Clinically significant changes in anal sphincter hiatal area in patients with gestational diabetes mellitus and pelvic organ prolapse

BACKGROUND The prevalence of pelvic organ prolapse(POP)increases with age and parity.Specifically,the prevalence of POP among women aged 20 to 39 is 9.7%,while it rises to 49%among women over 80 years old.Additionally,as the number of deliveries increases,the prevalence of POP also rises accordingly,with a rate of 12.8%for women with one delivery history,18.7%for those with two deliveries,and 24.6%for women with three or more deliveries.It causes immense suffering for pregnant women.AIM To evaluate the relationship between the levator ani muscle’s hiatus(LH)area and POP in patients with gestational diabetes mellitus(GDM)using perineal ultrasound.METHODS The study cohort comprised 104 patients aged 29.8±3.7 years who sought medical care at our institution between January 2021 and June 2023.All were singleton pregnancies consisting of 75 primiparas and 29 multiparas,with an average parity of 1.7±0.5.According to the POP diagnostic criteria,the 104 subjects were divided into two groups with 52 members each:POP group(patients with GDM combined with POP)and non-POP group(patients with GDM without POP).Perineal ultrasound was used to measure differences in the anteroposterior diameter,transverse diameter,and LH area.Receiver operating characteristic curves were drawn to determine the optimal cutoff values for the LH anteroposterior diameter,transverse diameter,and area for diagnosing POP.RESULTS Statistically significant increase in the LH area,anteroposterior diameter,and lateral diameter were observed in the POP group compared with the non-POP group(P<0.05).Both groups exhibited markedly elevated incidence rates of macrosomia and stress urinary incontinence.For the POP group,the area under the curve(AUC)for the LH area was 0.906 with a 95%confidence interval(CI):0.824-0.988.The optimal cutoff was 13.54cm²,demonstrating a sensitivity of 83.2%and a specificity of 64.4%.The AUC for the anteroposterior diameter reached 0.836 with a 95%CI:0.729-0.943.The optimal cutoff was 5.53 cm with a sensitivity of 64.2%and a specificity of 73.4%.For the lateral diameter,its AUC was 0.568 with a 95%CI:0.407-0.729.The optimal cutoff was 4.67 cm,displaying a sensitivity of 65.9%and a specificity of 69.3%.Logistic regression analysis unveiled that age,body weight,number of childbirths,total number of pregnancies,and gestational weight gain constituted the independent risk factors for the cooccurrence of GDM and POP.CONCLUSION Three-dimensional perineal ultrasonography of LH size and shape changes can effectively diagnose POP.Age,weight,number of births,number of pregnancies,and weight gain during pregnancy are independent risk factors affecting the cooccurrence of GDM and POP.GDM can increase the LH area in patients,and an enlarged LH leads to an increased incidence of POP.

Evaluation of the Clinical Advantages of Laparoscopic Transverse Abdominal Wall Suspension in the Treatment of Pelvic Organ Prolapse

Objective:To evaluate the clinical advantages of laparoscopic transverse abdominal wall suspension in treating pelvic organ prolapse.Methods:Sixty patients diagnosed with moderate to severe pelvic organ prolapse and underwent surgical treatment in our hospital between January 2022 and December 2023 were selected.According to different surgical methods,they were divided into an observation group(given laparoscopic transverse abdominal wall suspension)and a control group(given transvaginal mesh implantation),with 30 subjects/group.The data on perioperative-related indicators,quality of life scores,postoperative recurrence,and complications of the two groups of patients were collected.Results:The postoperative hospitalization days and intraoperative bleeding volume of the observation group were significantly lower than those of the control group,but had longer operation time than that of the control group(P<0.05).The differences between the two groups were statistically significant 6 months after surgery,and the Pelvic Floor Disease Quality of Life Impact Questionnaire(PFIQ-7)score of the observation group was significantly higher than the control group(P<0.05).Both groups of patients completed 12 months of follow-up without any postoperative recurrence.The number of complications in the observation group was slightly lower than that of the control group(P>0.05).Conclusion:Laparoscopic transverse abdominal wall suspension was more effective in treating pelvic organ prolapse and is an ideal surgical procedure.

