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Uterine Prolapse [keywords]
- Quality of information on pelvic organ prolapse on the Internet. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Oct 25.
This study aimed to determine the quality of available patient-centered information for pelvic organ prolapse (POP) on the Internet using a modified validated scale.Two independent investigators using three search engines (Google, Yahoo, Bing) searched and reviewed the top 30 unique sites for four terms: bladder prolapse; dropped bladder; uterine prolapse; dropped uterus. A total of 219 websites were reviewed by both reviewers excluding redundancies. A two-stage, 6-point rating scale with score range per question of 0-5 was developed from the DISCERN instrument. Also recorded was whether a site had Health On the Net (HON) Foundation certification. The 400 sites were (as stated) a separate search where in the the domain suffix for the top 100 sites per serach term was recorded.The summary of 400 sites reviewed across the four search terms identified 64 % .com, 19 % .org, 8 % .edu, 6 % other and 3 % .gov; .gov yielded the highest quality information. Only 23 (9.5 %) sites were HON certified, yet these sites possessed higher DISCERN scores (p < 0.0001). For the three questions referencing conservative treatments (i.e., pessary, physical therapy, watchful waiting), 115 (52 %) sites indicated a summed mean score of ≤3, indicating less complete information regarding these treatments.Web-based information available to women regarding treatment for POP based on the modified DISCERN instrument is incomplete and biased toward surgical treatments. Government-sponsored websites (.gov) appear to provide the best quality information regarding this condition.
- Prevention and management of pelvic organ prolapse. [Journal Article, Review]
- F1000Prime Rep 2014.:77.
Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery.
- Postprocessing of pelvic floor ultrasound data: How repeatable is it? [JOURNAL ARTICLE]
- Aust N Z J Obstet Gynaecol 2014 Oct 22.
Translabial 3D/4D pelvic floor ultrasound (PFUS) is increasingly used in the evaluation of pelvic floor disorders. Commonly, this involves the analysis of stored volume data sets by postprocessing. In this study, we aimed to assess the time requirement to reaching acceptable repeatability for commonly employed outcome measures in PFUS.Between 2010 and 2013, 20 individuals from 11 countries underwent training in postprocessing of PFUS volume data sets. They undertook test-retest series (n ≥ 20) between day 2 and day 15 of training. Outcome measures tested included levator hiatal area on Valsalva, descent of the bladder neck, bladder, uterus and rectal ampulla, and rectocele depth. After an initial training session of 10-20 cases, test-retest series were undertaken between the trainee and measurements obtained by the author or senior trainees.Trainees were obstetricians/gynaecologists in training (n = 4), obstetricians/gynaecologists or subspecialty trainees (n = 13), medical students (n = 1) and physiotherapists (n = 2). A total of 58 repeatability series were analysed, obtained between days 2 and 15 of training. When second or third retest series were necessary, there always was improvement in repeatability except for one series in one individual. Satisfactory repeatability (ICC > 0.7) was achieved by all trainees for all parameters required by them. Training lasted from 3 to 15 days, with means between 4 and 5.8 days.Postprocessing analysis of commonly used PFUS parameters can be taught to an acceptable standard within 1 week. Most commonly used ultrasound parameters obtained by postprocessing for prolapse assessment can be taught to an acceptable standard of repeatability within one week.
- Determinants and management outcomes of pelvic organ prolapse in a low resource setting. [Journal Article]
- Ann Med Health Sci Res 2014 Sep; 4(5):796-801.
The last decade has seen significant progress in understanding of the pathophysiology, anatomy and management modalities of pelvic organ prolapse. A review of the way we manage this entity in a low resource setting has become necessary.The aim of the study is to determine the incidence, risk factors and management modalities of pelvic organ prolapse.A 5-year cross-sectional study with retrospective data collection of women who attended the gynecologic clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria and were diagnosed of pelvic organ prolapse was made. Proforma was initially used for data collection before transfer to Epi-info 2008 (v 3.5.1; Epi Info, Centers for Disease Control and Prevention, Atlanta, GA) software.There were 199 cases of pelvic organ prolapse, out of a total gynecologic clinic attendance of 3082, thus giving an incidence of 6.5%. The mean age was 55.5 (15.9) years with a significant association between prolapse and advanced age (P < 0.001). The age range was 22-80 years. The leading determinants were menopause, advanced age, multiparity, chronic increase in intra-abdominal pressure (IAP) and prolonged labor. Out of the 147 patients with uterine prolapse, majority, 60.5% (89/147) had third degree prolapse. Vaginal hysterectomy with pelvic floor repair was the most common surgery performed. The average duration of hospital stay following surgery was 6.8 (2.9) days and the most common complication was urinary tract infection, 13.5% (27/199). The recurrence rate was 13.5% (27/199). Most of the patients who presented initially with pelvic organ prolapse were lost to follow-up.The incidence of pelvic organ prolapse in this study was 6.5% and the leading determinants of pelvic organ prolapse were - multiparity, menopause, chronic increase in IAP and advanced age. Most were lost to follow-up and a lesser proportion was offered conservative management. Early presentation of women is necessary so that conservative management could be offered if feasible.
