Home | Volume 37 | Article number 196

Case series

Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa

Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa

Antoine Tshimbundu Kayembe1,&, Andy Mbangama Muela2, Alex Mutombo Baleka2, Dieudonné Sengeyi Mushengezi2, Rahma Rachid Tozin2

 

1Department of Gynaecology and Obstetrics, Faculty of Medicine, University Notre-Dame of Kasayi, Central Kasaï, Democratic Republic of the Congo, 2Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo

 

 

&Corresponding author
Antoine Tshimbundu Kayembe, Department of Gynaecology and Obstetrics, Faculty of Medicine, University Notre-Dame of Kasayi, Central Kasaï, Democratic Republic of the Congo

 

 

Abstract

The aim of the study was to describe the epidemiological, clinical and therapeutical profile of genital prolapse in the Gynecology and Obstetrics Service of Saint Joseph Hospital of Kinshasa. This is a descriptive study carried out from medical files of patients who have suffered from genital prolapse in the Gynecology and Obstetrics Service of Saint Joseph Hospital from January 1st, 2008 to December 31st, 2017. It is based on the no probabilistic sampling of suitability. We recorded 161 cases of genital prolapses upon 13957 patients. The genital prolapses frequency was 1.2% with an annual average of 16.1 cases (SD 10.1) per year. The symptomatology consisted of pelvic mass associated with urinary and digestives troubles (94.0%, n=140). The stage III of cysto-colpocele was the most frequent (56.0%, n=82). The vaginal hysterectomy associated to rectocele and cystocele cure was the most performed operation (52.0%, n=69). The recurrence rate was of 2.0% (3 out of 148 cases). The genital prolapse really exist in our milieu, its symptomatology is classical and its treatment is mostly surgical by vaginal access.

 

 

Introduction    Down

Genital prolapse is a dynamic disease which can worsen or recede above all in pregnant women in the postpartum period [1, 2]. It comprises a great recurrence risk after surgical treatment [1, 3]. It causes several troubles such as: urinary, digestive and genital problems which hamper the patients [1, 4, 5]. Its diagnosis rest on the clinical and paraclinical exams as perineal ultrasound, Cysto-defecography (CDG) and Magnetic resonance imaging (MRI) [3, 6]. The treatment for genital prolapse can be medical or surgical [3, 6, 7]. The prevalence of genital prolapse varies from 2.9% to 97.7% in the world according to the method used for the study. It is estimated from 2.9% to 11.4% when the method used is a symptom´s questionnaire [4, 5, 8, 9-12] and from 31.8% to 97.7% when clinical exam with the pelvic organs prolapses quantification (POPQ) is performed [2, 13-17]. In Asia and Africa, this prevalence is not known due to the lack of survey and studies in the general population [18]. In the Democratic Republic of Congo, this prevalence is not known and data to estimate its incidence are inexistent [18]. The lack of epidemiological data of genital prolapse in our milieu pushed us to conduct the present in order to describe the epidemiological, clinical and therapeutical profile of genital prolapses in the Gynecology and obstetrics service (GOS) of Saint Joseph Hospital (SJH) of Kinshasa.

 

 

Methods Up    Down

Study design and setting: this descriptive study is based on the no probabilistic sampling of suitability for cases selection. It included the medical files of patients who suffered from genital prolapses and treated in GOS of SJH. All medical files not found and those that contained less than 50% of studied variables were excluded. One hundred and forty-eight available medical files have been included and thirteen were excluded because their medical files have not been found (either in total one hundred sixty-one cases of genital prolapses registered).

Study population: the target population comprised all patients who suffered from genital prolapse and admitted in GOS of SJH of Kinshasa from January 1st, 2008 to December 31st, 2017. The GOS of SJH of Kinshasa were chosen because of the presence of formed medical staff, the frequent contact with the patients who suffer from genital prolapses, and a free management through the fistula care program.

Data collection: data were collected from the registries of GOS and the operating rooms, the medical files of patients who suffered from genital prolapses at SJH and the data collection record. The study´s variables are year, clinical characteristic (symptomatology, types and stage of genital prolapses) and therapeutical variables (type of treatment performed, therapeutical complications and evolution).

