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Research paper
Published online: 2023-03-15
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Apical defect — the essence of cystocele pathogenesis?

Pawel Szymanowski1, Wioletta K. Szepieniec1, Hanna Szweda1, Janusz Ligeza2, Anna Sedakierska-Chudy3
Affiliations
  1. Department of Gynecology and Obstetrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Cracow, Poland, Poland
  2. Faculty of Medicine and Health Sciences, Division of Biochemistry, Andrzej Frycz Modrzewski Cracow University, Cracow, Poland
  3. Department of Genetics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Cracow University, Cracow, Poland

open access

Ahead of Print
ORIGINAL PAPERS Gynecology
Published online: 2023-03-15

Abstract

Objectives: Lack of standardization causes misunderstandings in planning of cystocele treatment and the evaluation of surgical method effectiveness. The POP-Q System and DeLancey’s three levels of pelvic support do not account for the phenomenon of cystocele caused by an apical defect. We aimed to evaluate the impact of level I defect on the formation of cystocele.

Material and methods: Women reporting complaints related to bladder prolapse (cystocele) were subjected to a urogynecological examination. For this purpose, a simple and standardized method was used, based on the POP-Q System and DeLancey’s three levels of pelvic support. Furthermore, it was expanded by evaluating the impact of level I defect (apical defect) on prolapse at level II of the anterior compartment.

Results: In total, contribution of an apical defect to the pathogenesis of cystocele was founded in 72.2% of 302 female patients included in this study. In 30.8% the cystocele was caused exclusively by an apical defect. In turn, in 41.4% of patients, it resulted from concomitant apical and level II defect of the anterior compartment (lateral or central).

Conclusions: The results of this study indicate that an apical defect may play a significant role in the development of a cystocele. Hence, it could be essential to take the influence of an apical defect on level II in anterior compartment into account when planning a surgical procedure. The authors suggest that lack of such procedures potentially exposes some cystocele patients to ineffective treatment.

Abstract

Objectives: Lack of standardization causes misunderstandings in planning of cystocele treatment and the evaluation of surgical method effectiveness. The POP-Q System and DeLancey’s three levels of pelvic support do not account for the phenomenon of cystocele caused by an apical defect. We aimed to evaluate the impact of level I defect on the formation of cystocele.

Material and methods: Women reporting complaints related to bladder prolapse (cystocele) were subjected to a urogynecological examination. For this purpose, a simple and standardized method was used, based on the POP-Q System and DeLancey’s three levels of pelvic support. Furthermore, it was expanded by evaluating the impact of level I defect (apical defect) on prolapse at level II of the anterior compartment.

Results: In total, contribution of an apical defect to the pathogenesis of cystocele was founded in 72.2% of 302 female patients included in this study. In 30.8% the cystocele was caused exclusively by an apical defect. In turn, in 41.4% of patients, it resulted from concomitant apical and level II defect of the anterior compartment (lateral or central).

Conclusions: The results of this study indicate that an apical defect may play a significant role in the development of a cystocele. Hence, it could be essential to take the influence of an apical defect on level II in anterior compartment into account when planning a surgical procedure. The authors suggest that lack of such procedures potentially exposes some cystocele patients to ineffective treatment.

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Keywords

apical defect; central defect; lateral defect; cystocele; pelvic organ prolapse

About this article
Title

Apical defect — the essence of cystocele pathogenesis?

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2023-03-15

Page views

497

Article views/downloads

414

DOI

10.5603/GP.a2023.0022

Pubmed

36929792

Keywords

apical defect
central defect
lateral defect
cystocele
pelvic organ prolapse

Authors

Pawel Szymanowski
Wioletta K. Szepieniec
Hanna Szweda
Janusz Ligeza
Anna Sedakierska-Chudy

References (15)
  1. 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(6): 1160–1166.
  2. Shull BL, Bachofen C, Coates KW, et al. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000; 183(6): 1365–1373; discussion 1373–1374.
  3. 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(1): 10–17.
  4. Houman J, Weinberger JM, Eilber KS. Native tissue repairs for pelvic organ prolapse. Curr Urol Rep. 2017; 18(1): 6.
  5. Vellucci F, Regini C, Barbanti C, et al. Pelvic floor evaluation with transperineal ultrasound: a new approach. Minerva Ginecol. 2018; 70(1): 58–68.
  6. Rooney K, Kenton K, Mueller ER, et al. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006; 195(6): 1837–1840.
  7. Kantartzis KL, Turner LC, Shepherd JP, et al. Apical support at the time of hysterectomy for uterovaginal prolapse. Int Urogynecol J. 2015; 26(2): 207–212.
  8. Summers A, Winkel LA, Hussain HK, et al. The relationship between anterior and apical compartment support. Am J Obstet Gynecol. 2006; 194(5): 1438–1443.
  9. Wu JM, Kawasaki A, Hundley AF, et al. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011; 205(3): 230.e1–230.e5.
  10. Walters MD, Ridgeway BM. Surgical treatment of vaginal apex prolapse. Obstet Gynecol. 2013; 121(2 Pt 1): 354–374.
  11. Maher C, Feiner B, Baessler K, et al. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016; 11(11): CD004014.
  12. Allen-Brady K, Norton PA, Hill AJ, et al. Risk of pelvic organ prolapse treatment based on extended family history. Am J Obstet Gynecol. 2020; 223(1): 105.e1–105.e8.
  13. Altman D, Forsman M, Falconer C, et al. Genetic influence on stress urinary incontinence and pelvic organ prolapse. Eur Urol. 2008; 54(4): 918–922.
  14. Vasin RV, Filimonov VB, Mnikhovich MV, et al. [Morphologic structure and immunohistochemical analysis of vaginal wall in women with pelvic organ prolapse]. Urologiia. 2019(6): 12–20.
  15. Tunn R, Albrich S, Beilecke K, et al. Interdisciplinary S2k Guideline: Sonography in Urogynecology: Short Version - AWMF Registry Number: 015/055. Geburtshilfe Frauenheilkd. 2014; 74(12): 1093–1098.

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