Journal of Female Pelvic Floor Medicine
Online ISSN : 2434-8996
Print ISSN : 2187-5669
Current issue
Showing 1-22 articles out of 22 articles from the selected issue
  • Kenichiro Ikuma, Nobuyuki Maruo, Hikari Yoshizawa, Chihiro Mikami, Mas ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 1-5
    Published: January 16, 2021
    Released: January 16, 2021
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    Native tissue repair (NTR) is becoming the cornerstone of the surgery for pelvic organ prolapse (POP) to avoid serious mesh related complications. We used intrafascial dissection technique (Aldridge’s method) for total laparoscopic hysterectomy (TLH). Cervical triangle zone (CTZ) defined by the apex (a part of cardinal ligament containing arteriovenous bundle of internal uterine os), sides (fascia) and the base (the part of uterosacral ligament and uterovesical ligament), is created during the operation. Reconstruction of CTZ was proposed as a novel procedure for uterine prolapse (lower than POP-Q stage II) and vaginal prolapse after TLH. In addition, laparoscopic fixation of the vaginal stump and round ligament produced a vaginal wall suspension, which is named as laparoscopic round ligament colpopexy (LRLC). Laparoscopic reconstruction of CTZ and LRLC may provide an additional option for the treatment of POP. Surgical technique of CTZ and LRLC were described in this report.

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  • Yoshiyuki Tsuji, Giannina Calongos, Yoshihiro Ito, Yoko Kubota, Masafu ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 6-13
    Published: January 16, 2021
    Released: January 16, 2021
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    Introduction: The female pelvic organ prolapses (POP) patients are increasing rapidly due to demographic change. Therefore, low cost, low invasive, and low recurrence surgical methods are desirable to prevent expanding social and medical costs. However, current POP surgeries such as native tissue repair colporrhaphy (NTR), transvaginal mesh (TVM), and laparoscopic sacro colpopexy (LSC) are not meet these requirements, due to because of high recurrence rate of NTR, mesh complications of TVM and high cost of LSC, respectively. Here we attempted to develop a new simple, low cost, low recurrence, and minimal invasive trans-vaginal POP surgical method.

    Method: Suture needle with polypropylene thread was directly sewed into pubocervical fascia from vaginal surface without any incision and sewing is continued from the fascia of bulbocavernous muscle on left side vaginal inlet, through the anterior vaginal wall to the right-side uterosacral ligament (USL) then return to left side uterosacral ligament passing through the anterior vaginal wall. The same sewing was done at right-side as same manner.

    By these procedures, a net structure with polypropylene threads was formed and anterior vagina with cystocele was covered and hammock-like suspended by it between both USL and fascia of bulbocavernous muscle at both side on the inlet of the vagina.

    Results: Among thirty-six of cystocele treated with this method, one recurrence found but no other recurrence nor complication.

    Discussion: This newly developed POP operation is a simple, low cost, low recurrence, minimally invasive, and widely applicable operation for POP.

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  • Tomoe Inoue-Hirakawa, Saki Iguchi, Daisuke Matsumoto, Yuu Kajiwara, To ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 14-18
    Published: January 16, 2021
    Released: January 16, 2021
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    The aim of this study was to assess the prevalence of urinary incontinence and consultation rate in postnatal women. One hundred and one postnatal women within 1 year after childbirth participated in this study. We retrospectively evaluated the prevalence of urinary incontinence before and during pregnancy using a self-administered questionnaire, and the prevalence of urinary incontinence after childbirth was assessed by the International Consultation on Incontinence-short form (ICIQ SF). Differences in the characteristics of the participants between postnatal women with and without urinary incontinence were assessed. In addition, we investigated the consultation rate for urinary incontinence and a desire to consult with health professionals using self-administered questionnaire.

    The prevalence of urinary incontinence before pregnancy, during pregnancy, and after childbirth was 4%, 64%, and 32%, respectively. The prevalence of urinary incontinence before and during pregnancy was significantly higher in postnatal women with urinary incontinence compared with those without urinary incontinence (P<0.05, P<0.001, respectively). The consultation rate among the postnatal women with urinary incontinence was 6%, whereas 19% of the postnatal women had a desire to consult health professionals. In conclusion, one third of the postnatal women who participated in this study had urinary incontinence; however, the consultation rate was quite low in Japan.

