Post void residue in women with pelvic organ prolapse: a prospective observational study

Background: The objective of the present study was to observe the post void residual volume (PVRV) in women with pelvic organ prolapse (POP) pre and postoperatively and to correlate stage of prolapse with lower urinary tract symptoms and quality of life in women with pelvic organ prolapse.Methods: This is a prospective observational cohort study of 100 women with symptomatic pelvic organ prolapse of stage II or greater. Patients were admitted for Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in Gynaecology Department at Christian Medical College Hospital, Vellore, India over one year were recruited. This study was approved by the institutional review board and ethical committee of the hospital. Pre- and post-operative PVR were measured. The statistical analysis was done by using SPSS version 21 and P value < 0.05 was considered as statistically significant.Results: In this study 100 patients were recruited and 11% of women had pre-operative high post void residual volume of more than 100 ml. Stages of POP did not correlate with severity of LUTS and QOL. Pre-operative elevated PVR resolved post operatively in 91%, the P value <0.000 which was highly significant.Conclusions: 11% of women had preoperative high PVR. Stages of POP did not correlate with severity of lower urinary tract symptoms (LUTS) and quality of life(QOL). Pre-operative elevated PVR resolved post operatively in 91%, the P value < 0.000 which was highly significant. Majority of the patient with severe pelvic organ prolapse had elevated pre-op PVR which resolved post- operatively after surgical correction

Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study

Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p<0.000 which was highly significant.Conclusions: Women with pelvic organ prolapse had high prevalence of voiding and defecatory dysfunction. Stages of prolapse have positive correlation with voiding dysfunction. Pre-operative voiding dysfunction resolved after vaginal hysterectomy and pelvic floor repair

Pelvic reconstructive surgery in geriatric urogynaecology: an uphill task

Female ageing “Geripause” is receiving much attention from the health care community due to worldwide increase in proportion of elderly population as a result of improved health services and awareness. Pelvic floor disorder such as urinary incontinence, faecal incontinence and pelvic organ prolapse disproportionately affect geriatric population and undermines the quality of life. Surgery remains an important and effective therapeutic option for many women with pelvic floor disorders. Operative outcome can be adversely affected in elderly because of physiologic changes associated with aging and the increased number of comorbidities. To present date there is limited information on morbidity and mortality following urogynaecology surgery in geriatric patients. A retrospective analysis was performed on all patients of age more than 60 years old who underwent urogynaecologic surgery in urogynaecology unit from January 2011 to December 2014. Total 551 patients of all age underwent pelvic reconstructive surgery and Out of 121 patients were of age more than 60 years. Overall in our series 66% patients had one or more than one risk factors and 23% of patients had one or more than one perioperative complications. Intraoperative and postoperative complications rate was 4.9% and 18.1% respectively. Elderly women can undergo urogynecologic surgery with an acceptable rate of complications and should not be excluded from interventions that may improve their quality of life. 

Pelvic actinomycosis: unrelated to prior intrauterine device use

Actinomycosis is a chronic, suppurative, granulomatous disease which is typically seen in the cervicofacial and thoracic regions and less commonly abdominopelvic (10-20%). It is caused by an anaerobic, filamentous gram positive bacterium which is a normal commensal of the oropharynx, gastrointestinal tract and genital tract. Pelvic actinomycosis is almost always associated with the current or prior use of an intrauterine contraceptive device. Clinical diagnosis is difficult owing to the close resemblance to an ovarian tumour. Definitive diagnosis is usually made only after histopathological correlation. Reported here is a patient with pelvic actinomycosis unrelated to the use of an intrauterine contraceptive device. This patient presented with clinical features suggestive of chronic pelvic inflammatory disease with a possible benign ovarian tumour. Operative findings were consistent with pelvic inflammatory disease. The typical histopathological features of the Splendor Hoeppli phenomenon with sulphur granules and isolation of the actinomyces organism (which is rare) revealed the diagnosis of actinomycosis of the fallopian tubes. Pelvic actinomycosis is a rare condition and seldom described in the absence of an intrauterine device. High dose, long term antibiotic therapy is the key to successful resolution with surgery reserved for refractory cases. This patient showed good clinical and radiological response

Abdominal wall endometriosis: accuracy of the diagnostic triad

Background: Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity and musculature. The objectives were to study the prevalence, the clinic-pathological presentation and the accuracy of the criteria for diagnosis of abdominal wall endometriosis.Methods: This is a retrospective observational study done at a tertiary hospital. The study was approved by the ethics committee and the IRB. Data was retrieved from computer generated medical records. Specificity, sensitivity and likelihood ratio along with univariate and multivariable penalized logistic regression analysis of each presenting symptom were done.Results: Of the 493 cases with genital endometriosis, 45 cases had AWE diagnosed clinically giving a prevalence of 8.3%. Histological diagnosis of AWE was made in 41, while 4 had suture granuloma. Pain, swelling and previous LSCS had sensitivity of 71%, specificity of 100% and the likelihood ratio was 0.29. The presentation was within 6 years after the index surgery of Caesarean section, with the odds ratio of having endometriosis of 19 (95% CI 1.7- 1595) and the P value of 0.016.Conclusions: The diagnostic triad of previous caesarian section with swelling and pain at the scar site should prompt the possibility of AWE. However, previous LSCS was the only factor that contributed to the presence of abdominal wall endometriosis.