New native tissue repair for pelvic organ prolapse:Medium-term outcomes of laparoscopic vaginal stump-round ligament fixation

BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs performed using patients’tissues[i.e.native tissue repair(NTR)]instead of mesh have attracted much attention.At our hospital,laparoscopic sacrocolpopexy(the Shull method)was introduced in 2017.However,patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this procedure.AIM To validate a new NTR treatment for POP,we examined patients undergoing laparoscopic vaginal stump–round ligament fixation(the Kakinuma method).METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for>12 mo after surgery.We retrospectively examined surgical outcomes for surgery duration,blood loss,intraoperative complications,and incidence of recurrence.The Kakinuma method involves round ligament suturing and fixation on both sides,effectively lifting the vaginal stump after laparoscopic hysterectomy.RESULTS The patients’mean age was 66.5±9.1(45-82)years,gravidity was 3.1±1.4(2-7),parity was 2.5±0.6(2-4)times,and body mass index was 24.5±3.3(20.9-32.8)kg/m2.According to the POP quantification stage classification,there were 8 patients with stage Ⅱ,11 with stage Ⅲ,and 11 with stage Ⅳ.The mean surgery duration was 113.4±22.6(88-148)min,and the mean blood loss was 26.5±39.7(10-150)mL.There were no perioperative complications.None of the patients exhibited reduced activities of daily living or cognitive impairment after hospital discharge.No cases of POP recurrence were observed 12 mo after the operation.CONCLUSION The Kakinuma method,similar to conventional NTR,may be an effective treatment for POP.

Medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with posterior approach for a pelvic organ prolapse:A retrospective study of 124 cases

Objective:Pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health concern.The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.Methods:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study.The results and complications were recorded.Data were retrospectively reviewed.Results:In total,124 patients were analyzed.Patients were followed up for 32.2712.90 months.The objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall prolapse.The objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall prolapse.Conchusions:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe POP.Long-term follow-up is needed to confirm the clinical effects.

Pelvic Organs Prolapse in Low-Resources Countries: Epidemiology, Risk Factors, Quality of Life. Narrative Review

Objective: Pelvic organ prolapse is an emerging public health problem affecting adult women of all ages with a negative impact on social, physical well-being, and psychological. Its presents several challenges in countries with low resources. This literature review aims to examine POP in its epidemiological aspects, risk factors, and staging by taking up the challenges associated with low-resource settings and identifying some avenues for future research. Methods: We searched the PubMed, Google Scholar, and Scopus databases. The other studies were identified by checking the secondary references in the original citation. We have collected studies on adult women published in English for the last 30 years. In total, 71 articles were read. We excluded studies from all newspaper articles, Studies presenting co-morbidities (fistulas, cervical cancer, pregnancy), those evaluating treatment, letters, comments, case reports, practice guidelines, news, historical articles, legal cases, published erratum, and congresses. Results: 16 studies examining the epidemiology have been identified with 11 in countries defined by the World Bank as limited or intermediate resources. 18 on risk factors whose 10 in countries with limited or intermediate resources, 10 on staging and 27 on physiopathology. Conclusion: POP affects the young more in low-resource settings. Its prevalence remains underestimated for several reasons. Several risk factors found are the same as those of women in countries with a high standard of living. However, there are some specific risk factors for these resource-limited settings.

Plasma Levels of Transforming Growth Factor-Beta 1 in Women with Pelvic Organ Prolapse

Objective: In women with pelvic organ prolapse (POP), decreased expression of transforming growth factor-beta 1 (TGF-β1) has been shown in POP tissues. However, no studies have evaluated plasma TGF-β1 levels in patients with POP, so it is unknown whether they are also changed or not. Therefore, we compared plasma TGF-β1 levels in women with and without POP. Methods: Participants were 49 women with POP and 23 healthy control women. All participants were postmenopausal. We measured plasma TGF-β1 and compared data between patients with POP and controls, and between patients with uterine prolapse (UP, n = 19) and those with a cystocele (CC, n = 30). In addition, in patients, we assessed the POP quantification system (POP-Q) stage. Results: Plasma TGF-β1 levels were significantly lower in patients than in healthy controls. POP-Q stage was not significantly different between the UP and CC subgroups, but POP-Q stage IV was diagnosed in 63% of patients with UP and 7% of those with CC. Plasma TGF-β1 levels were significantly lower in the CC subgroup than in the UP subgroup. Conclusion: Plasma TGF-β1 is decreased in POP. It remains unclear whether the lower levels indicate a reduction in systemic TGF-β1 activity, but they can be assumed to reflect reduced TGF-β1 expression in POP tissues.

