Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse

Shared decision making in pelvic organ prolapse: a thematic analysis of healthcare professional perspectives

Shared decision-making (SDM) is widely recognized for its benefits in patient-centered care, yet its application in the treatment of pelvic organ prolapse (POP) presents notable challenges. This study explores healthcare professionals (HCPs) experiences with SDM, identifying barriers and facilitators to its implementation. Twelve HCPs involved in POP management were interviewed. The data was analyzed using reflexive thematic analysis, revealing four key themes: (1) Experiences with SDM, (2) Differences in HCP perspectives, (3) Patient characteristics, and (4) Information provision. While HCPs value SDM, they face challenges including limited patient health literacy, time constraints, and differing patient expectations. Key facilitators included clear, tailored communication, structured patient education, and effective multidisciplinary collaboration. This study emphasizes the importance of preparing patients for active participation in SDM by enhancing health literacy and improving communication. Overcoming barriers and using facilitators can enhance SDM quality in clinical practice, improving patient outcomes and satisfaction in POP care.

Trends in patient characteristics, surgical techniques, and associated complications over time in pelvic organ prolapse repair

OBJECTIVE

To investigate trends in pelvic organ prolapse (POP) surgical repair procedures and patient characteristics over the past decade, focusing on peri-operative and post-operative complications.

METHODS

This retrospective cohort study analyzed POP surgeries and short-term complications among women over 18 at a tertiary medical center from 2014 to 2022. Exclusion criteria included pelvic radiation, malignancy, significant comorbidities, incomplete records, or loss to follow-up. Complications were assessed using the Clavien-Dindo Classification, focusing on infection rate, antibiotic use, blood transfusions, readmission within 30 days, and Intensive care unit admission. Univariate analysis and logistic regression were performed.

RESULTS

The study included 490 women, with 239 in 2014 and 251 in 2022. A decrease in invasive procedures, such as vaginal hysterectomy (25.1 % vs. 15.1 %, p < 0.01) and transabdominal hysterectomy (42.7 % vs 23.1 %, p < 0.01), alongside an increase in native tissue repairs like sacrospinous ligament fixation (SSLF) (2.1 % vs. 27.5 %, p < 0.01), anterior colporrhaphy (14.6 % vs. 24.7 %, p < 0.01), and posterior colporrhaphy (0.0 % vs. 2.4 %, p = 0.02), was noted. Additionally, the use of vaginal mesh decreased (4.2 % vs. 1.2 %, p = 0.04). Short-term complications significantly declined, including infection rate (10.9 % vs. 4.4 %, p < 0.01), post-operative antibiotics (10.9 % vs. 4.0 %, p < 0.01) and need for blood transfusion (16.7 % vs. 7.6 %, p < 0.01). SSLF was an independent protective factor against short-term complications (OR = 0.191, CI 0.044-0.826, p = 0.027), adjusted for year and patient age.

CONCLUSION

Our analysis suggests a shift toward less invasive POP surgeries, potentially contributing to improved short-term outcomes. The increase in native tissue repairs and reduction in hysterectomies may be associated with fewer short-term complications.

Pregnancy After Laparoscopic Hysteropexy: A Systematic Review

Background: Nowadays, there is an increasing desire among women suffering from pelvic organ prolapse (POP) to choose a uterus-sparing surgical treatment in order to preserve their fertility. The objective of this study was to conduct a systematic review of the literature to assess how pregnancy and delivery affect the recurrence of POP in women who had previously undergone laparoscopic hysteropexy as well as to improve and individualise the future counselling of patients of reproductive age desiring uterine-preserving treatment for POP. Methods: A comprehensive literature review was conducted using the MEDLINE (PubMed), Web of Science, and Scopus databases for articles published until January 2025, without previous historical limits. The research strategy adopted included different combinations of the following terms: hysteropexy, pregnancy, laparoscopy, and prolapse. Results: A total of ten case reports and three case series met the inclusion criteria for the review, comprising 26 patients. All authors used laparoscopic sacral hysteropexy (LSHP) for the treatment of POP. All patients underwent caesarean delivery at a mean gestational age of 38 weeks. Over a mean follow-up period of 9 months, only 4% of patients developed a recurrent uterine prolapse. A total of 8% of the patients developed de novo anterior compartment prolapse, 8% developed a recurrence of anterior compartment prolapse, and 4% developed posterior compartment prolapse. Conclusions: LSHP seems to be a safe option for women of reproductive age with incomplete family planning, as it does not seem to negatively impact foetal growth. Pregnancy does not appear to affect the long-term efficacy of hysteropexy in maintaining apical support. Given the limited data on the safety and efficacy of uterine-sparing surgery for POP followed by a subsequent pregnancy, further evidence is of great importance towards evaluating safety, efficacy, and providing better counselling for women.

Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study

Background

The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ∼40%-50% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models.

Objective

This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs.

Methods

This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire-short form 7, Urinary Impact Questionnaire-short form 7, Colorectal-Anal Impact Questionnaire-short form 7, and Pelvic Organ Prolapse Impact Questionnaire-short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis.

Results

The digital pelvic program had a high completion rate of 77.6% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69%). The overall impact of pelvic floor symptoms in participants' daily lives decreased significantly (-19.55 points, 95% CI -22.22 to -16.88; P<.001; response rate of 59.5%, 95% CI 54.9%-63.9%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (-18.09, 95% CI -19.99 to -16.20 and -15.08, 95% CI -17.52 to -12.64, respectively; P<.001). Mental health also improved, with 76.1% (95% CI 60.7%-84.9%; unadjusted: 97/149, 65.1%) and 54.1% (95% CI 39%-68.5%; unadjusted: 70/155, 45.2%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms' burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery.

Conclusions

This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life.

Role of the integrin‑β1/TGF‑β1 signaling pathway in the pathogenesis of pelvic organ prolapse: A study on vaginal wall tissue alterations and molecular dysfunction

Pelvic organ prolapse (POP) is a prevalent condition among middle‑aged and older women, and is associated with the irregular production and breakdown of the extracellular matrix. Mechanical forces serve a key role in preserving the equilibrium between matrix synthesis and degradation, thereby supporting the structural integrity of pelvic floor tissues. The aim of the present study was to investigate alterations in the composition of vaginal wall tissues in individuals suffering from POP and to investigate the molecular mechanisms through which mechanical forces trigger fibroblast apoptosis and influence collagen expression via the integrin‑β1/TGF‑β1 signaling pathway. Masson's trichrome and Elastica van Gieson staining were used to examine the pathological alterations in the tissue associated with POP. Analysis of immunofluorescence, western blotting and reverse transcription‑quantitative PCR data was performed to assess changes in the levels of proteins and genes such as collagen, integrin‑β1, TGF‑β1, MMP‑1 and tissue inhibitor of metalloproteinase‑1 (TIMP‑1). Fibroblasts were incubated with an integrin‑β1 antagonist RGD peptide to mimic cellular injury induced by mechanical forces, and cell migration and apoptosis were analyzed using scratch assays and flow cytometry. Cytoskeletal alterations were detected via immunofluorescence staining, and western blot analysis was conducted to examine the expression levels of integrin‑β1, TGF‑β1, TIMP‑1, MMP‑1, collagen type I α1 chain (COL1A1) and collagen type III α1 chain (COL3A1) across various groups. Analysis revealed that in the POP group, the collagen fibers in the vaginal wall tissues were loose and irregularly arranged, the number of elastic fibers was reduced and the structure was degraded. Furthermore, stress fibers were incomplete and their functions were impaired, resulting in damage to the connective tissue structure of the pelvic floor. Integrin‑β1 was key for fibroblast migration, apoptosis and collagen synthesis. Additionally, the integrin‑β1/TGF‑β1 signaling pathway served a role in mediating fibroblast apoptosis, and influencing the synthesis and metabolism of COL1A1 and COL3A1 induced by mechanical forces. Understanding the underlying pathogenesis of pelvic floor organ prolapse could pave the way for future investigations into innovative prevention and treatment strategies.

Assessing the link between birth interval and pelvic organ prolapse severity in reproductive-age women in rural Turkey: A cross-sectional study on quality of life

OBJECTIVE

Pelvic organ prolapse (POP) impacts women's quality of life globally. We aimed to assess the association between the number of births, minimum birth intervals, and POP grade, and their relationship with quality of life in reproductive-aged women in rural Turkey.

METHODS

This cross-sectional study was conducted in rural Turkey from June to September 2024, involving women attending a rural state hospital's gynecology clinic. Participants were divided into group 1 (n = 96, POP stage 0-1) and group 2 (n = 96, POP stage 2-3-4), using Pelvic Organ Prolapse Quantification (POP-Q) system staging. Genital hiatus and perineal body measurements were recorded, and the Prolapse Quality of Life (P-QOL) questionnaire was administered. As outcome measures, we assessed the number of births, minimum birth intervals, genital hiatus, perineal body measurements, and sociodemographic factors, for their associations with POP-Q stage and quality of life.

