Pelvic organ prolapse: current understanding, assessment and management

Pelvic organ prolapse: current understanding, assessment and management

Kosturika Ash and Alok Ash review the current literature regarding prolapse, including assessment techniques and means of treatment.

 

Introduction

Genito-urinary prolapse or pelvic organ prolapse (POP) is a common gynaecological problem, the presentation of which varies in type and severity among patients.

 

Epidemiology of POP

It is difficult to know the exact prevalence of pelvic organ prolapse since many patients do not report it and symptom-based diagnosis underestimates the true prevalence of the condition.

In developed countries, the prevalence is high among postmenopausal women,1-3 whereas in developing countries, the condition is also common in women of reproductive age.4,5 The global prevalence of POP is reported to be 2-20 percent in women under the age of 45 years…6

 

For the full article, contact us and ask about subscription:

David Warne
T: 01423 851 150
E: david.warne@barkerbrooks.co.uk

 

References

  1. Fritel X, Varnoux N, Zins M, Breart G, Ringa V: Symptomatic pelvic organ prolapse at midlife, quality of life, and risk factors. Obstet Gynecol 2009, 113(3): 609–616.
  2. Barber MD, Neubauer NL, Klein-Olarte V: Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol 2006, 195(4): 942-948
  3. Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasman JM, Subak LL: Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 2007, 109(6):1396–1403.
  4. Bonetti TR, Erpelding A, Pathak LR: Listening to “felt needs”: investigating genital prolapse in western Nepal. Reprod Health Matters 2004, 12(23):166–175.[Cross Ref. BMC Women’s Health 2013, 13:22]
  5. Lukman Y: Utero-vaginal prolapse: a rural disability of the young. East Afr Med J 1995, 72(1):2–9. [Cross Ref. BMC Women’s Health 2013, 13:22]
  6. WHO: Report on the Regional Reproductive Strategy Workshop: South East Asia Region. Geneva, Switzerland: World Health Organization; 1995.
  7. King’s College Hospital. Pelvic Organ Prolapse: Information for outpatients. www.kch.nhs.uk. PL541.1 May 2012 [accessed 28 Dec 2012]
  8. Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999; 180(2 Pt 1): 299-305.
  9. RCOG. Information for you: Pelvic organ prolapse, March 2013
  10. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL: Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997, 89(4): 501-506.
  11. Fialkow MF, Newton KM, Lentz GM, Weiss NS: Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19(3):437-440.
  12. Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS: Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001; 98(4): 646.
  13. Graham CA, Mallett VT. Race as a predictor of urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol 2001;185(1):116–120. [PubMed: 11483914]
  14. Thom DH, van den Eeden SK, Ragins AI, et al. Differences in prevalence of urinary incontinence by race/ethnicity. J Urol 2006;175(1):259–264. [PubMed: 16406923]
  15. Dooley Y, Kenton K, Cao G, et al. Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey. J Urol 2008;179(2):656–661. [PubMed: 18082211]
  16. Shah AD, Kohli N, Rajan SS, Hoyte L. Racial characteristics of women undergoing surgery for pelvic organ prolapse in the United States. Am J Obstet Gynecol 2007;197(1):70.e1–70.e8. [PubMed: 17618763]
  17. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US. JAMA. 2008 September 17; 300(11): 1311–1316. doi:10.1001/jama.300.11.1311
  18. MacLennan, A. H., Taylor, A. W., Wilson, D. H. and Wilson, D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 2000; 107:1460–1470.
  19. Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol 2006;107(6):1253-1260.
  20. Delancey JO, Kearney R, Chou Q, et al. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol. 2003; 101:46–53.
