Health related quality of life of women suffering from Uterine Prolapse before and after six months of surgery

One of the goals of health for everybody in 21st century is the improvement of quality of life. Thus, to find the best treatment for medical problems, it is not only enough to evaluate the results of interventions on morbidity and mortality in clinical studies, but also that the outcome of interventions in terms of socio-cultural aspect should be evaluated. Uterine Prolapse strikes at the heart of a woman’s sense of her own women nature and therefore her security along with her marital relationship should be guaranteed after the surgery process. After the removal of uterus women can’t find herself fulfilled though it is sick one as changes appear in women’s life both in understanding of her health as well as socio-cultural position that they gained after being as women. Many of the women who underwent surgery process are still suffering from both physical and psychological impairments. Some of them are experiencing psychological problem as they feel no longer a whole or real woman because of the removal of their reproductive organs, while others still had an orgasm from intercourse not just feeling dead. The changes to their sex life have created problem to them as they still struggle to cope with the loss they feel in their life as husbands always fed up as they argue with him. Such types of suffering and pain happen due to the socio-cultural circumstances in which a woman is brought up. They are seen as productive machine which had never been stopped though they are passing from pain and suffering. Thus, the overall issue of surgery process is to assure the quality of life of women to be them as a good wife and mother as well as good employer outside the home but before all this feeling of a whole womanhood in their life.

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.

Uterovaginal Prolapse in the Newborn: A Case Report from the University Hospital of Conakry

Uterovaginal prolapse is an exceptional pathology in the newborn. It is defined by the descent and protrusion of the uterus and vaginal walls to the outside via the vaginal orifice. It particularly affects newborns with neural tube defects. The diagnosis is usually made at birth. Different types of conservative or surgical treatment have been suggested for genital prolapse in neonates. We report the case of a newborn of 6 hours of life who was received for congenital utero-vaginal without neural tube closure anomaly. He was successfully treated with digital reduction of the mass associated with a cerclage of the vaginal orifice. Conclusion: Digital reduction of the prolapse associated with a cerclage of the vaginal orifice is simple, effective and avoids any recurrence.

Current Situation of Transvaginal Mesh Repair for Pelvic Organ Prolapse

SURGICAL mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repairabdominal hernias. In the using surgical mesh products 1970s, gynecologists began to indicate the repair of pelvic organ prolapse （POP）, and in the 1990s, gynecologists began using surgical mesh for POP. Then the U.S. Food andDrug Administration （FDA） approved the first surgical mesh product specifically for use in POP.

Vaginal Hyperplasia and Progressive Vaginal Fold Prolapse in a Bullmastiff Bitch

Canine reproductive problems constitute some of the most challenging cases encountered in small animal veterinary practice. This is usually complicated in breeding dogs by the unwillingness of clients to give consent for surgical interventions, due to the fear of loss of reproductive function. In this case, a two-year-old Bullmastiff bitch was presented to the Veterinary Teaching Hospital with a mass protrusion from the vulva. Clinical examination revealed an eversion of a tongue-shaped vaginal tissue from the floor of the vaginal wall which subsequently progressed to an eversion of the complete vaginal circumference forming a doughnut-shaped mass. Investigations carried out included ultrasonography, hematology, hormonal assay, vaginal cytology, vaginal swab microbial culture and antimicrobial sensitivity test. A diagnosis of vaginal fold prolapse (type III) which progressed from a type II prolapse was made. Due to the client’s initial disinclination to a surgical intervention, the approach to the case evolved from a conservative management to an eventual surgical correction. There was a request to preserve the reproductive function of the bitch, therefore ovariohysterectomy was declined and the case was managed by surgical excision of the prolapsed vaginal mass under general anesthesia. A peri-vulvar purse string suture was placed temporarily to restrict any further prolapse. Histopathological evaluation of the excised vaginal tissue confirmed marked hyperplasia of the stratified squamous epithelium with intracellular edema and spongiosis. There was focal ulceration of vaginal mucosa with neutrophilic infiltration. The lamina propria showed reduced cellular density with loose and edematous connective tissue. Post-surgical care included daily care of surgical wound and the administration of analgesic, antibiotic and vitamin supplements. Subsequently, there was no recurrence of the condition in the bitch which came into estrus 27 weeks post-surgery, and was bred with successful conception.

