Background: The use of standardized mesh kits for repair of pelvic-organ prolapse has spread rapidly in recent years, but it is unclear whether this approach results in better outcomes than traditional colporrhaphy. Methods: In this multicenter, parallel-group, randomized, controlled trial, we compared the use of a trocarguided, transvaginal polypropylene-mesh repair kit with traditional colporrhaphy in women with prolapse of the anterior vaginal wall (cystocele). The primary outcome was a composite of the objective anatomical designation of stage 0 (no prolapse) or 1 (position of the anterior vaginal wall more than 1 cm above the hymen), according to the Pelvic Organ Prolapse Quantification system, and the subjective absence of symptoms of vaginal bulging 12 months after the surgery. Results: Of 389 women who were randomly assigned to a study treatment, 200 underwent prolapse repair with the transvaginal mesh kit and 189 underwent traditional colporrhaphy. At 1 year, the primary outcome was significantly more common in the women treated with transvaginal mesh repair (60.8%) than in those who underwent colporrhaphy (34.5%) (absolute difference, 26.3 percentage points; 95% confidence interval, 15.6 to 37.0). The surgery lasted longer and the rates of intraoperative hemorrhage were higher in the mesh-repair group than in the colporrhaphy group (P < 0.001 for both comparisons). Rates of bladder perforation were 3.5% in the mesh-repair group and 0.5% in the colporrhaphy group (P = 0.07), and the respective rates of new stress urinary incontinence after surgery were 12.3% and 6.3% (P = 0.05). Surgical reintervention to correct mesh exposure during follow-up occurred in 3.2% of 186 patients in the mesh-repair group. Conclusions: As compared with anterior colporrhaphy, use of a standardized, trocar-guided mesh kit for cystocele repair resulted in higher short-term rates of successful treatment but also in higher rates of surgical complications and postoperative adverse events. (Funded by the Karolinska Institutet and Ethicon; ClinicalTrials. gov number, NCT00566917.).

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Background: The use of standardized mesh kits for repair of pelvic-organ prolapse has spread rapidly in recent years, but it is unclear whether this approach results in better outcomes than traditional colporrhaphy. Methods: In this multicenter, parallel-group, randomized, controlled trial, we compared the use of a trocarguided, transvaginal polypropylene-mesh repair kit with traditional colporrhaphy in women with prolapse of the anterior vaginal wall (cystocele). The primary outcome was a composite of the objective anatomical designation of stage 0 (no prolapse) or 1 (position of the anterior vaginal wall more than 1 cm above the hymen), according to the Pelvic Organ Prolapse Quantification system, and the subjective absence of symptoms of vaginal bulging 12 months after the surgery. Results: Of 389 women who were randomly assigned to a study treatment, 200 underwent prolapse repair with the transvaginal mesh kit and 189 underwent traditional colporrhaphy. At 1 year, the primary outcome was significantly more common in the women treated with transvaginal mesh repair (60.8%) than in those who underwent colporrhaphy (34.5%) (absolute difference, 26.3 percentage points; 95% confidence interval, 15.6 to 37.0). The surgery lasted longer and the rates of intraoperative hemorrhage were higher in the mesh-repair group than in the colporrhaphy group (P < 0.001 for both comparisons). Rates of bladder perforation were 3.5% in the mesh-repair group and 0.5% in the colporrhaphy group (P = 0.07), and the respective rates of new stress urinary incontinence after surgery were 12.3% and 6.3% (P = 0.05). Surgical reintervention to correct mesh exposure during follow-up occurred in 3.2% of 186 patients in the mesh-repair group. Conclusions: As compared with anterior colporrhaphy, use of a standardized, trocar-guided mesh kit for cystocele repair resulted in higher short-term rates of successful treatment but also in higher rates of surgical complications and postoperative adverse events. (Funded by the Karolinska Institutet and Ethicon; ClinicalTrials. gov number, NCT00566917.).