The role of lysyl oxidase-like 1 and fibulin-5 in the development of atherosclerosis and pelvic organ prolapse

Dear Editor： I would like to congratulate Zhou et al.[1] on their study of the correlation between expression of lysyl oxidase-like 1 （LOX-1） and fibulin-5 （F5） in the car- dinal ligament tissue and pelvic organ prolapse （POP）. In their elegant work, they evaluated the levels of LOX-1 and F5 in connective tissue of the cardinal ligament in order to demonstrate signs of elastinopa- thy in women with POP. They stress the concept that several environmental risk factors could cause qualitative and quantitative changes in the connective tissue promoting POP. The above authors conclude that the specific mechanism of LOXL1 and F5 involved in the development of POP is unclear.

Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four patients.CONCLUSION: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.

Prospective Evaluation of Outcomes of Mechanical Devices in Women with Symptomatic Pelvic Organ Prolapse in Ogbomoso, South-Western Nigeria

Background: Symptomatic pelvic organ prolapse (POP) impacts the sufferers’ quality of life negatively. There is a preference for a mechanical device in certain conditions though the definitive management of POP is surgical. Objectives: We conducted the study to evaluate the outcome of management of POP using mechanical devices. Methods: It was a prospective study. It took place in the gynecology unit of the Bowen University Teaching Hospital Ogbomoso between May 2014 and April 2019. We followed up with eligible patients who opted for pessary use for a median duration of 18 months (Range 12 - 84 months). We excluded those who refuse to participate in the study. Results: Of the 127 patients with symptomatic POP, seventy-five (59.1%) opted for the use of mechanical devices, and 70 successfully retained them four weeks after insertion. We lost Six (9.2%) patients to follow up. Of the 64 women included in the analysis, 16 (25%) discontinued use at some point after four weeks, whereas 36 (56.3%) used the pessary successfully throughout the follow-up period. Overall, 12.1% of the women experienced minor complications (6.9% pain or discomfort, 3.2% excoriation or bleeding, and 2.0% dis-impaction or constipation). After cessation of pessary use, 12 (25%) of the 48 women chose surgery, and 10 (20.8%) chose no further treatment. Conclusion: This study concluded that pessary use for pelvic organ prolapse is safe in low resource settings. Therefore, it is justifiable to offer pessaries in the initial management of uterovaginal prolapse to all patients who opt for conservative management and those awaiting surgery.

Transvaginal mesh implant for pelvic organ prolapse:Huaxi protocol

With increasing age,pelvic organ prolapse(POP),due to its high incidence,has become a common disease that seriously affects patients’quality of life and places a heavy economic burden on families and society.Transvaginal mesh(TVM)is a minimally invasive and effective treatment for POP,although its use remains controversial due to the potential risk of mesh-related complications.The US Foods and Drugs Administration,along with authorities in England,Australia,New Zealand,and other countries,have banned the sale and distribution of commercial TVM kits designed for POP.The TVM procedure remains an option for POP treatment and still appeals to many surgeons and patients today in Asia and most European countries,which suggests that a considerable number of POP patients can benefit from its continued refinement.Here we introduce the Huaxi protocol of the TVM plant for the treatment of POP.

