OBJECTIVE: The aim of our study is to reveal the correlation between the posterior vaginal wall and apex in pelvic organ prolapse. METHODS: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic between January 2013 and December 2015. RESULTS: Four hundred five cases were enrolled in our study. When all POP stages were included, the Bp (pelvic organ prolapse quantification point) had a moderate correlation with the C (Pearson's r=0.419; P < 0.001). Cases where Bp was stage 3 and above presented strong positive correlations with C (Spearman's ρ=0.783; P < 0.001). Cases where C was stage 3 and above presented also strong positive correlations with Bp (Spearman's ρ=0.718; P < 0.001). CONCLUSION: Posterior vaginal wall prolapse and apical prolapse were correlated with each other, and this correlation was more prominent as stage increased. Therefore, when admitting a patient suspected of posterior vaginal wall prolapse or apical prolapse, it is necessary to evaluate both conditions. Especially in cases more severe or equal to stage 3, it is a must to suspect both conditions as the 2 are strongly correlated.
Cystocele ; Humans ; Pelvic Organ Prolapse* ; Prolapse ; Rectocele ; Retrospective Studies ; Uterine Prolapse ; Vagina

OBJECTIVE: To assess the results of the sacrospinous ligament suspension using Miya hook for the treatment of uterovaginal prolapse or vault prolapse following hysterectomy. METHODS: Between October 1997 and December 2000, in Kyung Hee Medical Center, 50 pelvic organ prolapse patients underwent vaginal hysterectomy and sacrospinous ligament suspension or sacrospinous ligament suspension only. We evaluated age, parity, operation time, recovery time, duration of hospitalization, change of Hemoglobin level, number of vaginal delivery, type of prolapse, and complications. RESULTS: Forty-four patients (88%) had uterine prolapse and six patients (12%) had vaginal vault prolapse. All patients underwent sacrospinous suspension and anterior-posterior colporraphy in which forty-one patients (82%) underwent concomitant vaginal hysterectomy. There has been one failure case. And then repeat sacrospinous ligament suspension with anterior and posterior vaginal repair was performed successfully. Recurrent prolapse hasn't been developed yet. Most common problems were transient voiding difficulty and vague buttock pain. CONCLUSION: The sacrospinous ligament suspension is considered to be effective and safe in the treatment of vault and uterine prolapse. It avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele.
Buttocks ; Cystocele ; Female ; Hospitalization ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Ligaments* ; Parity ; Pelvic Organ Prolapse* ; Prolapse ; Rectocele ; Uterine Prolapse

PURPOSE: We aimed to evaluate the anatomical and functional outcomes of posterior intravaginal slingplasty (P-IVS) for the treatment of a vaginal vault or uterine prolapse (VP/UP). MATERIALS AND METHODS: This was a 12-month prospective, multicenter, observational study. Women aged over 30 years who presented with stage II or greater VP/UP underwent P-IVS by four urologists at four university hospitals. Preoperatively, pelvic examination by use of the Pelvic Organ Prolapse Quantification (POP-Q) system, the Pelvic Floor Distress Inventory (PFDI) questionnaire, the 3-day frequency volume chart, and uroflowmetry were completed. At the 12-month follow-up, changes in the POP-Q, PFDI, frequency volume chart, and uroflowmetry parameters were assessed. Cure was defined as VP/UP stage 0 and improvement as stage I. RESULTS: The cure and improvement rates among the 32 women were 65.6% and 34.4%, respectively. All subscale scores of the Urinary Distress Inventory, the general subscale score of the Pelvic Organ Prolapse Distress Inventory, and the rectal prolapse subscale score of the Colo-Rectal-Anal Distress Inventory were significantly improved. There were no significant changes in the frequency volume chart or uroflowmetry parameters. There was one case of surgery-related transfusion. CONCLUSIONS: Trans-vaginal repair by P-IVS is an effective and safe procedure for restoring the anatomical defect and improving the associated pelvic floor symptoms in women with VP/UP.
Aged ; Female ; Follow-Up Studies ; Gynecological Examination ; Hospitals, University ; Humans ; Pelvic Floor ; Pelvic Organ Prolapse ; Prospective Studies ; Rectal Prolapse ; Treatment Outcome ; Uterine Prolapse

