Transvaginal management of severe pelvic organ prolapse in nulliparous women.
OBJECTIVE
The aim of this study was to evaluate the management outcomes of advanced pelvic organ prolapse (POP) in nulliparous women.


METHODS
Eight nulliparous women diagnosed with POP ≥ stage 3 between January 2005 and August 2013, according to the Pelvic Organ Quantification System (POPQ), were reviewed. Seven were managed surgically and one was managed with pessary. Primary outcome was surgical objective cure (POP-Q ≤ 1) and subjective cure, defined as negative response to questions 2 and 3 on Pelvic Organ Prolapse Distress Inventory 6. Secondary outcomes were complications, symptoms' severity and quality of life according to validated questionnaires.


RESULTS
A total of 1275 prolapse patients with POP-Q ≥ stage 3 were managed surgically, among whom seven (0.55%) were nulliparous. Each woman had at least one risk factor associated with POP. Risk factors identified were history of pelvic trauma, obesity, menopause, chronic cough, hard physical labor and constipation. Five patients underwent surgical correction (vaginal hysterectomy with sacrospinous fixation) with mesh (Perigee, n = 3; Avaulta, n = 2). Two patients had uterine preservation without mesh (hysteropexy with sacrospinous ligament fixation). One patient preferred treatment with pessary. The total cure rate (objective and subjective cure rates) was 86% after surgical reconstructive surgery.


CONCLUSIONS
Management of nulliparous advanced POP poses significant challenges with regard to uterine preservation, future pregnancy and childbirth. Conservative management with pessary insertion should be offered followed by surgical correction. Reconstructive surgery with mesh may improve prolapse symptoms objectively and subjectively.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Medical Center, Keelung, Taiwan.|Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.|School of Medicine, Chang Gung University, Taoyuan, Taiwan.
Tsia-Shu
TS
Lo
Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Hospital Sultanah Nurzahirah, Kuala Terengganu, Malaysia.
Sukanda
S
Jaili
Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Dr Pablo O. Torre Memorial Hospital, Bacolod City, Philippines.
Ma Clarissa
MC
Uy-Patrimonio
Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Hospital Tuanku Jaafar, Seremban, Malaysia.
Nazura Bt
NB
Karim
Fellow of Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.|Department of Obstetrics and Gynecology, Al-Bashir Hospital, Amman, Jordan.
Rami
R
Ibrahim
D000328:Adult; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D008875:Middle Aged; D010298:Parity; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D010570:Pessaries; D019651:Plastic Surgery Procedures / Q000379:methods; D012720:Severity of Illness Index; D013526:Surgical Mesh; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery*; D055815:Young Adult
development; migration; nulliparous; pelvic organ prolapse; vaginal hysterectomy; vaginal pessary