ prolapse (POP) among women of reproductive age in rural Nepal.

METHODS

This is a case-control study nested within a community-based cross-sectional survey of parous women of reproductive age with PFDs in the Sarlahi District of Nepal. The presence of PFDs was confirmed by clinical assessment. Detailed sociodemographic information and histories were captured.

RESULTS

We examined 406 women; the mean (SD, range) age was 32.7 (8.5, 16-49) years, mean BMI (SD) was 19.7 (3.3) kg/m2, and median (range) number of pregnancies was 4 (1-11). Two hundred and three women (50.0%) had either SUI or UUI, 85 (17.8%) had both SUI and UUI, and 71 (17.5%) had POP at or beyond the hymen. After controlling for other variables significant on bivariate analysis, age (adjusted odds ratio [aOR] 1.06 [95% CI 1.03-1.09]), illiteracy (aOR 2.24 [95% CI 1.04-4.80]), and presence of upper gastrointestinal issues (aOR 3.30, [95% CI 1.77-6.16]) were independently associated with SUI/UUI. Age (aOR 1.05 [95% CI 1.02-1.09]), bispinous diameter (aOR 2.88 ([95% CI 1.11-7.47]), and subpubic angle (aOR 2.78 [95% CI 1.55-5.03]) were independently associated with POP.

CONCLUSION

Risk factors for PFDs in a homogenous community of parous women of reproductive age in rural Nepal are similar to those found in parous women in higher income countries.

Identifying Current Barriers in Patient Educational Content Surrounding Rectal Prolapse and Rectocele: Using Animation to Bridge the Gaps

BACKGROUND

Patient-centered educational resources surrounding rectal prolapse and rectocele can be difficult to locate and understand. Findings of video animation as patient-specific material for these conditions can help guide the creation of effective educational tools for patients.

OBJECTIVE

To identify female patient preferences for learning about rectal prolapse and rectocele and to obtain feedback on an animation developed to aid patient education on these conditions.

DESIGN

This was a multiple-methods study. Participants received a 20-question survey about educational preferences and a 100-second video animation on rectal prolapse and rectocele. Respondents were invited for a semistructured interview to further express their thoughts regarding health education.

SETTING

This study was conducted from 2022 to 2023. Surveys were administered via e-mail, and interviews were held virtually.

PATIENTS

Female patients in the institutional review board-approved Stanford Rectal Prolapse Registry were included.

MAIN OUTCOME MEASURES

Assess and describe the ability of short video animations to supplement patient education on rectal prolapse and rectocele.

RESULTS

Forty-six female participants responded and 10 were interviewed. About 97% of participants indicated that the video animation explained the condition clearly and 66% felt comfortable explaining the condition. During feedback, participants recommended showing the animation during the first appointment and creating similar content for surgery preparation. Patient challenges while researching rectal prolapse and rectocele online included difficulty finding content (41.5%), complex language (18.8%), and uncertainty about source reliability (16.9%).

LIMITATIONS

Small sample size with little socioeconomic diversity and highly educated participants.

CONCLUSIONS

Patient-centered resources surrounding specific pelvic floor disorder(s) are not always readily accessible online. This study demonstrated the value of a short video animation to enhance patients' understanding of rectal prolapse and rectocele. See Video Abstract .

IDENTIFICACIN DE BARRERAS ACTUALES EN EL CONTENIDO EDUCATIVO PARA PACIENTES EN TORNO AL PROLAPSO RECTAL Y RECTOCELE USO DE LA ANIMACIN PARA CERRAR LAS BRECHAS