RESULTS

Participants' mean age was 38.0 ± 7.4 years. Women in group 2 had more vaginal deliveries (4.4 ± 1.5 vs. 4.0 ± 1.5; P = 0.042), shorter minimum birth intervals (18.5 ± 7.9 vs. 25 ± 29.5 months; P = 0.004), higher birth weight of the heaviest child (3667.5 ± 540.6 vs. 3468.1 ± 523.3 g; P = 0.008), and larger genital hiatus (4.3 ± 0.9 vs. 3.5 ± 1.0 cm; P < 0.001). Group 2 had significantly higher P-QOL scores, indicating poorer quality of life. Receiver operating characteristic (ROC) curve analysis identified predictive thresholds for severe prolapse: six or more vaginal deliveries, genital hiatus diameter ≥5.25 cm, and heaviest child's birth weight ≥4250 g.

CONCLUSION

Increased number of vaginal births, higher birth weight of the heaviest baby, and shorter intervals between births are significantly associated with more severe POP stages.

Long-Term Outcome of Anterior-Apical Mesh (Surelift) Versus Anterior Colporrhaphy and Sacrospinous Ligament Fixation in Advanced Pelvic Organ Prolapse Surgery

OBJECTIVE

This study first aims to compare the outcomes of Surelift (anterior-apical transvaginal mesh) and sacrospinous ligament fixation (SSF) with anterior repair using objective and subjective cure rates. Second, to compare the quality of life and its major and minor complications.

MATERIAL AND METHODS

A retrospective study was conducted between December 2011 and January 2020. Patients with symptomatic stage ≥ 3 anterior or apical prolapse were included. Those who had prior POP mesh and who were unfit for surgery were excluded. Preoperative evaluation included history and physical exam, urodynamic studies, and validated questionnaires (IIQ-7, UDI-6, POPDI-6) at baseline, 1, 3, and 5 years later.

RESULTS

One hundred eighty-one patients were included: 98 underwent anterior-apical transvaginal mesh and 83 had SSF with anterior colporrhaphy (SSF+A). Anterior-apical transvaginal mesh and SSF+A patients had mean follow-up periods of 83.5 ± 6.1 and 91.6 ± 39 months, respectively. At 1 year, no statistically significant difference was noted in objective and subjective cure rates between anterior-apical transvaginal mesh (96.8% and 94.7%) and SSF+A (89.9% and 88.6%). However, after 3 and 5 years, anterior-apical transvaginal mesh showed superior results with objective cure rates of 94.1% and 89.1%, respectively, compared to 80% and 64.4% for SSF+A (p = 0.008). At 3 and 5 years, anterior-apical transvaginal mesh had 92.9% and 85.9% subjective cure rates compared to SSF's 77.1% and 60%, respectively (p = 0.005).

CONCLUSIONS

The long-term follow-up showed that native tissue repair was strongly associated with increased risk of recurrence compared to the anterior-apical mesh with minor complications in both groups.

Ciliary neurotrophic factor (CNTF) contributes to pelvic organ prolapse by modulating collagen expression via the JAK2-STAT3 pathway

Pelvic organ prolapse (POP) is a prevalent condition that affects postmenopausal women and significantly impacts their quality of life. The most common potential causes include vaginal delivery, age, and obesity. However, the specific pathophysiological mechanisms involved remain unclear. Therefore, we conducted a comparative analysis of vaginal anterior wall-associated proteins between POP patients and non-POP patients using Masson staining, immunohistochemistry, western blotting, and real-time quantitative fluorescence PCR. Additionally, we investigated the effect of ciliary neurotrophic factor (CNTF) on collagen secretion by fibroblasts in cell culture and instantaneous transfection experiments. Furthermore, the role of CNTF in the development of POP was investigated by constructing a rat prolapse model in which bilateral ovaries were removed and vaginal delivery was simulated. The findings indicated that the anterior vaginal wall of POP patients exhibited high CNTF expression, low collagen I expression, and high collagen III expression. Furthermore, cell transfection experiments demonstrated that CNTF may inhibit collagen I expression and promote collagen III expression by activating the JAK2-STAT3 pathway. A rat model constructed by simulating vaginal delivery after bilateral ovary removal is also an appropriate animal model for studying POP.

Identification of potential drug targets for pelvic organ prolapse using a proteome-wide Mendelian randomization approach

Pelvic organ prolapse (POP) significantly impacts patients' quality of life, and current treatment options remain limited due to high recurrence rates, making the exploration of new therapeutic targets essential. Using data from the FinnGen cohort, we performed a proteome-wide Mendelian randomization (PW-MR) analysis. Through PW-MR and Bayesian colocalization analyses, we identified EFEMP1 and MFAP4 as potential key drug targets, with EFEMP1 potentially exerting a protective effect, whereas MFAP4 may be associated with an increased risk of POP. To further support these findings, we analysed single-cell RNA sequencing data to evaluate the expression patterns of EFEMP1 and MFAP4 in different cell populations. The analysis revealed that EFEMP1 and MFAP4 are specifically enriched in cell types involved in tissue remodelling and fibrosis. Findings of phenome-wide association studies indicated that the risk of side effects for these targets may be low, suggesting the safety of treatment focused on these targets. Preliminary molecular docking analysis findings suggested that EFEMP1 and MFAP4 may have strong binding affinities with candidate drugs, further supporting the feasibility of EFEMP1 and MFAP4 as drug targets. In conclusion, our findings indicate that EFEMP1 and MFAP4 are promising therapeutic targets for POP, providing important insights for the development of safe and effective treatments.

Meta-analysis of the comparison of laparoscopic pectopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse

BACKGROUND

The effectiveness and safety of laparoscopic pectopexy (LP) in the treatment of female pelvic organ prolapse (POP) have recently gained significant interest.

OBJECTIVE

This study aimed to compare the outcomes and effectiveness of LP and laparoscopic sacrocolpopexy (LSC).

SEARCH STRATEGY

A comprehensive literature search was conducted across multiple databases, including PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Clinical Trials, and CNKI. No language restrictions were applied in the search. The search encompassed the entire period from the inception of the respective databases to April 2023.

SELECTION CRITERIA AND DATA COLLECTION

All randomized controlled trials and comparative studies were included. A cumulative analysis was conducted on 10 studies, accounting for 15% of the overall research pool. The sample sizes of these studies were 760. Two researchers independently evaluated the eligibility of the studies, collected the relevant data, and evaluated their potential bias.

MAIN RESULTS

Compared with LSC, the average operation time for LP in the simple surgery group was shorter (standardized mean difference [SMD] -2.14, 95% CI -2.68 to -1.60, P < 0.001). The average bleeding volume was lower (SMD -3.17, 95% CI -5.22 to -1.12, P = 0.002), the postoperative indwelling catheterization time was shorter (SMD -0.35, 95% CI -0.67 to -0.02, P = 0.040), and there were fewer total postoperative complications (odds ratio [OR] 0.53, 95% CI 0.30-0.94, P = 0.030). In terms of effectiveness, the LP group had fewer postoperative prolapse recurrences than the LSC group (OR 0.33, 95% CI 0.14-0.77, P = 0.010).

CONCLUSION

LP demonstrates a comparable surgical efficacy to LSC. However, the surgical safety of LP is significantly improved. These findings should be validated by including additional randomized controlled trials.

Pelvic floor dysfunction in patients with gestational diabetes mellitus

In this editorial, we comment on an article by Wang et al. Recent literature shows an increase in research on pelvic organ prolapse (POP). Although the true incidence of POP remains uncertain, its impact on quality of life is substantial. Anatomical studies report high incidence rates, surpassing those observed in symptom-based surveys. Weakness of the endopelvic fascia is a primary anatomical risk factor for POP. Additionally, gestational diabetes mellitus (GDM) has emerged as a growing concern, as poor glycemic control increases complications for both mother and fetus. GDM and POP are interconnected, with factors like maternal obesity, macrosomia, and hormonal changes exacerbating pelvic floor dysfunction. Modifiable risk factors, such as obesity and chronic hyperglycemia, along with multiparity, instrumental deliveries, and obstetric trauma, further increase susceptibility. For patients with GDM, gynecological exams, Pelvic Organ Prolapse Quantification staging, and pelvic floor ultrasonography are valuable diagnostics, with proctological exams and magnetic resonance defecography aiding in multi-compartment prolapse diagnoses. Imaging, though uncomfortable during pregnancy, is safe in the early postpartum period. This editorial emphasizes the need for further research on the pathophysiology of GDM-related POP and offers recommendations for improving diagnosis and clinical management of patients with GDM.

Laparoscopic Hysteropexy: How, When and for Whom Is It an Alternative Option? A Narrative Review of the Literature

Background/Objectives: Surgical repair of apical prolapse most commonly includes hysterectomy. However, nowadays, the number of women who seek uterine preserving surgical treatment is increasing. Our objective is to review the current evidence on laparoscopic hysteropexy techniques, outcomes and appropriate patient selection. Methods: A literature search was carried out in MEDLINE/PubMed and ClinicalTrials.gov databases. The search was restricted to humans, female patients and currently used surgical procedures. Results: Laparoscopic hysteropexy was found to be associated with good anatomic outcomes, symptom improvement and low complication or reoperation rates. Conclusions: Laparoscopic hysteropexy appears to be a good alternative option for women who undergo surgical treatment for apical prolapse and desire preservation of the uterus. However, further prospective comparative studies, as well as longer follow-up periods, are necessary for evaluating long-term safety and efficacy outcomes of the method.

Risk prediction models for stress urinary incontinence after pelvic organ prolapse (POP) surgery: a systematic review and meta-analysis

OBJECTIVE

To systematically evaluate existing developed and validated predictive models for stress urinary incontinence after pelvic floor reconstruction.