OBJECTIVE: To determine the success rate and complications of transvaginal sacrospinous colpopexy for symptomatic uterine/vault prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 105 women with a symptomatic uterine/vault prolapse were treated with transvaginal sacrospinous ligament colpopexy at samsung cheil hospital. Primary outcome measures were complications (acute and long term) and success rate, with failure defined as any degree of uterine/vault prolapse requiring repeat operation, any degree of symptomatic isolated uterine/vault prolapse, any pelvic organ prolapse at or beyond the introitus. Statistical analysis was performed using simple descriptive technique. RESULTS: During the study period, 105 transvaginal sacrospinous ligament colpopexy were performed: 41 with vaginal hysterectomy, 38 without hysterectomy, 25 for post-hysterectomy vault prolapse and 1 cervical amputation. The mean duration of follow-up was 17.7 months (0-66) There were no acute hemorrhage and no deaths. There were four intraoperative complications - three rectal wall injury and one bladder wall injury. There was a complaints of postoperative right buttock pain in 8 of the 105 procedure (7.6%), with this persisting on a chronic basis in 2 patients (1.9%). Postoperatively, there were 11 patients with uterine/valut prolapse, 4 with a cystocele and 1 with a rectocele. Of these 105, there were 6 failures (5.7%). CONCLUSION: Transvaginal sacrospinous colpopexy for the correction of uterine/vault prolapse, when performed by a surgeon experienced in the procedure, is safe and effective surgical procedure and rare major complications.
Amputation ; Buttocks ; Cystocele ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hysterectomy ; Hysterectomy, Vaginal ; Intraoperative Complications ; Ligaments ; Outcome Assessment (Health Care) ; Pelvic Organ Prolapse ; Prolapse ; Rectocele ; Urinary Bladder ; Uterine Prolapse

OBJECTIVE: To compare the efficacy of transvaginal sacrospinous colpopexy with hysterectomy and without hysterectomy for symptomtic uterine prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 59 women with a symptomatic uterine prolapse were treated with either transvaginal sacrospinous ligament colpopexy with hysterectomy (30 cases=Group A) or transvaginal sacrospinous cervicocolpopexy without hysterectomy (29 cases=Group B). Patients were reviewed at least 12 months after operation. RESULTS: The mean age, parity, prolapse grade, menopausal status, body weight and length of follow-up for two groups were no difference. There were two intraoperative complications-Rectal wall injury one patient in group A and one in group B. The mean duration of surgery, hemoglobin change, inpatient days and catheter days were shorter in group B compared with group A. Recurrent asymptomatic cystocele developed in 2 patients in group A and 2 in group B. One patient in group A and one patient in group B required repeat operation for recurrent pelvic organ prolapse. There was no significant difference between the two groups in postoperative satisfactory result (96.7% vs 98.6%, respectively p=0.51). CONCLUSION: Sacrospinous cervicocolpopexy without hysterectomy and sacrospinous colpopexy with hysterectomy are equally effective surgical operation for uterine prolapse. Sacrospinous cervicocolpopexy without hysterectomy avoids the potential morbidity of vaginal hysterectomy and decreases the operation time, blood loss, inpatient days and catheter days. Vaginal hysterectomy may not be necessary in the correction of uterine prolapse.
Body Weight ; Catheters ; Cystocele ; Female ; Follow-Up Studies ; Humans ; Hysterectomy* ; Hysterectomy, Vaginal ; Inpatients ; Ligaments ; Parity ; Pelvic Organ Prolapse ; Prolapse ; Uterine Prolapse

A rate com;lication of hysterectomy is complete prolapse and inversion of vagina. This can occur whether the hysterectomy was abdominal or vaginal and cystocele and/or enterocele is often associated with this condition. Traditionally, prolapse has been treated by surgery, the types of operation for prolapse are generally but not always, carried out through the vaginal rather than through the abdominal surgical route. We experienced five cases who had repair of posthysterectomy vaginal vault prolapse by transabdominal sacral colpopexy and report with brief review of literatures.
Cystocele ; Hernia ; Hysterectomy* ; Pelvic Organ Prolapse* ; Prolapse ; Vagina

PURPOSE: Pelvic organ prolapse is a multifactorial disorder in which extracellular matrix defects are implicated. Fibrillin-1 level is reduced in stress urinary incontinence. In Marfan syndrome, which is associated with mutations in Fibrillin-1, pelvic floor disorders are commonly observed. We hypothesize that Fibrillin-1 gene expression is altered in pelvic organ prolapse. METHODS: Thirty women undergoing colporrhaphy or hysterectomy because of cystocele, rectocele, cystorectocele, or uterine prolapse were assigned to a pelvic prolapse study group, and thirty women undergone hysterectomy for nonpelvic prolapse conditions were assigned to a control group. Real-time polymerase chain reaction was conducted on vaginal tissue samples to measure the expression of Fibrillin-1. Expression levels were compared between study and control groups by Mann-Whitney U test with Bonferroni revision. RESULTS: Fibrillin-1 gene expression was not significantly lower in the study group than in the control group. Similarly, no significant correlation between Fibrillin-1 levels and grade of pelvic prolapse was found. Age over 40 years (P=0.018) and menopause (P=0.027) were both associated with reduced Fibrillin-1 levels in the pelvic prolapse group, whereas the delivery of babies weighing over 3,500 g at birth was associated with increased Fibrillin-1 expression (P=0.006). CONCLUSIONS: The results did not indicate a significant reduction in Fibrillin-1 gene expression in pelvic prolapse disorders; however, reduced Fibrillin-1 may contribute to increased pelvic organ prolapse risk with age and menopause. Increased Fibrillin-1 gene expression may be a compensatory mechanism in cases of delivery of babies with high birth weight. Further studies are needed for a better understanding of these observations.
Birth Weight ; Cystocele ; Extracellular Matrix ; Female ; Gene Expression ; Humans ; Hysterectomy ; Marfan Syndrome ; Menopause ; Parturition ; Pelvic Floor Disorders ; Pelvic Organ Prolapse* ; Prolapse ; Real-Time Polymerase Chain Reaction ; Rectocele ; Urinary Incontinence ; Uterine Prolapse