Clinical analysis of laparoscopic lateral peritoneal suspension in the treatment of severe pelvic organ prolapse

Objective:To investigate the clinical effects of laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse(POP).Methods:Thirty-eight patients who underwent laparoscopic lateral peritoneal suspension for pelvic organ prolapse in the gynecology department of our hospital from January 2019 to January 2020 were selected for retrospective analysis.Postoperative outcomes were recorded for patients at 3,6,and 12 months postoperatively.Results:All 38 patients completed the surgery safely,and the duration of surgery was 85-190 min,with a mean of(138±40.75)min;surgical bleeding was 30-80 ml,with a mean of(57±35.4)ml;the duration of postoperative catheterization was 4-6 days,with a mean of(5±0.73)days;postoperative hospitalization was 6-12 days,with a mean of(8.49±2.18)days.2.18)days.At 3,6,and 12 months after the end of surgery,all follow-up patients had their uterus and anterior vaginal wall restored to normal position without prolapse.The pelvic floor rehabilitation of the patients after surgery was good and their sexual life was significantly improved in all cases.Conclusion:Laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse is safe,efficacious,minimally traumatic,less painful,with short hospital stay,fast postoperative recovery,greater choice of uterine de-positioning,with the advantages of permanence and good pelvic floor anatomical recovery,and this procedure can maintain a certain vaginal length with 100%efficiency,which is worthy of clinical promotion.

Anatomic Evaluation of Uterosacral and Cardinal Ligament during Robotic and Laparoscopic Surgery for Pelvic Organ Prolapse

Introduction: It is widely accepted that the uterosacral ligaments (UTSL), together with the cardinal ligament (CL), hold the upper vagina and cervix over the levator plate. The aim of this study is to evaluate the anatomical relationship between the right vs. left CL and UTSL during robotic and laparoscopic utero-sacral ligament suspension (UTSLS) and its implication with the surgical technique during UTSL suspension. Material and Methods: We evaluated 25 women with apical pelvic organ prolapses of stages 2 - 4 and we analyzed 100 uterosacral and cardinal ligaments. They were assigned (non-randomly) to: a) robotic-assisted laparoscopic uterosacral ligament suspension (RAL-UTSLS), b) robotic-assisted single-site utero-sacral ligament suspension (RASS-UTSLS) or laparo-endoscopic single site utero-sacral ligament suspension (LESS-UTSLS). We evaluated the length (distance between origins and insertions) of the aforementioned ligaments using the Da Vinci Si and other laparoscopic instruments like calipers. Results: The mean length of the UTSL in their caudal-cranial extent was 3.5 ± 0.5 cm (right side) and 2.58 ± 0.3 cm (left side). Measurements were performed on the same way for the CL, resulting in 5.1 ± 0.3 cm (both side). The only significant difference was observed when comparing the right vs. left UTSL. This anatomic difference translates to 5 ± 1 suture stitches on the right UTSL vs. 2 ± 1 on the left UTSL. Conclusion: In our evaluation on cardinal and uterosacral ligament, the right UTSL was significantly longer as compared to the left and this allowed us to take 3 additional stitches on the right UTSL vs. left during RAL-UTSLS. Future studies are necessary to compare females with/without POP.