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  • Takehiro Kato, Jun Morioka, Satoshi Kobayashi, Takehiro Takagi, Takano ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 19-23
    Published: January 16, 2021
    Released: January 16, 2021
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    An 86-year-old female without any histories of neither abdominal surgery nor peritonitis presented with rectal prolapse and pelvic organ prolapse. We planned to perform laparoscopic sacrocolpopexy with ventral rectopexy (LSC+LVR). The preoperative CT revealed medially displaced descending colon and no SD-junction at the supposed area, and the patient was considered as having persistent descending mesocolon. Intraoperative findings revealed dense matted adhesion of sigmoid colon with mesentery and right pelvic wall. L5S1 anterior longitudinal ligament was exposed and secured the anchoring suture after the dissection of these adhesions and consecutive plane oriented presacral dissection, and LSC+LVR was completed. The peritoneal closure was also completed although was complicated due to widely dissected area. Operative time was 190 min, blood loss was minimal, and no complication or recurrence was observed by 1 year after operation. Dense adhesion inside pelvis with PDM could be some difficulty during LSC procedure, herein we report the case.

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  • Yuki Sekiguchi, Ryoko Nakamura, Yukari Utugisawa, Yoshiko Maeda, Akiko ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 24-29
    Published: January 16, 2021
    Released: January 16, 2021
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    GSM is an abbreviation for genitourinary syndrome of menopause. A general term for morphological changes such as atrophy of the genitourinary tract caused by decreased sex hormone secretion due to menopause, and the accompanying unpleasant physical symptoms and dysfunctions. It is a concept that comprehensively describes the condition.

    GSM is a chronic, progressive disease that has been reported to affect about half of middle-aged and older women. The three signs are: 1) Dry and discomfort around the genital area. 2) Sexual pain and other sex troubles. 3) Urinary trouble (frequent urination, urinary leakage, recurrent cystitis). GSM may be diagnosed if vulvar findings include rounding of the urethral orifice and drying of the vaginal vestibule. Prevention is moisturization of the vulva and vagina , continued sexual intercourse and pelvic floor exercise. If general HRT does not improve the symptoms, local administration of both female and male hormones and fractional CO2 laser irradiation are used.

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  • Maki Nakata, Chiharu Ueshima, Yoko Hasumi
    Type: case-report
    2021 Volume 17 Issue 1 Pages 30-37
    Published: January 16, 2021
    Released: January 16, 2021
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    Aim: Due to the tendency of later childbearing, ever-larger number of women are at risk of developing pelvic organ prolapse (POP) over a short period after delivery. To review the general trends of POP following childbirth, we conducted a retrospective hospital record survey.

    Methods: Subjects were consecutive 31 paras who newly visited our department since January 2018, seeking surgical repair of a POP that had developed before the age of 50. The electronic hospital record was reviewed for physical assessment description and ultrasound image data.

    Results: The mean age and BH was 46.5 years and 1.7 times, respectively. The average age of POP onset was 38.6 years.

    The prevalence of retroverted uterus was significantly higher than in the general population. Ultrasound imaging revealed substantial damage to either or both of the levator ani and the external anal sphincter. Other frequent findings were, abnormal levator ani function and/or enlargement of the levator hiatus, funnel-shape bladder neck enlargement, and urethral hypermobility.

    Conclusion: Dynamic translabial ultrasonography with a convex probe is highly useful for evaluating levator ani function, bladder neck deformity and urethral mobility. 3D introital ultrasonography using a transvaginal probe is a reliable tool for detecting levator ani muscle and anal sphincter damages. Our study suggests that retroverted uterus, obstetric trauma to the levator ani muscle and the external anal sphincter, reduced contractility of the levator ani muscle, as detected by physical assessment and ultrasound imaging, are associated with the development of POP at a younger age.

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  • Junko Tomita, Seiki Matsuo, Tomoharu Okubo
    Type: case-report
    2021 Volume 17 Issue 1 Pages 38-41
    Published: January 16, 2021
    Released: January 16, 2021
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    We report on a case of a 71-year old female patient who developed increasing foul-smelling vaginal discharge, low back pain, and general fatigue 2 weeks after laparoscopic sacrocolpopexy (LSC) with supracervical hysterectomy. She was admitted to our hosipital due to a high fever 25 days after LSC. CT scan revealed she developed pelvic abscess without spondylodiscitis nor osteomyelitis. Vaginal examination showed a tiny fistula at the left side of the anterior fornix. Purulent discharge was flowing out spontaneously from the fistula but not from the external uterine orifice. Streptococcus agalactiae was detected by culture examination of the discharge. It was possible that mesh infection might be caused transvaginally via the fistula.