METHODS

Relevant literature in PubMed, Embase, Web of Science, Cochrane Library, OVID, China National Knowledge Infrastructure(CNKI), Wan Fang Database, VIP database and Chinese Biomedical Literature Service System (SinoMed) were search from inception to 1 March 2024. Literature screening and data extraction were performed independently by two researchers. The chosen study's statistics included study design, data sources, outcome definitions, sample size, predictors, model development, and performance. The Predictive Modelling Risk of Bias Assessment Tool (PROBAST) checklist was used to assess risk of bias and applicability.

RESULTS

A total of 7 studies containing 9 predictive models were included. All studies had a high risk of bias, primarily due to retrospective design, small sample sizes, single-center trials, lack of blinding, and missing data reporting. The meta-analysis revealed moderate heterogeneity (I² = 68.8%). The pooled AUC value of the validated models was 0.72 (95% CI: 0.65, 0.79), indicating moderate predictive ability.

CONCLUSION

The prediction models evaluated demonstrated moderate discrimination, but significant bias and methodological flaws. The meta-analysis revealed moderate heterogeneity (I² = 68.8%) among the included studies, reflecting differences in study populations, predictors, and methods, which limits the generalizability of the findings. Despite these challenges, these models highlight the potential to identify high-risk patients for targeted interventions to improve surgical outcomes and reduce postoperative complications. The findings suggest that by integrating these models into clinical decision-making, clinicians can better tailor surgical plans and preoperative counseling, thereby improving patient satisfaction and reducing the incidence of postoperative stress urinary incontinence. Future research should follow TRIPOD and PROBAST principles, focus on addressing sources of heterogeneity, improve model development through robust designs, large sample sizes, comprehensive predictors, and novel modelling approaches, and validate tools that can be effectively integrated into clinical decision-making to manage stress urinary incontinence after pelvic floor reconstruction.

Risk factors for pelvic organ prolapse, a case-control study in a tertiary hospital in Iran

BACKGROUND

Pelvic organ descent is a common gynecological disorder called pelvic organ prolapse (POP). Conservative care and surgical repair are women's primary treatments for pelvic organ prolapse. Modifying risk factors is a crucial keystone to reducing its prevalence.

METHODS

This unmatched case-control study was conducted at a Tehran referral hospital (June 15 to September 10, 2020) and involved 287 participants (139 cases, 148 controls). Structured questionnaires gathered socio-demographic, obstetric, health, and lifestyle data. Analyses encompassed univariate and multivariate logistic regression.

RESULTS

Among cases, 69 (49.6%) had anterior prolapse, 46 (33.1%) had posterior prolapse, and 24 (17.3%) experienced complete prolapse. The mean age of participants with POP was 62.7 ± 10.7 years compared to 44.5 ± 12.7 years for controls. Risk factors significantly associated with POP included higher BMI (28.01 ± 4.7 vs 26.18 ± 4.6; p = 0.002), gravidity (4.49 ± 2.89 vs 2.18 ± 1.63; p < 0.001), vaginal deliveries (3.60 ± 2.07 vs 1.03 ± 1.57; p < 0.001), prolonged labor (12.2% vs 2.7%; OR: 4.91, 95% CI: 1.61-14.99), and comorbidities such as diabetes mellitus (30.2% vs 8.8%; OR: 4.49, 95% CI: 2.29-8.83) and hypertension (34.5% vs 6.8%; OR: 7.28, 95% CI: 3.50-15.12). Protective factors included higher education levels and a history of cesarean delivery (mean cesarean count: 0.31 ± 0.72 vs 0.78 ± 0.88; p < 0.001).

CONCLUSIONS

This study highlights key risk factors for POP among Iranian women, emphasizing the need for targeted preventive strategies. Public health interventions addressing these factors may reduce the burden of POP in developing regions.

Combining pelvic floor ultrasonography with deep learning to diagnose anterior compartment organ prolapse

Background

Anterior compartment prolapse is a common pelvic organ prolapse (POP), which occurs frequently among middle-aged and elderly women and can cause urinary incontinence, perineal pain and swelling, and seriously affect their physical and mental health. At present, pelvic floor ultrasound is the primary examination method, but it is not carried out by many primary medical institutions due to the significant shortcomings of training in the early stage and the variable image quality. There has been great progress in the application of deep learning (DL) in image-based diagnosis in various clinical contexts. The main purpose of this study was to improve the speed and reliability of pelvic floor ultrasound diagnosis of POP by training neural networks to interpret ultrasound images, thereby facilitating the diagnosis and treatment of POP in primary care.

Methods

This retrospective study analyzed medical records of women with anterior compartment organ prolapse (n=1,605, mean age 45.1±12.2 years) or without (n=200, mean age 38.1±13.4 years), who were examined at West China Second University Hospital between March 2019 and September 2021. Static ultrasound images of the anterior chamber of the pelvic floor (5,281 abnormal, 535 normal) were captured at rest and at maximal Valsalva motion, and four convolutional neural network (CNN) models, AlexNet, VGG-16, ResNet-18, and ResNet-50, were trained on 80% of the images, then internally validated on the other 20%. Each model was trained in two ways: through a random initialization parameter training method and through a transfer learning method based on ImageNet pre-training. The diagnostic performance of each network was evaluated according to accuracy, precision, recall and F1-score, and the receiver operating characteristic (ROC) curve of each network in the training set and validation set was drawn and the area under the curve (AUC) was obtained.

Results

All four models, regardless of training method, achieved recognition accuracy of >91%, whereas transfer learning led to more stable and effective feature extraction. Specifically, ResNet-18 and ResNet-50 performed better than AlexNet and VGG-16. However, the four networks learned by transfer all showed fairly high AUCs, with the ResNet-18 network performing the best: it read images in 13.4 msec and provided recognition an accuracy of 93.53% along with an AUC of 0.852.

Conclusions

Combining DL with pelvic floor ultrasonography can substantially accelerate diagnosis of anterior compartment organ prolapse in women while improving accuracy.

Determining the levels of pelvic floor disorders in women diagnosed with urinary incontinence: a mix-method study

Introduction

Urinary incontinence (UI) significantly affects women's quality of life and may contribute to pelvic floor disorders. This study aimed to investigate the impact of UI on pelvic floor disorders through a mixed-methods approach.

Methods

A convergent parallel design was employed, integrating quantitative and qualitative data. Quantitative data were collected using the "Global Pelvic Floor Disorders Questionnaire," and semi-structured interviews were conducted for qualitative insights. Quantitative data were analyzed using SPSS 26.0, while qualitative data underwent content analysis with MAXQDA Pro 22 software.

Results

Among the participants, 41.7% were diagnosed with stress urinary incontinence, which was associated with the highest level of discomfort. Qualitative findings revealed four main categories: effects on daily life, emotional and psychological effects, coping strategies, and treatment approaches and expectations. Participants reported that UI led to social isolation, reduced self-esteem, and increased anxiety.

Discussion

The findings highlight that UI adversely affects both the physical and psychosocial well-being of women. Addressing this condition requires a holistic approach combining medical treatment with psychosocial support to mitigate its multifaceted impact.

Comprehensive analysis of the circRNA expression profile and circRNA-miRNA-mRNA network in pelvic organ prolapse

Pelvic organ prolapse (POP) is a common gynecological disease caused by pathological defects, lesions, or mechanical weakening of the support structures of the pelvic floor. However, its pathogenesis is unclear. Circular RNAs (circRNAs) are covalently closed, endogenous biomolecules, which are thought to play an important role on skeletal muscle development by regulating gene expression. In this study, five pairs of peripheral blood samples from control and POP groups were used for circRNA sequencing analysis to obtain differential expression profiles. A total of 75 differentially expressed circRNAs (DEcircRNAs) were identified (fold change >2.0, P < 0.05). Furthermore, RT-qPCR confirmed that the expression levels of two circRNAs (hsa_circ_0067962 and hsa_circ_0057051) were significantly lower in the POP group. The two validated DEcircRNAs were abundantly involved in the collagen catabolic process. The circRNA-miRNA-mRNA network of two DEcircRNAs comprised nine mRNAs, which indicated that hsa_circ_0067962 and hsa_circ_0057051 may be involved in the pathogenesis of POP by regulating these nine mRNAs.

COL3A1 Gene Polymorphism and Its Impact on Female Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a women's health problem in both developed and developing countries. Various studies have found that the occurrence of POP is related to the supporting structures of the pelvic floor, including type III collagen levels. Most studies reported no correlation between collagen 3 alpha 1 (COL3A1) rs1800255 gene polymorphism and the occurrence of POP. However, the studies carried out still need to be clarified in terms of the type of research, the involvement of women of various ages, the method of diagnosing POP, and differences in the measurement of COL3A1 rs1800255 gene polymorphism. Prospectively, as the outcomes of the trials are still inconsistent, more research is required to determine which patients are at risk of pelvic organ prolapse and would benefit from preventive interventions, particularly those using collagen. This article aims to review the relationship between COL3A1 rs1800255 gene polymorphism and female pelvic organ prolapse.