  21. Dietz HP, Lanzarone V. Levator trauma after vaginal delivery. Obstet Gynecol. 2005; 106:707–712.
  22. Chan SS, Cheung RY, Yiu AK, et al. Prevalence of levator ani muscle injury in Chinese women after first delivery. Ultrasound Obstet Gynecol. 2012; 39:704–709. [PubMed: 22045587]
  23. Albrich SB, Laterza RM, Skala C. Impact of mode of delivery on levator morphology: a prospective observational study with three-dimensional ultrasound early in the postpartum period. BJOG. 2012; 119: 51–60.
  24. Shek KL and Dietz HP. Intrapartum risk factors for levator trauma. BJOG. 2010; 117:1485–1492.
  25. Hösli I. Influence of pregnancy and delivery to the pelvic floor. Ther Umsch 2010; Jan;67(1):11-8. doi: 10.1024/0040-5930/a000003. [PubMed – indexed for MEDLINE].
  26. de Tayrac R, Panel L, Masson G, Mares P. [Episiotomy and prevention of perineal and pelvic floor injuries]. J Gynecol Obstet Biol Reprod (Paris). 2006 Feb;35(1 Suppl):1S24-1S31 [PubMed: Indexed for MEDLINE]
  27. Memon H and Handa VL. Pelvic floor disorders following vaginal or cesarean delivery. Curr Opin Obstet Gynecol. 2012 October; 24(5): 349–354. doi:10.1097/GCO.0b013e328357628b
  28. Lammers, K., Lince, S. L., Spath, M. A., van Kempen, L. C., Hendriks, J. C., Vierhout, M. E., & Kluivers, K. B. Pelvic organ prolapse and collagen-associated disorders. International urogynecology journal, 2012;  23(3), 313-319.
  29. Bump RC, Mattiasson A, Bo K Brubaker, Bo K, Brubaker LP, DeLancey, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175:10-17.
  30. Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V. The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG: an International Journal of Obstetrics and Gynaecology 2005; 112(7): 971–976. DOI: 10.1111/j.1471-0528.2005.00568.x
  31. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. Standardisation Sub-Committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: Report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn 2002;21:167–168.
  32. Marchionni M, Bracco GL, Checcucci V, Carabaneanu A, Coccia EM, Mecacci F, et al. True incidence of vaginal vault prolapse. Thirteen years experience. J Reprod Med 1999; 44: 679–684.
  33. Digesu GA, Khullar V, Cardozo L, Robinson D, Salvatore S. P-QOL:A validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct 2005 May-Jun;16(3):176-181 [PubMed – indexed for MEDLINE]
  34. Swift SE, Tate SB, Nicholas J. Correlation of symptoms with degree of pelvic organ support in a general population of women: what is pelvic organ prolapse. Am J Obstet Gynecol. 2003; 189: 372–377.
  35. Pauls RN, Segal JL, Silva WA, Kleeman SD, Karram MM  Sexual function in patients presenting to a urogynecology practice. Int Urogynecol J Pelvic Floor Dysfunct 2006; 17(6):576-580
  36. Thibault F, Wagner L, Rouvellat P, Seni G, de Tayrac R, Droupy S, Costa P. Sexual function before surgery for pelvic organ prolapse. Prog Urol. 2012 Oct;22(11):665-70. doi: 10.1016/j.purol.2012.08.266. Epub 2012 Sep 5 [PubMed – Indexed for MEDLINE]
  37. Kammerer-Doak D. Assessment of sexual function in women with pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunct. 2009 May; 20 Suppl 1:S45-50. doi: 10.1007/s00192-009-0832-y
  38. Rogers RG, Coates KW, Kammerer-Doak D, Khalsa S, Qualls C. A short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J 2003; 14: 164–168 DOI 10.1007/s00192-003-1063-2
  39. Ghetti C, Gregory WT, Edwards SR, et al. Pelvic organ descent and symptoms of pelvic floor disorders. Am J Obstet Gynecol. 2005; 193:53–57.
  40. Broekhuis SR, Futterer JJ, Hendriks JC, et al. Symptoms of pelvic floor dysfunction are poorly correlated with findings on clinical examination and dynamic MR imaging of the pelvic floor. Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20:1169–1174.
