International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP)

Deprest, Jan; Cartwright, Rufus; Dietz, Hans Peter; Brito, Luiz Gustavo Oliveira; Koch, Marianne; Allen‐Brady, Kristina; Manonai, Jittima; Weintraub, Adi Y.; Chua, John W. F.; Cuffolo, Romana; Sorrentino, Felice; Cattani, Laura; Decoene, Judith; Page, Anne-Sophie; Weeg, Natalie; Pereira, Gláucia Miranda Varella; Cunha, Marina Gabriela Monteiro Carvalho Mori da; Mackova, Katerina; Hympánová, Lucie; Moalli, Pamela; Shynlova, Oksana; Alperin, Marianna; Bortolini, Maria Augusta Tezelli

doi:10.1007/s00192-022-05081-0

Cited by 18 publications

(7 citation statements)

References 65 publications

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“…Notably, there is a risk of recurrence of cervical trauma and prolapse in the next pregnancy. A recent report by the International Urogynecological Association (IUGA) shows that caesarean delivery is protective against symptoms of POP [ 22 ]. Therefore, it is pertinent to counsel women and provide them with information to enable them to make informed decisions, which must be respected.…”

Section: Discussionmentioning

confidence: 99%

Childbirth resulting in traumatic stretching and prolapsing of the anterior lip of the cervix outside the vagina: A case report

Orji

Ngene

2022

Case Reports in Women's Health

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Section: Discussionmentioning

confidence: 99%

Childbirth resulting in traumatic stretching and prolapsing of the anterior lip of the cervix outside the vagina: A case report

Orji

Ngene

2022

Case Reports in Women's Health

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“…Multiple factors contribute to the development of primary and recurrent POP. These factors include childbirth, constipation, strenuous work and heavy lifting, congenital connective tissue weakness, obesity, menopause, chronic increased intra-abdominal pressure (IAP) and iatrogenic causes [1,3]. Available treatments are watchful waiting, lifestyle interventions such as avoiding constipation and straining, pelvic floor muscle training (PFMT), pessaries or surgery.…”

Section: Introductionmentioning

confidence: 99%

International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training

et al. 2022

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Introduction and hypothesis This manuscript from Chapter 3 of the International Urogynecology Consultation (IUC) on Pelvic Organ Prolapse (POP) describes the current evidence and suggests future directions for research on the effect of pelvic floor muscle training (PFMT) in prevention and treatment of POP. Methods An international group of four physical therapists, four urogynecologists and one midwife/basic science researcher performed a search of the literature using pre-specified search terms on randomized controlled trials (RCTs) in Ovid Medline, EMBASE, CINAHL, Cochrane, PEDro and Scopus databases for publications between 1996 and 2021. Full publications or expanded abstracts in English or in other languages with abstracts in English were included. The PEDro rating scale (0–10) was used to evaluate study quality. Included RCTs were reviewed to summarize the evidence in six key sections: (1) evidence for PFMT in prevention of POP in the general female population; (2) evidence for early intervention of PFMT in the peripartum period for prevention and treatment of POP; (3) evidence for PFMT in treatment of POP in the general female population; (4) evidence for perioperative PFMT; (5) evidence for PFMT on associated conditions in women with POP; (6) evidence for the long-term effect of PFMT on POP. Full publications in English or in other languages with abstracts in English and expanded abstracts presented at international condition specific societies were included. Internal validity was examined by the PEDro rating scale (0–10). Results After exclusion of duplicates and irrelevant trials, we classified and included 2 preventive trials, 4 trials in the post-partum period, 11 treatment trials of PFMT for POP in the general female population in comparison with no treatment or lifestyle interventions, 10 on PFMT as an adjunct treatment to POP surgery and 9 long-term treatment trials. Only three treatment studies compared PFMT with the use of a pessary. The RCTs scored between 4 and 8 on the PEDro scale. No primary prevention studies were found, and there is sparse and inconsistent evidence for early intervention in the postpartum period. There is good evidence/recommendations from 11 RCTs that PFMT is effective in reducing POP symptoms and/or improving POP stage (by one stage) in women with POP-Q stage I, II and III in the general female population, but no evidence from 9/10 RCTs that adding PFMT pre- and post -surgery for POP is effective. There are few long-term follow-up studies, and results are inconsistent. There are no serious adverse effects or complications reported related to PFMT. Conclusions There are few studies on prevention and in the postpartum period, and the effect is inconclusive. There is high-level evidence from 11 RCTs to recommend PFMT as first-line treatment for POP in the general female population. PFMT pre- and post-POP surgery does not seem to have any additional effect on POP. PFMT is effective and safe but needs thorough instruction and supervision to be effective.

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“…The recently published examination by the "International Gynecological Consultation (IUC)" of the pathophysiology of pelvic organ prolapse (POP) 1 appears to have been restricted in its brief. Genetics, pregnancy, labor and delivery, age and menopause, and animal models were assessed.…”

mentioning

confidence: 99%

“…No clinically usable conclusions were made on genetics; 1 conclusions on pregnancy labor and delivery were generally those that might be expected; conclusions on age and menopause were of interest; conclusions on animal models were again not clinically usable. 1 It is a pity that two very clinically relevant factors, (i) prior hysterectomy and (ii) the retroverted uterus were not subject to evaluation. In the former factor, a prior hysterectomy was noted in 46.3% of one series of 300 consecutive prolapse repairs.…”

mentioning

confidence: 99%

“…It is again ignored in the recent article. 1 In framing the scope of that document, it is again a pity that subjects "outside the square" were not examined. The utility of such documents might be questioned if the methodology of a "comprehensive" literature search on a limited range of subcategories ends up with conclusions little more than what is already known.…”

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confidence: 99%

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The retroverted uterus: Again ignored but still core to prolapse

Haylen

2022

Neurourology and Urodynamics

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International Urogynecological Consultation (IUC): pathophysiology of pelvic organ prolapse (POP)

Cited by 18 publications

References 65 publications

Childbirth resulting in traumatic stretching and prolapsing of the anterior lip of the cervix outside the vagina: A case report

Childbirth resulting in traumatic stretching and prolapsing of the anterior lip of the cervix outside the vagina: A case report

International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: Pelvic floor muscle training

The retroverted uterus: Again ignored but still core to prolapse

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