Statistical analysis: data were analyzed using Statistical Package for Social Sciences (SPSS) software version 20. We used the average (SD) to present the quantitative variables and the proportion to present the qualitative variables.

Ethical considerations: principles of medical ethics and documentary studies rules have been respected; the data were collected confidentially and treated anonymously.

 

 

Results Up    Down

Genital prolapses frequency: we registered 161 cases of genital prolapses out of 13957 patients in the GOS of SJH, resulting in an overall frequency of 1.2%. During the study´s period and according to the Figure 1, this frequency evolved in saw way cog, from 0.6% in 2008 to 3.7% in 2017. The annual average of genital prolapses cases was of 16.1 cases (SD 10.1) per year. We remind that 148 available cases have been included and 13 excluded because their medical files have not been found or were not available (in total 161 cases of genital prolapses registered).

Clinical characteristics of genital prolapses: the most frequent complaint was an association of urinary, genital and digestive troubles. The pre-operative symptomatology was made of the sensation of pelvic mass essentially associated to urinary incontinence of stress, imperious micturition with or without incontinence, dysuria, constipation, anal incontinence and dyspareunia (Table 1). The most frequent genital prolapses type was anterior made of the cysto-colpocele essentially. The stage III of genital prolapses was the most frequent in 55.4% of cases.

Therapeutical characteristics of genital prolapse: surgery was the most performed in 89.2% of cases and the vaginal access was most used in 98.6% of cases. Hysterectomy associated to rectocele and cystocele cure was the most performed in 57.0% of cases whereas the most frequent therapeutical complications was the vesical lesions in 2.0% of cases. The post-therapeutical evolution was marked by the disappearance of genital prolapses in 80.0% of cases, its recurrence in 2.0% of cases and its spontaneous regression in 18.0% of cases (Table 2).

 

 

Discussion Up    Down

The frequency of genital prolapses was of 1.2% at SJH. Its evolution was in a saw cog way from 0.6% in 2008 to 3.7% in 2017 during the period of our study. The high frequency observed in 2017 was linked to the first public awareness campaign for the free treatment of genital prolapses at SJH. Our frequency is lower than those found by the Hamri et al. study in Morocco [19], Seven et al. in Turkey [20] and Rodrigues et al. in Brazil [21] which were of 2.4%, 5.6% and 7.5% respectively. It is almost identical to those found by Kishawas et al. at Bangladesh (1.1%) [22], Alherrech et al. in Morocco (1.1%) [23] and Zhu et al. in China (1.2%) [24]. It is higher than 0.5% of Fanny et al. in Ivory Coast [25]. This frequency difference can be explained by the single institution character of our study and the more or less free treatment of genital prolapses in the account of fistula care. The most frequent complaint at consultation was an association of urinary, digestive and genital troubles in 97.3% of cases and the preoperative symptomatology was made of sensation of pelvic mass associated to imperious micturition with or without UIS in 41.9%, Urinary incontinence of stress (UIS) in 30.4%, constipation in 27.0%, dysuria in 25.0% and anal incontinence in 7.4%. Our results were in accordance with those found by Rivaux et al. [26]. These symptoms are due not only to anatomical anomaly of pelvic fascia and anal levator secondary to direct traumatic lesions or to innervation abolition at the roof of the pelvic floor´s weakening, but also to high intra-abdominal pressure (≥6mmHg) with high intra-vesical pressure [27-29].

The anterior genital prolapses which is made of the cysto-colpocele was the most frequent type of genital prolapses: isolated in 35.0% of cases and associated to middle genital prolapses in 20.0%, to posterior genital prolapses in 10.0% and to two precedent in 20.0%. Our results corroborate those of Amblard et al. [30], Handa et al. [2], Blain et al. [16] and Hamri et al. [24]. Our types sequence of genital prolapses was cystocele-hysterocele-rectocele, which is similar to some other African studies [18, 19, 23, 25]. This shows that the type sequence of genital prolapses is the same in Africa whereas elsewhere authors reported a different sequence made of cystocele-rectocele-hysterocele [2, 16, 17]. This differences in sequence are based on the epidemiological arguments or observations. As for the stage of genital prolapses, the stage III was the most frequent in 56.0% whereas the stage I was absent. Our results meet those of Thomin et al. [31] and Maadi et al. [32]. According to Handa et al. the advanced stages of genital prolapses had a long term bad prognosis because of their multiple symptom which push the patients to consult whereas the stage I is not symptomatic and do not necessitate treatment [19]. The absence of stage I in our study explains the symptomatic character of our genital prolapses and would be due to its easy regression to stage 0 or its weak progression toward stages II and III as noted by many authors [2, 33].