- Histopathological audit of 373 nononcological hysterectomies in a teaching hospital. [Journal Article]
- Patholog Res Int 2014.:468715.
Hysterectomy, the most common gynecological surgery, provides a definitive cure to various diseases like DUB (dysfunctional uterine bleeding), leiomyoma, adenomyosis, chronic pelvic pain, prolapse, and malignancy. However, with advent of effective medical and conservative treatment modalities for nononcological causes it is now posing question mark on justification of hysterectomy. Therefore, an audit is required to assess the correlation between preoperative diagnosis and histopathological examination of specimen for justification of the procedure. In this study over period of one year (April 2013 to March 2014) 373 hysterectomies specimens were received in the department of pathology for nononcological causes. The age of patients ranged from 22 to 85 years with mean 45 ± 9.2 years. All cases were divided into five categories on the basis of age and audit was done. In this study the most common finding was leiomyoma (43.7%) followed by adenomyosis (19.3%). Almost 50% of hysterectomies causes were justified as preoperative diagnosis matched with histopathology. Cohen kappa statistics were used to measure agreement between preoperative and postoperative histopathological diagnosis which was found to be fair with κ value being 0.36. This study highlights that regular audit of surgeries can help improve quality of health care services and provide safe conservative option to patients.
- Vaginal hysterectomy for uterovaginal prolapse: what is the incidence of concurrent gynecological malignancy? [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Oct 8.
Vaginal hysterectomy (VH) is a commonly performed procedure for the operative treatment of uterovaginal prolapse (UVP). The reported incidence of unexpected gynecological cancer in cases of VH for UVP ranges between 0.3 and 0.8 %. Aim of the study is to assess the incidence of malignant and premalignant gynecological histopathological findings among women who underwent a VH for UVP and had a normal preoperative workup.The histopathology reports of women who underwent VH for the treatment of UVP were retrospectively assessed. All women had a history of normal cervical smear tests and a normal preoperative transvaginal scan. Patients with a history of a premalignant or malignant gynecological pathological condition and women with abnormal uterine bleeding were excluded.Overall, 14 out of 333 women who underwent VH (4.2 %) were found to have abnormal histopathological findings of the uterus. Among them, there were 9 cases of endometrial hyperplasia of any type (2.7 %), 1 case of cervical cancer (0.3 %), 1 case of cervical intraepithelial neoplasia (CIN) III (0.3 %), and 3 cases of CINI (0.9 %). No cases of endometrial cancer were detected. Among women who underwent salpingo-oophorectomy (n = 86) three simple serous cysts (3.5 %) were found, with no cases of ovarian cancer.The incidence of unexpected premalignant or malignant gynecological pathological conditions among asymptomatic women who underwent VH, with a history of normal cervical smear tests and normal preoperative TVS, was low but not negligible. This information should be included in the preoperative counseling of women planning to undergo surgery for UVP.
- Factors that affect early recurrence after prolapse repair by a nonanchored vaginal mesh procedure. [Journal Article]
- Taiwan J Obstet Gynecol 2014 Sep; 53(3):337-42.
Prosima (Ethicon, Somerville, NJ, USA) is a novel procedure for treating pelvic organ prolapse (POP) that uses nonanchored vaginal mesh. However, nonfixation of the mesh may limit effectiveness. The aim of this study was to evaluate the safety, efficacy, and limitations of this procedure.From January 2011 through to December 2011, 52 patients with symptomatic POP ≥ Stage 2 undergoing the Prosima procedure at a tertiary hospital were enrolled consecutively in this prospective study. A Data and Safety Monitoring Plan (DSMP) was developed to assess the results.Fifty of the 52 patients (96%) attended the 3-6-month postoperative assessment. Symptom and quality-of-life scores were found to have improved significantly after surgery (p < 0.05). Forty-two patients (84%) underwent successful treatment for POP (Stage 0-1). The other eight patients (16%) were found to have recurrent Stage 2 anterior vaginal wall prolapse, although most of them (5/8) were asymptomatic. The highest morbidity, namely vaginal mesh exposure, occurred in four patients (8%) and was managed as a minor issue. Statistical analysis showed that anatomic recurrence was significantly (p < 0.05) associated with a "preoperative Ba ≥ +4 cm" (odds ratio = 20.57), "conservation of the prolapsed uterus" (odds ratio = 10.56) and "use of a concomitant midurethral sling" (odds ratio = 0.076).Prosima seems to have limitations when used to manage severe anterior vaginal wall prolapse and concomitant surgery may further affect its effectiveness. The information obtained from this study's DSMP will contribute to developing a strategy to improve the use of nonanchored vaginal mesh for POP repair.
