R. Cheung

Levator ani muscle avulsion is a risk factor for expulsion within 1 year of vaginal pessary placed for pelvic organ prolapse

The aim of this study was to investigate whether the presence of levator ani muscle (LAM) avulsion is associated with expulsion within 1 year of a vaginal pessary placed for pelvic organ prolapse (POP).

OP34.07: Levator ani muscle injury after first delivery in Chinese primiparous women

Objectives: Vaginal delivery has been identified as risk on pelvic floor; 18–35% of Caucasian women having their first vaginal delivery were found with levator ani muscle injury (LAM). Variation in pelvic connective tissue quality was found between ethnicity. This study aims at examining the prevalence of LAM injury after vaginal delivery in primiparous Chinese women. Methods: Nulliparous Chinese women with singleton pregnancies were recruited. Trans-labial 3D-ultrasound at 35–38 weeks of gestation and 8 weeks post-delivery were performed at rest and at pelvic floor contraction. Demographic and delivery data were collected and the mode of delivery determined by Obstetric indications. Two investigators blinded to the information reviewed the volume data set and searched in its entirety of the continuity of the V-shape LAM. Defects were identified when a loss of continuity within the pubovisceral muscle was visualised. Results: 282 women completed the study, 219 (77.7%) had vaginal delivery including 42 vacuum extractions and 9 forceps; 63 (22.3%) had Caesarean sections (11 elective and 52 emergency). No LAM injury was found antenatally and in the postnatal Caesarean section group. 56 women (25.6%) had LAM injury after vaginal delivery (18 bilateral and 38 unilateral). Instrumental delivery and longer duration of second stage of labour were found statistically associated with LAM injury (Table 1). Conclusions: 25.6% of primiparous Chinese women had levator ani muscle injury after their first vaginal delivery.

Mesh-related complications from reconstructive surgery for pelvic organ prolapse in Chinese patients in Hong Kong

INTRODUCTION Mesh-related complications from reconstructive surgery for pelvic organ prolapse are of international concern. The present study aimed to review the incidence, management, and surgical outcomes of mesh-related complications in a Chinese population compared with existing studies involving Western populations. METHODS This was an analysis of a prospectively collected cohort. Laparoscopic sacrocolpopexy, laparoscopic hystercolposacropexy, or transvaginal mesh surgery were offered with or without concomitant vaginal hysterectomy or continence surgery. Patients were followed up and mesh-related complications were noted. RESULTS Overall, 276 Chinese women who received mesh surgery were included for data analysis. There were 22 mesh-related complications found during a mean follow-up period of 40 months. Mesh exposure accounted for 20 these complications; significantly more occurred after transvaginal than after abdominal mesh surgery (16 vs 4; P=0.01). Median duration from primary operation to the time of mesh exposure detection was 12 months (interquartile range=4.8-32.8 months). Ten patients required surgical excisions of exposed mesh. The re-operation rate after mesh complications was 6.7% (9/134) for transvaginal mesh surgery and 1.4% (2/142) for laparoscopic sacrocolpopexy (P=0.03). All excisions were performed transvaginally and 95% remained well after surgery. Occurrence of mesh exposure was higher in transvaginal mesh surgery (adjusted odds ratio=6.1; P=0.008), in sexually active patients (adjusted odds ratio=5.4; P=0.002), and in obese patients (adjusted odds ratio=3.7; P=0.046). Over 90% were satisfied with the outcome, regardless of mesh complications. CONCLUSIONS The rates of mesh exposure and re-operation were consistent with those reported in the literature, suggesting no significant differences in outcome between Chinese and Western patients for this type of surgery.

Tension-free vaginal mesh for the treatment of pelvic organ prolapse in Chinese women.

OBJECTIVE To assess perioperative and short-term outcomes after tension-free vaginal mesh repair of pelvic organ prolapse in local Chinese women. DESIGN Case series. SETTING The urogynaecology unit of a university teaching hospital in Hong Kong. PATIENTS All women with stage III or more pelvic organ prolapse who underwent tension-free vaginal mesh repair with or without vaginal hysterectomy from May 2007 to June 2011. MAIN OUTCOME MEASURES Perioperative and short-term outcomes. RESULTS In all, 47 women underwent the procedure during the study period. The mean operating time was 94 minutes, the mean estimated blood loss was 163 mL, and the mean hospital stay was 4 days. Four patients had visceral injuries, all of which were identified and repaired during the operation; all four patients recovered uneventfully. The mean duration of follow-up was 25 (standard deviation, 13) months. Pelvic organ prolapse quantification improved significantly; nine (19%) of the patients had recurrent stage II prolapse but only one was symptomatic, six (13%) had postoperative mesh exposure, three of whom underwent mesh excision. There were five (11%) who had de-novo urodynamic stress incontinence, which was mostly mild and managed conservatively. Overall 91% (43/47) were satisfied with their operative outcome. CONCLUSIONS The success rate of tension-free vaginal mesh repair for the treatment of pelvic organ prolapse in local Chinese women was comparable to rates reported internationally. There was a high degree of subjective satisfaction with the procedure. There were low rates of mesh exposure and de-novo stress incontinence that was mostly asymptomatic or mild.

P12.01: Pelvic floor biometry after the delivery in Chinese primiparous women

Results: Thirty-eight women were diagnosed of Cesaeran scar defect at TUS. The number of previous Caesarean sections in patients with uterine dehiscence and ectopic pregnancy in Cesarean scar is shown in Table 1. Eleven patients (29%) showed a uterine dehiscence. Seven cases were repaired by laparoscopy and 4 cases required hysterectomy. Five ectopic pregnancies (13%) were diagnosed at TUS. Two patients required hysterectomy, 2 were treated with local methotrexate guided by TUS and 1 was surgically sutured. Two patients (5%) had a complete uterine rupture. One of them diagnosed 6 months after Cesarean section and required hysterectomy. The other which was diagnosed during puerperium period was treated by surgical repair. Conclusions: TUS is useful for detecting Cesarean scar defects providing information for a treatment in case of complications.

OP13.02: Pelvic floor biometries during the first singleton pregnancy in Chinese nulliparous women

Objectives: This study aims at evaluating the pelvic floor biometries during the first pregnancy of Chinese nulliparous women. The relationship with pelvic floor symptoms was also explored. Methods: Nulliparous Chinese women with singleton pregnancies were recruited. They were assessed at 10–13 weeks, 26–28 weeks and 35–38 weeks of gestation. Trans-labial 3D-ultrasound was performed at rest, Valsalva maneuver (VM) and pelvic floor contraction (PFMC) during each visit. Stress urinary incontinence, urgency urinary incontinence and dragging discomfort were also asked during each visit. Offline analysis of USG volume data sets were done by an investigator blinded to the information. Position of the anterior compartment (bladder neck vertical position), middle compartment (most inferior part of cervix) and posterior compartment (ano-rectal junction) and the hiatal dimensions were measured in a standard way. Results: In all, data of 187 women were reported here. Their mean age was 30.4 ± 4.0 years. There were significant descent of all three compartments and enlargement of hiatal area during rest, VM or PFMC as the pregnancy advanced. At second and third trimester, 54 (29%) and 60 (32%) women reported stress urinary incontinence, but there was no association with the bladder neck mobility. And 41 (22%) and 60 (32%) reported symptoms of dragging sensation but there was no association with the hiatal area. Conclusions: There were significant changes of pelvic floor biometries with descent of three compartments at rest, at VM and PFMC as pregnancy advanced. Stress urinary incontinence and dragging sensation were common during pregnancy; however, both were not associated with parameters of pelvic floor biometries.