The surgical treatment was the most practiced in 89.2%. Our results are in accordance with Boulanger et al. [34, 35]. According to Villet et al. and De tayrac et al. surgical treatment in the genital prolapses is ideal because it allows to correct the anatomical degradation without causing the new troubles [36, 37]. This must be the purpose of surgery performed in our milieu. The rate of pessary´s usage is of 0% in our cases series whereas it´s more than 11.0% in many studies [35, 38, 39]. This can be explained by the policy in our milieu to favour the surgical reparation in all the patient´s in good health as Boulanger et al. observed it [34, 35]. According to Clemons et al. the high number of exteriorized genital prolapses was very difficult to control, with the pessary and the long-term complications linked to the pessary´s usage, it prevented its usage [40]. These two arguments can also explain our null rate of pessary´s usage.

The vaginal surgical access was predominant with 98.0%. Our results meet De tayrac et al. [36]. According to Boulanger et al. and Maher et al. the vaginal surgical access has the advantage of operative duration smaller than abdominal surgical access and of a faster resumption of activities [34, 35, 41]. These two advantages can explain our high rate of surgery by vaginal access. The laparoscopic access hasn´t been used in our cases series because of the absence of laparoscopy´s equipment and of formed medical staff. As for the surgical types, the hysterectomy associated to cystocele and rectocele cure was the most performed. This can be explained by the high percentage of our genital prolapses cases which associated the three types: anterior, middle and posterior. Our results rejoin Hamri et al. [19] and Alharrech et al. [23]. According to Boulanger, the hysterectomy which is performed in the prolapses cases must be associated to the correction´s gesture of prolapse, and the uterine conservation is realized only if it doesn´t exist the uterine anomalies which are discovered to cervical smear, to endometrium biopsy and to systematic pelvic ultrasound [34, 35]. Unfortunately, these systematic pre-operative exams weren´t realized in our milieu because of not only ignorance of practitioners but low social and economic level of our population.

In the study of Korahanis et al. the fixing of trans-vaginal prosthesis in polypropylene associated to genital prolapses cure was the most performed in 80.0% [42]. This is not the case in our study because of the unavailability of prosthesis. Per-operative complications were present in 2.0% (vesical lesions) whereas post-operative complications were missing. Our results are smaller than De tayrac et al. which reported an overall rate of per-operative complications of 5.8% [36]. The difference in complications rates can be explained by the surgical techniques mastery of genital prolapses treatment by the practitioners, despite the equipment´s poverty. In the study of Hefni et al. and of Lovartsis et al. the post-operative complications was rare [43, 44]. These results are almost similar to ours and express the best cares quality. Concerning the post-therapeutical evolution, the recurrence rate was of 2.0%. Our results are smaller than those of many authors who reported a recurrence rate higher than 30.0% [36, 45-48]. The difference of recurrence rates can be explained by the single hospital character of our study and the surgical techniques mastery by our practitioners. Weakness of our study is the no evaluation of the genetic factors impact upon the genital prolapses appearance and its strength is to be the first to study the particularity of epidemiology, clinical and therapeutical characteristic of genital prolapses in the hospital milieus of Kinshasa.

 

 

Conclusion Up    Down

It appeared in this study clearly that, the genital prolapses really exists with a frequency of 1.2% with symptomatology almost classical and made of pelvic mass associated to urinary and digestive troubles (94.0%), the cysto-colpocele of stage III is the most frequent type (56.0%), the hysterectomy associated to rectocele and cyctocele cure by vaginal access is the most performed (52.0%) with a recurrence rate of 2.0%. Our results are the base of deepened studies upon genital prolapses and they allow the scientists awareness upon genital prolapses studies and the improvement of its treatment in our milieu.

