Site specific repair tied to anatomic and functional improvement in Pelvic organ prolapse: IJOGR
Pelvic organ prolapse can be defined as a downward descent of female pelvic organs, including the bladder, uterus, post hysterectomy vaginal cuff and the small or large bowel resulting in protrusion of vaginal walls, uterus or both. Pelvic organ prolapse is a poorly understood condition that affects millions of women worldwide. It is a disease with low morbidity and it affects primarily quality of life.
Poor understanding of symptoms related to pelvic organ prolapse makes it difficult to counsel patients as to which of the symptoms will improve with treatment. Women with pelvic organ prolapse may present with a variety of bladder dysfunctions such as increased frequency of micturition, urge incontinence and stress urinary incontinence
There has been a trend towards repair of site specific defects in the anatomy of pelvic floor for management of pelvic organ prolapse. This study by Sawant, Bhalerao and Bhalerao was done to determine the veracity of hypothesis – Site specific anterior repair of pelvic organ prolapse is better than Traditional anterior repair of pelvic organ prolapse.
During the study period of 2 years 140 women belonging to reproductive, peri-menopausal and postmenopausal age groups were included in the study. Employing past literature, the sample size calculated was 140. All women were assessed pre-operatively by the assessment method – Pelvic organ prolapse quantification (POP-Q) system. 70 women belonging to Group A were treated according to vaginal hysterectomy with traditional anterior repair and 70 women belonged to Group B who were treated according to vaginal hysterectomy with site specific anterior repair. Post-operatively, all women were followed up till 7th post-operative day and were assessed for anatomical and functional improvement to determine a better method for repair in reduction of urinary symptoms in women with pelvic organ prolapse.
This study shows functional and anatomical outcomes of traditional anterior repair and site specific anterior repair. 48 of 70 women (68.2%) who were subjected to traditional anterior repair and 52 of 70 women (73.4%) who were subjected to site specific anterior repair had marked functional improvement after surgery.
58 of 70 women (83.2%) belonging to traditional anterior repair group and 67 of 70 women (95.3%) belonging to Site specific anterior repair group had considerable anatomical improvement post-operatively. This impresses the role of site specific anterior repair in women with pelvic organ prolapse for attaining better functional and anatomical outcome.
The study concludes that site specific repair for anterior vaginal wall prolapse with urinary symptoms was more effective than traditional anterior colporrhaphy. There was significant improvement anatomically and functionally in women with pelvic organ prolapse with urinary symptoms who were treated with site specific repair compared to traditional repair.
Source: Sawant, Bhalerao and Bhalerao / Indian Journal of Obstetrics and Gynecology Research 2021;8(4):507–512
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