ANTECEDENTES:Los recursos educativos centrados en el paciente sobre el prolapso rectal y el rectocele pueden ser difíciles de localizar y comprender. Los hallazgos de la animación en vídeo como material específico para estos pacientes pueden ayudar a guiar la creación de herramientas educativas efectivas para los pacientes.OBJETIVO:Identificar las preferencias de las pacientes para aprender sobre el prolapso rectal y el rectocele y obtener retroalimentación sobre una animación desarrollada para ayudar a la educación del paciente sobre estas condiciones.DISEÑO:Este fue un estudio de métodos múltiples. Los participantes recibieron una encuesta de 20 preguntas sobre preferencias educativas y un vídeo de animación de 100 segundos sobre el prolapso rectal y el rectocele. Se invitó a los encuestados que respondieron a una entrevista semiestructurada para expresar sus opiniones sobre la educación sanitaria.ESCENARIO:Este estudio se realizó entre 2022 y 2023, las encuestas se administraron por correo electrónico y las entrevistas se realizaron virtualmente.PACIENTES:Se incluyeron pacientes mujeres en el Registro de Prolapso Rectal de Stanford aprobado por el IRB.PRINCIPALES MEDIDAS DE RESULTADO:Evaluar y describir la capacidad de animaciones de video corto para complementar la educación del paciente sobre el prolapso rectal y el rectocele.RESULTADOS:Respondieron 46 mujeres participantes y 10 fueron entrevistadas. Alrededor del 97% de los participantes indicaron que la video-animación explicaba la afección con claridad y el 66% se sentía cómoda explicando dicha afección. En los comentarios de retroalimentación sugirieron mostrar la animación durante la primera cita y crear contenido similar para la preparación de la cirugía. Los desafíos de los pacientes al investigar el prolapso rectal y el rectocele en línea incluyeron dificultad para encontrar contenido (41.5%), lenguaje complejo (18.8%) e incertidumbre sobre la confiabilidad de la fuente (16.9%).LIMITACIONES:Tamaño de muestra pequeño con poca diversidad socioeconómica y participantes con alto nivel educativo.CONCLUSIONES:Los recursos centrados en el paciente sobre trastornos específicos del piso pélvico no siempre son fácilmente accesibles en línea. Este estudio demostró el valor de un vídeo de animación breve para mejorar la comprensión de los pacientes sobre el prolapso rectal y el rectocele. (Traducción-Dr. Jorge Silva Velazco ).

Validation of the Lithuanian version of the Prolapse Quality-of-Life questionnaire

INTRODUCTION AND HYPOTHESIS

We aimed to translate and validate the Lithuanian version of the Prolapse Quality-of-Life (P-QOL) questionnaire.

METHODS

The P-QOL questionnaire was translated into Lithuanian and administered to women recruited from a gynaecology outpatient clinic at a tertiary referral centre. The scores of the final version were compared in symptomatic (n = 137) and asymptomatic (n = 137) women and with findings on vaginal examination using the Pelvic Organ Prolapse Quantification system. The reliability was assessed by calculating Cronbach's alpha and by performing a test-retest analysis.

RESULTS

There was a significant difference in median score for each P-QOL domain between symptomatic and asymptomatic women (p < 0.001). P-QOL scores correlated significantly with the stage of urogenital prolapse in most domains. High internal consistency was shown in all domains with a Cronbach's alpha range of 0.775 to 0.958, except for the "social limitations" domain, which was shown to be acceptable (0.647). Test-retest reliability was also high in all domains (p < 0.05).

CONCLUSION

The Lithuanian version of the P-QOL questionnaire has proven to be a valid, reliable and easily comprehensible instrument for assessing symptom severity and impact on the quality of life of Lithuanian-speaking women with urogenital prolapse.

Complications of Pelvic Prolapse Surgery Using Mesh: A Systematic Review

BACKGROUND

Pelvic organ prolapse (POP) is a public health problem that influences millions of women around the globe, and it has a significant impact on the quality of life. From the FDA statement regarding the complications of using mesh implants in POP surgery to studies that have shown the benefits and side effects, we conducted a systematic review investigating the complications associated with surgical mesh implantation for POP repair.

METHODS

Relevant studies were identified through a comprehensive search of scientific databases. Studies evaluating the use of mesh in POP surgery and reporting on associated complications were included.

RESULTS

Among 2816 studies, 28 studies met the research criteria, with a total number of 8958 patients, revealing that in laparoscopic mesh surgery, the rate of mesh exposure was lower compared to vaginal mesh surgery, among other complications.

CONCLUSIONS

Laparoscopic mesh surgery is superior as a long-term approach for POP repair compared to vaginal mesh surgery, offering lower complication rates and potentially better anatomical success. However, vaginal mesh surgery remains a valuable option for patients who are unsuitable for laparoscopy due to specific factors. Future research should explore alternative techniques, like pectopexy with or without mesh, to further improve surgical outcomes and patient experience.