    The patient received conservative treatment with the administration of antibiotics and the transvaginal drainage of abscess. These conservative approaches were successful without the mesh removal. The patient has no signs of recurrence of pelvic organ prolapse, mesh infection, or other complications 18 months after LSC.

    Surgical excision of the mesh is the treatment of choice in most cases of mesh infection with pelvic abscess after LSC. However, conservative treatment of pelvic abscess should be allowed in the case of possible spontaneous drainage without critical complications.

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  • Kurenai Kinno, Akiko Fujisaki, Misa Shimoinaba, Shuko Honda, Noritoshi ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 42-45
    Published: January 16, 2021
    Released: January 16, 2021
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    Objectives: Transvaginal mesh (TVM) surgery remains a widely used key procedure in Japan due to its favorable outcomes in repairing pelvic organ prolapse (POP). However, POP can frequently reoccur after repair, and so countermeasures are needed. Here, we report on outcomes of TVM surgery using a reduced-size Uphold™-type mesh (transvaginal minimal mesh surgery) in a procedure that does not involve passage of mesh arms through the obturator foramina, as treatment for recurrent POP.

    Methods: We retrospectively examined 11 patients who had undergone transvaginal minimal mesh surgery for recurrent POP after initial TVM surgery.

    Results: Median age at time of initial TVM surgery was 65 [range, 51-77]years; 7 patients had the procedure at other facilities, and 4 had undergone the procedure at our hospital. The initial TVM procedure used a Prolift™-type mesh, involved passage of mesh arms through the obturator foramina, and was performed in 10 patients; the minimal mesh procedure was performed in 1 patient. Median age at the time of TVM for recurrent POP was 69 [range, 60-79]years, median operative time was 56 [range, 34-91] min, and median blood loss was 20 [range, 10-65]mL. Sacrospinous ligament puncture was successful even when the ligament had been used in the initial procedure. No damage to adjacent organs, POP recurrence, or exposure of the mesh through the vaginal wall was observed during follow-up (median, 6 [range, 118] months).

    Conclusion: Transvaginal minimal mesh surgery for POP recurrence can be performed safely and completed within a short operative time.

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  • Masao Kataoka, Hitomi Imai, Toru Meguro, Yuuki Yoshida, Ruriko Honda, ...
    2021 Volume 17 Issue 1 Pages 46-49
    Published: January 16, 2021
    Released: January 16, 2021
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    A 74-year-old woman was admitted to our hospital complaining of perineal mass palpation during the strain. Eight years ago, she had undergone anterior colporrhaphy with a diagnosis of cystocele. Reappearance of the sensation of drooping at the age of 70, and at 74, she visited our hospital in hope of surgical treatment. On examination,

    POP-Q is Aa / Ba / C / gh / pb / tvl / Ap / Bp / D + 0.5 / + 0.5 / -3 / 4.5 / 3/6 / -3 / -3 / -5 respectively, Stage2 Urinary bladder was observed. MRI examination revealed thinning of the left internal obturator muscle and bilateral para vaginal defects. She was mainly wearing cotton clothes because she had an allergy to synthetic fibers, and she was hesitant to perform surgery using polypropylene mesh. Therefore, we performed laparoscopic para vaginal defect repair and anterior colporrhaphy using absorbing thread. No perioperative or postoperative allergic symptoms were observed. Up to now, about 3 years have passed without recurrence.

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  • Yuka Kitajima, Masahiko Takemura, Eriko Funatsu, Kana Yamamoto, Saki K ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 50-53
    Published: January 16, 2021
    Released: January 16, 2021
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    A 67-year-old woman with stress urinary incontinence and third-stage rectocele underwent trans obturator tape surgery and perineoplasty. She complained of strong vulvar pain without incentives 21 days after surgery, and the pain continued thereafter. No resistance or tenderness was noted at the puncture site or along the tape route, and we did not observe an inflammatory reaction. We administered drug therapy as we believed that the pain was likely related to the mesh graft; however, treatment with nonsteroidal anti-inflammatory drugs, and pregabalin had no effect. Therefore, we decided to perform an operation to remove the mesh. Simultaneously, the patient started taking escitalopram oxalic acid, and her pain quickly disappeared. An existing guideline recommends the use of a serotonin noradrenaline reuptake inhibitor for chronic postsurgical pain, including pain after mesh graft surgery. In this case, a selective serotonin reuptake inhibitor was effective.

