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Points and landmarks for POP–Q system examination. Aa, point A anterior, Ap, point A posterior, Ba, point B anterior; Bp, point B posterior; C, cervix or vaginal cuff; D, posterior fornix (if cervix is present); gh, genital hiatus; pb, perineal body; tvl, total vaginal length
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The prolapse of one or several pelvic organs is a condition that has been known by medicine since its early days, and different therapeutic approaches have been proposed and accepted. But one of the main problems concerning the prolapse of pelvic organs is the need for a universal, clear and reliable staging method.
Because the prolapse has been kn...
Citations
... We assessed the pelvic organ prolapse symptoms using the Pelvic Floor Disability Index (PFDI-20) [15] and the Pelvic Organ Prolapse Quantification (POP-Q) system [16]. During outpatient visits, patients underwent pelvic examination in the lithotomy position conducted by experienced gynecologists to evaluate the position and stage of prolapse. ...
(1) Background: Treating female pelvic organ prolapse (POP) is challenging. Surgical meshes have been used in transvaginal surgeries since the 1990s, but complications such as mesh exposure and infection have been reported. Polyvinylidene fluoride (PVDF) mesh, known for its stability and non-reactive properties, has shown promise in urogynecological surgeries. (2) Methods: A retrospective analysis was conducted on 27 patients who underwent a modified PVDF vaginal mesh repair procedure using DynaMesh®-PR4 and combined trans-obturator and sacrospinous fixation techniques. Additional surgeries were performed as needed. (3) Results: The mean operation time was 56.7 min, and the mean blood loss was 66.7 mL. The average hospitalization period was 4.2 days with Foley catheter removal after 2 days. Patients experienced lower pain scores from the day of the operation to the following day. Postoperative follow-up revealed that 85.2% of patients achieved anatomic success, with 14.8% experiencing recurrent stage II cystocele. No recurrence of apical prolapse was observed. Complications were rare, with one case (3.7%) of asymptomatic mesh protrusion. (4) Conclusions: The modified vaginal mesh procedure using DynaMesh®-PR4 showed favorable outcomes with a short operation time, low recurrence rate, rare complications, and improved functional outcomes. This surgical option could be considered for anterior and apical pelvic organ prolapse in women.
... Various studies have reported inter and intraobserver variability in this technique due to its complex nature and limited usage. Despite these limitations, POP-Q is widely adopted and is considered a good standard among gynecologists [9][10][11][12]. ...
... Pelvic organ prolapse frequently affects women's physical, sexual, social, and psychological functions (4, 7,11,12). It has a significant economic burden due to impaired daily activities and decreased productivity (10). ...
Background
Pelvic organ prolapse (POP) affects millions of women globally, with resource-limited countries, such as Ethiopia, carrying the highest burden. Previously, the prevalence of POP was estimated using seven studies. However, this study lacks generalization because of the limited number of studies and low geographical representation. In total, 12 additional primary studies were conducted after this review, and their reported prevalence was significantly variable across the studies. In addition, different new factors were reported in the primary studies. Therefore, this study aimed to update the pooled prevalence of POP and its associated factors in Ethiopia.
Methods
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Articles that were published between 2000 and 2023 were searched using the African Journal of Online, ScienceDirect, DOAJ, PubMed, and Google Scholar. The quality of the studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted using Microsoft Excel and analyzed by Stata version 11. A random effect model was used to investigate the pooled prevalence of POP and its associated factors. The I ² test and Egger's regression test were used to detect the presence of heterogeneity and publication bias across studies, respectively.
Result
A total of 21 studies met the inclusion criteria and represented the data of 14,575 women. The pooled prevalence of POP was found to be 22.70%. History of home delivery (pooled odds ratio (OR) =2.93, 95% CI =1.46, 5.91), prolonged labor (OR = 4.63, 95% CI = 2.56, 8.38), history of perineal tear (OR = 4.83, 95% CI = 2.31, 10.11), instrumental delivery (OR =3.70, 95% CI =2.01, 6.81), grand multipara (OR = 5.42, 95% CI = 4.06, 7.23), family history of POP (OR = 3.30, 95% CI = 2.07, 5.25), and carrying heavy objects (OR = 3.23, 95% CI = 2.22, 4.70) were significantly associated with POP.
Conclusion
The pooled prevalence of POP was high in Ethiopia. The Ministry of Health and clinicians should emphasize counseling on modifiable risk factors and develop further prevention strategies.
... All included patients had a symptomatic Stage 2 prolapse or higher in any of the three compartments according to the Pelvic Organ Prolapse Quantification (POP-Q) system (24). The prolapse was diagnosed by gynecologic clinical examination and transvaginal ultrasound. ...