- Current situation of transvaginal mesh repair for pelvic organ prolapse. [Journal Article]
- Chin Med Sci J 2014 Sep 29; 29(3):188-90.
SURGICAL mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repair abdominal hernias. In the 1970s, gynecologists began using surgical mesh products to indicate the repair of pelvic organ prolapse (POP), and in the 1990s, gynecologists began using surgical mesh for POP. Then the U.S. Food and Drug Administration (FDA) approved the first surgical mesh product specifically for use in POP. Surgical mesh materials can be divided into several categories. Most surgical mesh devices cleared for POP procedures are composed of non-absorbable synthetic polypropylene. Mesh can be placed in the anterior vaginal wall to aid in the correction of cystocele (anterior repair), in the posterior vaginal wall to aid in correction of rectocele (posterior repair), or attached to the top of the vagina to correct uterine prolapse or vaginal apical prolapse (apical repair). Over the past decades, surgical mesh products for transvaginal POP repair became incorporated into "kits" that included tools to aid in the delivery and insertion of the mesh. Surgical mesh kits continue to evolve, adding new insertion tools, tissue fixation anchors, surgical techniques, and ab- sorbable and biological materials. This procedure has been performed popularly. It was also performed increased in China. But this new technique met some trouble recently and let shake in urogynecology.
- Laparoscopic sacral uteropexy with cravat technique--experience and results. [Journal Article]
- Int Braz J Urol 2014 Jul-Aug; 40(4):526-32.
The aim of the present study was to evaluate the safety and efficacy of a ″Cravat″ technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh.A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV) who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as 'very satisfied', 'satisfied' and 'not satisfied' at the 6th month postoperatively.Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy). Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months.Laparoscopic sacral uteropexy with "Cravat technique" was found to be safe and simple procedure.
- Hysteropexy in the treatment of uterine prolapse stage 2 or higher: a multicenter randomized controlled non-inferiority trial comparing laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy (LAVA-trial, study protocol). [Journal Article]
- BMC Womens Health 2014.:112.
Pelvic organ prolapse is a common health problem: the lifetime risk of undergoing surgery for pelvic organ prolapse by the age of 85 years is 19%. Pelvic organ prolapse has significant negative effects on a woman's quality of life. Worldwide, vaginal hysterectomy is the leading treatment method for patients with symptomatic uterovaginal prolapse. Several studies have shown that vaginal sacrospinous hysteropexy and laparoscopic sacrohysteropexy are safe and effective alternatives in treating uterine descent. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Therefore, we conducted the LAVA trial.The LAVA trial is a randomized controlled multicenter non-inferiority trial. The study compares laparoscopic sacrohysteropexy with vaginal sacrospinous hysteropexy in women with uterine prolapse stage 2 or higher. The primary outcome of this study is surgical success of the apical compartment at 1 and 5 years follow-up. Secondary outcomes are subjective improvement on urogenital symptoms and quality of life (assessed by disease-specific and general quality of life questionnaires), complications following surgery, hospital stay, post-operative recovery, sexual functioning and costs-effectiveness. Evaluation will take place pre-operatively, and 6 weeks, 6 months, 12 months and annually till 60 months after surgery. Validated questionnaires will be used.Analysis will be performed according to the intention to treat principle. Based on comparable recurrence rates of 3% and a non-inferiority margin of 10%, 62 patients are needed in each arm to prove the hypothesis with a 95% confidence interval.The LAVA trial is a randomized controlled multicenter non-inferiority trial that will provide evidence whether the efficacy of laparoscopic sacrohysteropexy is non-inferior to vaginal sacrospinous hysteropexy in women with symptomatic uterine prolapse stage 2 or higher.Netherlands Trial Register (NTR): NTR4029.