Characterizing the Phenotype of Advanced Pelvic Organ Prolapse

Abstract

Objective Genetic studies require a clearly defined phenotype to reach valid conclusions. Our aim was to characterize the phenotype of advanced prolapse by comparing women with stage III to IV prolapse with controls without prolapse. Methods Based on the pelvic organ prolapse quantification examination, women with stage 0 to stage I prolapse (controls) and those with stage III to stage IV prolapse (cases) were prospectively recruited as part of a genetic epidemiologic study. Data regarding sociodemographics; medical, obstetric, and surgical history; family history; and body mass index were obtained by a questionnaire administered by a trained coordinator and abstracted from electronic medical records. Results There were 275 case patients with advanced prolapse and 206 controls with stage 0 to stage I prolapse. Based on our recruitment strategy, the women were younger than the controls (64.7±10.1 vs 68.6±10.4 years; P<0.001); cases were also more likely to have had one or more vaginal deliveries (96.0% vs 82.0%; P<0.001). There were no differences in race, body mass index, and constipation. Regarding family history, cases were more likely to report that either their mother and/or sister(s) had prolapse (44.8% vs 16.9%, P<0.001). In a logistic regression model, vaginal parity (odds ratio, 4.05; 95% confidence interval, 1.67–9.85) and family history of prolapse (odds ratio, 3.74; 95% confidence interval, 2.16–6.46) remained significantly associated with advanced prolapse. Conclusions Vaginal parity and a family history of prolapse are more common in women with advanced prolapse compared to those without prolapse. These characteristics are important in phenotyping advanced prolapse, suggesting that these data should be collected in future genetic epidemiologic studies.

Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach

“…The development of POP has been associated with older age, Hispanic race, higher body mass index (BMI), parity, weight of vaginally delivered fetus, and previous hysterectomy . Vaginal parity and family history have specifically been identified as factors affecting the severity of prolapse …”

Quantitative evaluation of age‐related changes to pelvic floor muscles in magnetic resonance images from 369 patients

“…Fourth, we did not consider bodyweight or body mass index among all patients, or history of vaginal delivery among women. Vaginal parity reportedly shows a strong association with the development of POP . Future studies should examine how pelvic floor muscles change in the presence of a history of vaginal delivery.…”

“…Vaginal parity reportedly shows a strong association with the development of POP. 19 Future studies should examine how pelvic floor muscles change in the presence of a history of vaginal delivery.…”

Transvaginal management of severe pelvic organ prolapse in nulliparous women

“…This may be caused by physiologic insult via vaginal delivery or it may occur over time, as a result of gravity and aging . Vaginal parity is strongly associated with POP . This increased risk is believed to occur secondary to stretching, compression or avulsion during labor, which can cause structural compromise and denervation to the levator ani musculature, leading to pelvic floor disorders .…”

“…8 Vaginal parity is strongly associated with POP. 9 This increased risk is believed to occur secondary to stretching, compression or avulsion during labor, which can cause structural compromise and denervation to the levator ani musculature, leading to pelvic floor disorders. [10][11][12] Approximately one in 10 women sustains avulsion injury to the pubococcygeus muscle during vaginal delivery.…”