Unveiling novel regulatory mechanisms of miR-5195-3p in pelvic organ prolapse pathogenesis†

Pelvic organ prolapse is a condition that significantly affects women's quality of life. The pathological mechanism of pelvic organ prolapse is not yet fully understood, and its pathogenesis is often caused by multiple factors, including the metabolic imbalance of the extracellular matrix. This study aims to investigate the role of miR-5195-3p, a microRNA, in the pathology of pelvic organ prolapse and its regulatory mechanism. Using various molecular biology techniques such as real-time reverse transcription Polymerase Chain Reaction (PCR), fluorescence in situ hybridization, immunohistochemistry, and Western blot, miR-5195-3p expression was examined in vaginal wall tissues obtained from pelvic organ prolapse patients. Results revealed an up-regulation of miR-5195-3p expression in these tissues, showing a negative correlation with the expression of extracellular matrix-related proteins. Further analysis using bioinformatics tools identified Lipoxygenase (LOX) as a potential target in pelvic organ prolapse. Dual luciferase reporter gene experiments confirmed LOX as a direct target of miR-5195-3p. Interestingly, regulating the expression of LOX also influenced the transforming growth factor β1 signaling pathway and had an impact on extracellular matrix metabolism. This finding suggests that miR-5195-3p controls extracellular matrix metabolism by targeting LOX and modulating the TGF-β1 signaling pathway. In conclusion, this study unveils the involvement of miR-5195-3p in the pathological mechanism of pelvic organ prolapse by regulating extracellular matrix metabolism through the LOX/TGF-β1 axis. These findings reveal new mechanisms in the pathogenesis of pelvic organ prolapse, providing a theoretical foundation and therapeutic targets for further research on pelvic organ prolapse treatment.

Unveiling the depths of pelvic organ prolapse: From risk factors to therapeutic methods (Review)

Pelvic organ prolapse (POP) is a condition where one or more pelvic organs (such as the uterus, bladder and rectum) descend from their normal anatomical positions into the vagina, primarily due to the weakening of the pelvic floor support structures. While not life-threatening, POP can substantially diminish the patient's quality of life and lead to serious social and psychological complications. Researchers have explored novel directions regarding the etiology, mechanism and treatment of POP. However, existing literature on the subject often lacks comprehensive and systematic overviews. To address this gap and enhance researchers' understanding of POP, the present study reviewed the risk factors and molecular mechanisms of POP [including matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs, transforming growth factor β, advanced glycation end products (AGEs)/receptor for AGE, phosphoinositide 3-kinase/protein kinase B, fibulin, lysyl oxidase-like 1, homeobox A11, collagen α-1 (XVIII) chain, Wnt signaling pathways and estrogen receptor α], as well as therapeutic approaches, such as lifestyle interventions, physical methods, pharmacotherapy, stem cell transplantation and surgical techniques. The present review aims to provide new insights for future research and contribute to the advancement of diagnosis and treatment strategies for POP.

A single step transvaginal surgery in managing vesicovaginal fistula with grade III cystocele in post hysterectomy patient: A case report and literature review

INTRODUCTION

Vesicovaginal fistula (VVF) is a persistent issue, particularly after obstetric surgeries such as hysterectomy. Complications like pelvic organ prolapse (POP) and underactive bladder often occur (Barber and Maher, 2013; Rajaian et al., 2019). Women with both VVF and cystocele experience reduced quality of life and psychological challenges (Alio et al., 2011). This case report highlights the management of a woman with VVF and cystocele following hysterectomy.

CASE PRESENTATION

A 53-year-old woman presented with urinary incontinence and a vaginal bulge two years post-hysterectomy. She had type 2 diabetes mellitus and obesity but had not sought prior treatment. Examination revealed urinary incontinence and grade III cystocele. She underwent one-step transvaginal surgery with two weeks of postoperative catheterization. After catheter removal, no urinary leakage or prolapse was observed, significantly improving her quality of life.

DISCUSSION

VVF with cystocele post-hysterectomy is rare, accounting for only 1 % of complications (Njoku et al., 2016). Symptoms include continuous urinary leakage (Lee et al., 2012). Treatment options vary from conservative to surgical approaches (Lee and Zimmern, 2019). In this case, single-step transvaginal surgery resulted in positive outcomes, improving the patient's condition (Hadzi-Djokic et al., 2009; Mancini et al., 2021).

CONCLUSION

Concomitant VVF and cystocele are rare but significantly impact women's health. Single-stage transvaginal surgery offers cost-effective and favorable results, reducing the need for multiple procedures. This case adds valuable insight into the management of such cases.

Laparoscopic Shull Technique for Uterine Prolapse and Risk of Recurrences: A Retrospective Comparison with Vaginal Hysterectomy

INTRODUCTION AND HYPOTHESIS

The objective was to compare the vaginal and laparoscopic approaches with natural tissue vaginal repair of pelvic organ prolapse (POP) in terms of recurrence rate and complete remission rate (CRR) of symptoms.

MATERIALS AND METHODS

This retrospective cohort study analyzed women who underwent hysterectomy for uterine prolapse at two Italian hospitals between October 2021 and March 2023. Group A included 89 patients who received vaginal hysterectomy and colposuspension (VCH), whereas group B included 58 patients who underwent laparoscopic hysterectomy followed by laparoscopic colposuspension sec Shull (LPSS).

RESULTS

The study included 147 patients with comparable baseline characteristics regarding menopausal age and body mass index. Concerning preoperative data, it is worth mentioning that group A had a higher proportion of patients with more than two previous deliveries and, overall, more severe prolapse stages. Concerning postoperative results, the patients undergoing laparoscopic surgery had longer operation times than group A. Moreover, group B had a higher recurrence rate after surgery (5.6% vs 13%, p = 0.057). Kaplan-Meier analysis indicated a lower rate of prolapse-free patients over time in group B. Cox regression showed a higher hazard ratio for recurrence in the LCSS group than in the VCH group. Complete remission rates for urinary symptoms varied, with group B showing higher CRR for stress incontinence (33% vs 71%, p < 0.001).

CONCLUSION

Both VCH and LCSS are effective for POP treatment, with VCH showing better outcomes in terms of symptom remission and shorter operation times. At the same time, LCSS had better CRR for stress incontinence but a higher recurrence rate. Further high-quality prospective studies are needed to confirm these findings and determine the best surgical approach for POP.

Treatment decision-making process among postmenopausal women with pelvic organ prolapse before gynecological surgery: A qualitative study from Romania

Pelvic organ prolapse (POP) affects quality of life of many women. This paper aims to identify the experience of postmenopausal women in treatment decision-making process about POP before gynecological surgery. The characteristics of twelve postmenopausal women with stage II, III and IV POP, such as age, body mass index (BMI), physical exercise, education, parity, abortions, comorbidities, previous surgical interventions, and smoker/nonsmoker were evaluated. Each woman was given a semi-structured interview consisted of open-ended questions describing different treatments for POP. Interviews were conducted from January 2022 from May 2022, audio-recorded, transcribed verbatim and analyzed. The mean age was 64 years and most women were obese (BMI ≥ 30, 66.66%) with associated hypertension (58.33%). After constant comparison of the data using qualitative descriptive design, 7 dominant themes were obtained, namely: lack of information about prolapse; the decisive moment for the choice of treatment; the most disturbing symptoms; sources of information on prolapse; decisions regarding the treatment; preferences for conservative treatment; and uncertainty about treatment options. Most of the postmenopausal women stated that treatment decision-making process was mainly influenced by the physician, while supervised pelvic floor muscle (PFM) training was seen as an alternative to surgical treatment (58.33%). Therefore, it is essential to inform in time such women about different treatment options, allowing to decide on their preferred treatment.

Treatment Strategies for Painful Pelvic Floor Conditions: A Focus on the Potential Benefits of Cannabidiol

Painful conditions of the pelvic floor include a set of disorders of the pelvic region, discreetly prevalent in the female population, in which pain emerges as the predominant symptom. Such disorders have a significant impact on quality of life as they impair couple relationships and promote states of anxiety and irascibility in affected individuals. Although numerous treatment approaches have been proposed for the management of such disorders, there is a need to identify strategies to promote muscle relaxation, counter pelvic pain, and reduce inflammation. The endocannabinoid system (ECS) represents a complex system spread throughout the body and is involved in the regulation of numerous physiological processes representing a potential therapeutic target for mood and anxiety disorders as well as pain management. Cannabidiol (CBD), acting on the ECS, can promote relief from hyperalgesia and allodynia typical of disorders affecting the pelvic floor and promote muscle relaxation by restoring balance to this delicate anatomical region. However, its use is currently limited due to a lack of evidence supporting its efficacy and harmlessness, and the mechanism of action on the ECS remains partially unexplored to this day. This comprehensive review of the literature examines the impact of pain disorders affecting the pelvic floor and major treatment approaches and brings together the main evidence supporting CBD in the management of such disorders.

Uterine artery projection relative to anatomical bony landmarks in CT-angiographies

PURPOSE

The aim was to find bony landmarks of the pelvis for the origins and routes of uterine arteries, hoping to improve speed and safety of embolization procedures (leiomyoma, post-partum bleedings…).

METHODS

We carried out a study based on the analysis of CT-angiographies in arterial phases of whole-body scans. Two measurements were done per artery, one from the origin of uterine arteries to a first perpendicular line passing through the lowest part of the sacroiliac joint, another one from the beginning of the parametrial segment from a second parallel line passing by the acetabular roof. Mean distances across all these measurements were calculated, as were potential associations with known variables such as anatomical variants, age, parity and any pelvic surgical history.

