Pelvic Organ Prolapse Clinical Trial
Official title:
Clinical and Three-dimensional Ultrasound Assessment of Cases With Apical Prolapse Surgeries. A Prospective Cohort Study
The levator ani muscle seems to play a key role in pelvic floor dysfunction. This muscle has two major components, the pubovisceral (including the pubococcygeus and puborectalis muscles) and the iliococcygeal muscles.Major levator ani defects are associated with pelvic organ prolapse (POP) and POP recurrence
The aetiology of female pelvic organ prolapse (FPOP) is complex and likely due to a
combination of factors. Genetics, race, aging and menopause, obesity and conditions
associated with a chronically increased intra-abdominal pressure such as chronic obstructive
pulmonary disease as well as childbirth trauma have been implicated. Delivery-related trauma
to the pubovisceral muscle is common and obviously associated with female pelvic organ
prolapse.
It is a common problem with an incidence as high as 40%, and 10-20% of women will require
surgery for prolapse at least once in their lifetime.
The levator hiatus defines the 'hernial portal' through which FPOP develops. Childbirth
clearly leads to an enlargement of the levator hiatus, even in the absence of levator trauma.
And the levator hiatal dimensions are strongly associated with FPOP and with prolapse
recurrence Enlargement of the levator hiatus is more likely to be the cause rather than the
effect of FPOP. Alterations of the levator hiatus morphology following delivery have been
demonstrated using magnetic resonance imaging (MRI) and more recently, three-dimensional (3D)
ultrasound imaging Magnetic resonance imaging (MRI) has been shown to visualize levator ani
defects effectively, but in recent years, translabial 3- and 4-dimensional (3D/4D) ultrasound
has shown to provide valuable information on biometrical properties of the pelvic floor and
morphology of the levator ani muscle.And recently three-dimensional ultrasonography is an
alternative for MRI in detecting levator defects.
Currently, technologic advances in 3D ultrasonography allow access to the arbitrarily defined
planes anywhere within ultrasound volume data and permit direct imaging of the entire levator
hiatus.
Translabial three-dimensional ultrasonography has practical advantages because it is less
expensive, easily accessible, and more readily available for gynecologists.
3D-Ultrasound in urogynecology could be helpful in diagnosing of urinary incontinence and
urethral hypermobility, to document pelvic floor anatomy and to assess anatomic and
functional changes before and after gynecologic surgery.
The objective of our research was to detect levator ani defects in women with POP before and
after apical prolapse surgeries and if they will be corrected after the operation or not.
The secondary objective was to 1)detect the most appropriate surgical procedure in restoring
the dimensions of the hiatal area.
2)Correlate between the levator ani defects and the complains, quality of life
questionnaires, clinical examination of the patient before and after the surgery.
3)The role of 3D-Ultrasound in diagnosing the pelvic floor defects and targeting the Surgical
procedure to restore the defects.
4)Introduce and stress on POP-Q system into Assuit general hospital and Abuteeg Hospital as
it will be used to evaluate all cases both pre-operatively and during post-operative follow
up being the standard method for evaluating cases of pelvic organ prolapse.
Objective cure was defined as the: absence of the prolapse as indicated by a POP-Q stage of
0-1.
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