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  • Chikako Kato, Tomoko Kuwata, Hiromi Kashihara, Masami Takeyama
    Type: case-report
    2021 Volume 17 Issue 1 Pages 54-59
    Published: January 16, 2021
    Released: January 16, 2021
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    Objective: To report medium-term outcomes after laparoscopic sacrocolpopexy in our facility.

    Method: Five hundred-twenty nine patients underwent LSC for pelvic organ prolapse (POP) between March 24, 2015 and February 28, 2019. The operation was performed with 4 ports according to the procedure of Wattiez. Subtotal hysterectomy were performed in 477 cases. As for the insertion site of the mesh, both the anterior and posterior walls were inserted in 453 cases. Complications, functions of bladder, bowel and sexual, and recurrence of POP were investigated.

    Results: The average age was 64 and the average BMI was 22.3.

    The average operation time was 163 minutes and the amount of bleeding was 16.1 g.

    We had intraoperative complications 4 cases of bladder injury and 5 cases of vaginal wall injury. As postoperative complications, there were a case of ureteral injury, a case of small bowel injury and 2 cases of intestinal obstruction.

    There was a significant postoperative improvement in urinary function, based on the questionnaire scores. There were 37 (7%), 36 (9.4%), and 26 (12.1%) recurrences of POP-Q Stage II or higher at three months, 1 year, and 2 years after surgery respectiverely.

    TVM and LSC were performed in each 3 cases as POP reoperation.

    TVT was performed in 37 patients for urinary incontinence.

    Conclusion: We were able to experience many cases of LSC in a short period.

    The procedure was performed safely with few intraoperative and postoperative complications, and there were few recurrences requiring reoperation.

    It is suggested that LSC is useful about POP in the medium-term.

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  • Junko Kato, Kosei Miwa, Saburo Yamagiwa, Toshiharu Ohta, Mitsuhiro Nag ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 60-64
    Published: January 16, 2021
    Released: January 16, 2021
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    OBJECTIVE: Our purpose was to have two examiners who engaged urogynecology at different institution evaluate the interobserver reliability of site-specific measurements and the stages of the pelvic organ prolapse quantification (POP-Q) system.

    STUDY DESIGN: Subjects were women attending the Urogyne Center of Gifu Red Cross Hospital who presented applicable symptoms or needed regular examinations after POP surgery and completed informed consent procedures. The subjects underwent examinations by two experienced examiners. One examiner was a urologist and the other was a gynecologist; each examiner was blind to the results of the other’s examination results. The reproducibility of the nine site-specific measurements was analyzed with Spearman’s correlation coefficient (γs), and the compartment stage and summary stage were analyzed with the weighted kappa correlation coefficient (κ).

    RESULTS: 32 subjects were recruited (mean age 68.0±9.3 years, mean parity 2.3±1.0, 3 women underwent hysterectomy). Correlations for Aa, Ba, Gh, Ap, Bp, D were statistically high and for C, Pb, Tvl were moderate. (γs for Aa: 0.909, Ba: 0.908, C: 0.486, Gh: 0.803, Pb: 0.440, Tvl: 0.318, Ap: 0.592, Bp: 592, D: 0.600, p=0.077 to <0.001). Staging was very highly reproducible. (κ for anterior wall: 0.873, posterior wall: 0.543, cervix/ vaginal vault: 0.662, summary stage: 0.820, p<0.001). Overall, 72% of the summary stages were fully consistent. With no single subject was there a variance of more than one stage.

    CONCLUSIONS: Highly consistent interobserver reproducibility of the POP-Q staging was confirmed in this study.

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  • Shiho Aoki, Shin Suga, Takayuki Kawai, Kengo Hiranuma, Aya Fujioka, Ma ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 65-69
    Published: January 16, 2021
    Released: January 16, 2021
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    BACKGROUND/PURPOSE: There are two prevalent approaches when it comes to surgery for pelvic organ prolapse. One method uses mesh and the other is non-mesh(Native Tissue Repair: NTR). Typically, patients who undergo NTR return to their original state more easily, compared to mesh surgery. Here, we consider factors regarding recurrence rates in vaginal hysterectomy and in colporrhaphy, one kind of NTR.