Global, regional, and national burden of premenstrual syndrome, 1990-2019: an analysis based on the Global Burden of Disease Study 2019

STUDY QUESTION

What is the burden of premenstrual syndrome (PMS) at the global, regional, and national levels across 21 regions and 204 countries and territories?

SUMMARY ANSWER

Over the past few decades, the global prevalent cases of PMS have grown significantly from 652.5 million in 1990 to 956.0 million in 2019, representing a 46.5% increase.

WHAT IS KNOWN ALREADY

PMS, which affects almost half of reproductive women worldwide, has substantial social, occupational, academic, and psychological effects on women's lives. However, no comprehensive and detailed epidemiological estimates of PMS by age and socio-demographic index (SDI) at global, regional, and national levels have been reported.

STUDY DESIGN, SIZE, DURATION

An age- and SDI-stratified systematic analysis of the prevalence and years lived with disability (YLD) of PMS by age and SDI across 21 regions and 204 countries and territories has been performed.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The prevalence and YLD of PMS from 1990 to 2019 were retrieved directly from the Global Burden of Diseases (GBD) 2019 study. The number, rates per 100 000 persons, and average annual percentage changes (AAPCs) of prevalence and YLD were estimated at the global, regional, and national levels.

MAIN RESULTS AND THE ROLE OF CHANCE

Globally, the prevalent cases of PMS increased by 46.5% from 652.5 million in 1990 to 956.0 million in 2019; in contrast, however, the age-standardized prevalence rate was approximately stable at 24 431.15/100 000 persons in 1990 and 24 406.51/100 000 persons in 2019 (AAPC, 0[95% CI: -0.01 to 0.01]). Globally, the YLD was 8.0 million in 2019 and 5.4 million in 1990, with a sizable increase over the past 30 years. The age-standardized YLD rate was stable (AAPC 0.01, P = 0.182), at 203.45/100 000 persons in 1990 and 203.76/100 000 persons in 2019. The age-standardized burden estimates were the highest in the low-middle SDI regions and the lowest in the high SDI regions. Peaks in burden rate estimates were all observed in the 40-44 years age group. Regional age-standardized burden estimates were the highest in South Asia and the lowest in Western Sub-Saharan Africa. The national age-standardized burden estimates were the highest in Pakistan and the lowest in Niger.

LIMITATIONS, REASONS FOR CAUTION

The accuracy of the results depended on the quality and quantity of the GBD 2019 data. Fortunately, the GBD study endeavoured to retrieve data globally and applied multiple models to optimize the completeness, accuracy, and reliability of the data. In addition, the GBD study took the country as its basic unit and neglected the influence of race. Further study is warranted to compare differences in PMS burden associated with race. Finally, no data are available on the aetiology and risk information related to PMS, which might help us to better understand the trends and age distribution of PMS and help local governments formulate more detailed policies and comprehensive interventions.

WIDER IMPLICATIONS OF THE FINDINGS

Although the age-standardized prevalence/YLD rate has been stable over the past 30 years, the absolute number of prevalent cases and YLD grew significantly worldwide from 1990 to 2019. Public health-related policies should be implemented to reduce the prevalence and alleviate the symptoms of PMS. Lifestyle changes and cognitive-behavioral therapy are critical in helping to reduce the burden of PMS.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the National Key Research and Development Program of China (grant number 2022YFC2704100) and the National Natural Science Foundation of China (No. 82001498, No. 82371648). The authors declare no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Global burden and trends in female premenstrual syndrome study during 1990-2019

PURPOSE

Premenstrual syndrome (PMS) is prevalent worldwide and considered a crucial issue regarding women's health. In the present study, the Global Burden of Disease (GBD) Study 2019 dataset was utilized to assess the distributional trends in PMS burden and prevalence in regional, national, and sociodemographic index (SDI) categories.

METHODS

The analytical methods and approaches used in the 2019 GBD study were adopted to investigate the incidence rates and disability-adjusted life years (DALY) related to PMS in 204 countries or regions. Age-standardized incidence rates (ASIR), 95% uncertainty intervals (95% UI), and annual percentage changes (EAPC) were calculated from the data.