IntroductionPelvic organ prolapse is a common health issue that affects 30.8% of women. Laparoscopic sacrocolpopexy and colpopectopexy are two of the most common procedures to restore the pelvic anatomy. Mesh application on the other hand carries an increased complications risk over the short and long terms. The aim of this study is to provide a basis for meshless sacrocolpopexy and colpopectopexy.Methods
This study is a retrospective cohort pilot study that analyzed the data of patients with a pelvic organ prolapse according to the pelvic organ prolapse quantification system and underwent the modified technique for sacrocolpopexy and colpopectopexy. Descriptive statistics were used to express the different variables.ResultsA total of 36 patients met the inclusion criteria and provided consent for the participation in this study. The majority of patients were postmenopausal. 22 out of 36 patients received a previous prolapse surgery. All patients presented with reducible vaginal lump. Dyspareunia and sexual dysfunction were the most commonly reported symptoms. The intraoperative complications rate was 0%. Only one patient had a postoperative persistent urinary retention that was managed medically.DiscussionSacrocolpopexy and colpopectopexy seems to be a safe alternative to the mesh-based pelvic surgeries with a very low rate of intraoperative complications and favorable follow up outcomes.
... This study was conducted between August 2017 and September 2018. Participants were included if they were women, aged 21-80 years, diagnosed with POP stages 2-4, according to the POP quanti cation (POP-Q) [21] in one or more sites along the vaginal walls, had used any ring pessary, able to use both hands and insert a vaginal device, able to retain a 61-91 mm pessary, and willing to comply with study restrictions. ...
Purpose
To investigate whether ProVate™, a novel, disposable, self-inserted vaginal device for pelvic organ prolapse management, clinically affects the vaginal microflora, as compared with a commercially available ring pessary, in order to assess its microbiological safety.
Methods
This interventional, prospective, multi-center, open-label, randomized, controlled, statistically powered (non-inferiority), home-use, cross-over study was conducted at seven sites. Participants were randomized into either group A (using ProVate™ and then a new reusable commercially available ring pessary [control]) or B (using control device and then ProVate™) with a 1:1 ratio. Primary endpoint was based on meeting one of the failure criteria: significant change in Lactobacillus spp., Gardnerella vaginalis, Candida morphotypes, or Staphylococcus aureus levels compared to the baseline (significant change: Nugent score ≥ 7 or > 1 scale unit increase in S. aureus or Candida morphotype), bothersome vaginal symptoms, or symptoms requiring treatment.
Results
The study included 58 participants (mean age: 64.5 years, 91.4% post-menopausal). The failure rate was 15.5% for ProVate™ and control groups while using 383 ProVate™ devices over 1,647 days or one control device throughout the study. Two patients had bothersome vaginal complaints and one had vaginal infection in the control group, but no such cases were observed in the ProVate™ group.
Conclusion
The primary endpoint of possible vaginal microbial changes, bothersome vaginal symptoms, or treatment-requiring vaginal complaints while using ProVate™ was successfully met. Our findings show that the vaginal microflora is comparable when using either ProVate™ or commercially available ring pessary (control) with a relatively low rate of vaginal infections.
Trial registration details
ClinicalTrials.gov;
... Of 60 patients, 45 had su cient medical records for the analysis. All patients quali ed for the study had an isolated apical defect POP-Q III C or POP-Q IV C. The vast majority were, however, patients with POP-Q III C. The POP-Q scale and the modi ed classi cation of pelvic static disorders according to DeLancey were used to objectively assess the type and degree of the disorder [20] All patients quali ed for the project had a cervical or vaginal stump suspension procedure performed using the AMI BSC system. The BSC mesh is designed to induce neoligament formation by establishing a symmetrical, two-sided vaginal vault suspension from sacral cruciate ligament. ...
Background:
Pelvic organ prolapse is an extremely important therapeutic problem and affects up to 50% of nulliparous women, and its frequency increases with age and parity and is more common after menopause. This ailment has a negative impact on many aspects of life, significantly reducing its quality. Nowadays, not only the cure of the problem, but also the improvement of the quality of life and life satisfaction of patients is of great importance for doctors, therefore the assessment of these aspects should also be constantlyevaluated. The objective of this study was to determine the quality of life and satisfaction with life of patients before, 1 year and 3 years after performing the surgery of an isolated apical defect using BSC synthetic mesh.
Methods:
Of 60 patients with an isolated apical defect, 45 had sufficient medical records for the analysis. Evaluation comprised the P-QOL and the SWLS questionnaires conducted three times.
Results:
The results obtained for the P-QOL questionnaire carried out after 3 years show that the quality of life of the patients improved. A statistically significant increase in the quality of life was achieved in almost all domains (p <0.05).
Conclusion:
The results obtained after completing the SWLS questionnaire indicate that 3 years after the surgery, patients' satisfaction with life showed an upward trend. Surgical treatment of an isolated apical defect using the AMI BSC kit results in an improvement in the quality of life in the majority of patients, even in a long-term evaluation.
... Baden-Walker Halfway evrelendirme sistemi, prolapsusu 4 evrede incelemektedir. Kolay uygulanması, hızlı kabul görmesine neden olmuştur ancak subjektif olması nedeniyle POP-Q evrelemesinden sonra kullanımı azalmıştır (7). 1996 yılında yayınlanan POP-Q evrelemesi, ICS tarafından onaylanmış ve yaygın kabul görmüştür. ...