RESULTS

Two hundred uterine arteries were analyzed. Concerning the origin, 83.5% of uterine arteries were located approximately one centimeter around the first line defined above, with a mean distance of + 4.8 mm. Concerning parametrial segment beginning, 88% were located approximately one centimeter around the second line defined, with a mean distance of only + 3.9 mm above the acetabular roof. Some significant differences were observed in subgroups, notably with a small trend to higher arising of uterine arteries in patients who had at least one childbirth, and expectedly lower arising in distal anatomical variants.

CONCLUSION

Clear pelvic anatomic landmarks exist and could help the guidance of arteries catheterization, and therefore indirectly lead to faster embolization and optimize procedures safety.

Female genital prolapse and risk of psychiatric disorders: A two-sample Mendelian randomization analysis

BACKGROUND

There is a growing body of evidence suggests a strong link between female genital prolapse (FGP) and mental health. However, the causal relationship between FGP and psychological disorders remains unclear.

OBJECTIVES

Bidirectional Mendelian Randomization (MR) analysis has been applied to investigate the potential impact of FGP on the risk of seven common psychiatric disorders.

METHODS

The two-sample MR analysis was conducted using genetic instruments such as Inverse variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode from the genome-wide association study (GWAS) summary data in European populations. In addition, the Cochrane's Q test, MR-Egger intercept test, MR pleiotropy residual sum and outliers (MR-PRESSO) test and leave-one-out analysis were employed to assess the sensitivity and heterogeneity.

RESULTS

The MR results revealed that FGP exhibited a potential marginal protective effect on bipolar disorder (BD) (odds ratio(OR) = 0.92, 95%confidence interval (95%CI: 0.85-0.99, P = 0.03) as well as schizophrenia(OR = 0.91, 95%CI:0.85-0.98, P = 0.01). Nevertheless, there was no causal correlation between genetically predicted FGP and obsessive compulsive disorder (OCD) (OR = 0.98, 95%CI:0.80-1.20, P = 0.84),depression (broad) (OR = 1.00, 95%CI:0.99-1.01, P = 0.76), major depression(OR = 0.98, 95%CI:0.94-1.03, P = 0.43), anxiety disorders (OR = 1.00, 95%CI:0.94-1.07,P = 0.97) and post-traumatic stress disorder(PTSD) (OR = 1.18, 95%CI:0.88-1.57,P = 0.27),respectively. In addition, BD was found to have a potential significant influence on FGP in the inverse MR analysis (OR = 0.83, 95%CI:0.72-0.97, P = 0.02). No significant heterogeneity or horizontal pleiotropy detected, and the results were deemed stable based on sensitivity analysis and leave-one-out test .

LIMITATIONS

There are shortcomings such as data limitations, population bias, potential pleiotropy, and stratified analysis.

CONCLUSIONS

While there is potential causal relationship between FGP and BD or schizophrenia, it does not exhibit any correction with OCD, depression (broad), major depression, anxiety disorders and PTSD among European populations.

Long-term follow-up after laparoscopic reparation of pelvic organ prolapses in a large teaching gynecological center

OBJECTIVE

To provide a description of laparoscopic approach to correct pelvic organ prolapses and evaluate the risk factors associated with the prolapse recurrence.

STUDY DESIGN

We retrospectively analyzed 418 patients with symptomatic pelvic organ prolapse who underwent a laparoscopic reparation at our university center from 2010 to 2020. Prolapses were assessed by Baden-Walker system (stage I-IV). The association between the potential prognostic factors and the recurrence was analyzed using Cox regression.

RESULTS

We included 418 patients. Most patients (97.6%) had at least one vaginal delivery and 92 (22%) had a previous prolapse surgery. In 29.74% of cases levator ani muscle avulsion was observed. We performed a cervicosacropexy in 336 (80.38%) cases, a sacrohysteropexy in 13 (3.11%), and a sacrocolpopexy in 69 (16.5%). Also, concomitantly, 66 (15.79%) patients with stress and occult urinary incontinence underwent TOT surgery. Surgical complications were low (9.51%) and the majority were minor. Median follow-up was 37 months (IQR 10.5, 61.4 months), and the global recurrence rate was 9.57%. Only 4.06% of cases required reintervention. In Cox regression analysis only levator ani muscle avulsion remained as a recurrence-associated factor.

CONCLUSION

Our series is one of the largest and with the longest follow-up. Recurrence rate was low, and comparable to other large series. The only independent factor related to recurrence was the levator ani muscle avulsion.

Modified first-level reconstruction and reinforcement during laparoscopic total hysterectomy for prevention of post-operative pelvic organ prolapse: a randomized clinical trial

Objective

This paper investigated that the clinical value of modified first-level reconstruction reinforcement in the prevention and treatment of pelvic floor dysfunction after laparoscopic total hysterectomy.

Methods

A total of 360 patients undergoing laparoscopic total hysterectomy from December 2018 to September 2021 were selected and divided into three groups (A, B, C) according to POP-Q criteria: This is a randomized clinical trial in which women with first- and second-degree pelvic organ prolapse, and women without pelvic organ prolapse were each randomized into 3 arms of the study. According to the informed consent of patients, three groups are as following: Arm 1: 60 cases in the non-suspension group (vaginal stump was only sutured continuous absorbable suture); Arm 2: 60 cases in traditional suspension group (as in Arm 1, plus suspension of vaginal stump with non-absorbable sutures to cardinal and round ligaments); Arm 3: 60 cases in the modified suspension group (vaginal stump reinforced with horizontal reconstruction). POP-Q score, sexual life quality questionnaire, urinary incontinence questionnaire and pelvic floor ultrasound were compared before and at 6 and 12 months after operation.

Results

(1) in the non-prolapse group and the prolapse group, the POP-Q score of the modified suspension group c was superior to that of the non-suspension group and the traditional suspension group b at 6 and 12 months after surgery (P < 0.05), and the postoperative POP-Q score of the prolapse group was significantly improved compared with that before surgery. (2) In both the non-prolapse and the prolapse study groups, the participants that were randomized to the modified suspension treatment (arm 3) had significantly better sexual function scores than those in arm 1 and arm 2 six and twelve months after surgery (p <0.05). (3) Similarly, participants in both the non-prolapse and the prolapse groups that were randomized to the modified suspension treatment arm (arm 3) were significantly less prone to. urinary incontinence than those randomized to arm 1 and arm 2 at 6 and 12 months after surgery.

Conclusions

Compared with traditional vaginal stump suture and traditional vaginal stump suspension, the modified first-level reconstruction and consolidation method can effectively prevent and cure pelvic floor dysfunction after laparoscopic total hysterectomy, and significantly improve the quality of life of patients.

Anterior Colporrhaphy and Paravaginal Repair for Anterior Compartment Prolapse: A Review

Pelvic organ prolapse, particularly in the anterior compartment, is a prevalent condition that significantly impacts women's quality of life. Two common surgical approaches for managing anterior vaginal wall prolapse are anterior colporrhaphy and paravaginal repair. Anterior colporrhaphy, a traditional technique, involves the plication of weakened fascial tissues to restore support to the bladder and anterior vaginal wall. Paravaginal repair addresses lateral detachment of the anterior vaginal wall by reattaching it to its supportive structures. This review aimed to compare the indications, techniques, and outcomes between these surgical methods, discussing their efficacy, recurrence rates, and complications. Although anterior colporrhaphy is widely used, paravaginal repair may offer superior results in specific cases, particularly those involving lateral defects. The review also explored the evolution of these techniques, the role of grafts and mesh, and the potential benefits of minimally invasive approaches such as laparoscopy and robotic surgery. The goal is to provide clinicians with comprehensive insights into choosing the appropriate surgical option based on individual patient anatomy and clinical presentation, thus optimizing outcomes and minimizing recurrence.

Outcomes of laparoscopic sacrocolpopexy using self-cut mesh on pelvic organ prolapse

Objectives

The objective of the study was to investigate the long-term outcome and complication rate of laparoscopic sacrocolpopexy (LSC) using self-cut mesh as pelvic organ prolapse treatment.

Methods

A retrospective cohort study on patients undergoing LSC was done at Kameda Medical Center from January 2013 to January 2018. Data for this study were taken from all women with pelvic organ prolapse who had undergone LSC using self-cut polypropylene mesh. Patients with a previous history of hysterectomy were excluded from the study. An evaluation was done preoperatively, on 6-month and 1-year postoperative follow-up period using Pelvic Organ Prolapse Quantification (POP-Q) and The International Consultation on Incontinence Questionnaire-short form (ICIQ-SF) questionnaire.

Results

There were 702 subjects who met the inclusion and exclusion criteria. The clinical characteristics of the subjects were recorded. The scores during admission, 6 months and 1 year postoperative are: POP Q scores: 6.50 ± 5.69 vs. 5.11 ± 4.85 vs. 4.78 ± 4.31, P = 0.049 and ICIQ SF scores: 2.92 ± 0.62 vs. 1.10 ± 0.36 vs. 1.13 ± 0.41, P < 0.001). A total of 17 (2.4%) perioperative and postoperative complications were observed on subjects.

Conclusion

LSC using self-cut mesh could produce satisfactory results in pelvic organ prolapse patients on 6-month and 1-year follow-up period with minimal perioperative complications.