POPQ system and dynamic MRI in assessment of female genital prolapse

Aim: To assess the role of Magnetic resonance imaging (MRI) and pelvic organ prolapse quantification (POPQ) system in the evaluation of female pelvic organ prolapse. Design: Prospective study. Setting: TantaUniversityHospital. Patients: The study was carried out on 60 patients having clinical manifestations suggesting pelvic floor weakness. Intervention: All the patients were subjected to history taking, physical examination including POPQ, and pelvic MRI (static and dynamic) examination. Outcome measures: Quantitative measurements of genital prolapse. Results: All patients showed loss of the normal position of the perineal plate indicating generalized weakness of the whole pelvic floor muscles. Dynamic MRI exhibited pelvic floor abnormalities in 46 patients who did not show any abnormalities on the static images. Conclusion: Dynamic MRI is a helpful tool in defining the nature and quantitative measurements of pelvic organ prolapse. Also, MRI has and advantage over POPQ system in diagnosing lateral prolapse.

Recurrent Prolapsed Giant Uterine Polyp Comprised of Adenomyotic Cysts

The commonest pathologic diagnosis of large prolapsed polyps is leiomyoma. Benign or malignant adenomyomatous polyps follow. Adenomyotic cyst is a rare form of adenomyosis. To our knowledge, a recurrent prolapsed giant uterine polyp comprised of adenomyotic cysts and with different pathogenesis from the original polyp has not been reported in the literature. This case report describes a 29 year old woman with meno/metrrorrhagia, who was found to have a large recurrent uterine polyp prolapsed into the vagina at two and a half years after removal of an initial large uterine polyp. The initial polyp was a large uterine leiomyoma protruding through cervix. The recurrent giant polyp was comprised of adenomyotic cysts. Thus, this case report demonstrates that a prolapsed giant polyp of the uterine corpus can be caused by enlarged adenomyotic cysts inside the polyp. The pathogenesis of a recurrent uterine polyp may be different from that of the initial polyp.

Surgical repair of pelvic organ prolapse and follow-up: An institutional multi-center experience

AIM: To investigate the effects of the Elevate Anterior and Posterior transvaginal mesh procedure on 30 patients affected by pelvic organ prolapse(POP) at 12 mo follow-up.METHODS: Between September 2011 and September 2012, a prospective multicenter observational study enrolled 30 consecutive patients with POP-Q ≥ stage Ⅱ. After a preoperative evaluation, patients underwent prolapse repair utilizing the Elevate Anterior and Posterior Prolapse Repair System(American Medical Systems, Minnetonka, MN, United States). Operative technique was standardized and performed by the same surgical team under spinal or general anesthesia. Patients were evaluated postoperatively at 1, 3, 6 and 12 mo.RESULTS: All 30 patients completed the 12 mo followup. The mean age was 65.3 years(range 49-81 years) and average hospital stay was 4.5 d. The mean operative time was 65 min(range 40-120 min). Related adverse events reported were mesh extrusions(6.7%) and post void residual urine volume(13.3%). There were no visceral injuries, no infection of the mesh, and no symptoms of recurrent prolapse. All quality-of-life scores signifi cantly improved from baseline. CONCLUSION: One year's follow-up of our 30 patients confi rms the safety and the effi cacy of the Elevate Anterior and Posterior transvaginal mesh procedure for POP treatment. Our fi nal results are comforting but longer term follow-up is ongoing.

Cost-effectiveness analysis comparing robotic sacrocolpopexy to a vaginal mesh hysteropexy for treatment of uterovaginal prolapse

Objective: To compare costs and QoL associated with 2 minimally invasive operations to treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy. Costs were derived from a hospital perspective. QoL estimates focused on: recurrent prolapse;erosion;infection;transfusion;cystotomy;chronic pain;lower urinary tract symptoms;and mortality. Actual procedural costs at our institution were calculated. Costs and quality adjusted life years were examined over 1 year. Results: The costs ($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of $22,657 per QALY. The costs ($14,890) and QALYs (0.9309) for vaginal mesh produced a CE Ratio of $15,995 per QALY. The incremental cost per QALYs for robotic surgery was $207,232. Sensitivity analysis on all utilities, cost estimates, and complication estimates didn’t cross any thresholds. Conclusion: Vaginal mesh was more cost-effective than robotic sacrocolpopexy even when the cost of the robot was not factored.