RESULTS

The global incidence and disability-adjusted life years of PMS exhibited a declining trend in the year 2019. Regions with medium-low SDI had the greatest burden of PMS, with the regions of South Asia (ASR = 7337.9 per 10,000) exhibiting the greatest Age-standardized incidence rates, while the high-income North American states presented the fastest upward trends in Age-standardized disability-adjusted life year rates. At the national level, 107 nations exhibited a decreasing trend in PMS incidence ASR, while 97 nations exhibited an increasing trend, with the United States presenting the greatest increase.

CONCLUSIONS

The present study highlighted that even though the global PMS incidence and disability-adjusted life years have decreased from the year 1990 to 2019, PMS remains a prevalent health concern for women worldwide. While addressing preventive measures and treatment, it is also important to consider the regional and national differences in PMS to develop further effective and targeted health policies.

Roles and mechanisms of biomechanical-biochemical coupling in pelvic organ prolapse

Pelvic organ prolapse (POP) is a significant contributor to hysterectomy among middle-aged and elderly women. However, there are challenges in terms of dedicated pharmaceutical solutions and targeted interventions for POP. The primary characteristics of POP include compromised mechanical properties of uterine ligaments and dysfunction within the vaginal support structure, often resulting from delivery-related injuries. Fibroblasts secrete extracellular matrix, which, along with the cytoskeleton, forms the structural foundation that ensures proper biomechanical function of the fascial system. This system is crucial for maintaining the anatomical position of each pelvic floor organ. By systematically exploring the roles and mechanisms of biomechanical-biochemical transformations in POP, we can understand the impact of forces on the injury and repair of these organs. A comprehensive analysis of the literature revealed that the extracellular matrix produced by fibroblasts, as well as their cytoskeleton, undergoes alterations in patient tissues and cellular models of POP. Additionally, various signaling pathways, including TGF-β1/Smad, Gpx1, PI3K/AKT, p38/MAPK, and Nr4a1, are implicated in the biomechanical-biochemical interplay of fibroblasts. This systematic review of the biomechanical-biochemical interplay in fibroblasts in POP not only enhances our understanding of its underlying causes but also establishes a theoretical foundation for future clinical interventions.

Global burden and risk factors of gastritis and duodenitis: an observational trend study from 1990 to 2019

In recent years, there has been a global trend of aging, which has resulted in significant changes to the burden of gastritis and duodenitis (GD). Using the global burden of disease (GBD) database spanning 1990 to 2019, we evaluated the temporal trends of age-standardized incidence rates (ASIR), age-standardized death rates (ASDR), and age-standardized disability-adjusted life years (AS-DALYs) for GD using estimated annual percentage changes (EAPC). Additionally, we examined the burden of GD across various strata, including social demographic index (SDI), age, and sex. Finally, the risk factors linked to the incidence and mortality of GD, utilizing Pearson correlation analysis. In 2019, there were 31 million GD patients globally, a notable increase of 12 million from 1990, while the ASIR, ASDR, and AS-DALYs for GD all showed a decrease. Correlation analysis showed a significant negative relationship between ASIR and SDI. Factors like hand hygiene and vitamin A deficiency had significant positive correlations with ASIR and ASDR in 2019. Over the past thirty years, the burden of GD has increased alongside global population aging. Future efforts should focus on exploring prevention for GD, with special attention to the elderly population in low SDI regions.

Attitudes Toward Hysterectomy in Saudi Arabian Women Undergoing Evaluation for Uterovaginal Prolapse: A Cross-Sectional Study

BACKGROUND

 Hysterectomy is an effective management approach for uterovaginal prolapse. However, the decision to undergo hysterectomy is a complex matter, influenced not only by medical factors but also cultural beliefs, societal norms, and individual attitudes. In Saudi Arabia, a nation with its distinctive cultural and social norms, the understanding of women's attitudes toward hysterectomy is of utmost importance. Unfortunately, such related attitudes have not been explored.

OBJECTIVE

This first-ever study aimed to investigate the attitudes toward hysterectomy among Saudi Arabian women undergoing evaluation for uterovaginal prolapse, by exploring the factors influencing their decision-making process and treatment choices, with a particular focus on the potential impact of cultural beliefs and societal norms.

