Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse

Abstract

The exact prevalence of pelvic organ prolapse is diffi cult to establish. The anatomical changes do not always consist with the severity or the symptoms associated with prolapse. There are many risk factors associated with pelvic organ prolapse and this review aims to identify the epidemiology and pathophysiology while looking at the known risk factors for pelvic organ prolapse. PubMed search involved a number of terms including: epidemiology, risk factors, reoccurrence indicators, management and evaluation. Several risk factors have been associated with pelvic organ prolapse, all contribute to weakening of the pelvic fl oor connective tissue/collagen, allowing the pelvic organs to prolapse through the vaginal walls. Among the risk factors are genetic background, childbirth and mode of delivery, previous hysterectomy, menopausal state and the ratio between Estrogen receptors. The "Integral theory" of Petros and the "Levels of Support" model of Delancey enable us to locate the defect, diagnose and treat pelvic organ prolapse. The currently available demographic data is not reliable enough to properly estimate the true extent of pelvic organ prolapse in the population. However, standardization of the diagnosis and treatment may signifi cantly improve our ability to estimate the true incidence and prevalence of this condition in the coming years.

<p>Polycystic Ovary Syndrome and Pelvic Floor Dysfunction: A Narrative Review</p>

“…Overall, studies suggests that cardiovascular diseases, chronic obstructive pulmonary disease, MetS, constipation, autoimmune and renal diseases and obstetric complications can all impair pelvic floor function. 72,76 Nonetheless, PCOS (endocrine-metabolic disorder) is associated with increasing risk of cardiovascular disease 77 and MetS. 78 Moreover, this review highlights knowledge gaps about protective effect of hyperandrogenism on pelvic floor dysfunction as well as destructive effect of metabolic changes on pelvic floor dysfunction in women with PCOS.…”

“…The obstetric factor association with pelvic floor disorders is well documented. 72 The results of a meta-analysis showed that women with PCOS have increased risk of cesarean section, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM). 73 Women with history of cesarean delivery have higher pelvic floor muscle (PFM) strengths than vaginal delivery group.…”

“…74 There is a multifactorial mechanism about the damage of pelvic floor during vaginal delivery. 72,75 However the cesarean section may reduce the risk of pelvic floor dysfunction but according to the abovementioned evidence comorbidities such as hypertension and diabetes may increase the risk of pelvic floor dysfunction.…”

Morphology of the Levator Ani in Patients with Genital Prolapse

“…С начала XXI века совершен ряд открытий в области перинеологии, однако ответы на главные вопросы еще не получены. За последние 20 лет проблема ПТО и НMТД стала одной из контраверсионных в гинекологии [7].…”

A new era of the the International Brazilian Journal of Urology

“…The papers came from many different countries such as Brazil, USA, Turkey, China, Spain, Japan, Israel and Qatar, and as usual the editor's comment highlights some of them. In the present issue we present two important reviews: in page 5 Weintraub and colleagues from Israel ( 2 ) reviews in a nice narrative of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse, and Correia and colleagues from Brazil ( 3 ) present in page 15 an important review on renal manifestations of sarcoidosis.…”