Is hysterectomy a risk factor for urinary incontinence?

Background: Hysterectomy is the most common gynecological surgery performed. There are few studies evaluating hysterectomy as a risk factor for urinary incontinence. If hysterectomy is found to be a risk factor for developing urinary incontinence, women undergoing hysterectomy can be well informed prior to the procedure regarding the same. The objective of the present study was to study the prevalence of urinary incontinence in post-menopausal women and its relationship to hysterectomy. To evaluate the association of metabolic syndrome, to urinary incontinence.Methods: This study was a prospective cohort study done in Christian Medical College and Hospital, Vellore, Tamil Nadu between December 2016- December 2017. Postmenopausal women both with natural and surgical menopause, were enrolled into the study after an informed consent. The UDI-6 questionnaire was used to assess urinary incontinence. The categorical variables were presented using frequencies and percentages. The comparison of categorical variables was done using Fisher's exact test. The odds ratio and confidence interval were calculated for the prevalence. P value < 0.05 was considered to be statistically significant.Results: A total of 600 women were enrolled into the study with 300 women having attained natural menopause and 300 women with a surgical menopause. The prevalence of urinary incontinence among these post-menopausal women was 46.24%. The prevalence of urinary incontinence amongst the women with natural menopause was 47.3% and amongst the women with surgical menopause was 45% (p = 0.566). Women with metabolic syndrome suffered from urinary incontinence more than their counterparts without metabolic syndrome (55.8% vs. 36%, p <0.0001).Conclusions: The prevalence of urinary incontinence in the natural menopause and surgical menopause groups was similar, thus proving that hysterectomy is not a risk factor for developing urinary incontinence. However, metabolic syndrome was found to be associated with urinary incontinence.

Prevalence of metabolic syndrome among postmenopausal women in South India

Background: As the average life expectancy of women extends 20-30 years after menopause, the medical impacts of changes leading to metabolic syndrome on postmenopausal women are significant. The menopausal state has been noted to be an independent risk factor for the occurrence of metabolic syndrome. This study was conducted to look at the prevalence of metabolic syndrome in postmenopausal women.Methods: A prospective cross sectional study was done and postmenopausal women were assessed for metabolic syndrome using the International Diabetes Federation Criteria.Results: The prevalence of metabolic syndrome was found to be 64%. Women with metabolic syndrome had a higher systolic blood pressure and larger waist circumference, however did not differ in terms of diabetes and dyslipidemia. There was no significant difference with regards to frequency and severity of menopausal symptoms between women with and without metabolic syndrome.Conclusions: The increased prevalence of metabolic syndrome in postmenopausal women may be directly due to ovarian insufficiency and indirectly due to metabolic consequences of central fat redistribution with estrogen deficiency

Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study

Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p&lt;0.000 which was highly significant.Conclusions: Women with pelvic organ prolapse had high prevalence of voiding and defecatory dysfunction. Stages of prolapse have positive correlation with voiding dysfunction. Pre-operative voiding dysfunction resolved after vaginal hysterectomy and pelvic floor repair

Pelvic actinomycosis: unrelated to prior intrauterine device use

Actinomycosis is a chronic, suppurative, granulomatous disease which is typically seen in the cervicofacial and thoracic regions and less commonly abdominopelvic (10-20%). It is caused by an anaerobic, filamentous gram positive bacterium which is a normal commensal of the oropharynx, gastrointestinal tract and genital tract. Pelvic actinomycosis is almost always associated with the current or prior use of an intrauterine contraceptive device. Clinical diagnosis is difficult owing to the close resemblance to an ovarian tumour. Definitive diagnosis is usually made only after histopathological correlation. Reported here is a patient with pelvic actinomycosis unrelated to the use of an intrauterine contraceptive device. This patient presented with clinical features suggestive of chronic pelvic inflammatory disease with a possible benign ovarian tumour. Operative findings were consistent with pelvic inflammatory disease. The typical histopathological features of the Splendor Hoeppli phenomenon with sulphur granules and isolation of the actinomyces organism (which is rare) revealed the diagnosis of actinomycosis of the fallopian tubes. Pelvic actinomycosis is a rare condition and seldom described in the absence of an intrauterine device. High dose, long term antibiotic therapy is the key to successful resolution with surgery reserved for refractory cases. This patient showed good clinical and radiological response