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Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
C The exercises have been shown from a randomized trial to significantly improve symptoms but not the anatomy of the prolapseWomen with pelvic organ prolapse should be given targeted advice regarding pelvic floor muscle training and may also benefit from targeted physiotherapy. A randomized controlled trial comparing individualized pelvic floor muscle training with no intervention found a statistically significant improvement in subjective assessment of prolapse symptoms in the intervention group but no significant improvement in objective assessment of anatomy, as assessed by the pelvic organ prolapse quantification system. (Jefferis H et al. Management of uterine prolapse: Is hysterectomy necessary? The Obstetrician & Gynaecologist 2016; 18: 17–23)
Ultralight type I transvaginal mesh: an alternative for recurrent severe posterior vaginal prolapse
Published in Climacteric, 2022
W. Tian, Y. Dai, P. Feng, Y. Ye, Q. Gao, J. Guo, Z. Zhang, Q. Yu, J. Chen, L. Zhu
The inclusion criteria were as follows: history of native tissue repair for any compartment prolapse; presentation with recurrent stage III or IV symptomatic PVP without another compartment prolapse according to the Pelvic Organ Prolapse Quantification System (POP-Q) [5,15]; provision of fully informed consent to use ultra-light, monofilament, macroporous, type I mesh (TiLOOP®10 cm × 15 cm; PFM Medical AG, Köln, Germany); and patient fully informed that there are no foolproof procedures for treating recurrent PVP and that TVM has been reported to have a high rate of mesh-related complications, the effectiveness of TVM for repairing recurrent PVP having not yet been proven. The exclusion criteria were genital malignancies, chronic pelvic pain, other serious comorbidities, mental illness and lack of willingness to comply strictly with follow-up requirements.
Short-term effects of an erbium/neodymium laser combination in superficial dyspareunia: a pilot study
Published in Climacteric, 2022
This pilot, prospective, comparative study was performed in sexually active PMW attending the outpatient Menopause Clinic of Pisa University Hospital. All women were suffering from GSM, with the most bothering symptom being pain at the vaginal opening during intercourse, or superficial dyspareunia. The protocol was revised by a National Independent Advisory Board and approved by the Ethics Committee of the Department of Obstetrics and Gynecology. All patients included were sexually active PMW, with plasma levels of gonadotropin and estradiol in the postmenopausal range (follicle stimulating hormone >40 U/l; estradiol <25 pg/ml), suffering from vaginal atrophy and superficial dyspareunia. All women had to have a negative Pap smear. They were not selected according to previous treatment outcomes. The main goal of the study was the evaluation of laser treatments on superficial dyspareunia. Exclusion criteria were: use of lubricants, local preparations, hormones or other medications to relieve menopausal symptoms in the 3 months prior to inclusion in the study; lesions, scars or infection, active or recent (30 days), of the genitourinary tract; abnormal uterine bleeding; history of photosensitivity disorder or use of photosensitizing drugs; genital prolapse (grade II–III of the classification Pelvic Organ Prolapse Quantification system [POP-Q]); or serious or chronic illness that could interfere with the study.
Can pelvic organ prolapse in postmenopausal women be treated with laser therapy?
Published in Climacteric, 2021
S. Athanasiou, E. Pitsouni, L. Cardozo, D. Zacharakis, E. Petrakis, D. Loutradis, T. Grigoriadis
This study is a randomized, assessor-blind, parallel-group, controlled trial with a 1:1 allocation ratio, conducted at ‘Alexandra Hospital’, a tertiary academic referral hospital (EUGA subspecialty accredited center), without funding support. The study followed the Helsinki Declaration for research on human participants, was approved by the local Ethics Committee, and was registered on ClinicalTrials.gov (NCT03714607). There was no patient and public involvement. Eligible for inclusion were postmenopausal women with symptomatic descent of the anterior and/or posterior vaginal wall stage 2 or 3, according to the Pelvic Organ Prolapse Quantification System (POP-Q)16, who opted to undergo surgery due to bothersome POP symptoms. Exclusion criteria were uterine prolapse > stage 1, history of POP surgery, stress urinary incontinence surgery, or intravaginal therapy with energy-based devices, presence of any vaginal pathology, and women who declined to sign an informed consent form.