METHODS

A survey was conducted among 404 women referred for uterovaginal prolapse evaluation. The participants completed a self-administered questionnaire, which included demographic information, perceptions on hysterectomy's impact on well-being, and factors affecting decision-making.

RESULTS

The mean ± standard deviation of participants was 51.07 ± 11.1 years. Most participants were currently married (n=327, 81%), were unemployed (n=309, 76.5%), and had an "excellent" self-rated general health status (n=138, 34%). Current prolapse management methods included Kegel exercises (n=103, 25.5%), pessary use (n=32, 8%), physical therapy (n=12, 3%), planned surgery (n=75, 18.5%), and no specific treatment (n=182, 45%). Overall, the study revealed diverse findings on the potential perceived impact of hysterectomy on different aspects of well-being. Notably, for pain symptoms, 152 participants (38%) reported potential improvement, while 123 participants (30%) predicted worsening, and 129 participants (32%) anticipated no change. Moreover, the study unveiled insights into the factors influencing patients' decision-making between hysterectomy and uterine-sparing procedures. Remarkably, 97 respondents (24%) considered the doctor's opinion to be "very Important," while 91 respondents (22%) rated the impact on surgical complication risk as "very important." Furthermore, the desire to preserve all healthy organs was deemed "very important" by 106 respondents (26%). The resources of information women depended on when making a decision to undergo hysterectomy varied and included a second opinion from another physician (n=68, 17%), social media (n=81, 20%), opinion from spouse/partner (21%), second opinion from female family members (n=99, 25%), and opinion from friends (n=70, 17%). Regarding preferences for decision-making, the responses varied substantially. Overall, 65 participants (16%) indicated a preference for their doctor to make the decision entirely, 81 participants (20%) preferred shared decision-making with their doctor, 89 participants (22%) wanted their doctor to make the decision after considering their input, 77 participants (19%) wished to make the final decision after discussing it with their doctor, and 93 participants (23%) expressed a preference for independently making the final decision. Lastly, correlations between women's responses and some demographic factors were identified.

CONCLUSION

This pioneering study provides valuable insights into Saudi Arabian women's attitudes toward hysterectomy, emphasizing the need for patient-centered care and culturally sensitive approaches in managing uterovaginal prolapse.

Global burden and trends of ectopic pregnancy: An observational trend study from 1990 to 2019

BACKGROUND

Ectopic pregnancy (EP) is one of the leading causes of death in women in early pregnancy, and the mortality of EP have gradually decreased over time in developed countries such as the United Kingdom and the United States. However, epidemiological information on EP has been lacking in recent years, so we analyzed EP data over a thirty-year period from 1990-2019 with the help of Global Burden of Disease study (GBD) data to fill this gap.

METHODS

According to the EP data in GBD for the three decades from 1990 to 2019, we used estimated annual percentage changes (EAPC) to assess the trend of age-standardized incidence rate (ASIR), age-standardized death rate (ASDR) and age-standardized disability adjusted life years (AS-DALYs) trends in EP and to explore the correlation between socio-demographic index (SDI) stratification, age stratification and EP.

RESULTS

Global ASIR, ASDR, AS-DALYs for EP in 2019 are 170.33/100,000 persons (95% UI: 133.18 to 218.49), 0.16/100,000 persons (95% UI, 0.14 to 0.19) and 9.69/100,000 persons (95% UI, 8.27 to 11.31), respectively. At the overall level, ASDR is significantly negatively correlated with SDI values (R = -0.699, p < 0.001). Besides that, ASDR and AS-DALYs have basically the same pattern. In addition, iron deficiency is one of the risk factors for EP.

CONCLUSIONS

In the past three decades, the morbidity, mortality and disease burden of EP have gradually decreased. It is noteworthy that some economically disadvantaged areas are still experiencing an increase in all indicators, therefore, it is more important to strengthen the protection of women from ethnic minorities and low-income groups.