Subjective and Objective Results of Native Anterior Vaginal Wall Repair in Local Anesthesia:A 10-Year Follow-Up

Introduction and Hypothesis: This follow-up study evaluates long-term subjective and objective outcome of native tissue anterior vaginal wall repair using local anesthesia. Methods: 72 women were operated. At 10-year follow-up anatomical results were evaluated by clinical examination. Furthermore, the women filled in a validated symptom and quality of life questionnaire. Results: Forty women (56%) completed the 10-year follow-up. Eighteen women (25%) had died within the ten-year follow-up period and fourteen women (19%) were lost to follow-up. Six (15%) of the women who came for follow-up had been reoperated for anterior vaginal wall prolapse within the 10-year follow-up period and were analysed as a separate group. Of the 40 women who came for the 10-year clinical examination none had stage 0 pelvic organ prolapse. Twenty (50%) women had stage 1, whereas, 13 (32%) had stage 2 and 1 (3%) had stage 3 pelvic organ prolapse. Ten years after surgery, 28 women (70%) had no bulge symptoms. Six (15%) of the women experienced bulge symptoms at the time of follow-up. Ten years postoperatively, 30 (75%) of the women in an overall quality of life assessment considered their condition improved after surgery. Conclusion: At 10-year follow-up 70% of women were relieved from their bulge symptoms and 75% still considered themselves better or much better than before the operation. However, 15% of women had been reoperated and 15% still experienced bulge symptoms.

Tailor-Made Mesh for Pelvic Organ Prolapses: Correlation between Patient’s Height and Mesh Size

Tension-free vaginal mesh (TVM) surgery is a common and minimally invasive procedure for pelvic organ prolapses. Since commercial kits are not readily available in Japan, we have planned tailor-made mesh by information of each patient before every TVM surgery. The aim of this report is to inform methods to design mesh for individual patients with pelvic organ prolapses. We also investigated the correlations among mesh size and height, weight, and body mass index (BMI). Before the operation, we obtained a KUB (abdominal X-ray). Three factors were measured from this X-ray: the first was the distance between the bilateral ischial spine, the second was the distance between the obturator foramen, and the third was the length of the arcus tendineus fascia pelvis (ATFP). These three factors always should be considered for designing of mesh. The correlations among the bilateral ischial spine distance, obturator foramen distance, ATFP length, height, weight, and BMI were assessed using the Pearson correlation coefficient. Although these three factors described above are necessary to design a mesh for individual patients, the bilateral ischial spine and obturator foramen distance correlated with the height of the patient. On the other hand, since the length of ATFP differs in each patient and is not correlated with height, we should consider this length when we design the mesh. Well-designed, tailor-made mesh will probably fit each pelvic organ prolapsed patient very well.

Digital Twin of the Female Pelvic Floor

Digital twin technology, originally developed for intricate physical systems, holds great potential in women’s healthcare, particularly in the management of pelvic floor disorders. This paper delves into the development of a digital twin specifically for the female pelvic floor, which can amalgamate various data sources such as imaging, biomechanical assessments, and patient-reported outcomes to offer personalized diagnostic and therapeutic insights. Through the utilization of 3D modeling and machine learning, the digital twin may facilitate precise visualization, prediction, and individualized treatment planning. Nevertheless, it is crucial to address the ethical and practical challenges related to data privacy and ensuring fair access. As this technology progresses, it has the potential to revolutionize gynecological and obstetric care by enhancing diagnostics, customizing treatments, and increasing patient involvement.