Expression and significance of lysyl oxidase-like 1 and fibulin-5 in the cardinal ligament tissue of patients with pelvic floor dysfunction

Pelvic organ prolapse （POP） is a disabling disorder in women characterized by a loss of pelvic floor support, leading to the herniation of the uterus into or through the vagina. POP is a complex problem that likely involves multiple mechanisms with limited therapies available, and is associated with defects in connective tissue including elastic fibers. This study was designed to investigate the expression of fibulin-5 and lysyl oxidase-like 1 （LOXL1） in the cardinal ligament in samples taken from the POP group compared to the non-POP group. Specimens were obtained during abdominal hysterectomy from the cardinal ligament of 53 women with POP and 25 age- and par- ity- matched women with non-POP among post-menopausal women with benign gynecologic pathology. Protein expression was evaluated using the immunohistochemical staining method. For statistical analyses, chi-square test and Spearman＇s correlation were used with the statistical package SPSS13.0 system. Our results showed that both fibulin-5 and LOXL1 expressions were decreased in the cardinal ligament in the POP group compared to the non- POP group （P 〈 0.05）. The expression of fibulin-5 and LOXL1 were correlated closely with the stage of POP, ac- companied by stress urinary incontinence and frequency of vaginal delivery （P 〈 0.05）, but had no relationship with post-menopausal state （P 〉 0.05）. The expression of fibulin-5 was positively associated with LOXL1 in POP （P 〈 0.05）. We conclude that changes in fibulin-5 and LOXL1 expression may play a role in the development of POP.

Uterus-reserved or hysterectomized total pelvic floor reconstruction for female pelvic dysfunction:a clinical analysis of 74 cases

Objective To evaluate the effectiveness and safety of the entire pelvic floor reconstruction(Prolift) with uterus reserved in the treatment of pelvic floor dysfunction diseases.Methods From March 2008 to January 2009,74 female cases from our hospital who had different defects in pelvic organ prolapse were treated with the entire reconstructive pelvic surgery,in which 38 had uterus retained(observation group) and 36 cases had hysterectomy(control group).The two groups were compared.The patients with combined stress urinary incontinence had transobturator tension-free vaginal tape(TVT-O technique) at the same time.The results of operations were objectively evaluatedaccording to Pelvic Organ Prolapse Quantification sub-degree method(POP-Q) developed by the International Continence Society.Results For observation group,the average operative time was 50 min,and the average amount of bleeding was 100 mL.For control group,the average operative time was 110 min,and the average amount of bleeding was 200 mL.During the postoperative follow-up(8 ~18 months),in the observation group the structures of patients' pelvic floor were normal;stress urinary incontinence was all cured;related symptoms disappeared or were markedly improved;and no postoperative infection appeared.In control group,two cases had postoperative infection;the patients ' pelvic structures were normal during the postoperative follow-up;the related symptoms disappeared or were significantly improved.After 3 months,POP-Q score was significantly elevated in the two groups.Conclusion Full reconstructive pelvic surgery with uterus retained can complete the whole pelvic floor structure and function of all or part of the reconstruction with fast recovery and clear short-term effect.However,the long-term efficacy remains to be revealed.

Exosomes from umbilical cord mesenchymal stromal cells promote the collagen production of fibroblasts from pelvic organ prolapse

BACKGROUND Pelvic organ prolapse(POP)involves pelvic organ herniation into the vagina due to pelvic floor tissue laxity,and vaginal structure is an essential factor.In POP,the vaginal walls exhibit abnormal collagen distribution and decreased fibroblast levels and functions.The intricate etiology of POP and the prohibition of trans-vaginal meshes in pelvic reconstruction surgery present challenges in targeted therapy development.Human umbilical cord mesenchymal stromal cells(hucMSCs)present limitations,but their exosomes(hucMSC-Exo)are promising therapeutic tools for promoting fibroblast proliferation and extracellular matrix remodeling.suppressed inflammation in POP group fibroblasts,stimulated primary fibroblast growth,and elevated collagen I(Col1)production in vitro.High-throughput RNA-seq of fibroblasts treated with hucMSC-Exo and miRNA sequencing of hucMSC-Exo revealed that abundant exosomal miRNAs downregulated matrix metalloproteinase 11(MMP11)expression.CONCLUSION HucMSC-Exo normalized the growth and function of primary fibroblasts from patients with POP by promoting cell growth and Col1 expression in vitro.Abundant miRNAs in hucMSC-Exo targeted and downregulated MMP11 expression.HucMSC-Exo-based therapy may be ideal for safely and effectively treating POP.

