Urogynecology and Reconstructive Pelvic Surgery has long been recognized specialty in the field of obstetrics and gynecology and it is not new to any of us. In 1979, the American College of Obstetrics and Gynecology officially recognized this field as a subspecialty. In the Philippines, however, urogynecology is still in its infancy stage. Urogynecology concerns problems of the female genital tract and lower urinary and lower intestinal tract disorders. More commonly, we provide care to women with various pelvic floor disorders such as pelvic organ prolapse, fecal incontinence, and bladder control problems, specifically urinary incontinence. They are, at present, aspects of women’s health that are frequently neglected or ignored. With the recent emphasis on women’s health and quality of life, caring for women with various pelvic floor disorders would become an increasingly important aspect of women’s healthcare. Moreover, for a rapidly growing and aging population, the demand for such care will inevitably escalate.
Pelvic Floor Disorders

Pelvic organ prolapse(POP) is a major health care problem. Up to 50% of parous women have some degree of pelvic organ prolapse although only 10?20% are symptomatic. The first line of treatment is surgical repair. Many surgical procedures have been described to correct pelvic organ prolapse. The majority of these procedures are performed either vaginally or abdominally, or with a combined abdominovaginal approach. With recent advancements of laparoscopic instruments and surgical techniques, interest in laparoscopic treatment of pelvic organ prolepse has surged. Beyond the well-known advantages of laparoscopy - less postoperative discomfort, shorter hospital stay, the laparoscopic approach offers the superior visualization of the pelvis, thereby allowing better exposure of the pelvic floor anatomy and more exact identification of the defect. Moreover, laparoscopic surgery provides a magnified view of the operative field and enables to perform an easier and more precise dissection. This enhances the identification of pelvic floor defects and allows more precise suture placement and improved correction of specific site defects. Laparoscopic pelvic floor repair is an effective procedure and enables to combine the advantages of laparotomy with the low morbidity of the vaginal route. This article reviews pelvic support anatomy and various laparoscopic surgical techniques currently available for reconstructive pelvic surgery.
Delivery of Health Care ; Female ; Humans ; Laparoscopy ; Laparotomy ; Length of Stay ; Pelvic Floor ; Pelvic Floor Disorders ; Pelvic Organ Prolapse ; Pelvis ; Sutures

The short forms of pelvic floor distress inventory (PFDI) and pelvic floor impact questionnaire (PFIQ) are useful disease specific questionnaires evaluating symptoms, quality of life for pelvic floor disorders. The purpose is to develop linguistic validation of the PFDI-20 and PFIQ-7 questionnaires. Three types of Korean version of questionnaires have been used in four locations of University Hospitals in Korea. Each version of questionnaires was developed by forward translation and back-translation by bilingual translators and was verified by the patients with pelvic floor disorder and healthy persons. For harmonization of 3 types of questionnaires, four authors reviewed, discussed all discrepancies, incorporated and produced a new version. The multi-step processes of translation and linguistic validation of the Korean version of PFDI-20 and PFIQ-7 questionnaire were completed. Further process of validation of Korean version of these questionnaires is required.
Hospitals, University ; Humans ; Korea ; Linguistics ; Pelvic Floor ; Pelvic Floor Disorders ; Pelvic Organ Prolapse ; Quality of Life ; Surveys and Questionnaires ; Translations ; Urinary Incontinence

Since Dr. Kegel first reported good outcomes for pelvic floor muscle training in women with urinary incontinence this therapy has become used for women with various pelvic floor disorders. The incidence of pelvic floor disorders such as urinary incontinence and pelvic organ prolapse has been steadily increasing. Although surgery or medications are commonly used, behavioral modification and pelvic floor rehabilitation are gaining in popularity both as primary treatment and as alternatives to surgery. The goal of this article is to review the pelvic floor rehabilitation with emphasis on biofeedback and electrical stimulation and examine the evidence of effectiveness and application of pelvic floor rehabilitation.
Biofeedback, Psychology ; Electric Stimulation ; Female ; Humans ; Incidence ; Pelvic Floor Disorders ; Pelvic Floor* ; Pelvic Organ Prolapse ; Rehabilitation* ; Urinary Incontinence

The pelvic floor disorder disease (PFDD) typically originates from supportive tissue defects or injuries in the pelvic floor with a wide spectrum of symptoms such as urinary incontinence, pelvic organ prolapse, sexual dysfunction, fecal incontinence and chronic pelvic pain. But its etiology is complex, involving multiple systems and organs. So the best management of PFDD requires the implementation of multidisciplinary team (MDT). Pelvic floor centers have been developed abroad to provide pelvic floor services. In the setting of PFDD, the concept of MDT starts lately and develops slowly in China. The MDT approach was demonstrated to improve general rehabilitation, psychological state and quality of life. However, there is no unified standardization for MDT diagnosis and treatment of PFDD at home and abroad. Meanwhile, the personnel composition, responsibilities, training, and operation mode of the MDT need to be further developed. Perfecting the management mode of MDT team members, establishing standardized training programs and assessment criteria play crucial role in the future development of MDT in PFDD.
China ; Fecal Incontinence ; Humans ; Pelvic Floor ; Pelvic Floor Disorders/therapy* ; Pelvic Organ Prolapse/therapy* ; Quality of Life ; Urinary Incontinence

OBJECTIVETo explore the value of dynamic three-dimensional ultrasound in detecting the levator ani muscle fissures morphological changes of female pelvic floor relaxation syndrome after biofeedback and acupuncture treatments.