Potential molecular targets for intervention in pelvic organ prolapse

Pelvic organ prolapse (POP) is a concerning gynecological benign illness in middle-aged and senior women. Its etiology is complex, the incidence rate is high, symptoms are clinically subjective, and its influence tends to be polarized. At present, for those who need medical treatment, whether surgical or non-surgical, complications cannot be ignored, and treatment effect needs to be optimized. However, there is a lack of accurate molecular biological interventions for the prevention, diagnosis, progression delay, and treatment of POP. Here, we reviewed the current state of understanding of the molecular mechanisms and factors associated with POP etiology. These factors include cyclins, matrix metal peptidases/tissue inhibitors of metalloproteinases, microRNAs, homeobox A11, transforming growth factor β1, insulin-like growth factor 1, fibulin 5, lysyl oxidase-like 1, oxidative stress, inflammatory response, estrogen, and other potential biomarkers associated with POP. In addition, relevant molecular targets that may be used to intervene in POP are summarized. The aim of this review was to provide more information to identify accurate potential biomarkers and/or molecular targets for the prevention, diagnosis, progression delay, and treatment of POP, with the goal of improving medical treatment for patients at-risk for POP or having POP. Continued research is needed to identify additional details of currently accepted molecular mechanisms and to identify additional mechanisms that contribute to POP.

Vesical Calculi and Female Pelvic Organ Prolapse: A Case Report and Literature Review

This study presents a case report and reviews the literature on the simultaneous occurrence of advanced uterovaginal prolapse and urolithiasis, aiming to provide a comprehensive analysis of the reported cases. A thorough search was conducted in PubMed and Google Scholar; the search strategy included specific keywords and terms related to both conditions aiming to identify relevant case reports describing the association between advanced uterovaginal prolapse and urolithiasis; a total of 22 case reports were found in English literature. We present a case report of a 56-year-old woman, para 4, presenting with complaints of vaginal bulge and urinary symptoms. Upon examination, a complete procidentia with superficial ulceration was observed. During the reduction of the uterus, multiple small stones were noted coming through the urethral meatus. The patient underwent a vaginal hysterectomy, and the bladder stone was successfully extracted through vaginal cystotomy without complications. Our case report highlights the association between vesical calculi and female high-grade pelvic organ prolapse. Managing bladder stones in the context of pelvic organ prolapse can be challenging and vary significantly, reflecting the individual patient characteristics and surgeon preferences. The lack of standardized guidelines for managing bladder stones in the presence of pelvic organ prolapse highlights the need for further research.

Static and Dynamic Magnetic Resonance Imaging in Female Pelvic Floor Dysfunction: Correlation With Pelvic Organ Prolapse Quantification

BACKGROUND

Pelvic organ prolapse (POP) is clinically assessed and staged commonly by the pelvic organ prolapse quantification (POP-Q) system. Dynamic magnetic resonance imaging (MRI) of the pelvic floor is an emerging modality for anatomical and functional assessment of the pelvic floor and staging of POP. The purpose of this study was to correlate the dynamic MRI findings with POP-Q examination for the staging of POP in each pelvic compartment by comparing various anatomic points.

METHODS

A prospective observational study of the comparative cross-sectional design was conducted among patients who underwent MRI of the pelvic floor and POP-Q at our institute. A total of 50 patients were included. Anatomical landmarks in the three compartments were analyzed in relation to standard reference lines on dynamic MRI and compared with POP-Q measurements.

RESULTS

Most of our patients had multicompartment disease (70%). When compared to POP-Q, MRI has a strong correlation for quantification of anterior (0.723) and middle (0.525) compartments and a weak correlation (0.232) for posterior compartment prolapse.

CONCLUSION

POP-Q examination is based on the various points within the vaginal canal, and all the points do not represent a true anatomic landmark. MRI, on the other hand, is based on a true anatomical plane and gives detailed information about various structures in all three compartments. Thus, MRI also helps bridge the gap between various referring specialties in treating pelvic floor disorders.

The prevalence of pelvic organ prolapse and associated factors in Ethiopia: a systematic review and meta-analysis

Background

Pelvic organ prolapse (POP) affects millions of women globally, with resource-limited countries, such as Ethiopia, carrying the highest burden. Previously, the prevalence of POP was estimated using seven studies. However, this study lacks generalization because of the limited number of studies and low geographical representation. In total, 12 additional primary studies were conducted after this review, and their reported prevalence was significantly variable across the studies. In addition, different new factors were reported in the primary studies. Therefore, this study aimed to update the pooled prevalence of POP and its associated factors in Ethiopia.