Educational video for adherence to vaginal pessary in pelvic organ prolapse treatment

OBJECTIVES

to construct and assess an educational video to promote the adherence of women with pelvic organ prolapse to vaginal pessary use.

METHODS

this is a methodological study, with a longitudinal design and quantitative analysis. The pre-production (synopsis, argument, script, storyboard), production and post-production stages were covered. Content and technical assessments were carried out by judges from the health and communication areas, respectively, and appearance assessment by the target audience.

RESULTS

the video was the first to be developed on the topic on the national scene, considered assessed from the point of view of appearance and content, presenting an overall Content Validity Index of 0.99 and a level of agreement among judges of 91.1% to 100%. Assessment by the target audience reached a percentage of 96% to 100%.

CONCLUSIONS

the educational video is an instrument capable of promoting adherence to pessary in women indicated for this therapeutic approach.

Analysis of the Clinical Value of Laparoscopic Sacrocolpopexy to Support the Posterior Compartment in Women with Multicompartment Prolapse Including Rectocele

Background/Objectives: Laparoscopic sacrocolpopexy is regarded as the gold standard treatment for apical or multicompartment prolapse, predominantly with anterior compartment descent. However, the optimal surgical approach for concurrent rectocele is still debated. The aim of this study was to evaluate the effectiveness of nerve-sparing laparoscopic sacrocolpopexy in managing multicompartment prolapse with concurrent rectocele (≥stage II), analyzing the anatomical outcomes, the necessity for concomitant or subsequent posterior repair, and the impact on bowel function in women undergoing surgery. Methods: Data from all women who underwent laparoscopic sacrocolpopexy with or without posterior repair between 01/2017 and 07/2022 for symptomatic multicompartment prolapse, including apical and posterior compartment descent ≥ stage II, were retrospectively evaluated. All women underwent a standardized urogynecological examination, including assessment of genital prolapse using the POP-Q quantification system, and completed the German-validated Australian Pelvic Floor Questionnaire before and after surgery (6-12 weeks). Preoperative anatomic support and bowel symptoms were compared with postoperative values. Results: In total, 112 women met the criteria for surgical correction. The majority (87%) had stage II posterior descent, with only 10% undergoing concurrent posterior repair during laparoscopic sacrocolpopexy. Significant (p < 0.001) objective improvement was seen for all compartments post- compared with preoperatively (Ba: 0 (-1/2) vs. -3 (-3/-2), C: -1 (-2/0) vs. -8 (-12/-7), Bp: 0 (-1/0) vs. -3 (-2/-2); (median (25%/75% quartiles)). Subsequent surgery for persistent rectocele and/or stool outlet symptoms was required in 4% of cases. Most bowel-specific questions in the German-validated Australian Pelvic Floor Questionnaire showed significant improvement (p < 0.001). Conclusions: Nerve-sparing sacrocolpopexy alone appears to be a suitable surgical approach to correct multicompartment prolapse, including a rectocele ≥ stage II, and results in a reduction of objective signs and symptoms of pelvic organ prolapse.

The role of GZMA as a target of cysteine and biomarker in Alzheimer's disease, pelvic organ prolapse, and tumor progression

Objective: This study aims to investigate how changes in peripheral blood metabolites in Alzheimer's Disease (AD) patients affect the development of Pelvic Organ Prolapse (POP) using a multi-omics approach. We specifically explore the interactions of signaling pathways, gene expression, and protein-metabolite interactions, with a focus on GZMA and cysteine in age-related diseases. Methods: This study utilized multi-omics analysis, including metabolomics and transcriptomics, to evaluate the perturbations in peripheral blood metabolites and their effect on POP in AD patients. Additionally, a comprehensive pan-cancer and immune infiltration analysis was performed on the core targets of AD combined with POP, exploring their potential roles in tumor progression and elucidating their pharmacological relevance to solid tumors. Results: We identified 47 differential metabolites linked to 9 significant signaling pathways, such as unsaturated fatty acid biosynthesis and amino acid metabolism. A thorough gene expression analysis revealed numerous differentially expressed genes (DEGs), with Gene Set Enrichment Analysis (GSEA) showing significant changes in gene profiles of AD and POP. Network topology analysis highlighted central nodes in the AD-POP co-expressed genes network. Functional analyses indicated involvement in critical biological processes and pathways. Molecular docking studies showed strong interactions between cysteine and proteins PTGS2 and GZMA, and molecular dynamics simulations confirmed the stability of these complexes. In vitro validation demonstrated that cysteine reduced ROS levels and protected cell viability. GZMA was widely expressed in various cancers, associated with immune cells, and correlated with patient survival prognosis. Conclusion: Multi-omics analysis revealed the role of peripheral blood metabolites in the molecular dynamics of AD and their interactions with POP. This study identified potential biomarkers and therapeutic targets, emphasizing the effectiveness of integrative approaches in treating AD and POP concurrently. The findings highlight the need for in-depth research on novel targets and biomarkers to advance therapeutic strategies.

Pelvic floor muscle training in women with urinary incontinence and pelvic organ prolapse: A protocol study

OBJECTIVE

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP).

METHODS

This study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of p<0.05 will be considered for all statistical tests.

ETHICS AND DISSEMINATION

This study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery.

At What Point in the Menstrual Cycle Are the Pelvic Floor Muscles at Their Weakest?

Pelvic floor muscle (PFM) strength is a critical factor for optimal pelvic floor function. Fluctuations in strength values based on different phases of the menstrual cycle (MC) could signify a need for a paradigm shift in evaluating, approaching, and planning training. This research aims to examine and contrast the pelvic floor muscle strength during different phases of the menstrual cycle. A prospective observational study employing digital assessment with the modified Oxford scale and vaginal dynamometry measurements was performed, in order to assess the baseline strength and the contraction strength of the PFMs in eumenorrheic females at three different phases of the MC: the early follicular phase (EFP), the late follicular phase (LFP), and the mid-luteal phase (MLP). During two complete cycles, tympanic temperature and body weight were measured and the urinary luteinizing hormone concentration was tested to determine the time of ovulation. In total, 216 dynamometric measurements of PFM strength were obtained from eighteen nulliparous women (25.72 ± 5.03 years). There were no differences between the baseline strength (p = 0.886) and the contraction strength (p = 0.756) with the dynamometric speculum. In the post hoc analysis, the baseline strength, contraction strength, and strength showed no significant differences between MC phases. As no differences in PFM strength in women were found, the PFMs do not seem to be weaker at any time during the menstrual cycle. It appears that the assessment, establishment, and monitoring of a PFM training program could be initiated at any point in the cycle.

Potential therapeutic targets for pelvic organ prolapse: insights from key genes related to blood vessel development

Objective

Pelvic organ prolapse (POP) is a disease in which pelvic floor support structures are dysfunctional due to disruption of the extracellular matrix (ECM). The vascular system is essential for maintaining ECM homeostasis. Therefore, this study explored the potential mechanism of blood vessel development-related genes (BVDRGs) in POP.

Methods

POP-related datasets and BVDRGs were included in this study. Differentially expressed genes (DEGs) between the POP and control groups were first identified in the GSE12852 and GSE208271 datasets, and DE-BVDRGs were identified by determining the intersection of these DEGs and BVDRGs. Subsequently, the feature genes were evaluated by machine learning. Feature genes with consistent expression trends in the GSE12852 and GSE208271 datasets were considered key genes. Afterward, the overall diagnostic efficacy of key genes in POP was evaluated through receiver operating characteristic (ROC) curve analysis. Based on the key genes, enrichment analysis, immune infiltration analysis and regulatory network construction were performed to elucidate the molecular mechanisms underlying the functions of the key genes in POP.

Results

A total of 888 DEGs1 and 643 DEGs2 were identified in the GSE12852 and GSE208271 datasets, and 26 candidate genes and 4 DE-BVDRGs were identified. Furthermore, Hyaluronan synthase 2 (HAS2), Matrix metalloproteinase 19 (MMP19) and Plexin Domain Containing 1 (PLXDC1) were identified as key genes in POP and had promising value for diagnosing POP (AUC > 0.8). Additional research revealed that the key genes were predominantly implicated in immune cell activation, chemotaxis, and cytokine release via the chemokine signaling pathway, the Nod-like receptor signaling pathway, and the Toll-like receptor signaling pathway. Analysis of immune cell infiltration confirmed a decrease in the proportion of plasma cells in POP, and MMP19 expression showed a significant negative correlation with plasma cell numbers. In addition, regulatory network analysis revealed that MALAT1 (a lncRNA) targeted hsa-miR-503-5p, hsa-miR-23a-3p and hsa-miR-129-5p to simultaneously regulate three key genes.

Conclusion

We identified three key BVDRGs (HAS2, MMP19 and PLXDC1) related to the ECM in POP, providing markers for diagnostic studies and investigations of the molecular mechanism of POP.

Clinical effect and prognostic factor of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse

OBJECTIVE

To explore the effects of electric stimulation and biofeedback therapy in patients with postpartum pelvic organ prolapse and to identify factors that can affect therapeutic efficacy outcomes.

METHOD

This retrospective study analysed clinical data about patients with postpartum pelvic organ prolapse. A total of 328 women with pelvic organ prolapse at 6 weeks postpartum were recruited from one tertiary hospitals in Sichuan province in China, between March 2019 and March 2022. The prognostic factors of therapeutic efficacy were analysed using logistic regression and decision tree model.

