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

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

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 ; Prevalence ; Mitral Valve ; Mitral Valve Prolapse ; Adventitia

Humans ; Prevalence ; Mitral Valve ; Mitral Valve Prolapse ; Adventitia

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

Humans ; Intervertebral Disc ; Paraplegia/etiology* ; Prolapse

Colon, Sigmoid/surgery* ; Colostomy ; Humans ; Ostomy ; Prolapse ; Surgical Stomas

Surgery is currently the only cure for rectal prolapse. Standardized preoperative evaluation and appropriate selection of surgical methods are crucial to the outcome of rectal prolapse surgery. With the development of a series of clinical studies in China and abroad, transabdominal surgery (such as ventral mesh fixation) and transperineal (anal) surgery (such as Altemeier surgery) have been widely recognized. Precise preoperative assessment of rectal prolapse and appropriate selection of surgical approaches has important clinical value in reducing postoperative recurrence rates and surgical-related complications. However, the current rectal prolapse assessment system needs to be improved, and the choice of surgical procedures remains controversal. To guide the diagnosis and surgical treatment of patients with rectal prolapse in China, nationwide specialists of colorectal and pelvic floor surgery have been organized by the of Chinese Medical Doctor Association Anorectal Branch, the Pelvic Floor Surgery Committee, and Clinical Guidelines Committee. Experts have conducted rounds of discussions on the core content of standardized diagnosis and surgical treatment for rectal prolapse, and jointly formulated the "Chinese expert consensus on the diagnosis and surgical treatment of rectal prolapse (2022)". We hope that this consensus will provide useful resources for the colorectal and pelvic floor surgeons, and promote the standardization of diagnosis and surgical treatment for the rectal prolapse in China.
Humans ; Rectal Prolapse/complications* ; Consensus ; East Asian People ; Treatment Outcome ; Colorectal Neoplasms/complications* ; Surgical Mesh/adverse effects*

OBJECTIVE: To explore the clinical effect of the simple nucleus pulposus removal and small incision interlaminar window in the treatment of prolapsed and displaced lumbar disc herniation. METHODS: From February 2016 to February 2018, 35 patients with single-segment prolapse and displaced lumbar disc herniation were treated by the simple nucleus pulposus removal and small incision interlaminar window under general anesthesia. Among them, there were 21 males and 14 females;aged (42±17) years;27 cases of L RESULTS: All the operations were successful and the operation time was 30 to 60 min with an average of 40 min, the intraoperative blood loss was 10 to 30 ml with an average of 20 ml. All the patients were followed up for 1 to 3 years with an average of 1.2 years. Thirty-five patients with low back pain and lower limb symptoms were significantly relieved or disappeared. According to modified Macnab standard, 29 cases obtained excellent results, 5 good, and 1 fair. CONCLUSION Applying the concept of minimally invasive operation, small incision interlaminar window and simple nucleus pulposus removal for the treatment of prolapsed and displaced lumbar disc herniation has the advantages of short operation time, definite curative effect, and less trauma. And it is a safe and effective surgical method under the premise of strict control of the indications.
Adult ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Intervertebral Disc Displacement/surgery* ; Lumbar Vertebrae/surgery* ; Male ; Middle Aged ; Nucleus Pulposus ; Prolapse ; Retrospective Studies ; Treatment Outcome