Umbilical Cord Prolapse Managed by Assisted Vacuum Delivery

G4P3L3 was at 40 weeks of gestation who was admitted in active stage of labor with normal fetal heart rate. At 8 cm cervical dilatation she experienced spontaneous rupture of membrane with clear liquor. Cord prolapse was detected and was prepared for caesarian section meanwhile she was kept in knee chest position and bladder was filled with normal saline 0.9%. 30 min before operation she was fully dilated with signs of Non reassuring fetal status, vacuum extraction was done to assist delivery as soon as possible. The APGAR score was 6 and 10 in the first and fifth minutes respectively. Mother and the baby were discharged the next day in good condition.

Uterine prolapse in buffaloes: A review

Uterine prolapse is an emergency postpartum problem occurring within 24 h of parturition and resulting in death or serious complications in unattended cases. Poor myometrial contractions during the post-partum period and traction during difficult births are two postulated etiologies and low serum calcium appear to be a significant risk factor for uterine prolapse in buffaloes. Shortly after eversion the uterus gets inflamed and edematous and shock may ensue in cases with excessive bleeding. Prompt replacement of prolapsed uterus with sufficient care assures good prognosis. The etiology, risk factors, clinical findings and approaches for therapy of uterine prolapse in buffaloes are mentioned in this review.

Huge Intravaginal Pedunculated Fibroid Embolization and Resectoscopy—A Case Report and Review of Literature

Background: Submucosal fibroids account for approximately 15 - 20 percent of total fibroids. Rarely, they prolapse. Common size is 2 - 6 cm, because larger fibroids are unlikely to fit through the cervix. Larger fibroids are associated with significant bleeding and pose a surgical challenge. Case Presentation: We present a 38-year-old woman nulliparous with an intravaginal pedunculated fibroid, 12 cm in diameter. She presented with metrorrhagia and an intense malodorous vaginal discharge, irresponsive to oral therapy. The patient had a history of resectoscopic fibroid enucleation, 7 months earlier, followed by insertion of an (intra-uterine device) IUD. There was no uterine prolapse. Management involved bilateral uterine artery embolization, followed by hysteroscopic excision with rigid resectoscope. The fibroid was “delivered” transvaginally intact. The uterus was preserved. The IUD was partly buried within the mass. Blood loss was negligible. Patient recovery was quick and uneventful. At 6-months follow up, pelvic anatomy has been restored. Conclusion: Large pedunculated fibroids are very rare. Embolization of uterine arteries has proven a valuable tool in challenging gynecologic operations. In our case, not only it prevented massive bleeding during excision, but also allowed a fertility-sparing minimally invasive management.

Frequency of Cervix Dysplasia in Women with Prolapsed Uterus: Cross-Sectional Descriptive Study at Panzi General Referral Hospital

Introduction: According to the WHO (January 7, 2022), cervical cancer is the second leading cause of cancer death worldwide among women of childbearing age. However, cervical cancer is highly preventable and treatable due to its well-known disease history which goes through several detectable pre-cancerous phases with available treatments. There are very few data on the prevalence of dysplastic lesions of the cervix in the Democratic Republic of the Congo. Panzi General Referral Hospital is a care center for women with genital prolapse, and our study aimed to determine the prevalence of dysplastic lesions of the cervix in this particular population. Methodology: This is a cross-sectional study of all women aged ≥ 18 years who consulted at the HGR Panzi from September 01 to December 31, 2022, diagnosed with uterine prolapse and who consented to the study. Results: The mean (±SD) age of the patients was 47.44 (±14.42) years and the majority (67.7%) of them were aged 40 and over. For all of the respondents, the Pap smear was normal in 62.6% and inflammatory in 2% of cases, while cytological abnormalities, which were found in 35.4% of cases, including 12.1% of lesions high-grade dysplastic (HSIL), i.e. 12 out of a total of 99 women examined. Conclusion: Women with uterine prolapse are twice as likely to develop dysplastic lesions as the general female population. A screening and management program for these lesions is essential in our preoperative protocol at the HGR Panzi and at the national level in general.

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.

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.