Retrospective audit of genital prolapse management
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20220906Keywords:
Genital prolapse, Pessary, Vaginal hysterectomy, Sacrocolpopexy, Hysterosacropexy, Massive prolapseAbstract
Background: Pelvic organ prolapse is a descent of the pelvic organs into the vagina, frequently associated with local pelvic symptoms. Pelvic floor support is essential to maintain the normal anatomy. Recent studies of genital prolapse suggests that it is more important to improve the patient satisfaction and reduce complication than to achieve anatomical success. The purpose of the audit of genital prolapse management in this retrospective study is to know and understand the decision making, selection of patients for a particular surgery and to know and avoid the complications of genital prolapse management.
Methods: This retrospective descriptive study was conducted at SVMCH and RC during the period of January 2020 to December 2021. The detailed analysis of the cases, symptomatology, surgical methods, complications and follow up were studied.
Results: We managed 110 cases of genital prolapse. 35 patients had massive/ huge genital prolapse (POP Q Stage 4). 75.4%were found in the age group beyond 55 years, 66.3% were multiparous. 31% of the patients came with massive prolapse (POP Q-stage IV), 5% showed cervical elongation ,7% showed vault prolapse, Majority of our patients (63%) were managed by vaginal hysterectomy with pelvic floor repair. Followed by pessary, Fothergill’s surgery, Purandare’s surgery, Le forte’s, sacrospinal fixation, hysterosacropexy, pessary with thiersch stitch.
Conclusions: The choice of management of genital prolapse has to be tailored according to the patients needs and pathology. The younger trainees have to be trained to get the skills of various surgeries of genital prolapse.
References
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501-6.
Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol. 1997;104:57985.
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:5016.
Maclennan AH, Taylor AW, Wilson D. The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery. Br. J. Obstet. Gynaecol. 2000;107:1460-70.
Al-Rawi ZS, Al-Rawi ZT. Joint hypermobility in women with genital prolapse. Lancet. 1982;1:1439-41.
Gilpin SA, Gosling JA, Smith ARB, Warrell DW. The pathogenesis of genitourinary prolapse and stress incontinence in women. A histological and histochemical study. Br. J. Obstet. Gynaecol. 1989;96:15-23.
Smith AR, Hosker GL, Warrell DW. The role of partial denervation of the pelvic floor in the aetiology of genitourinary prolapse and stress incontinence of urine. A neurophysiological study. Br. J. Obstet.Gynaecol. 1989;96:24-8.
Allen RE, Hosker GL, Smith ARB,Warrell DW. Pelvic floor damage and childbirth: a neurophysiological study. Br. J.Obstet. Gynaecol. 1990;97:770-9.
Ko KJ, Lee KS. Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes: Clin Urol. 2019;60:413-24.
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):646-51.
Jones KA, Harmanli O. Pessary use in pelvic organ prolapse and urinary incontinence. Rev Obstet Gynecol. 2010;3:3-9.
Zimmerman CW. Pelvic organ prolapse- Basic principles: Surgery for correction of defects in pelvic supports and fistulas. Te Linde’s operative gynaecology. 10th ed. Wolters Kluwer publication. 2009;854-71.
Downing KT. Uterine prolapse: from antiquity to today. Obstet Gynecol Int. 2012;2012:649459.
Sutton C. Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol. 1997;11(1):1-22.
Chung SH, Kim WB. Various Approaches and Treatments for Pelvic Organ Prolapse in Women. J Menopausal Med. 2018;24(3):155-62.
Park JY, Han SJ, Kim JH, Chun KC, Lee TS. Le Fort partial colpocleisis as an effective treatment option for advanced apical prolapse in elderly women. Taiwan J Obstet Gynecol. 2019;58(2):206-11.
Ryan GA, Purandare NC, Ganeriwal SA, Purandare CN. Conservative Management of Pelvic Organ Prolapse: Indian Contribution. J Obstet Gynaecol India. 2021;71(1):3-10.
Jia X, Glazener C, Mowatt G. Systematic review of the efficacy and safety of using mesh in surgery for uterine or vaginal vault prolapse. Int Urogynaecol. Journal. 2010;21:1413-31
Jones CS. Urogynaecology and the pelvic floor: Pelvic organ prolapse. Shaw’s Textbook of operative gynaecology. 7th ed. Elsevier. 2013;259-73.
Weber AM, Walters MD, Piedomonte MR, Ballard LA. Anterior colporrhaphy: A randomized trial of three surgical techniques. Am J Obstet Gynaecol. 2001;185(6):1299-304.
