ABSTRACT: To evaluate whether major levator ani muscle defects were associated with differences in postoperative vaginal support after primary surgery for pelvic organ prolapse (POP).
A retrospective chart review of a subgroup of patients in the Organ Prolapse and Levator (OPAL) study. Of the 247 women recruited into OPAL, 107 underwent surgery for prolapse and were the cohort for the present analysis. Major levator ani defects were diagnosed when more than 50% of the pubovisceral muscle was missing on MRI. Postoperative vaginal support was assessed via POP-quantification system. Postoperative anatomic outcome was analyzed according to levator ani defect status, as determined by MRI.
Support of the anterior vaginal wall 2 cm above the hymen occurred among 62% of women with normal levator ani muscles/minor defects and 35% of those with major defects. Support of the anterior wall 1cm above the hymen occurred among 32% women with normal muscles /minor defects and 59% of those with major defects. Levator ani defects were not associated with differences in postoperative apical/posterior vaginal support.
Six weeks after primary surgery for prolapse, women with normal levator ani muscles/minor defects had better anterior vaginal support than those with major levator defects.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 06/2011; 114(2):141-4. · 1.41 Impact Factor
ABSTRACT: Correction of apical vaginal prolapse has been described via abdominal, laparoscopic, and transvaginal approaches. The uterosacral and sacrospinous ligament suspension procedures are common transvaginal native tissue repairs to restore apical vaginal support. Preoperative evaluation, operative decision making, surgical techniques, and objective and subjective outcomes of each technique are reviewed.
Clinical obstetrics and gynecology 03/2010; 53(1):72-85. · 2.06 Impact Factor
ABSTRACT: This study aimed to describe the self-perceived natural history of pelvic organ prolapse (POP) in women seeking care.
Women presenting to a university-based urogynecology clinic for POP (n = 107) completed a questionnaire including questions about how and when their prolapse was discovered. A urogynecologic examination including the pelvic organ prolapse quantification (POP-Q) was also performed.
Forty-eight percent of these women sought medical attention "immediately" after discovering a bulge. The median time to seek care was 4 months (range from 1 month to 45 years). Twenty-six percent associated their prolapse with a specific event (e.g., moving furniture or pushing a car). POP was self-discovered by 76% (81/107) of women. Self-discovered prolapses were larger than those diagnosed by physicians (Ba +1.3 vs 0.1 cm, P = .03, respectively).
Women seek medical advice within months of discovering their prolapse. Self-discovery is associated with higher stage prolapse than prolapse diagnosed by health care providers.
International Urogynecology Journal 05/2009; 20(8):927-31. · 1.83 Impact Factor