What is known about this topic

  • The genital prolapse is the dynamic disease which can worsen or recede above all in pregnant women during the postpartum period;
  • It comprises a great recurrence’s risk after surgical treatment and it causes urinary, digestive and genital problems which hamper the patients;
  • The absence of epidemiology, clinic and therapeutic of genital prolapse in hospitals in Kinshasa, DR Congo.

What this study adds

  • The genital prolapses frequency is 1.2%, the cysto-colpocele of stage III is the most frequent type and treated surgically with the recurrence rate of 2.0% in Kinshasa (DRC): this is the base on deepened studies upon genital prolapses in hospital of Kinshasa in DR Congo;
  • Scientists will gain awareness upon genital prolapse’s studies and to improve its treatment in our milieu.

 

 

Competing interests Up    Down

The authors declare no competing interests.

 

 

Authors' contributions Up    Down

Antoine Tshimbundu Kayembe did the conception and the configuration, the data acquisition, and data analysis and interpretation, the redaction and correction of this article. Andy Mbangama Muela made a substantial contribution to the conception and the configuration, to the data acquisition, to data analysis and interpretation, and to the correction of this article. Alex Mutombo Baleka also made a substantial contribution to the conception and the configuration, to the data acquisition, to data analysis and interpretation, and to the correction of this article. Dieudonné Sengeyi Mushengezi did a substantial contribution to the conception and the configuration, to the data acquisition, to the data analysis and interpretation, and to the correction of this article. Rahma Rachid Tozin made a substantial contribution to the conception and the configuration, to the data acquisition, to data analysis and interpretation, and to the correction of this article. All authors read and approved the final version of this manuscript and equally contributed to its content.

 

 

Acknowledgments Up    Down

To the medical staff of Saint Joseph Hospital (Dr. Mukendi and Dr. Messia) for having allowed us and facilitated the data collection of this study.

 

 

Tables and figure Up    Down

Table 1: pre-operative symptomatology of genital prolapse

Table 2: clinical and therapeutical characteristics of genital prolapses

Figure 1: frequency evolution of genital prolapse during our study period

 

 

References Up    Down

  1. Lousquy R, Costa P, Delmas V, Haab F. Etat de lieux de l´épidémiologie des prolapsus génitaux. Progrès en Urol. 2009;19(19):907-15. Google Scholar

  2. Handa VL, Garrett E, Hendrix S, Gold E, Robbins J. Progression andr remission of pelvic organ prolapse: A longitudinal study of menopausal women. Am J Obstet Gynecol. 2004;190(1):27-3. PubMed | Google Scholar

  3. Dällenbach P, Kaelin-Gambirasio I, Dubuisson JB, Boulvain M. Risk factors for pelvic organ prolapse repair after hysterectomy. Obstet Gynecol. 2007;110(3):625-32. PubMed | Google Scholar

  4. Bradley CS, Zimmerman MB, Wang Q, Nygaard IE, Women's Health Initiative. Vaginal descent and pelvic floor symptoms in postmenopausal women: a longitudinal study. Obstet Gynecol. 2008;111(5):1148-53. PubMed | Google Scholar

  5. Miedel A, Tegerstedt G, Maehle-schmidt M, Nyren O, Hammarström M. Symptoms and pelvic support defects in specific compartments. Obstet Gynecol. 2008;112(4):851-8. PubMed | Google Scholar

  6. Donon L, Warembourg S, Lapray J-F, Cortesse A, Hermieu J-F, Fatton B. Bilan avant le traitement chirurgical d´un prolapsus génital: recommandation pour la pratique clinique. Prog en Urol. 2016;26 Suppl 1:s8-2. PubMed | Google Scholar

  7. Lansac J, Lecomte P, Marret H. Prolapsus génital. In Gynécologie pour le praticien. 8ème Edition Elsevier Masson, Paris. 2012:131-148.