    METHOD: Between January 2017 and September 2018, medical records of 91women receiving non-mesh surgery (trans vaginal hysterectomy, anterior and posterior vaginal wall formation, McCall) were reviewed. The they were then followed for

    12-24 months.

    RESULTS: The recurrence rate over POP-Q stage3 was 11.3% (9 cases) out of 80 cases. Three cases( 3.8%) required re operation. When we compared the two groups (recurrence and non-recurrence), there was no between-group difference in age, Body Mass Index (BMI), operation time, blood loss, nor specimen weight. In the pre-operative POP-Q stage, the stage 4 group had a higher recurrence rate compared with stage 3. Regarding Aa, Ba, and C points, there were no between-group difference. However, Ap, Bp, and D points in the recurrence group were larger than that in the non-recurrence group. It seems that serious pelvic organ prolapse was the leading recurrence factor.

    CONCLUSION: Serious pelvic organ prolapse was determined to be the leading factor for recurrence after vaginal non mesh surgery. Therefore, regarding serious prolapse, we recommend serious consideration of other methods, along with the standard procedures.

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  • Masao Ichikawa, Hanako Kaseki, Kenichiro Watanabea, Shuichi Ono, Seiic ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 70-74
    Published: January 16, 2021
    Released: January 16, 2021
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    Rare site endometriosis is a relatively rare disease in endometriosis and is represented by bladder endometriosis and rectal endometriosis. This time, we present these rare cases of endometriosis and report the characteristics such as clinical symptoms and pathological findings. Also, we would like to discuss the role of the endopelvic fascia composed of the uterosacral ligaments and the rectovaginal septum in the development of endometriosis. Furthermore, we introduce a new concept; ectopic uterus as one possible mechanism of endometriosis progression.

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  • Tomoko Sho, Hitomi Nakagawa, Daisuke Nakajima, Mai Myoga, Kazuaki Yosh ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 75-79
    Published: January 16, 2021
    Released: January 16, 2021
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    To evaluate the relationship between laparoscopic sacrocolpopexy (LSC) for pelvic organ prolapse (POP) and urinary incontinence, a prospective analysis was carried out including 258 POP patients who underwent LSC between 2014 and 2018 at our hospital. The average age, BMI, operation time of LSC, and blood loss were 64.3±7.8 years, 27.2±3.2 kg/m2 , 122.6±43.0 minutes, and 53.6±123.3mL. The recurrence rate of higher than POP-Q stage 2 was 8.4% (24/258). One hundred twenty five cases (56%) complained of SUI preoperatively and de novo SUI was found in 37 cases (17%). Urethral sling operation (TVT) was performed in 10 cases (4.6%). Multivariate analysis of the risk factors for postoperative SUI revealed that preoperative CLSS question 5 score and hypertension were related to postoperative SUI significantly. Alsothe satisfaction rates from the patients significantly increased postoperatively ; perioperative questionnaires and evaluations of urinary function of the POP patients help to predict postoperative SUI.

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  • Akane Yamaguchi, Natsui Waku, Akio Hoshi, Hiroyuki Nishiyama
    Type: case-report
    2021 Volume 17 Issue 1 Pages 80-85
    Published: January 16, 2021
    Released: January 16, 2021
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    Vesico-vaginal fistula is a rare condition that is caused primarily by iatrogenic injury in developed countries. A fistula induced by radiation is more difficult to repair because of tissue weakness. Our patient was a 45-year old female who complained of stress urinary incontinence after radical hysterectomy with postoperative radiation for cervical cancer. At 13 months after surgery, a fistula draining urine was found 1 cm from the vaginal stump. Cystoscopy revealed reddish mucosa in front of the right ureteral orifice. We diagnosed the patient with a vesico vaginal fistula. After an 11-month follow-up, surgical repair was performed via a transvaginal approach with a Martius flap derived from the labial fat pad. At one year and six months after surgery, there was no recurrence of fistula or cervical cancer.

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  • Eri Kokubo, Tamami Taniguchi, Mikiko Sakurai, Yasue Kobayashi, Satoko ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 86-91
    Published: January 16, 2021
    Released: January 16, 2021
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    [Purpose] This study aimed to compare the clinical progress of pelvic organ prolapse patients who underwent treatment selected at the initial examination with that treatment selected at the end of outpatient visits.