A Large Vaginal Bulge Might Not Be a Genital Prolapse

Vaginal tumors, whether benign or malignant, are rare. They include fibroepithelial polyps (FEPs), which are benign lesions originating in mesenchymal cells, comprised of a core of connective tissue covered by squamous epithelium. They are usually small and asymptomatic. When symptomatic or very large, they may cause bleeding, genital discomfort or the presence of a bulge in the vagina. In the last case, they may be mistaken for a genital prolapse. Although their physiopathology is still not clearly understood, the presence of hormonal receptors and the occurrence of FEPs during the use of hormone therapy or pregnancy suggest that changes in the stroma of these lesions may be induced by hormones. We report on the case of a patient who presented with a vaginal bulge and was referred to the urogynecology outpatient ward with a diagnosis of genital prolapse, which had actually a large fibroepithelial polyp on the posterior vaginal wall.

Health Promotion to Patients with Pelvic Floor Dysfunction: An Integrative Review

Introduction and Hypothesis: The Pelvic Floor Dysfunction (PFD) is a common gynecological condition that causes significant morbidity in the affected population, increasing clinical and financial challenge for the Public Health Services. Methods: This study aimed to review the available evidence and interventions to promote the health of women with PFD. We used the following databases to select papers for this review: Scopus, PubMed, CINAHL, LILACS and Cochrane. The sample consists of seven articles, with evidence levels 1 and 2. Results: The results of the articles point out to a greater number of activities related to the management of Urinary Incontinence (UI) behavioral support to the patient and physical therapy of the pelvic floor muscles. They were both beneficial to UI prevention and treatment. Conclusions: The physical therapy approach, when associated with cognitive and behavioral strategies, leverages UI outcomes in patients.

Telomerase-mediated immortalization of human vaginal wall fibroblasts derived from patients with pelvic organ prolapse

Background: Extracellular matrix (ECM) remodeling is the most important pathomechanism of pelvic organ prolapse (POP). Fibroblasts are the key to ECM regulation. The passaging capacity of human vaginal wall fibroblasts (hVWFs) is limited in vitro . Here, we aimed to immortalize hVWFs through the introduction of human telomerase reverse transcriptase (hTERT). Methods: Primary cells were derived from the vaginal wall tissue of patients with POP. Cellular senescence was detected via senescence-associated β-galactosidase staining. We employed a lentiviral transfection vector to stably express hTERT in hVWFs at passage 3, generating immortalized hVWFs (i-hVWFs). We then assessed cellular proliferation via the CCK-8 and EdU assays as well as cellular migration via wound healing assays. G-banded chromosome karyotypic analysis was performed to evaluate chromosomal karyotype stability. Finally, cellular tumorigenesis capacity was assessed in nude mice. A two-tailed Student’s t test was used to compare differences between the two groups. Results: Our results showed that senescence of primary hVWFs significantly increased from passage seven. From passage 11, hVWFs showed a significantly higher senescence percentage than i-hVWFs. During the continuous passage, i-hVWFs presented stability in proliferation, migration capacity, expression of ECM regulation-related genes, and chromosome karyotype. In vivo tumorigenesis was absent in i-hVWFs. Conclusions: The senescence of hVWFs significantly increased from the seventh passage, and we successfully used hTERT to immortalize hVWFs derived from patients with POP. Studies on POP that require a long-lived hVWF line will benefit from our technique.

Sensory threshold for defecation and its correlation with pelvic organ prolapse:An exploration of related factors

Objectives This research aimed to investigate changes in defecation sensory threshold and related factors in patients with posterior vaginal wall prolapse.Methods A total of 214 patients with pelvic organ prolapse were recruited between October 2019 to January 2021.All patients underwent a defecation sensory threshold examination,physical examination,and pelvic floor ultrasound examination.Factors related to the defecation sensory threshold were analyzed.Results(1)Among the participants,57 patients(26.6%)had a defecation sensory threshold of more than 90ml.Patients with a threshold>90ml showed higher scores of defecation dysfunction in the Constipation Scoring System(CSS)score(p=0.003)and higher scores of constipation in the Colorectal-anal Distress Inventory 8(CRADI-8)score(p=0.002).(2)The defecation sensation threshold positively correlated with the Ap point(r=0.448,p<0.001),the Bp point(r=0.345,p=0.009),the area of the levator-ani hiatus measured by transvaginal ultrasound(r=0.403,p=0.002),and parity(r=0.355,p=0.007).Conclusions Patients diagnosed with pelvic organ prolapse commonly experience an increased threshold of defecation sensation.Elevated thresholds were associated with more frequent constipation symptoms.Additionally,the severity of posterior pelvic prolapse positively correlated with the defecation sensory threshold.