Methods

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles that were published between 2000 and 2023 were searched using the African Journal of Online, ScienceDirect, DOAJ, PubMed, and Google Scholar. The quality of the studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted using Microsoft Excel and analyzed by Stata version 11. A random effect model was used to investigate the pooled prevalence of POP and its associated factors. The I2 test and Egger's regression test were used to detect the presence of heterogeneity and publication bias across studies, respectively.

Result

A total of 21 studies met the inclusion criteria and represented the data of 14,575 women. The pooled prevalence of POP was found to be 22.70%. History of home delivery (pooled odds ratio (OR) =2.93, 95% CI =1.46, 5.91), prolonged labor (OR = 4.63, 95% CI = 2.56, 8.38), history of perineal tear (OR = 4.83, 95% CI = 2.31, 10.11), instrumental delivery (OR =3.70, 95% CI =2.01, 6.81), grand multipara (OR = 5.42, 95% CI = 4.06, 7.23), family history of POP (OR = 3.30, 95% CI = 2.07, 5.25), and carrying heavy objects (OR = 3.23, 95% CI = 2.22, 4.70) were significantly associated with POP.

Conclusion

The pooled prevalence of POP was high in Ethiopia. The Ministry of Health and clinicians should emphasize counseling on modifiable risk factors and develop further prevention strategies.

Long-term menopause exacerbates vaginal wall support injury in ovariectomized rats by regulating amino acid synthesis and glycerophospholipid metabolism

Purpose

Menopause is a risk factor for pelvic organ prolapse (POP) and is frequently associated with diminished vaginal wall support. To uncover relevant molecular mechanisms and provide potential therapeutic targets, we evaluated changes in the transcriptome and metabolome of the vaginal wall in ovariectomized rats to identify important molecular changes.

Methods

Sixteen adult female Sprague-Dawley rats were randomly assigned to either the control or menopause group. Seven months after the operation, hematoxylin and eosin (H&E) staining and Masson trichrome staining were used to observe changes in the rat vaginal wall structure. Differentially expressed genes (DEGs) and metabolites (DEMs) in the vaginal wall were detected by RNA-sequencing and LC-MS, respectively. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses of DEGs and DEMs were performed.

Results

We verified that long-term menopause causes vaginal wall injury by H&E and Masson trichrome staining. From the multiomics analyses, 20,669 genes and 2193 metabolites were identified. Compared with the control group, 3255 DEGs were found in the vaginal wall of long-term menopausal rats. Bioinformatics analysis showed that the DEGs were mainly enriched in mechanistic pathways, including cell-cell junction, extracellular matrix, muscle tissue developments, the PI3K-Akt signaling pathway, the MAPK signaling pathway, tight junctions and the Wnt signaling pathway. Additionally, 313 DEMs were found, and they consisted mostly of amino acids and their metabolites. DEMs were also enriched in mechanistic pathways, such as glycine, serine and threonine metabolism, glycerophospholipid metabolism, gap junctions and ferroptosis. Coexpression analysis of DEGs and DEMs revealed that biosynthesis of amino acids (isocitric acid and PKM) and glycerophospholipid metabolism (1-(9Z-hexadecenoyl)-sn-glycero-3-phosphocholine and PGS1) are critical metabolic pathways, suggesting that POP induced by menopause may be associated with the regulation of these processes.

Conclusion

The findings showed that long-term menopause greatly exacerbated vaginal wall support injury by decreasing the biosynthesis of amino acids and interfering with glycerophospholipid metabolism, which may result in POP. This study not only clarified that long-term menopause exacerbates damage to the vaginal wall but also provided insight into the potential molecular mechanisms by which long-term menopause induces POP.

