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Pelvic Organ Prolapse: Current Progress and Clinical Challenges
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Pelvic Organ Prolapse: Current Progress and Clinical Challenges

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 1887

Special Issue Editors

Dr. Riccardo Lombardo

E-Mail Website
Guest Editor
Ospedale Sant’Andrea, Sapienza University of Rome, 00185 Rome, Italy
Interests: pelvic organ prolapse; bladder; prostate; oncology
Special Issues, Collections and Topics in MDPI journals
Dr. Cosimo De Nunzio

E-Mail Website
Guest Editor
Department of Urology, Sant’Andrea Hospital, Sapienza University, 00189 Rome, Italy
Interests: prostate; urodynamics; prostate cancer; urologic oncology; bladder cancer; urology surgery

Special Issue Information

Dear Colleagues,

Pelvic organ prolapse (POP) is a significant health concern, affecting a substantial proportion of women, particularly during postmenopausal and post-childbirth phases. It occurs when pelvic organs like the bladder, uterus or rectum drop from their normal position and bulge into the vagina due to weakening of the muscles and tissues supporting these organs. This condition can cause discomfort, urinary problems and sexual dysfunction, severely impacting the quality of life.

Recent progress in understanding and managing POP includes advancements in diagnostic techniques, such as high-resolution imaging, which provides a detailed view of the pelvic anatomy and helps in precise identification of the prolapse. There has also been development in minimally invasive surgical techniques, such as laparoscopic and robotic surgeries, which offer quicker recovery and fewer complications compared to traditional surgeries.

However, clinical challenges remain. These include a need for better risk prediction and prevention strategies, especially for women at higher risk due to genetic factors or lifestyle. Additionally, the long-term efficacy and safety of surgical mesh, used in POP surgeries, are under scrutiny due to complications like mesh erosion. Thus, current research is also focused on developing new biomaterials for safer and more effective treatments.

Overall, while significant strides have been made in the treatment and management of POP, ongoing research and clinical trials are crucial for addressing the remaining challenges and improving patient outcomes.

Dr. Riccardo Lombardo
Dr. Cosimo De Nunzio
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pelvic organ prolapse (POP)
  • postmenopausal
  • urinary dysfunction
  • minimally invasive surgery
  • laparoscopic surgery
  • robotic surgery
  • surgical mesh

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Published Papers (2 papers)

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11 pages, 15956 KiB  
Article
Influence of Transperineal Ultrasound on the POP-Q System in the Surgical Indication of Symptomatic Pelvic Organ Prolapse
by José Antonio García-Mejido, Ana Hurtado-Guijosa, Alfonso Fernández-Gomez, Fernando Fernández-Palacín, Carolina Lao-Peña and José Antonio Sainz-Bueno
J. Clin. Med. 2024, 13(20), 6224; https://doi.org/10.3390/jcm13206224 - 18 Oct 2024
Viewed by 490
Abstract
Background/Objectives: The diagnostic capacity of the preoperative pelvic organ prolapse quantification (POP-Q) system to define surgical pelvic organ prolapse (POP) is sometimes limited. On the other hand, pelvic floor ultrasound can influence the surgical indication for patients with symptomatic POP. Therefore, our [...] Read more.
Background/Objectives: The diagnostic capacity of the preoperative pelvic organ prolapse quantification (POP-Q) system to define surgical pelvic organ prolapse (POP) is sometimes limited. On the other hand, pelvic floor ultrasound can influence the surgical indication for patients with symptomatic POP. Therefore, our objective is to determine how transperineal ultrasound can influence the surgical indication for symptomatic POP. Methods: This is a prospective observational study conducted over two years including patients who underwent corrective surgery for symptomatic POP. All patients underwent a preoperative examination using the POP-Q system to assess POP. Patients in whom the pelvic floor specialist had diagnostic doubts about the stage of POP underwent an ultrasound examination of the POP. Before the surgical procedure and with the patient anesthetized, a new clinical examination was performed using the POP-Q system and surgical correction of the POP was executed when the patient had a decline to stage II or higher. Cohen’s kappa coefficient of agreement was used to assess the agreement. Results: Of the 180 patients who met the inclusion criteria, 167 were included (99 with preoperative clinical examination and 68 with preoperative clinical examination and ultrasound study). The kappa index for the diagnosis of surgical uterine prolapse of the preoperative clinical examination (moderate correlation) was lower than the ultrasound examination (very good correlation) (0.493 p < 0.001 and 0.924 p < 0.001). The kappa index for the diagnosis of cervical elongation without surgical uterine prolapse also showed differences between the preoperative clinical examination (good correlation) and the ultrasound examination (very good correlation) (0.749 p < 0.001 and 0.853 p < 0.001). Conclusions: Transperineal ultrasound has a higher concordance than presurgical clinical examination, based on the POP-Q system, for detecting POP with central compartment surgical indication. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Progress and Clinical Challenges)
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20 pages, 658 KiB  
Systematic Review
Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Urogynecological Surgery: A Systematic Review
by Lorenzo Vacca, Eleonora Rosato, Riccardo Lombardo, Paolo Geretto, Simone Albisinni, Riccardo Campi, Sabrina De Cillis, Laura Pelizzari, Maria Lucia Gallo, Gianluca Sampogna, Andrea Lombisani, Giuseppe Campagna, Alessandro Giammo, Vincenzo Li Marzi, Cosimo De Nunzio and Young Research Group of the Italian Society of Urodynamics
J. Clin. Med. 2024, 13(19), 5707; https://doi.org/10.3390/jcm13195707 - 25 Sep 2024
Viewed by 1089
Abstract
Background: Minimally invasive surgery could improve cosmetic outcomes and reduce the risks of surgical injury with less postoperative pain and a quicker patient’s discharge. Recently, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been introduced in urogynecology with exciting results. Evidence Acquisition: After [...] Read more.
Background: Minimally invasive surgery could improve cosmetic outcomes and reduce the risks of surgical injury with less postoperative pain and a quicker patient’s discharge. Recently, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been introduced in urogynecology with exciting results. Evidence Acquisition: After PROSPERO registration (n°CRD42023406815), we performed a comprehensive literature search on Pubmed, Embase, and Cochrane CENTRAL, including peer-reviewed studies evaluating transvaginal natural orifice transluminal endoscopic surgery. No limits on time or type of study were applied. Evidence synthesis: Overall, 12 manuscripts were included in the analysis. Seven studies evaluated uterosacral ligament suspension, four studies evaluated sacral colpopexy, three evaluated sacrospinous ligament suspension, and one study evaluated lateral suspension. Overall success rates were high (>90%); however, definitions of success were heterogeneous. In terms of complication, most of the studies reported low-grade complications (Clavien–Dindo I and II); only two patients needed mesh removal because of mesh exposure. The risk of bias of the trials was rated in the medium to high-risk category. Conclusions: The present review highlights important initial results for vNOTES. Future randomized clinical trials are needed to better define its role in the management of urogynecological procedures. Full article
(This article belongs to the Special Issue Pelvic Organ Prolapse: Current Progress and Clinical Challenges)
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