Role of different childbirth strategies on pelvic organ prolapse and stress urinary incontinence： a prospective study

Background Traumatic damage to fascial and muscular support structures during childbirth may be a major factor of the development of stress urinary incontinence （SUI） and pelvic organ prolapse （POP）. The aim of this study was to prospectively investigate the role of different childbirth strategies on POP and SUI. Methods A total of 120 selected pregnant women were recruited and divided into two groups： vaginal delivery group （n=72） and selective cesarean delivery group （n=48）. The women were questioned with SUI sheet and estimated with POP quantification （POP-Q） within 6-8 weeks after delivery. The correlations of SUI and results of POP-Q with the strategies of delivery were analyzed, ttest, X2 test, and the Mann-Witney test were used for statistical analysis. Results Among the 120 women, SUI was developed during 29-30 gestational weeks in 20 patients （16.6%）, of whom 14 （70%） had symptoms of SUI till 6 weeks postpartum. Totally 20 （16.6%） women had SUI symptoms after delivery. The prevalence of postpartum SUI was positively correlated with the occurrence of SUI during 29-30 gestational weeks （P〈0.001）. In the vaginal delivery group, 100% of the women suffered form urinary prolapse 6 weeks postpartum, while 87.5% of those in the selective cesarean delivery group developed POP （P〈0.01）. The percentages of the first- and second-degree urinary prolapse in the vaginal delivery group were 20.8% and 79.2% respectively, which were significantly different from those in the selective cesarean delivery group （64.6% and 22.9%; both P=0.000）. Conclusions Pregnancy and delivery play an etiologic role in the development of SUI and POP. The onset of SUI during late pregnancy implies a significant risk of postpartum SUI symptoms. The prevalence of POP is significantly higher after vaginal delivery than after cesarean delivery.

A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse

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.

Tension-free Polypropylene Mesh-related Surgical Repair for Pelvic Organ Prolapse has a Good Anatomic Success Rate but a High Risk of Complications

Background： Food and Drug Administration announcements have highlighted the standard rate of mesh-related complications. We aimed to report the short-term results and complications of tension-free polypropylene mesh （PROSIMATM） surgical repair of pelvic organ prolapse （POP） using the standard category （C）, timing （T）, and site （S） classification system. Methods： A prospective cohort study of 48 patients who underwent PROS1MATM mesh kit-related surgical repairs were followed for two years at Peking Union Medical College Hospital. Recurrence was defined as symptomatic POP quantification （POP-Q） Stage II or higher （leading edge ≥ -1 cm）. The Patient Global Impression of Change Questionnaire, the Chinese version of the Pelvic Floor Impact Questionnaire short-form-7 and POP/Urinary Incontinence Sexual Questionnaire short-form- 12 were used to evaluate the self-perception and sexual function of each patient. Mesh-related complications conformed to the International Urogynecological Association/International Continence Society joint terminology. The paired-sample t-test, one-way analysis of variance, Fisher＇s exact test, Kaplan-Meier survival analysis and log-rank test were used to analyze data. Results： All patients were followed up for ≥12 months; 30 （62.5%） patients completed the 24 months study. We observed a 93.8% （45/48） positive anatomical outcome rate at 12 months and 90.0% （27/30） at 24 months. Recurrence most frequently involved the anterior compartment （P 〈 0.05）. Pelvic symptoms improved significantly from baseline （P 〈 0.05）, although the patients＇ impressions of change and sexual function were not satisfying. Vaginal complication was the main complication observed （35.4%, 17/48）. The survival analysis did not identify any relationship between vaginal complication and anatomical recurrent prolapse （POP-Q 〉 Stage II） （P = 0.653）. Conclusions： Tension-free polypropylene mesh （PROSIMA^TM）-related surgical repair of POP has better short-term anatomical outcomes at the apical and posterior compartments, but a low patient satisfaction rate. The mesh complications were not the definitive cause of recurrence.