  41. Dhital R, Otsuka K, Poudel KC, et al. Improved quality of life after surgery for pelvic organ prolapse in Nepalese women. BMC Women’s Health (Open Access), May 2013, 13:22 [http://www.biomedcentral.com/1472-6874/13/22; Accessed 9 December 2013]
  42. Gutman RE, Ford DE, Quiroz LH, et al. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms. Am J Obstet Gynecol. 2008; 199: 683.
  43. NICE: National Institute for Health and Clinical Excellence. Urinary incontinence: The management of urinary incontinence in women. Clinical Guideline 40: Issue date: October 2006
  44. Rogers RG, Kammerer-Doak D, Villarreal A, Coates K, Qualls C A new instrument to measure sexual function in women with urinary incontinence and/or pelvic organ prolapse. Am J Obstet Gynecol 2001; 184:552–558
  45. Rogers RG, Rockwood TH, Constantine M et al. A new measure of sexual function in women with pelvic floor disorders (PFD); Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). Int Urogynecol J 2013; 24(7): 1091-1103.
  46. Wren PA, Janz NK, FitzDerald MP, Barber KL, Cundiff DW et al, Optimism in women undergoing abdominal sacrocolpopexy for pelvic organ prolapse. J Am Coll Surg 2008; 207(2): 240-245.
  47. Jelovsek JE and Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. Am J Obstet Gynecol. 2006 May;194(5):1455-1461.
  48. Ghetti C, Lowder JL, Ellison R, Krohn MA, Moalli P: Depressive symptoms in women seeking surgery for pelvic organ prolapse. Int Urogynecol J 2010, 21(7):855–860.
  49. Chauvin C, Chéreau E, Ballester M, Daraï E. Potential relevance of pre-operative quality of life questionnaires to identify candidates for surgical treatment of genital prolapse: a pilot study. BMC Urology , March 2012, 12:9. [http://www.biomedcentral.com/1471-2490/12/9; Accessed 27/12/2013]
  50. NICE. Urinary incontinence in women. 2013 [pdf] Available at: www.nice.org.uk/nicemedia/live/14271/65356/65356.pdf [Accessed 28 January, 2014].
  51. Subramanian D, Szwarcensztein K, Mauskopf JA, Slack MC: Rate, type, and cost of pelvic organ prolapse surgery in Germany, France, and England. Eur J Obstet Gynecol Reprod Biol 2009, 144(2):177-181.
  52. RCOG Green-Top Guideline. No. 46. Royal College of Obstetricians and Gynaecologists, London, 2007.
  53. Gorti M, Hudelist G, Simons A. Evaluation of vaginal pessary management: a UK-based survey. J Obstet Gynaecol 2009 Feb; 29(2):129-31. doi: 10.1080/01443610902719813.
  54. Cundiff GW, Weidner AC, Visco AG, Bump RC, Addison WA. A survey of pessary use by members of the American urogynecologic society. Obstet Gynecol. 2000 Jun;95(6 Pt 1):931-935.
  55. Bugge C, Adams EJ, Gopinath D, Reid F. Pessaries (mechanical devices) for pelvic organ prolapsed in women. Cochrane Database of Systematic Review 2013, Issue 2, Art. No. CD004010. doi: 10.1002/14651858.CD004010.pub3
  56. Hagen S, Stark D, Maher C, Adams E. Conservative management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2006; 4:CD003882.
  57. NICE: National Institute for Health and Clinical Excellence (NICE). Surgical repair of vaginal wall prolapsed using mesh. Interventional Procedure Guidance 267. Issue date: June 2008
  58. Maher CM, Feiner B, Baessler K, Glazener CMA. Surgical management of pelvic organ prolapse in women: the updated summary version Cochrane review.  International Urogynecology Journal, November 2011, Volume 22, Issue 11, pp 1445-1457
  59. Ramavath KK, Murthy PS. Robotic sacrocolpopexy: an observational experience at Mayo Clinic, USA. J Gynecol Endosc Surg. 2011 Jan;2(1):53-57. doi: 10.4103/0974-1216.85285.[PubMed]
  60. Uzoma A, Farag KA. Vaginal vault prolapse. Obstet Gynecol Int. 2009; Article ID:275621. doi: 10.1155/2009/275621. Epub 2009 Aug 11.
  61. Smith FJ, Holman CD, Moorin RE. Lifetime Risk of Undergoing Surgery for pelvic organ prolapse. Obstet Gynecol. 2010; 116:1096–1100.
Categories: ARTICLES

About Author