    [Methods] A retrospective observation study was conducted at the Department of Urology, University of Yamanashi Hospital. The subjects were 54 pelvic organ prolapse patients with a mean age of 74.2 years, and were diagnosed at the Urology Outpatient Department between January 2018 and March 2019. The patients’ backgrounds, pelvic symptoms, objective diagnosis, purpose of the examination, and clinical progress of the treatment were collected and analyzed at their initial visit and again at the end of the research period.

    [Results] The most common symptoms at the initial examination was a drooping feeling, followed by complaints of a feeling of protrusion, hesitancy, and urinary incontinence. Forty-one of the patients desired surgery; the remaining twelve desired detailed treatment and conservative therapy which included ① surgery, ② pelvic floor muscle training, ③ pelvic floor supporter, and ④ pessary. The conservative therapy included procedures that combine ②–④ in accordance with the state of the organ prolapse and activities of daily living of the patients. The procedures resulted in a decrease in the number of patients who opted for surgery, but an increase in the number of those who opted for conservative therapy at the end of the outpatient visits.

    [Discussion] The number of patients who selected surgery as the first choice in the initial examination was high, but at the end of the outpatient visits, the number of those who chose conservative therapy was higher. The elderly patients with improved symptoms, such as alleviation of the drooping feeling due to conservative therapy were satisfied with the conservative therapy, leading to a decrease in the surgical patients.

    Pelvic organ prolapse is a quality-of-life-related disease, and treatment must be selected in accordance with the patient’s lifestyle and sense of value.

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  • Hirotaka Sato, Syouta Ootsuka, Hirokazu Abe, Katsuhiko Sato
    Type: case-report
    2021 Volume 17 Issue 1 Pages 92-99
    Published: January 16, 2021
    Released: January 16, 2021
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    Objectives: To investigate the effect of laparoscopic sacrocolpopexy (LSC) on patients of negative preoperative prolapse reduction stress testing (PRST). Data was collected regarding the postoperative morbidity and risk factors of stress urinary incontinence (SUI).

    Methods: This study is a retrospective observational study. Preoperative PRST was carried out on pelvic organ prolapse (POP) patients to check the presence of postoperative stress urinary incontinence (SUI). Eighty-two patients were evaluated for postoperative SUI using a questionnaire (ICIQ-SF) at 3 and 12 months after surgery.

    Results: In cases representing preoperative SUI, the prevalence of SUI at 3 and 12 months after LSC was 43.2% and 37.8% respectively. In cases representing non-preoperative SUI, the prevalence was 24.4% and 13.3% respectively. Risk factors for postoperative SUI included preoperative SUI (OR 4.03, 95% CI; 1.26-12.9, P = .018), advanced cystocele stage 3-4 (OR 5.31, 95% CI 1.65-17.1, P = .005) and the parity (OR .387, 95% CI .15-.997, P = .049).

    Conclusions: Regardless of the PRST status (including negative status), the risks of SUI must be thoroughly explained to the patient. Only with this informed consent can the proper steps for the operation be realized.

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  • Ken-ichi Honda, Takuma Wada, Yasushi Kurihara, Koji Kajitani, Yuko Nis ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 100-103
    Published: January 16, 2021
    Released: January 16, 2021
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    A case of transvaginal small bowel evisceration in a pelvic organ prolapse

    A 67-year-old woman with stage 4 pelvic organ prolapse presented with evisceration of her bowel through her vagina. She had complained of vaginal pain before the evisceration. A 3 cm longitudinal laceration on the posterior vaginal wall was repaired the following day under general anesthesia. Vaginal hysterectomy was performed 10 days later and the vaginal wall epithelium was sutured following the LeFort method. However, the sutures in the vaginal wall broke apart 3 months after surgery, but the epithelium gradually recovered within 1 year.