Objective To evaluate the interobserver repeatability of measurement of the pubovisceral muscle and levator hiatus, and the position of related organs, during rest, muscle contraction and Valsalva maneuver using three-and fourdimensional (3D and 4D)

Objective To investigate the risk factors for pelvic organ prolapse (POP), including physical activity, clinically measured joint mobility and pelvic floor muscle (PFM) function.Design One-to-one age-and parity-matched case-control study.Setting Akershus university hospital and one outpatient physiotherapy clinic in Norway.Population Forty-nine women with POP (POP quantification, stage ‡II) and 49 controls (stages 0 and I) were recruited from community gynaecologists and advertisements in newspapers.Methods Validated questionnaires, interview and clinical examination, including Beighton's scoring system (joint hypermobility) and vaginal pressure transducer measurements (PFM function), were used. Univariate and multivariate conditional logistic regression analyses for one-to-one matched case-control studies were used, and odds ratios with 95% CIs are reported.Main outcome measures Pelvic floor muscle function (strength, endurance and resting pressure), socioeconomic status, body mass index, heavy occupational work, physical activity, family history, obstetric factors and markers of connective tissue weakness (striae, varicose veins, bruising, diastasis recti abdominis, joint hypermobility).Results No significant differences were found between groups with regard to postmenopausal status, current smoking, current low-intensity exercise, type of birth (caesarean, forceps, vacuum), birth weight, presence of striae, diastasis recti abdominis and joint hypermobility. Body mass index (OR 5.0; 95% CI 1.1-23.0), socioeconomic status (OR 10.5; 95% CI 2.2-50.1), heavy occupational work (OR 9.6; 95% CI 1.3-70.3), anal sphincter lacerations (OR 4.5; 95% CI 1.0-20.0), PFM strength (OR 7.5; 95% CI 1.5-36.4) and endurance (OR 11.5; 95% CI 2.0-66.9) were independently related to POP.Conclusions Body mass index, socioeconomic status, heavy occupational work, anal sphincter lacerations and PFM function were independently associated with POP, whereas joint mobility and physical activity were not.Keywords Anal sphincter lacerations, body mass index, casecontrol, joint hypermobility, occupational work, pelvic floor muscle, pelvic organ prolapse, socioeconomic status, varicose veins.Please cite this paper as: Braekken I, Majida M, Ellström Engh M, Holme I, Bø K. Pelvic floor function is independently associated with pelvic organ prolapse.

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A correct pelvic floor muscle (PFM) contraction was described by Kegel (1) as an inward lift and squeeze around urethra, vagina and rectum. In addition, DeLancey (2;3) suggested that a PFM contraction may press the urethra against the pubic symphysis (PS), further mechanically increasing urethral pressure. Traditionally PFM function and strength have been assessed by visual observation, digital palpation and use of different manometers and dynamometers (4). None of these measurement methods are capable of simultaneously measuring both the lifting and squeezing function in a responsive, reliable and valid way.Neither can any of these methods measure muscle morphology. Today imaging techniques such as ultrasound and magnetic resonance imaging have the potential of yielding more detailed information about muscle morphology and action during PFM contraction. 3D and 4D ultrasound allow multi planar imaging, assessment in an upright body position and utilizing a rapid sampling time. In addition, there are few contraindications and it may, due to relatively low cost, therefore be adopted into future clinical practice (5). To date, mainly the lift of the bladder neck (BN) has been investigated (6;7). To our knowledge only one study has quantified pubovisceral muscle length reduction (8), and no studies have quantified narrowing of levator hiatus (LH) area and transverse distance during contraction. Position of cervix uteri, rectal ampulla or back sling of the puborectal muscle has not been assessed, neither has the magnitude nor the direction of the displacement of these organs during PFM contraction.The aims of the present study were to evaluate test-retest measurements of functional aspects of PFM contraction using 4D real time ultrasound by:1. Measuring pubovisceral muscle length, LH area, antero-posterior and transverse dimensions at rest and maximal contraction (axial plane) 2. Measuring lift (displacement) of the BN, cervix uteri, rectal ampulla and back sling of the puborectal muscle (sagittal plane) MATERIALS AND METHODSThe study was designed as a test-retest intra-tester study. Two test series were performed with an interval of 7 to 35 days. The participants received a random identification number. The assessor was blinded to the results of test 1 during test 2. SubjectsSeventeen female volunteers were recruited for the study. Inclusion criterion was ability to contract the PFMs. Correct contraction was defined as inward lift of the PFM as assessed by ultrasound. Exclusion criterion was inability to understand instructions given in the Norwegian language. No volunteers had to be excluded. The study was approved by the Regional Medical Ethics Committee, and the Data Inspectorate of Norway. All subjects gave written informed consent to participate. ApparatusA GE Voluson 730 expert ultrasound system (GE Healthcare, Oslo, Norway) with 4-8 MHz curved array 3D/4D ultrasound transducer (RAB 4-8 l/obstetric) was used. The field of view angle was set to its maximum of 70 º in the sagittal plane and volume acquisition an...