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Tεύχος 09 | Ιανουάριος - Φεβρουάριος 2021
ASSESSMENT OF FEMALE LORGAN PROLAPSE
aparoscopic has become a revolution in the treatment of incontinence and pelvic floor problems. Laparoscopic sacrocolpopexy (LSC) is, nowadays, the gold standard treatment for pelvic organ prolapse correction as is a safe technique that offers the
best anatomical and functional results.
The essential difference lies in the level of the subjective benefit of the awareness of prolapse that the patient obtains in its correction after LSC. Was more common after vaginal procedures (risk ratio (RR) 2.11, 95% confidence interval (CI) 1.06 to 4.21, 3 RCTs, n = 277, I2 = 0%, moderate-quality evidence). If 7% of women are aware of prolapse after LSC, 14% (7% to 27%) are likely to be aware after vaginal procedures (...). As in the case of other diseases, timely and suitable diagnosis of POP is the recipe for successful treatment. Many women with prolapse experience symptoms that impact daily activities, sexual function, and exercise. The presence of POP can have a detrimental impact on body image and sexuality.
The incidence of POP is increasingly due to the aging of the population. Age, as well as obesity, pregnancies and previous hysterectomy are risk factors for this entity. Wu et al () calculate that the number of women with POP will increase by 46%, rising from 3.3 to 4.9 million cases between 2010 and 2050.
The assessment of a woman who is referred should start by performing a thorough history. The most specific symptom is seeing or feeling a bulge of tissue that protrudes the vaginal, although most patients are asymptomatic. The clinical records should include questions regarding urgency and stress continence status and other urinary symptoms; the use of absorbents, as well as bowel and sexual symptoms. In order to obtain an adequate assessment of pelvic organ prolapse, it is necessary to evaluate the maximal organ descent and hiatal distension during valsalva. Pelvic Organ Prolapse Quantification (POPQ) (...) is recommended by the International Continence Society (ICS) as it provides a standardized and objective tool with proven interobserver and intraobserver reliability.
As urinary symptoms are the most frequent in POP patients we strongly encourage urogynecology to use validated questionnaires as International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), and also a 3-day voiding diary including pad test if incontinence is present. The routine use of preoperative urodynamic is controversial. Currently there is no universal consensus. Although prior UDS do not improve the outcome of surgery, it is clear that could add some information and facilitate a dialogue and provide advice to patients. A free flowmetry with post voiding residual volume is always necessary.
Dynamic Magnetic resonance imaging (MRI) is a very helpful tool in defining the nature, degree and quantitative measurements of POP and perineal descent. The importance of identifying perineal descent is the association with chronic straining in patients with chronic constipation, occasionally a consequence of LSC. An integral perineal LSC could be a good solution in these cases (...).
Ultrasound could help us to assess the degree of prolapse and also the pelvic floor muscle contraction in real time. The current use of ultrasound in these patients is to understand the correct location of previous suburethral slings or prolapse meshes implants.
Luis López-Fando Lavalle
CEO UROLF
Urology department, Hospital Universitario San Francisco de Asís, Madrid
REFERENCES
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