RESULTS

Overall, 259 women showed clinical benefits from the treatment. The logistic regression model showed that parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were independent prognostic factors. The decision tree model showed that the pelvic organ prolapse quantitation stage before treatment was the main prognostic factor, followed by parity. There was no significant difference in the area under the receiver operating characteristic curve between the two models.

CONCLUSION

Parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were important prognostic factors of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse.

Bidirectional Relationships between Sarcopenia and Pelvic Floor Disorders

Sarcopenia and pelvic floor disorders (PFDs) are prevalent and often cooccurring conditions in the aging population. However, their bidirectional relationship and underlying mechanisms remain underexplored. This narrative review aims to elucidate this relationship by exploring potential causative interplays, shared pathophysiological mechanisms, and common risk factors. A comprehensive literature search was conducted to identify relevant studies focusing on epidemiological associations, interaction mechanisms, and implications for patient care. While epidemiological studies demonstrate associations between sarcopenia and PFDs, our findings reveal a cyclical relationship where sarcopenia may exacerbate PFDs through mechanisms such as decreased muscle strength and mobility. Conversely, the presence of PFDs often leads to reduced physical activity due to discomfort and mobility issues, which in turn exacerbate the muscle atrophy associated with sarcopenia. Additionally, shared risk factors such as physical inactivity, nutritional deficiencies, metabolic syndrome, and menopausal hormonal changes likely contribute to the onset and progression of both conditions. These interactions underscore the importance of concurrently integrated care approaches that address both conditions. Effective management requires comprehensive screening, the recognition of contributing factors, and tailored exercise regimens supported by a multidisciplinary approach. Future research should focus on longitudinal studies tracking disease progression and evaluating the efficacy of multidisciplinary care models in optimizing patient outcomes.

Effect of human umbilical cord stem cells (HUMSC) administration on collagen expression in the anterior vaginal wall in menopausal rats

Objective

To evaluate the outcome of human umbilical cord stem cells (HUMSC) administration on collagen expression within the frontal vaginal wall of menopausal rats.

Materials and Methods

We conducted an experimental, randomized post-test-only controlled group design. The study samples were 40 healthy female Winstar rat with the age of 8-12 weeks that had been ovariectomized, had never mated, and weighed 18-22 grams. The umbilical cord was obtained from voluntary donors who did not have a history of hepatitis B, hepatitis C, HIV, cytomegalovirus infection, treponema pallidum infection, or a history of other infections transmitted through the blood, placental tract, and genitals. Data collection (frontal vaginal wall of the rat) was carried out in a controlled environment with the consideration that all conditions were maintained equally and could be controlled.

Results

There were 36 samples. A total of 13 menopausal rats (72%) had strong collagen expression and 5 rats had weak-to-moderate collagen expression (28%). On the other hand, 18 menopausal rats (100%) that belonged to the control group had weak-moderate collagen expression, and no menopausal rats appeared to have strong expression (0%). The administration of collagen to the anterior vaginal wall of postmenopausal rats proved to be effective by increasing the strong collagen expression in the damaged anterior vagina of postmenopausal female rats (p<0.05).

Conclusion

Administration of HUMSC resulted in an increase in collagen levels in the anterior vaginal tissue of postmenopausal female rats. These results demonstrate significant therapeutic potential for the treatment of pelvic floor dysfunction.

Pelvic floor disorders among amateur runners

BACKGROUND

Sports and physical activity are known risk factors for pelvic floor dysfunction (PFD). The aim of this study is to examine the impact of amateur running on PFD, quality of life (QoL), and sexual function.

METHODS

Amateur runners were contacted through social media. Their PFD, sexual function, and QoL were evaluated by self-reporting validated questionnaires (PFDI-20, PISQ-12, IIQ-7). They were divided by degree of effort into two categories, 'High effort' and 'Moderate effort'. The differences between the two groups were examined by a Mann-Whitney U Test, T-Test, and Chi-square test.

RESULTS

180 women were included. A high incidence of PFD was found among 'High effort' runners in comparison to 'Moderate effort' runners. In addition, women who scored above the median in the PFDI-20 showed significantly greater impairment in QoL and sexual function. Interestingly, the 'High effort' group reported experiencing higher intensity orgasms compared with women in the 'Moderate effort' group. A correlation was also found between the weekly running distance and the intensity of orgasm experienced (P value = 0.004).

CONCLUSION

'High effort' runners present a higher incidence of PFD in comparison to 'Moderate effort' runners. Professional pelvic floor muscle training counselling should be considered even for amateur runners. Future interventional physical therapy studies should be carried out in order to investigate preventative strategies.

A 5-year evaluation of quality of life, pelvic discomfort, and sexual function following posterior pericervical repair

The aim of this study was to evaluate the quality of life, pelvic discomfort, and sexual function of patients who underwent posterior pericervical repair or level I to III surgical procedures for pelvic organ prolapse (POP) after 5 years of follow-up. This retrospective cohort study enrolled 107 women with POP who were referred to the Imam Khomeini Hospital Complex, an academic center affiliated with the Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2021. The patients underwent transvaginal surgery using native tissue, in which the rectovaginal fascia was attached to the pericervical ring. The Pelvic Floor Distress Inventory-20 (PFDI-20) and Lower Urinary Tract Symptoms Module (ICIQ-FLUTSsex) questionnaires were completed by each patient before and 5 years after surgery. Of the 107 patients, only 78 completed the 5-year follow-up. The mean PFDI-20 scores before, 12 months, and 5 years after surgery were 141.87 ± 34.48, 100.87 ± 26.48, and 37.49 ± 56.39, respectively, indicating a significant improvement in the patients' symptoms after surgery (P < 0.001). The total mean score of ICIQ-FLUTSsex was 3.67 ± 3.63 (range, 0-10). In total, 22 (28.2%) women had an ICIQ-FLUTSsex score of 0, indicating no problems. The attachment of the rectovaginal fascia to the pericervical rings can be an effective surgical technique for correcting posterior vaginal wall prolapses, without significant morbidity. The PFDI-20 score improved significantly from before surgery to 12 months and 5 years after surgery.

MRI characterization of pelvic floor ligaments in nulliparous women: Technique development and morphometry within the 3D pelvic inclination correction system (3D-PICS)

PURPOSE

The aim of the MRI-study was to evaluate the visibility of the pelvic floor ligaments and to analyze the ligament morphometry in 3D space.

METHODS

Twenty-two nulliparous women underwent MRI with a ligament specific protocol. MR datasets were evaluated using the 3D Pelvic Inclination Correction System (3D-PICS). The round ligament (RL), sacrospinous ligament (SSL), sacrotuberous ligament (STL), urogenital diaphragm (UGD) and uterosacral ligament (USL) were analyzed. Qualitative and quantitative analysis was performed. 3D coordinates for origin and insertion points were determined relative to the symphysis; subsequently lengths and angles were calculated. Interrater reliability was calculated to validate the point determination method.

RESULTS

Moderate to good visibility was reported for the RL, the SSL, the STL and the UGD. Standard deviation of the points analyzed in the different dimensions vary from 1.5 mm to 21.3 mm. Origin and insertion points of the ligaments are found within a mean standard distance of 10.7 mm. The highest variability was seen in insertion points of RL, with a standard distance of 25.4 mm. The interrater reliability was good to very good (range of intraclass correlation coefficients (ICC) from 0.58 to 0.96), except for the UGD ventral points (ICC from 0.27 to 0.55).

CONCLUSIONS

This in-vivo MRI technique development study offers first exact data describing the pelvic floor ligaments in nulliparous women in 3D-PICS. Visibility, exact 3D coordinates of the origin and insertion points, lengths, angles and interrater reliability assessed for all parameters were evaluated morphometrically.

Pelvic Organ Prolapse Reconstruction with the Chitosan-Based Novel Haemostatic Agent in Ovine Model-Preliminary Report

This prospective study aimed to assess the feasibility of chitosan biomaterial and subcutaneous gel implantation in an ovine model, with implications for women with genital prolapse. Twenty-four ewes were divided into four groups (n = 6 per group): chitosan type B, chitosan type C, chitosan unmodified injections, and polypropylene mesh. Ovine models were chosen due to their morphological resemblance to human reproductive organs. Animals were sacrificed after 90 days for macroscopic, pathomorphological, and immunohistochemical analysis. In the chitosan type B group, IL-6 and IL-10 levels decreased after 28 days, while chitosan type C and injection groups exhibited higher IL-6 than IL-10 levels. The polypropylene group displayed the highest IL-6 and lowest IL-10 levels. Histological examination of the polypropylene group revealed no degenerative changes or inflammation, whereas chitosan injection induced local inflammation. Other groups exhibited no degenerative changes. Ewes implanted with chitosan displayed reduced inflammation compared to polypropylene-implanted ewes. Chitosan implantation facilitated vaginal tissue healing, in contrast to polypropylene mesh, which led to extrusion. While chitosan holds promise as an alternative to polypropylene mesh, further research is imperative for comprehensive evaluation. This study suggests the potential of a chitosan biomaterial in pelvic organ prolapse treatment, warranting additional investigation.