PURPOSE: To evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach. METHODS: This was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months. RESULTS: Ninety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P < 0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%–90% for every time point (P < 0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%). CONCLUSIONS: This midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications.
Cystocele ; Dyspareunia ; Female ; Follow-Up Studies* ; Hemorrhage ; Humans ; Ligaments ; Muscles ; Pelvic Floor ; Pelvic Organ Prolapse ; Polypropylenes ; Prolapse* ; Prospective Studies* ; Reoperation ; Surgical Mesh ; Urinary Incontinence ; Urinary Retention ; Urinary Tract Infections ; Uterine Prolapse ; Vagina

OBJECTIVE: The aim of this study was to compare the efficacy of sacrospinous colpopexy without hysterectomy and with hysterectomy for symptomatic uterine prolapse. METHODS: A retrospective chart review was performed in the women who underwent sacrospinous ligament suspension between March 1998 and March 2002. A hundred fifty five women with a symptomatic uterine prolapse were treated with either sacrospinous colpopexy without hysterectomy and/or anterior-posterior repair (83 cases=Group A) or sacrospinous colpopexy with hysterectomy and/or anterior-posterior repair (72 cases=Group B). RESULTS: The mean duration of surgery, hemoglobin change, catheter days and inpatient days were shorter in group A compared with group B. (Group A 102.5+/-33.4 min, 2.4+/-0.7 mg/dL, 5.2+/-1.4 days, 7.6+/-2.2 days vs. Group B 135.3+/-33.9 min, 2.9+/-0.8 mg/dL, 6.1+/-2.1 days, 9.4+/-3.7 days, p<0.05 respectively) Recurrent pelvic organ prolapse developed in 14.5% in group A and 12.5% in group B. Six patients (7.2%) in group A and 5 patients (6.9%) in group B required repeat operation for recurrent pelvic organ prolapse. CONCLUSIONS: Sacrospinous colpopexy without hysterectomy and with hysterectomy are equally effective surgical operation for uterine prolapse. This study shows that hysterectomy is not essential for the correction of uterine prolapse.
Catheters ; Female ; Humans ; Hysterectomy* ; Inpatients ; Ligaments ; Pelvic Organ Prolapse ; Retrospective Studies ; Uterine Prolapse*

PURPOSE: The recent development of posterior intravaginal slingplasty (IVS) has led to significant changes for the treatment of vaginal vault or uterine prolapse. We analyzed the efficacy of performing posterior IVS for the patients with vaginal vault and uterine prolapse. MATERIALS AND METHODS: This study analyzed the treatment outcomes of 56 patients with vaginal vault or uterine prolapse and these patients were seen at our hospital from March 2004 to August 2005. The degree of prolapse was classified according to the POP-Q system. The grades were 17 cases of stage 2, 8 cases of stage 3 and 5 cases of stage 4 in the vaginal vault prolapse group, and 14 cases of stage 2, 6 cases of stage 3 and 6 cases of stage 4 in the uterine prolapse group. RESULTS: Fifteen cases in the vaginal vault prolapse group and 9 cases in the uterine prolapse group received combined tension-free vaginal tape (TVT) or the tension-free vaginal tape obturator system (TVT-O). The patients who received combined rectocele repair were 17 cases in the vaginal vault prolapse group and 17 cases in the uterine prolapse group. The mean operation time was 37 minutes and the mean bleeding volume was 94ml. The mean admission period was 3.5 days and the mean follow-up time was 9.5 months (1-17). Polypropylene tape was used for 56 patients without any rejection reactions or rectal perforation. Among the 30 patients operated on for vaginal vault prolapse, 24 patients were cured and 6 patients showed improvement. Among the 26 patients operated on for uterine prolapse, 23 patients were cured and 3 patients showed improvement. CONCLUSIONS: Posterior IVS proved to be a highly effective therapeutic procedure for vaginal vault and uterine prolapse.
Follow-Up Studies ; Hemorrhage ; Humans ; Pelvic Organ Prolapse ; Polypropylenes ; Prolapse ; Rectocele ; Suburethral Slings ; Surgical Mesh ; Uterine Prolapse* ; Vagina