Quality of life following vaginal reconstructive versus obliterative surgery for treating advanced pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Although colpocleisis is effective in selected women, the low-morbidity obliterative procedure for treating pelvic organ prolapse (POP) and its impact on postoperative quality of life (QOL) have rarely been studied. Our aim was to assess QOL in women after colpocleisis and compare it with that of women after reconstructive vaginal surgery. METHODS: This retrospective cohort study included women (aged 35-85 years) with POP who underwent obliterative or reconstructive surgical correction during 2009-2015. Patients who met the inclusion criteria underwent telephone interviews that included the validated Prolapse QOL questionnaire (P-QOL Thai). RESULTS: Of 295 potential participants, 197 (67%) completed the questionnaire: 93 (47%) with obliterative and 104 (53%) with reconstructive surgery. Most were Thai (95.4%), multiparous (87%), and sexually inactive (76%). Their histories included hysterectomy (12%), incontinence or prolapse surgery (11%), and POP stage 3/4 (77%). Patients undergoing obliterative surgery were significantly older than those undergoing a reconstructive procedure (69 vs 58 years, P < 0.05). The obliterative group had more children, less education, and more advanced POP. There were no significant differences in operative parameters or complications. The obliterative surgery group had a significantly shorter hospital stay: median 2 (range 1-17) days vs 3 (1-20) days (P = 0.016). P-QOL scale revealed significantly less postoperative impairment in the obliterative surgery group (1.75 vs 5.26, P = 0.023). There were no significant differences in other P-QOL domains. CONCLUSIONS: Colpocleisis improves condition-specific QOL in selected patients with advanced POP and remains an option for this group. Surgeons should consider counseling elderly women with advanced POP about obliterative vaginal surgery.

Effect of Local Estrogen Cream on Vaginal Health after Pessary Use for Prolapsed Pelvic Organ: A Randomized Controlled Trial.

Background: Currently, there is no evidence whether local estrogen cream should always be used in conjunction with a pessary as atrophic prevention. There is still no consensus about the long-term safety of local estrogen cream. Therefore, it is recommended to use hormone for the shortest duration as possible. Objective: Evaluate the effect of local estrogen cream on vaginal health in pessary use for pelvic organ prolapse. Material and Method: Forty postmenopausal women with pelvic organ prolapse who had used a pessary in conjunction with local estrogen cream for six weeks were randomly selected to use vaginal conjugated equine estrogen (CEE) cream 0.5 g once a week (treatment group) or no treatment (control group) for 24 weeks. The primary outcome was vaginal health assessment composed of vaginal symptom score, vaginal pH, and vaginal maturation index. The secondary outcome measures were the difficulty to use pessary and the endometrial thickness. Results: No statistical differences were found for all vaginal health assessment at baseline, 12, and 24 weeks among the treatment and the control groups. There was also no significant difference between the groups about the difficulty to insert and remove the pessary or the endometrial thickness. Conclusion: Vaginal CEE cream 0.5 g once a week did not show any additional positive effect on vaginal health in pessary use.

Clinical, endocrine and ultrasonographic features of polycystic ovary syndrome in Thai women.

AIM: To study the prevalence, reproductive hormone profiles and ovarian sonographic appearance of Thai women with polycystic ovary syndrome (PCOS). METHODS: One thousand and ninety-five women were screened for oligomenorrhea/amenorrhea, and the clinical symptoms of hyperandrogenism. Ovarian morphology and volume were assessed by ultrasonography in diagnosed cases. Blood was taken for the measurement of the follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, androstenedione, dehydroepiandrosterone and 17-hydroxyprogesterone. RESULTS: The prevalence of PCOS was 5.7%. The mean age of women with PCOS was less than that of non-PCOS cases (27.4 +/- 6.5 and 31.1 +/- 6.4 years, respectively; P < 0.0001). Abnormal uterine bleeding and infertility were the leading presenting symptoms. The mean ovarian volume in women with PCO appearance was 9.22 +/- 4.36 mL compared to 6.53 +/- 3.31 mL in those without this appearance (P = 0.04). Hyperandrogenemia was confirmed in 23 of the 62 cases (37.1%). CONCLUSIONS: The prevalence and clinical presentations of Thai women with PCOS were similar to those in other reports. However, hirsutism, elevated testosterone level and acanthosis nigricans were uncommon in our population. Serum androstenedione was a more sensitive indicator of hyperandrogenemia than total testosterone. Further research is needed to clarify whether there is an ethnic difference in endocrine profiles and risks of metabolic syndrome.