How Old Is Too Old? Outcomes of Prolapse Native-Tissue Repair through Uterosacral Suspension in Octogenarians

INTRODUCTION

Medical advancements are expected to lead to a substantial increase in the population of women aged 80 and older by 2050. Consequently, a significant number of individuals undergoing corrective prolapse surgery will fall into the elderly-patient category. The research indicates a notable rise in complications associated with prolapse surgery in patients older than 80, irrespective of frailty and other risk factors. Despite these challenges, the vaginal approach has been identified as the safest surgical method for pelvic organ prolapse (POP) repair in the elderly population. For this reason, we aimed to investigate the efficacy, complication rate, and functional outcomes associated with vaginal hysterectomy and an apical suspension/high uterosacral ligaments suspension as a primary technique for prolapse repair, both within a cohort of elderly patients.

METHODS

We retrospectively analyzed patients who underwent transvaginal hysterectomy plus an apical suspension procedure for stage ≥ II and symptomatic genital prolapse between January 2006 and December 2013. Anatomical and functional outcomes were evaluated. The Patient Global Impression of Improvement (PGI-I) score was used to evaluate subjective satisfaction after surgery.

RESULTS

Sixty-five patients were included in the analysis. The median age was 81.3 years. All individuals exhibited an anterior compartment prolapse stage II or higher, and the majority also a central prolapse stage II or higher. Notably, all participants reported symptoms of vaginal bulging. Over half of the population (58.6%) complained of incomplete bladder emptying. The intervention for all participants involved a vaginal hysterectomy with an apical suspension. Sixty-three patients (96.9%) and forty-four patients (67.6%) underwent a simultaneous anterior or posterior repair, respectively. Long-term complications (>30 days from surgery) were observed during follow-up, with a median duration of 23 ± 20 months. Seven (10.7%) anatomical recurrences were recorded, five (7.69%) concerning the anterior compartment, one (1.5%) the central, and three (4.6%) the posterior. Nevertheless, none of them necessitated further surgical intervention due to symptoms. Significant anatomical improvements for the anterior, central, and posterior compartments were noticed, compared to preoperative assessment (p < 0.001 for Aa and Ba, p < 0.001 for Ap and Bp, and p < 0.001 for C). PGI-I values established that 100% of patients were satisfied (PGI-I ≥ 2), with a median score of 1.12. Consequently, objective and subjective cure rates were 89.5% and 100%, respectively.

CONCLUSION

Vaginal hysterectomy combined with apical suspension, particularly high uterosacral ligaments suspension, is a safe and effective primary surgical approach, even in elderly patients.

Roles and mechanisms of biomechanical-biochemical coupling in pelvic organ prolapse

Pelvic organ prolapse (POP) is a significant contributor to hysterectomy among middle-aged and elderly women. However, there are challenges in terms of dedicated pharmaceutical solutions and targeted interventions for POP. The primary characteristics of POP include compromised mechanical properties of uterine ligaments and dysfunction within the vaginal support structure, often resulting from delivery-related injuries. Fibroblasts secrete extracellular matrix, which, along with the cytoskeleton, forms the structural foundation that ensures proper biomechanical function of the fascial system. This system is crucial for maintaining the anatomical position of each pelvic floor organ. By systematically exploring the roles and mechanisms of biomechanical-biochemical transformations in POP, we can understand the impact of forces on the injury and repair of these organs. A comprehensive analysis of the literature revealed that the extracellular matrix produced by fibroblasts, as well as their cytoskeleton, undergoes alterations in patient tissues and cellular models of POP. Additionally, various signaling pathways, including TGF-β1/Smad, Gpx1, PI3K/AKT, p38/MAPK, and Nr4a1, are implicated in the biomechanical-biochemical interplay of fibroblasts. This systematic review of the biomechanical-biochemical interplay in fibroblasts in POP not only enhances our understanding of its underlying causes but also establishes a theoretical foundation for future clinical interventions.

Single-cell analysis of uterosacral ligament revealed cellular heterogeneity in women with pelvic organ prolapse

Pelvic organ prolapse (POP) markedly affects the quality of life of women, including significant financial burden. Using single-cell RNA sequencing, we constructed a transcriptional profile of 30,452 single cells of the uterosacral ligament in POP and control samples, which has never been constructed before. We identified 10 major cell types, including smooth muscle cells, endothelial cells, fibroblasts, neutrophils, macrophages, monocytes, mast cells, T cells, B cells, and dendritic cells. We performed subpopulation analysis and pseudo-time analysis of POP primary cells, and explored differentially expressed genes. We verified previous cell clusters of human neutrophils of uterosacral ligaments. We found a significant reduction in receptor-ligand pairs related to ECM and cell adhesion between fibroblasts and endothelial cells in POP. The transcription factors related to the extracellular matrix, development, and immunity were identified in USL. Here we provide insight into the molecular mechanisms of POP and valuable information for future research directions.

FZD3 regulates the viability, apoptosis, and extracellular matrix degradation of vaginal wall fibroblasts in pelvic organ prolapse via the Wnt signaling pathway

The occurrence of pelvic organ prolapse (POP) seriously affects women's quality of life. However, the pathogenesis of POP remains unclear. We aimed to clarify the role of Frizzled class receptor 3 (FZD3) in POP. FZD3 expression in the vaginal wall tissues was detected using immunohistochemistry, real-time polymerase chain reaction, and western blot analysis. Then, vaginal wall fibroblasts (VWFs) were isolated from patients with POP and non-POP, and were identified. Cell viability and apoptosis were evaluated using Cell Counting Kit-8 and flow cytometry, respectively. Extracellular matrix (ECM) degradation was assessed by western blot analysis. The results illustrated that FZD3 was downregulated in POP. VWFs from POP had lower cell viability, ECM degradation, and higher apoptosis. Knockdown of FZD3 inhibited cell viability, ECM degradation, and promoted apoptosis of VWFs, whereas overexpression of FZD3 had opposite results. Moreover, IWP-4 (Wingless-type [Wnt] pathway inhibitor) reversed the role of FZD3 overexpression on biological behaviors. Taken together, FZD3 facilitates VWFs viability, ECM degradation, and inhibits apoptosis via the Wnt pathway in POP. The findings provide a potential target for the treatment of POP.

Prevention of complications of surgical treatment of stage III-IV cystocele using light polypropylene mesh

OBJECTIVE

The purpose of study was to report the subjective and objective results of different methods of surgical treatment of cystocele using the transvaginal Mesh-system.

METHODOLOGY

A prospective study was conducted from January 2017 to December 2020 comparing anterior colporrhaphy with vaginal mesh and two distinct types of vaginal wall repair sutures in the surgical treatment of cystocele. The primary endpoint was the incidence rate of vaginal wall erosion complications 12 months after surgery. Secondary endpoints were anatomic outcomes, TVM-related morbidity, and patient satisfaction measured using validated questionnaires.

RESULTS

In total, 102 patients with stage III-IV cystocele and the average age of 67.2 ± 3.1 years (age range of 47-79 years old) took part in the study. Of the 102 women initially enrolled, 102 (100%) were successfully followed up 12 months after primary surgery. The primary result, the objective erosion development, was radically different in the comparison groups (1.6% against 23.5%, respectively). Analysis of the improved method of operative treatment showed a prominent level of positive, uncomplicated, surgery results of 98.4% (60/61). The anatomic success rate of recovery from cystocele was 99.9% (101/102) 12 months after surgery.

CONCLUSION

The suggested method of restoring the anterior vaginal wall in stage III-IV isolated cystocele without signs of incomplete and complete prolapse of the uterus showed a radically positive result. The number of complications was relatively high in the comparison group, but no difference was observed in satisfaction with the anatomical results of the surgery. The percentage of the vaginal wall erosion when using a single-layer suture is 23.5%, when using a two-layer suture is 1.6.

Pelvic floor muscle strength and influencing factors based on vaginal manometry among healthy women at different life stages: A multicentre cross-sectional study

OBJECTIVE

To assess pelvic floor muscle (PFM) strength and influencing factors among healthy women at different life stages.

DESIGN

Multicentre cross-sectional study.

SETTING

Fourteen hospitals in China.

POPULATION

A total of 5040 healthy women allocated to the following groups (with 1680 women per group): premenopausal nulliparous, premenopausal parous and postmenopausal.

METHODS

The PFM strength was evaluated by vaginal manometry. Multivariate logistic regression was used to determine the influencing factors for low PFM strength.

MAIN OUTCOME MEASURES

Maximum voluntary contraction pressure (MVCP).

RESULTS

The median MVCP values were 36, 35 and 35 cmH2 O in premenopausal nulliparous (aged 19-51 years), premenopausal parous (aged 22-61 years), and postmenopausal (aged 40-86 years) women, respectively. In the premenopausal nulliparous group, physical work (odds ratio, OR 2.05) was the risk factor for low PFM strength, which may be related to the chronic increased abdominal pressure caused by physical work. In the premenopausal parous group, the number of vaginal deliveries (OR 1.28) and diabetes (OR 2.70) were risk factors for low PFM strength, whereas sexual intercourse (<2 times per week vs. none, OR 0.55; ≥2 times per week vs. none, OR 0.56) and PFM exercise (OR 0.50) may have protective effects. In the postmenopausal group, the number of vaginal deliveries (OR 1.32) and family history of pelvic organ prolapse (POP) (OR 1.83) were risk factors for low PFM strength.

CONCLUSIONS

Physical work, vaginal delivery, diabetes and a family history of POP are all risk factors for low PFM strength, whereas PFM exercises and sexual life can have a protective effect. The importance of these factors varies at different stages of a woman's life.