Apical defect - the essence of cystocele pathogenesis?

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.

The impact of cystocele repair on urge symptoms in women with pelvic organ prolapse.

OBJECTIVES: The purpose of this study was to evaluate the impact of cystocele repair on urinary urge symptoms and to determine the likelihood that urge symptoms are caused by cystocele and therefore cured by cystocele repair. The secondary aim was to assess the impact of baseline cystocele stage POP on the improvement of urge symptoms following surgical treatment of POP. MATERIAL AND METHODS: A total of 321 female patients with cystocele stages II, III or IV (POP), who underwent repair surgery for pelvic organ prolapse, were included. A retrospective analysis was performed to determine the presence of urge symptoms in patients with cystocele and to evaluate how many patients were cured from urge symptoms by the cystocele repair. Postoperative data were obtained by interview during a follow-up examination six weeks after surgery. RESULTS: Preoperatively, 52.02% of all patients diagnosed with cystocele stages II, III or IV POP experienced urge symptoms. Urge symptoms were cured in 88.62% of patients with cystocele stages II after POP repair (p < 0.005). 88.60% of patients with cystocele stage II POP and 88.68% of patients with cystocele stages III to IV POP reported improvement in urge symptoms (p < 0.005). Despite cystocele repair, 11.4% of patients with preoperative cystocele stage II POP and 11.32% with preoperative cystocele stages III and IV POP reported persistent urge symptoms. 5.84% of the study group who showed no urge symptoms preoperatively, experienced de novo urge symptoms after following surgery (p < 0.005). CONCLUSIONS: Cystocele repair cured urge symptoms in the majority of patients. Therefore, repair of bladder prolapse may help to differentiate urge symptoms from other urinary tract dysfunctions and assist in determining a proper diagnosis and treatment. However, the severity of POP had no significant influence on the improvement in urge symptoms following cystocele repair. Risk of de novo urge symptoms after anatomical repair still needs to be explored.

Preperitoneal laparoscopic lateral repair in pelvic organ prolapse - a novel approach.

OBJECTIVES: The aim of this study is to present a novel approach for a paravaginal defect treatment. This extraperitoneal approach can be performed in patients with comorbidities and on obese patients. The main advantages are: not requiring the pneumoperitoneum and the Trendelenburg position and the avoidance of peritoneal adhesions. MATERIAL AND METHODS: This study presents the results in 27 patients with cystocele caused by a lateral defect pelvic organ prolapse quantification (POP Q) stage II or higher. The procedure was performed with a modified Richardson and Burch technique using a preperitoneal approach. Three follow-up examinations were conducted two, six weeks, and six months after the operation. A quality of life assessment was conducted before and after surgery using the short form of the PFIQ-7. RESULTS: All patients had a POP Q II cystocele and 59% had concomitant stress urinary incontinence. In all patients cystocele was reduce to asymptomatic POP Q stage I or 0. Mean operation time was approximately 80 minutes. In six months post-operation follow up, one case of recurrence was noted. The patients' quality of life revealed a statistical improvement from an average of 6.8 points before, to an average of 0.7 points after the operation (p < 0.05) in the PFIQ-7. CONCLUSIONS: Preperitoneal laparoscopic lateral repair is a relatively fast procedure and it is also feasible for obese women and for patients with a cardiopulmonary risk. Neither the Trendelenburg position nor the pneumoperitoneum are required. Postoperatively, the patients witnessed a reduction of the cystocele and complaints connected with their previous condition.

Multimodal ultrasound computer-assisted tomography: An approach to the recognition of breast lesions.

The research here presented aims at developing a new, promising method for the imaging diagnostics of breast lesions - ultrasound tomography (UST). A currently implemented device enables the reconstruction three complementary images for each coronal breast section. Based on in vivo breast examination, the authors developed an approach to breast diagnostics which employs ultrasound transmission and reflection tomography imaging. The obtained transmission images of ultrasound speed distribution show good correlation of glandular tissue areas with their visualization on MRI images. The results also allow a prediction that the implemented UST device offering fusion of reconstructed images may contribute to achieving a new standard for breast cancer diagnostics through non-invasive, fast and cheap screening tests.