The pelvic floor support in operative hysteroscopy patients

Aim: Pelvic organ prolapse is a pelvic floor disorder in which advancing age, obesity, and parity are the main risk factors. Although itis known that the prevalence is around 10% in the whole population, approximately half of the cases are asymptomatic. Pelvic organprolapse is not expected in the absence of risk factors such as obesity, age, and parity. The aim of this study was to evaluate thepelvic floor support -without these risk factors- in patients who underwent operative hysteroscopy for benign gynecological reasonsin a university hospital.Material and Methods: In this prospective study, the Pelvic Organ Prolapse Quantification System (POP-Q) examination wasperformed in patients undergoing operative hysteroscopy with benign gynecological indications. The relationship between pelvicorgan prolapse and risk factors such as obesity, age, and parity was investigated in these patients who were asymptomatic for pelvicfloor disorders.Results: 1256 patients underwent operative hysteroscopy under general anesthesia with benign gynecological indications. Themean age of the patients was 29.8 years. The most common indication for operative hysteroscopy was the endometrial polyps(21.9%). None of the patients who underwent operative hysteroscopy had any symptoms of pelvic floor disorders. Pelvic organprolapse was detected in 57.5% of the patients in Stage-0, 22.4% in Stage-1, 19.2% in Stage-2, and 0.9% in Stage-3. None of thepatients had total uterine procidentia (Stage-4). Even though they were asymptomatic, stage-2 pelvic organ prolapse was detectedin 20% of normal-weight nulliparous patients younger than 30 years.Conclusion: Pelvic floor disorders can also be seen in non-obese and nulliparous patients at a young age. Although such patients areasymptomatic, they should be referred to urogynecology clinics for optimal pelvic floor support in the following years.

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1. Wu JM, Hundley AF, Fulton RG, et al. Forecasting the prevalence of pelvic floor disorders in U.S. Women: 2010 to 2050. Obstet Gynecol 2009;114:1278.
2. Oliphant SS, Jones KA, Wang L, et al. Trends over time with commonly performed obstetric and gynecologic inpatient procedures. Obstet Gynecol 2010;116:926.
3. Rortveit G, Brown JS, Thom DH, et al. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 2007;109:1396.
4. Smith FJ, Holman CD, Moorin RE, et al. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol 2010; 116:1096.
5. Lowder JL, Ghetti C, Nikolajski C, et al. Body image perceptions in women with pelvic organ prolapse: a qualitative study. Am J Obstet Gynecol 2011;204:441. e1.
6. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 2013;24:1783.
7. Friedman T, Eslick GD, Dietz HP. Risk factors for prolapse recurrence: systematic review and metaanalysis. Int Urogynecol J 2018;29:13. 8. Jelovsek JE, Maher C, Barber MD. Pelvic organ prolapse. Lancet 2007;369:1027.
9. World Human Organization: Body mass index - BMI http://www.euro.who.int/en/health-topics/diseaseprevention/nutrition/a-healthy-lifestyle/body-massindex-bmi
10. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 1996;175:10–7.
11. Vergeldt TF, Weemhoff M, IntHout J, et al. Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J 2015; 26:1559.
12. Olsen AL, Smith VJ, Bergstrom JO, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 1997;89:501
13. 13. Hendrix SL, Clark A, Nygaard I, et al. Pelvic organ prolapse in the Women’s Health Initiative: gravity and gravidity. Am J Obstet Gynecol 2002; 186:1160.
14. 14. Tinelli A, Malvasi A, Rahimi S, et al. Age-related pelvic floor modifications and prolapse risk factors in postmenopausal women. Menopause 2010;17:204.
15. 15. Swift S, Woodman P, O’Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005; 192:795.
16. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA 2008; 300:1311. Sze EH, Sherard GB 3rd, Dolezal JM. Pregnancy, labor, delivery, and pelvic organ prolapse. Obstet Gynecol 2002;100:981.
17. Mant J, Painter R, Vessey M. Epidemiology of genital prolapse: observations from the Oxford Family Planning Association Study. Br J Obstet Gynaecol 1997;104:579.
18. Patel DA, Xu X, Thomason AD, et al. Childbirth and pelvic floor dysfunction: an epidemiologic approach to the assessment of prevention opportunities at delivery. Am J Obstet Gynecol 2006;195:23.
19. DeLancey JO, Kearney R, Chou Q, et al. The appearance of levator ani muscle abnormalities in magnetic resonance images after vaginal delivery. Obstet Gynecol 2003;101:46
20. Kudish BI, Iglesia CB, Sokol RJ, et al. Effect of weight change on natural history of pelvic organ prolapse. Obstet Gynecol 2009;113:81.
21. Giri A, Hartmann KE, Hellwege JN, et al. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol 2017.
22. Yıldız E, Dinçgez Çakmak B, Ketenci Gencer F, et al. Perimenopozal Kadınlarda Pelvik Organ Prolapsusu Sıklığı, Şiddeti ve Risk Faktörleri. Okmeydanı Tıp Dergisi 2018;34:148-53.
23. Swift S, Woodman P, O’Boyle A, et al. Pelvic Organ Support Study (POSST): the distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. Am J Obstet Gynecol 2005;192:795.
24. Tegerstedt G, Maehle-Schmidt M, Nyrén O, et al. Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct 2005;16:497.
25. Cinar M, Aksoy RT, Tokmak A, et al. Does pelvic organ prolapse relate with expulsion of intrauterine devices? Gynecol Obstet Reprod Med 2016;22:80-3.
26. Gokmen Karasu AF, Aydin S, Adanir I, et al. Age may be the only variable effecting microhematuria prevalance in pelvic organ prolapse. Gynecol Obstet Reprod Med 2018;24:143-6.