METHODSForty female constipation patients with pelvic floor relaxation syndrome were screened from the Constipation Designed Disease Clinic in our hospital between October 2011 and September 2012. Cleveland Constipation Score (CCS) scale was used. Anteroposterior and transverse diameters of the levator ani muscle fissures were measured by dynamic three-dimensional ultrasound in Valsalva maneuver. After a course (10 days) of biofeedback and acupuncture treatments, CCS scale was filled, and dynamic three-dimensional ultrasound was performed in Valsalva maneuver as well. Associated data before and after treatment were compared.

RESULTSTwenty-five patients completed the trial. As compared to pre-treatment, the longitudinal axes of levator ani muscle fissure [(4.89±0.89) cm vs. (5.13±0.82) cm, P<0.01], the horizontal axes of the levator ani muscle fissure [(4.62±0.75) cm vs. (4.86±0.74) cm, P<0.01], and the area of the levator ani muscle fissure [(18.16±6.42) cm(2) vs. (19.92±6.33) cm(2), P<0.01] decreased significantly after treatment, while CCS scale (9.52±2.50 vs. 15.80±3.42, P<0.01) declined significantly as well.

CONCLUSIONSThe dynamic three-dimensional ultrasound is an effective, simple and non-invasive method for the determination of levator ani muscle fissure in female patients with pelvic floor relaxation syndrome.

Adult ; Aged ; Female ; Humans ; Imaging, Three-Dimensional ; Middle Aged ; Pelvic Floor ; diagnostic imaging ; Pelvic Floor Disorders ; diagnostic imaging ; Ultrasonography

OBJECTIVE: The study aimed to evaluate the contributions of levator ani muscle (LAM) injury, vesical neck movement, urethral length and mobility, and urethral sphincter dysfunction observed on magnetic resonance imaging (MRI) towards stress urinary incontinence (SUI) after vaginal delivery. MATERIALS AND METHODS: Fifty primiparous women after 6 months of delivery (15 with SUI and 35 without) and 35 nulliparous as continent controls underwent MRI at rest and Valsalva maneuver. A published levator ani scoring system was used to characterize morphological changes of LAM. The severity of the injury was divided into three categories as none, minor, and major. A series of common parameters including levator plate angle, iliococcygeal angle, and levator hiatus were used to describe the functional conditions of LAM. Urethral mobility was defined based on the rotation of the urethra between Valsalva and rest status. Vesical neck movement was evaluated by its distance to the pubococcygeal line. Urethral sphincter dysfunction was defined as the widening of the proximal urethra and/or funneling at the urethrovesical junction during Valsalva. RESULTS: Primiparous incontinent (PI) women had additional major levator ani defects (33.3% vs. 17.1%) while less minor defects (0.7% vs. 31.4%) than primiparous continent (PC) women. Vesical neck downward movement in PI women was more obvious than PC women (28.5 mm vs. 24.2 mm, p = 0.006). Urethral mobility was more active in primiparous women than in nulliparous continent controls (57.4 vs. 52.4), whereas no difference was observed on urethral mobility in the primiparous group (p = 0.25). Urethral sphincter dysfunction and funneling were present in 80% of PI women versus 22.9% in PC women (p < 0.001). CONCLUSION: The MRI findings revealed that de novo SUI was associated with major LAM injury, vesical neck downward movement as well as urethral sphincter dysfunction. Vesical neck funneling on sagittal images can be treated as a valuable predictor for SUI. The intervention for the PI should focus on the elevation of vesical neck, rehabilitation of LAM as well as recovery of the urethral sphincter muscle.
Female ; Humans ; Magnetic Resonance Imaging* ; Neck ; Pelvic Floor Disorders ; Pelvic Floor* ; Rehabilitation ; Urethra ; Urinary Incontinence* ; Valsalva Maneuver

OBJECTIVE: Women with pelvic floor disorders and urinary incontinence (UI) are at an increased risk of sexual dysfunction. The purpose of this study was to investigate the effect of surgery for UI on sexual function. METHODS: We retrospectively reviewed the charts of 82 women who underwent mid-urethral transobturator tape (TOT) surgery between March 2010 and December 2014. The Pelvic Floor Distress Inventory-20 (PFDI-20) and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 (PISQ-12) were administered pre- and postoperatively. RESULTS: We observed a significant increase in the total postoperative PISQ-12 scores compared to the preoperative scores (from 27.1±7.3 to 30.5±6.8, P < 0.001). Improved sexual function was confirmed in the physical (13.3±4.5 vs. 15.8±3.5, P < 0.001) and partner-related domains (6.7±2.6 vs. 7.4±2.4, P=0.001). Coital incontinence and preoperative urinary distress inventory score were significant factors influencing postoperative sexual function in women undergoing TOT surgery for UI after adjusting for age, body mass index, menopause, and preoperative PISQ-12 score in multivariate regression analysis. CONCLUSION: TOT surgery for UI correction resulted in significant improvement in sexual function.
Body Mass Index ; Female ; Humans ; Menopause ; Pelvic Floor ; Pelvic Floor Disorders ; Retrospective Studies ; Sexual Dysfunction, Physiological ; Suburethral Slings ; Urinary Incontinence

