While uterine preservation is a viable option for the surgical management of uterine prolapse the evidence on safety and efficacy is currently lacking.

OBJECTIVE The objective of this study was to determine the minimum threshold level at which maximum anatomic prolapse predicts bothersome pelvic floor symptoms. STUDY DESIGN We performed a cross-sectional study of women older than 40 years undergoing gynecologic and urogynecologic examinations using Pelvic Organ Prolapse Quantification (POP-Q) examinations to assess support and Pelvic Floor Distress Inventory questionnaires to assess symptoms. Across the spectrum of prolapse severity, we calculated receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for each symptom. RESULTS Of 296 participants, age was 56.3 ± 11.2 years, and 233 (79%) were white. POP-Q stage was 0 in 39 (13%), 1 in 136 (46%), 2 in 89 (30%), and 3 in 33 (11%). ROC analysis for each symptom revealed an AUC of 0.89 for bulging/protrusion; 0.81 for splinting to void; 0.55–0.62 for other prolapse and urinary symptoms; and 0.48–0.56 for bowel symptoms. Using a threshold of 0.5 cm distal to the hymen, the sensitivity (69%) and specificity (97%) were high for protrusion symptoms but poor for most other symptoms considered. CONCLUSION Vaginal descensus 0.5 cm distal to the hymen accurately predicts bulging/protrusion symptoms; however, we could not identify a threshold of prolapse severity that predicted other pelvic floor symptoms.

The clinical criteria for diagnosing bacterial vaginosis can be simplified to 2 clinical criteria without loss of sensitivity and specificity.

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Objectives To examine risk factors for prevalence and incidence of pelvic organ prolapse (POP) in whites, Hispanics, and blacks. Methods This is a secondary analysis of the Women’s Health Initiative (WHI) Estrogen plus Progestin Clinical Trial. Out of the original E+P trial population of 16,608, 12,667 (78.3%) women (11,194 Whites, 804 Blacks, 669 Hispanics) were included in the final study sample and evaluated over the 5 year period. The outcomes evaluated were any prolapse (WHI Prolapse Grades 1–3) and WHI Prolapse Grades 2 or 3. Descriptive analyses, logistic regression and proportional hazard meodeling were performed. Results Increasing parity correlates with increasing WHI Prolapse Grades (0–3) in Whites and Blacks but not Hispanics. The incidence of Grade 2/3 POP increased by 250% in white women with one child (HR 2.50, 1.68–3.71) in comparison to nulliparous women and grew with higher parity. For Blacks, a weak association between the parity and Grade 2/3 POP was noted only in women who had 5 or more kids (HR 10.41, 1.38–78.77). Blacks were less likely (HR 0.53, 0.40–0.71) to develop Grade 2/3 POP compared to whites. For Grade 2/ 3 POP, age was found to be a risk factor in whites (OR 1.03, 1.02–1.04) only and BMI (≥25kg/m2, <30kg/m2) in whites (OR 1.64, 1.34–2.02) and Hispanics (OR 2.87, 1.03–2.02). Conclusions White women are at a much greater risk for developing Grade 2/3 POP compared to blacks. Parity correlates most strongly with the risk of prolapsed development in whites and possibly in grand multiparous blacks.

Although anatomic results are similar, ASC is associated with a higher rate of complications compared with MISC.

Female urethral diverticulum is a disorder that affects 1% to 6% of women. Women with diverticula may present with a variety of nonspecific genitourinary complaints, making the diagnosis challenging. Diagnosis is made by physical examination and can be confirmed with cystourethroscopy and/or radiographic imaging. Asymptomatic women can be managed conservatively, whereas treatment for symptomatic women usually involves a diverticulectomy. Potential complications from diverticulectomy include diverticulum recurrence, de novo stress incontinence, urethrovaginal fistula, urethral stricture, and recurrent urinary tract infections. This article reviews the etiology, differential diagnoses, evaluation, and management of female urethral diverticula.