  8. Barber MD, Neubauer NL, Klein-olarte V. Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies? Am J Obstet Gynecol. 2006;195(4):942-. PubMed | Google Scholar

  9. Mouritsen L. Classification and evaluation of prolapse. Best Pract Res Clin Obstet Gynaecol. 2005;19:895-911. PubMed | Google Scholar

  10. Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311-6. PubMed | Google Scholar

  11. Rortveit G, Brown JS, Thom DH, Van Den Eeden SK, Creasma JM, Subak LL. Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol. 2007 Jun;109(6):1396-403. PubMed | Google Scholar

  12. Slieker-tenhove MCP, Pool-Goudzwaard AL, Eijkemans MJC, Steegers-theunissen RPM, Burger CW, Vierhout ME. Symptomatic pelvic organ prolapse and possible risk factors in a general population. Am J Obstet Gynecol. 2009;200(2):1841-7. PubMed | Google Scholar

  13. Sewell CA, Chang E, Sultana CJ. Prevalence of genital prolapse in 3 ethnic groups. J Reprod Med. 2007;52(9):769-73. PubMed | Google Scholar

  14. Nygaard I, Bradley C, Brandt D. Pelvic organ prolapse in older women: prevalence ond risk factors. Obstet Gynecol. 2004;104(3):489-97. PubMed | Google Scholar

  15. Trowbridge ER, Fultz NH, Patel DA, Delancey JOL, Fenner DE. Distribution of pelvic organ support measures in a population based sample of middle-aged, community-dwelling African American and white women in southeastern Michigan. AJOG. 2008;198(5):5481-6. PubMed | Google Scholar

  16. Blain G, Dietz HP. Symptoms of female pelvic organ prolapse: correlation with organ descent in women with single compartment prolapse. Aust N Z J Obstet Gynaecol. 2008;48(3):317-21. PubMed | Google Scholar

  17. Versi E, Harvey MA, Cardozo L, Brincat M, Studd JW. Urogenital prolapse and atrophy at menopause: a prevalence study. Int Urogynecol J. 2001;12(2):107-10. PubMed | Google Scholar

  18. Ntabe Namegabe, Bosse Rafiki, Mumbere Mayani. Profil des Patientes opérées à l´Hôpital Général de HEAL AFRICA et à l´Hôpital Général de Référence de BÉNI, Province du Nord Kivu, République Démocratique du Congo. Accessed 9th June 2017.

  19. Hamri A, Soummani A, Asmouki H, Aboulfala A, Essadki O, Dahami Z. Epidémiologie et Diagnostic du prolapsus génital. Tunis Med. 2015;6(1):181-9.

  20. Seven M, Akyüz A, Açıkel C. Ürogenital prolapsus yaşam kalitesiölçeğinin geçerlik ve güvenirlik çalışması. TAF Prev Med Bull. 2008;7(4):317-22. Google Scholar

  21. Rodrigues AM, De Oliveira LM, Matins KF, Del Roy CA, Ferreira MG, Girão MJBC et al. Factores de risco para o prolapso genital em população Brasileira. Serator Uroginecologiae cirurgica vaginal escola Paulista de Medicina de Universidade Federal de são Paul, Brasil. Rev Bras Ginecol Obstet. 2009;31(1):17-21. PubMed | Google Scholar

  22. Kishawas S, Tanira G, Omar E, Begum K. Prolapsus génital chez les femmes du groupe d´âge de reproduction dans une communauté rurale de Bangladesh. J Dhaka Med Coll. 2010;19:118-21.

  23. El harrech Y, Hajji F, Chafiki M, Ghadouane G, Ameur A, Abbar M. Prolapsus génitaux chez la femme, voie haute ou voie basse? Prothèse ou non ? hystérectomie ou non ? J Maroc Urol. 2010;18:15-23.

  24. Zhu L, Bian X-m, Long Y, Lang J-h. Role of different childbirth strategies on pelvic organ prolapse and stress urinary incontinence a prospective study. Chin Med J. 2008;3:213-5. PubMed | Google Scholar

  25. Mouhamed F, Andrew H, Anguy TE, Edmond MK, Malik K. Traitement chirurgical des prolapsus génitaux, expérience de la Clinique de gynécologique et obstétricale du CHU de Yopougon, à propos de 30 cas. Méd Afr Noire. 2010;57:91-7.

  26. Rivaux G, Fatton B, Letouzey V, Cayrac M, Boileau L, De Tayrac R. Suspension utéro-vaginale par sacrospinofixation antérieure bilatérale prothétique par voie vaginale. Prog Urol. 2012;22(17):1077-83. Google Scholar

  27. Chow D, Rodriguez LV. