Background: Pelvic organ prolapse (POP) is an inconvenience that can affect a woman’s well-being. Reconstructive pelvic floor surgery involves repairing defects in the endopelvic fascia and pelvic floor musculature as close to the physiologic and anatomic norm. The cornerstone of successful prolapse repair is a strong apical support. Objective: The aim of the study is to determine the outcomes of abdominal sacrocolpopexy (ASC) and abdominal sacrohysteropexy (ASH) in the Philippines. Methods: The study utilized a descriptive study design to compare the pre-operative and post-operative Pelvic Organ Prolapse Quantification Score (POP-Q Score), presence of mesh complications, and urinary/bowel symptoms in patients operated within 2010-2016 in a Philippine tertiary training hospital. Based on recovered charts and inclusion/ exclusion criteria, this study sampled 34 of 50 patient records. Statistical measures of median and range were used to describe pre-operative and post-operative POP-Q scores in any two follow-ups within 6-, 12-, 18-, and 24-month interval. The objective success rate and incidence of urinary/bowel symptoms were described using frequencies and percentages. Presence of any mesh erosion was noted for each follow-up. McNemar's test was applied to assess the comparative occurrence of each symptom comparing between the pre-operative and first follow-up periods. Results: ASC had a success rate of 73.7% at six months and 56.3% at 12 months post-surgery. ASH showed an 84.6% success rate at six months and 71.4% at 12 months. Apical support has a 97% success rate without affecting the anterior or posterior compartments. Out of 20 ASC patients, 5 (25%) exhibited anterior compartment descent, whereas two out of 14 ASH patients (14.2%) had the same condition. It is observed that the anterior vaginal wall has the higher tendency to descend after reconstructive surgery, independent of route or technique. In addition, not all patients with surgical prolapse beyond -1 experienced symptomatic vaginal bulges. Overall, a notable decrease in the occurrence of urine symptoms was seen after the surgery. No mesh erosion was seen within the initial two years of followup but there was a single reported instance of abdominal hernia, an uncommon consequence. Conclusion This study demonstrated that ASC and ASH have good success rate in apical support; however, descent of the anterior or posterior compartment diminishes the overall success rate in terms of over-all objective POP-Q score. Both resulted to improvement in symptoms with minimal complications.
Pelvic Organ Prolapse

Pelvic floor ultrasound can clearly visualize the position and morphology of pelvic floor organs, observe the pelvic organ prolapse in real-time, and quantify and analyze the degree of the levator ani muscle injury, which is the most common imaging method to assess the morphology and function of the levator ani muscle to date. The different ultrasound imaging techniques provide a variety of indicators, each with its own advantages and limitations.Furthermore, two-dimensional ultrasound is the basis of imaging, but it fails to detect cross-sectional images of the pelvic floor; three-dimensional ultrasound can acquire the axial plane of the levator hiatus; tomographic ultrasound imaging allows real-time observation of the levator ani muscle injury; shear wave elastography can provide a quantitative assessment of the contractility and elastic characteristics of the levator ani muscle in real-time. It is of great significance to summarize the basic principles of various ultrasound imaging techniques, summarize the ultrasound image characteristics of levator ani muscle and its hiatus in different populations and different states, and explore the cut-off values and diagnostic criteria-related ultrasound parameters for improving the diagnostic efficiency of pelvic floor ultrasound for levator ani muscle injury, leading to reducing missed diagnosis and misdiagnosis of lesions.
Humans ; Female ; Pelvic Floor/pathology* ; Pelvic Organ Prolapse/pathology* ; Ultrasonography/methods* ; Imaging, Three-Dimensional

Humans ; Matrix Metalloproteinase 9 ; Collagen Type I ; Pelvic Organ Prolapse/metabolism*

Background: The rate of prolapse recurrence after vaginal hysterectomy ranges from 6% to 12%. Vaginal vault fixation procedures like the iliococcygeus fixation and the cul-de-sac obliteration (McCall culdoplasty) have been used to address the loss of apical support in patients with advanced-stage prolapse to prevent this recurrence. Objectives: This study aims to assess the rate of prolapse recurrence and risk factors for recurrence as well as urinary, bowel, and sexual symptoms in women who have undergone vaginal hysterectomy with and without vaginal vault fixation for pelvic organ prolapse stage 2 or higher. Methods: This study is a retrospective study that included patients with pelvic organ prolapse stage 2 or greater who underwent vaginal hysterectomy with and without vaginal vault fixation from 2009 to 2014 seen at the urogynecology clinic of a Philippine tertiary referral center. The cohorts were divided into those with iliococcygeal fixation (n=171) and those without (n=83). The Z test of mean difference was used in comparing average values between the two groups. Chi-square test of independence was used in comparing the proportion of patients as stratified by various variables and their corresponding groups, while some variables were adjusted for 2x2 Fischer Exact test. Any associated p-value less than 0.05 alpha were considered statistically significant. Results: Of the 876 patients operated on for prolapse between 2009 to 2014, 254 were included in the study. They were divided into those with iliococcygeal fixation (n=171) and those without (n=83). Recurrence was significantly lower in the group who underwent iliococcygeal fixation (23.39% vs 36.14%, p=0.037) after a median follow-up of 28.98 months for those with fixation and 31.08 for those without. The posterior compartment prolapse recurrence rate is higher in those without fixation (16.87% vs 6.43%, p=0.013). Longer duration of menopause (16.96 ± 7.16 vs 13.37 ± 7.1, p=0.001), unemployment (52.85% vs 36.41%, p=0.22) and longer time from surgery (37.84 ± 15.69 vs 26.55 ± 12.59, p=0.000) were significantly associated with recurrence. Moreover, higher pre- (6.24 ± 1.41 vs 5.78 ± 0.95, p=0.003) and post-operative genital hiatus (4.53 ± 0.97 vs 4.23 ± 0.54, p=0.002) and shorter pre-operative perineal body (1.86 ± 0.35 vs 1.97 ± 0.35, p=0.025) measurements were also significantly associated with recurrence. Both groups have no significant difference in urinary, sexual or bowel symptoms. Conclusion Iliococcygeus fixation is an effective method of preventing prolapse recurrence. Increased duration of menopause, longer time from surgery, longer genital hiatus, and shorter perineal body all contribute to recurrence. Moreover, urinary, sexual and bowel symptoms do not differ significantly between those with and without iliococcygeus fixation. Thus performing prophylactic vaginal vault fixation should be contemplated in patients undergoing prolapse surgery, with careful consideration of patient factors and potential morbidities.
Pelvic Organ Prolapse ; Recurrence ; Hysterectomy, Vaginal

BACKGROUND: It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011. METHODS: A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided). RESULTS: The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107). CONCLUSIONS: The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly. TRIAL REGISTRATION NUMBER NCT03620565, https://register.clinicaltrials.gov.
China ; Female ; Gynecologic Surgical Procedures/adverse effects* ; Humans ; Pelvic Floor/surgery* ; Pelvic Organ Prolapse/surgery* ; Surgical Mesh/adverse effects* ; Treatment Outcome ; Vagina

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

Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence. Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group. Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(
Humans ; Pelvic Floor/diagnostic imaging* ; Pelvic Organ Prolapse/diagnostic imaging* ; Retrospective Studies ; Surgical Mesh/adverse effects* ; Ultrasonography

OBJECTIVES: To assess short-term functional outcomes achieved by robot-assisted sacrocolpopexy for pelvic organ prolapse. METHODS: We retrospectively collected clinical and operative data for female patients who underwent either pure laparoscopic sacrocolpopexy (a control group, =20) or robot-assisted laparoscopic sacrocolpopexy (a study group, =20) between December 2017 and December 2018. The clinical indicators included age, gestational age, parity, the stage of pelvic organ prolapse. Perioperative data included operative time and total blood loss. Post-operative outcomes included hospital stay, the time of detaining urethral catheterization, and the restart of anal exhaust after surgery. At the same time, complications and quality of life were observed till 6 months after the surgery. RESULTS: There were no definitely differences in the perioperative data between the 2 groups. It is worth mentioning that robot-assisted laparoscopic sacrocolpopexy was superior in strict operative time. With a follow-up of 6 months, the study group's anatomic repair rate was 100% (20/20), while the control group was 95% (19/20). Pelvic Floor Distress Inventory-short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire-short Form 7 (PFIQ-7) were used to evaluate patients' quality of life. There was no significant difference in the scores between the study group and the control group before and 6 months after surgery. Only the data of the PFDI-20 questionnaires at 1 month after operation were statistically significant, and in the control group was larger than that in the study group, showing that robotic surgery can recover faster than laparoscopy, and the quality of life can be improved quickly. CONCLUSIONS Robot-assisted laparoscopic sacrocolpopexy is a safe and reliable technique, faster than laparoscopy in recovery and has a short-term effect.
Female ; Humans ; Laparoscopy ; Pelvic Organ Prolapse ; Quality of Life ; Retrospective Studies ; Robotics ; Treatment Outcome

BACKGROUND/AIMS: Although symptoms related to the pelvic floor, such as pelvic organ prolapse (POP) and lower urinary tract symptoms (LUTS), are common in patients with chronic constipation (CC), its impact is not clear. Our aims were to investigate the following (1) compare pelvic floor symptom related dysfunction in irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC), and (2) symptom correlation with findings on anorectal manometry (ARM) and balloon expulsion test. METHODS: This was a retrospective analysis of patients with CC undergoing ARM. IBS-C and FC were diagnosed by Rome III criteria. Pelvic Floor Distress Inventory (PFDI-20) was used to measure pelvic floor symptom distress. Constipation Severity Scale was used to assess constipation severity. RESULTS: A total of 107 patients underwent ARM (64 FC, 43 IBS-C). The overall PFDI-20 score in IBS-C was higher compared with FC patients (118.0 vs 79.2, P = 0.001). In those with IBS-C, POP, LUTS, and colorectal symptoms subscales were all higher compared with FC patients (P < 0.05 for each). On multivariable regression, IBS-C (P = 0.001) and higher constipation severity (P = 0.001) were both independently associated with higher PFDI scores. ARM parameters and abnormal balloon expulsion test did not correlate with PFDI scores. CONCLUSIONS: Compared with FC patients, those with IBS-C have significantly higher distress from pelvic floor specific symptoms including POP and LUTS. Higher abdominal pain among IBS-C patients did not entirely explain these findings. A diagnosis of IBS-C and higher constipation severity correlated with PFDI-20 scores, but dyssynergia did not.
Abdominal Pain ; Arm ; Ataxia ; Constipation ; Defecation ; Diagnosis ; Humans ; Irritable Bowel Syndrome ; Lower Urinary Tract Symptoms ; Manometry ; Pelvic Floor ; Pelvic Organ Prolapse ; Retrospective Studies

Surgery is the mainstay of treatment for symptomatic pelvic organ prolapse (POP), and a variety of procedures can be performed to correct POP. When deciding on the proper surgical procedure, the surgeon must take into consideration the individual patient's risk for surgical complication and prolapse recurrence and her preference. This review will discuss the key issues faced in the surgical decision-making process for POP and recommendations based on the current scientific evidence.
Decision Making ; Pelvic Organ Prolapse ; Prolapse ; Recurrence