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  • Toshio Kimura, Hiromi Miyata, Kobu Chien
    Type: case-report
    2021 Volume 17 Issue 1 Pages 104-109
    Published: January 16, 2021
    Released: January 16, 2021
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    For the patients with pelvic organ prolapse (POP) who are not sexually active, vaginal obliterative procedure (colpocleisis) is an excellent surgical technique with less recurrence without using a mesh—it can be performed under local anesthesia even in cases with high risk of complications. There are two types of vaginal closure: complete vaginal closure and partial vaginal closure (LeFort surgery); both procedures require vaginal mucosa dissection. We report a novel vaginal obliteration procedure without removing the vaginal mucosa for the POP patient with unstoppable anticoagulants. We named the procedure Simple Colpocleisis. Local anesthesia was implemented in both the anterior and the posterior vaginal wall, and transverse incisions were made in both sides. First, the proximal side (uterine side) of the anterior wall and the posterior wall’s incisions were sutured. Next, the distal side (perineal side) of the anterior wall and the posterior wall’s incisions were sutured to close the vaginal canal without removing the vaginal mucosa. Because of local anesthesia, the patient was able to walk immediately after surgery and was discharged the day after surgery. Colpocleisis is an effective procedure for POP patients who do not anticipate sexual intercourse but (both complete and partial) colpocleisis requires removal of the vaginal mucosa. We performed a simple vaginal closure by simple incision and suturing of the anterior and the posterior vaginal walls without removing the vaginal mucosa. This procedure is simpler than a conventional vaginal closure and has less risk of bleeding and postoperative hematoma. Although the long-term prognosis is unknown, we presume that our simple colpoclesis procedure can be an effective procedure for POP patients with multiple complications.

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  • Kohei Urago, Kazuaki Nishimura, Masato Ishimatsu, Yayoi Nakanami, Yumi ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 110-114
    Published: January 16, 2021
    Released: January 16, 2021
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    Laparoscopic sacrocolpopexy (LSC) is one of the surgical treatments for pelvic organ prolapse (POP). We started LSC in 2017. In the LSC surgical procedures, incision of retroperitoneal in front of the sacral promontory and exposure of the anterior longitudinal ligaments is a unique procedure that cannot be handled by other gynecological laparoscopic surgery. The common iliac artery and vein cross in front of the sacral promontory, and the median sacral artery and vein also run longitudinally, and sometimes the inferior vena cava is present down to the sacral promontory. Vascular plexus is complicated and there are many variations. Then, if hemorrhage occurs, it is not easy to stop bleeding.

    In the field of view from the umbilicus, depending on the sacral morphology, there are many cases where the position of mesh fixation cannot be sufficiently observed, so preoperative evaluation was considered useful. Evaluation of blood vessels around the sacrum is particularly important in LSC where the mesh is fixed at the sacrum promontory. From the time of introduction, we have been using 3D computerized tomography (3D-CT) to grasp the mesh fixation position on the front surface of the sacrum in three dimensions. In addition, we constructed the view from the first trocar to capture the actual operative field view. We examined 15 patients who underwent 3D-CT and found that the area of the avascular region in front of the sacrum promontory was significantly narrower in 3D-CT view from the first trocar compared with it of open surgery.

    As a preoperative evaluation of LSC, we will evaluate and show the usefulness of 3D-CT.

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  • Hideji Kawanishi, Kumiko Kato, Shoji Suzuki, Akinobu Ishiyama, Hirotak ...
    Type: case-report
    2021 Volume 17 Issue 1 Pages 115-119
    Published: January 16, 2021
    Released: January 16, 2021
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    (Purpose)This report reviews two cases of bladder stones 15 and 17 years after the Stamey procedure for stress urinaryincontinence (SUI).

    (Case 1) A 72-year-old female with gross hematuria, painful urination and bladder stone. In 1999, she underwent the Stameyprocedure for SUI at another hospital. In 2016, 17 years later, she was referred to our hospital, and underwent transurethralcystolithotripsy. A stone surrounding a GORE-TEX sleeve was removed from the left side of the bladder neck. After that, sheremained symptom-free and continent.

    (Case 2) A 72-year-old female with gross hematuria. In 1997, she underwent the Stamey procedure at another hospital. In2010, she was referred to our hospital due to gross hematuria. Exposure of a GORE-TEX sleeve was observed on the rightside of the bladder neck. We endoscopically removed it and the Nylon thread. In 2012, she had gross hematuria again andworsening of urge urinary incontinence (UUI). Then, a stone surrounding a GORE-TEX sleeve was observed on the left sideof the bladder neck. An indwelling urethral catheter was used temporarily due to urinary retention. Later, the stone and theNylon thread was removed endoscopically. After the surgery, urinary retention was relieved, and there was no recurrence ofSUI. However, UUI continued, and pharmacotherapy was necessary.

    (Discussion)In the 1980’s, the Stamey procedure was introduced to Japan and became a widespread surgical option for SUI inthe1980’s and 1990’s. Bladder stones are a known postoperative complication of the Stamey procedure with a rate of 0.3%.Physicians should be aware of and attentive to the possibility of bladder stones associated with the Stamey procedure evenafter many years.

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