Rate of Postoperative Urinary Retention after Anterior Compartment Prolapse Surgery: A Randomized Controlled Trial Comparing Early versus Conventional Transurethral Catheter Removal

BACKGROUND

Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior compartment prolapse-related surgeries. As we know, postoperative urinary retention (POUR) is one of the most common complications following pelvic floor surgery. To prevent this complication, indwelling bladder catheterization is routinely applied. In contrast, to minimize risk of infection and the patient's discomfort, the catheter should be removed as soon as possible. However, there is a lack of clarity regarding the optimal timing for catheter removal. Therefore, the aim of this trial is to compare the rate of POUR after anterior prolapse surgery between early transurethral catheter removal (24 h postoperatively) and our standard practice (on postoperative day 3).

METHODS

We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed, and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction. Analysis was performed according to the intention to treat principle. The calculated sample size was 68 patients (34 patients in each group) for a 95% confidence interval, 80% power, 5% probability of type I error, and 10% data loss.

DISCUSSION

This study demonstrated that early catheter removal was comparable in POUR rate to conventional treatment with shorter hospitalization among patients undergoing anterior compartment prolapse surgery. Additionally, we observed no re-hospitalization owing to POUR. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse-related surgery.

Multiparity and Aging Impact Chondrogenic and Osteogenic Potential at Symphyseal Enthesis: New Insights into Interpubic Joint Remodeling

Pregnancy and childbirth cause adaptations to the birth canal to allow for delivery and fast recovery. To accommodate delivery through the birth canal, the pubic symphysis undergoes changes that lead to the interpubic ligament (IpL) and enthesis formation in primiparous mice. However, successive deliveries influence joint recovery. We aimed to understand tissue morphology and chondrogenic and osteogenic potential at symphyseal enthesis during pregnancy and postpartum in primiparous and multiparous senescent female mice. Morphological and molecular differences were found at the symphyseal enthesis among the study groups. Despite the apparent incapacity to restore cartilage in multiparous senescent animals, the symphyseal enthesis cells are active. However, these cells have reduced expression of chondrogenic and osteogenic markers and are immersed in densely packed collagen fibers contiguous to the persistent IpL. These findings may indicate alterations of key molecules in the progenitor cell population maintenance of the chondrocytic and osteogenic lineages at the symphyseal enthesis in multiparous senescent animals, possibly compromising the mouse joint histoarchitecture recovery. This sheds light on the distention of the birth canal and the pelvic floor that may play a role in pubic symphysis diastasis (PSD) and pelvic organ prolapse (POP), both in orthopedic and urogynecological practice in women.

Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review's scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies.

Impact of Lumbar Postures on the Functioning of Pelvic Floor Muscles Among Osteoporotic Post-Menopausal Women

Introduction Maintaining continence and providing support to the abdominal contents and sexual functioning are among the primary roles of pelvic floor muscles. The pelvic floor muscles work in synergy with the abdominal muscle to perform these functions. Abdominal muscle activation in the sagittal plane is influenced by the lumbar spine posture. As pelvic floor dysfunction is common among post-menopausal women, this study aims to find out the relationship between lumbar posture and electromyographic (EMG) activity of the rectus abdominis (RA) muscle and vaginal pressure (VP) as a functioning of the pelvic floor muscles among osteoporotic post-menopausal females. Methods A total of 78 osteoporotic post-menopausal women were recruited and allocated into three groups depending on lumbar lordotic angle, namely normal lordosis (n=26) hyperlordosis (n=26), and hypolordosis (n=26). All the subjects were recorded for RA EMG activity and VP for pelvic floor function in the quiet standing (QS) position, and voluntary dynamic tasks such as maximal coughing (MC) and Valsalva maneuver (VM). Data were analyzed using one-way analysis of variance (ANOVA) and post hoc analysis. A 5% probability level was considered statistically significant, i.e., p<0.05. Results The results showed a significant reduction in the RA activity and VP during the dynamic tasks (MC and VM) among subjects with the altered lumbar lordotic angle (p<0.05). The reduction in RA activity and VP was found to be significantly higher (p<0.05) in subjects with hyperlordotic lumbar spine than in those with hypolordotic lumbar spine as compared to normal lordosis during QS, MC, and VM. Conclusion We conclude that osteoporotic post-menopausal women with different lumbar lordotic angle show variations in RA activity and pressure generated by the vagina as a function of the pelvic floor during voluntary dynamic tasks.