Cystocele

BackgroundPregnancy and childbirth are thought to be the strongest environmental risk factors for pelvic organ prolapse, but prolapse does occur in nulliparae.AimTo characterise prolapse in vaginal nulliparae.Material and methodsThis was a retrospective study using archived clinical and imaging data of 368 vaginally nulliparous women seen between 2006 and 2017 at two tertiary urogynaecological centres. Patients underwent a standardised interview, clinical examination and 3D/4D translabial ultrasound. Volume datasets were analysed by the second author, blinded against all clinical data, using post-processing software on a personal computer. Significant prolapse was defined as Pelvic Organ Prolapse Quantification system stage ≥2 for the anterior and posterior compartment, and stage ≥1 for the central compartment. On imaging, significant prolapse was defined as previously described.ResultsOf 4297 women seen during the inclusion period, 409 were vaginally nulliparous, for whom 368 volume data sets could be retrieved. Mean age was 50 years (17-89) and mean body mass index 29 (16-64). Eighty-one (22%) presented with prolapse symptoms. On clinical examination, 106 women (29%) had significant prolapse, mostly of the posterior compartment (n = 70, 19%). On imaging 64 women showed evidence of significant prolapse (17%), again mostly posterior (n = 47, 13%). Rectovaginal septal defects were even more common in 69 (19%). On multivariate analysis we found no differences between true nulliparae (n = 184) and women delivered exclusively by caesarean section (n = 184).ConclusionsProlapse occurs in vaginal nulliparae, but it has distinct characteristics. Rectocele predominates, while cystocele and uterine prolapse are uncommon. Pregnancy and caesarean delivery seem to have little effect.

PurposeIn the present study we want to propose a classification system to quantify cystoceles by perineal ultrasound (PUS).Materials and methods120 PUS data were analyzed measuring the distance between the lowest point of the bladder and the midpubic line (MPL) during rest and Valsalva. Results were classified into groups and compared to POP-Q using the κ-coefficient. Results for exact bladder position were checked for interrater reliability using ICC and Pearson's coefficient and results for classification were checked using the κ-coefficient. Bladder positions at rest and Valsalva were correlated with the distance between these points.ResultsHighly significant differences concerning the position at rest and the distance between rest and Valsalva were found between the groups. For the interrater agreement, the Pearson correlation coefficient was ρ = 0.98, the ICC (A-1) = 0.98, and κ = 1.00. Comparing the classification results for POP-Q and PUS, the kappa-coefficient was κ = 0.65.ConclusionPUS using the MPL and the classification system is a highly reliable tool for the evaluation of cystoceles. PUS shows good correlation with POP-Q. Furthermore, PUS offers a doubtless identification of the descending organ. Further studies are needed to evaluate the clinical use of the classification system proposed here.

The aim of the study was to describe the epidemiological, clinical and therapeutical profile of genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital of Kinshasa. This is a descriptive study carried out from medical files of patients who have suffered from genital prolapse in the gynecology and obstetrics service of Saint Joseph Hospital from January 1st, 2008 to December 31st, 2017. It is based on the no probabilistic sampling of suitability. We recorded 161 cases of genital prolapses upon 13957 patients. The genital prolapses frequency was 1.2% with an annual average of 16.1 cases (SD 10.1) per year. The symptomatology consisted of pelvic mass associated with urinary and digestives troubles (94.0%, n=140). The stage III of cysto-colpocele was the most frequent (56.0%, n=82). The vaginal hysterectomy associated to rectocele and cystocele cure was the most performed operation (52.0%, n=69). The recurrence rate was of 2.0% (3 out of 148 cases). The genital prolapse really exist in our milieu, its symptomatology is classical and its treatment is mostly surgical by vaginal access.

Background and Objectives: After the publication by Haylen et al. introducing the MUSPACC (midline uterosacral plication anterior colporrhaphy combination) procedure, we implemented this technique in our clinical practice for the treatment of cystocele and vaginal vault prolapse (VVP). The aims of this study were to evaluate peri- and postoperative complications, as well as vaginal and urinary symptoms, including patient satisfaction 3 months postoperatively. Materials and Methods: A retrospective analysis was conducted on 58 women who underwent MUSPACC over a five-year period. Patient-reported outcomes were assessed using three prolapse-related items from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), administered preoperatively and at three months following surgery. Demographic characteristics, as well as perioperative and postoperative complications, were obtained through review of medical records. Results: At follow-up, patients demonstrated improvement in vaginal symptoms, with the mean preoperative ICIQ-VS score decreasing from 15.2 to 1.16. Among those with preoperative urinary incontinence (UI), 42.1% became completely dry after MUSPACC procedure alone. Three patients (15%) developed de novo UI. Perioperative complications occurred in one patient. The postoperative complication rate was 20.7% (12/58), including one patient who experienced a postoperative fistula between the right ureter and vagina. No further surgeries were required. Overall, 96.4% of patients were satisfied postoperatively. Conclusions: MUSPACC procedure appears to be an effective treatment for VVP and cystocele, with improvement in vaginal and urinary symptoms, high patient satisfaction, and a low rate of serious complications. Routine perioperative cystoscopy is now performed for immediate detection and management of urinary tract injuries.