... Baden-Walker Halfway evrelendirme sistemi, prolapsusu 4 evrede incelemektedir. Kolay uygulanması, hızlı kabul görmesine neden olmuştur ancak subjektif olması nedeniyle POP-Q evrelemesinden sonra kullanımı azalmıştır (7). 1996 yılında yayınlanan POP-Q evrelemesi, ICS tarafından onaylanmış ve yaygın kabul görmüştür. ...
... 3. Abnormal results of pelvic floor EP examination: defined as type I or II pelvic floor muscle fiber abnormalities involving muscle strength and fatigue degree; 4. Vaginal dynamic pressure: The vaginal dynamic pressure was measured using a balloon probe, with a normal range being 80-150 cm H 2 O. 5. POP (Haylen et al., 2016;Akın et al., 2018): Downward displacements of one or more areas, such as the anterior vaginal wall, posterior vaginal wall, and uterus (cervix) or vaginal apex, were defined anatomically as anterior POP, posterior POP, and apical POP, respectively. The degree of prolapse was quantified and classified into five stages according to POP-Q (Persu et al., 2011) (Table 1). 6. Urinary incontinence (UI) (Abrams et al., 2003): UI was mainly stress urinary incontinence, and the diagnosis relied on the patient's urinary incontinence history, urinary incontinence questionnaire (ICI-Q-SF), and gynecological examination, as well as stress testing and Marshall-Bonney testing. ...
Objective: To investigate the incidence of pelvic floor dysfunction (PFD) and electrophysiological indicators in postpartum women at 6–8 weeks and explore the influence of demographic characteristics and obstetric factors.
Methods: A survey questionnaire collected information about the conditions of women during their pregnancy and puerperal period and their demographic characteristics; pelvic organ prolapse quantitation (POP-Q) and pelvic floor muscle electrophysiology (EP) examination were conducted in postpartum women at 6–8 weeks.
Results: Vaginal delivery was a risk factor for anterior pelvic organ prolapse (POP) (OR 7.850, 95% confidence interval (CI) 5.804–10.617), posterior POP (OR 5.990, 95% CI 3.953–9.077), anterior and posterior stage II POP (OR 6.636, 95% CI 3.662–15.919), and postpartum urinary incontinence (UI) (OR 6.046, 95% CI 3.894–9.387); parity was a risk factor for anterior POP (OR 1.397,95% CI 0.889–2.198) and anterior and posterior stage II POP (OR 4.162, 95% CI 2.125–8.152); age was a risk factor for anterior POP (OR 1.056, 95% CI 1.007–1.108) and postpartum UI (OR 1.066, 95% CI 1.014–1.120); body mass index (BMI) was a risk factor for postpartum UI (OR 1.117, 95% CI 1.060–1.177); fetal birth weight was a risk factor for posterior POP (OR 1.465, 95% CI 1.041–2.062); and the frequency of pregnancy loss was a risk factor for apical POP (OR 1.853, 95% CI 1.060–3.237).
Conclusion: Pelvic floor muscle EP is a sensitive index of early pelvic floor injury. The changes in muscle strength and fatigue degree coexist in different types of postpartum PFD, and each has its own characteristics.
... The higher the score, the more severe the pelvic floor dysfunction [11]. Furthermore, the degree of POP was assessed through a dedicated clinical urogynecologic examination using the "Pelvic Organ Prolapse Quantification (POP-Q)" system with grades 0 (no prolapse) to 4 (maximum descent) scored according to the extent of organ prolapse relative to the hymen as the anatomic reference point [12,13]. ...
Purpose
To compare multi-slice (MS) MRI sequences of the pelvis acquired at rest and straining to dynamic midsagittal single-slice (SS) sequences for the assessment of pelvic organ prolapse (POP).
Methods
This IRB-approved prospective single-center feasibility study included 23 premenopausal symptomatic patients with POP and 22 asymptomatic nulliparous volunteers. MRI of the pelvis at rest and straining was performed with midsagittal SS and MS sequences. Straining effort, visibility of organs and POP grade were scored on both. Organ points (bladder, cervix, anorectum) were measured. Differences between SS and MS sequences were compared with Wilcoxon test.
Results
Straining effort was good in 84.4% on SS and in 64.4% on MS sequences (p = 0.003). Organ points were always visible on MS sequences, whereas the cervix was not fully visible in 31.1–33.3% on SS sequences. At rest, there were no statistically significant differences of organ point measurements between SS and MS sequences in symptomatic patients. At straining, positions of bladder, cervix, and anorectum were + 1.1 cm (± 1.8 cm), − 0.7 cm (± 2.9 cm), and + 0.7 cm (± 1.3 cm) on SS and + 0.4 mm (± 1.7 cm), − 1.4 cm (± 2.6 cm), and + 0.4 cm (± 1.3 cm) on MS sequences (p < 0.05). Only 2 cases of higher-grade POP were missed on MS sequences (both with poor straining effort).
Conclusion
MS sequences increase the visibility of organ points compared to SS sequences. Dynamic MS sequences can depict POP if images are acquired with sufficient straining effort. Further work is needed to optimize the depiction of the maximum straining effort with MS sequences.
Graphical abstract