BACKGROUND/AIMS: The aim of this study is to evaluate defecographic and anorectal manometric findings in patients with rectocele and to identify associated pelvic floor findings. METHODS: We reviewed defecography in 90 patients (all females;mean age, 44.7 years) with rectocele, who were collected from 427 patients who underwent defecography. We also reviewed a colon transit time study, and an anorectal manometry examination. 56 healthy volunteers (mean age 36.5, female 30, male 26) were studied. RESULTS: In the patient group, the depth of rectocele was 2.92+/-0.89 cm, while in the control group, it was 1.62+/- 0.66 cm (p value < 0.001). The mean rest, squeezing, and straining centroid anorectal angle(degrees) in both groups were: 99.7+/-19.3 vs. 126.2+/-19.3; 120.4+/-15.8 vs. 111.5+/-18.9; 132.2+/-14.6 vs. 141.0+/-15.7 (p < 0.05). The mean pelvic floor descent(cm) during rest, squeezing and straining were: 5.90+/-1.26 vs. 5.08+/-1.28 (p < 0.01); 4.89+/- 1.17 vs. 3.65+/-1.13(p < 0.01); 8.61+/-1.6 vs. 7.27+/-1.39(p < 0,001). In 60 of the 90 patients with rectocele, the mean barium trap was 32.7% after defecation. The mean maximal anal resting pressure and squeezing pressure(mmHg) in both groups were: 85.8+/-25.3 vs 47.1+/-9.3(p < 0.01); 138.9+/-35.14 vs. 92.7+/-28.1(p < 0.01). The mean anal canal was opened to 2.52cm in patients with rectocele and to 2.47cm in control subjects during defecation. Associated findings were a pelvic spastic syndrome in 16, pelvic descent syndrome in 37, rectoanal intussusception in 37 and rectal prolapse in 4 of the patients. Colon transit time was more prolonged in the patient group than the control group. CONCLUSIONS: Rectocele may be associated with various pelvic floor diseases. Careful preoperative investigations are important before surgical treatment of rectocele.
Anal Canal ; Barium ; Colon ; Defecation ; Defecography ; Female ; Healthy Volunteers ; Humans ; Intussusception ; Male ; Manometry ; Muscle Spasticity ; Pelvic Floor Disorders ; Pelvic Floor* ; Rectal Prolapse ; Rectocele* ; Time and Motion Studies

OBJECTIVES: To investigate if vitamin D receptor (VDR) gene polymorphisms and circulating vitamin D levels are associated with pelvic floor disorders (PFDs). METHODS: In this case-control study, 25-hydroxy-vitamin D (25[OH]D) serum levels were analyzed in 47 females with PFDs and 87 healthy females (controls), respectively. The VDR gene polymorphisms were determined by using polymerase chain reaction and performing digestions with 4 restriction enzymes i.e., ApaI, TaqI, FokI, and BsmI. Vitamin D levels of patients were divided into <20 ng/mL, 20 to 30 ng/mL, and ≥30 ng/mL categories. RESULTS: Our correlative analysis of VDR polymorphisms as a function of the presence of PFD showed that ApaI and BsmI polymorphisms were significantly associated with PFD in vitamin-D-deficiency and insufficiency groups (P < 0.05). Mean vitamin D levels did not differ between the PFD case (13.01 ± 0.84 ng/mL) and control (15.11 ± 1.04 ng/mL) groups (P > 0.05). However, there was a significant difference in the distribution of vitamin D levels between study group and controls using Pearson's χ2 test (<20 ng/mL, 20–30 ng/mL, and >30 ng/mL: 87.2%, 12.8%, and 0% in the study group and 75.9%, 16.1%, and 8.0% in controls, respectively, P < 0.05). Taken together, our observations suggest that vitamin D levels could be associated with PFDs and that 2 polymorphisms (i.e., ApaI and BsmI) in the VDR gene may contribute to an increased prevalence of PFDs in women with insufficient levels of vitamin D. CONCLUSIONS: Examining vitamin D levels and performing a VDR genotype analysis may be helpful for assessing PFD risk.
Case-Control Studies ; Female ; Genotype ; Humans ; Pelvic Floor Disorders ; Pelvic Floor ; Polymerase Chain Reaction ; Prevalence ; Receptors, Calcitriol ; Vitamin D Deficiency ; Vitamin D ; Vitamins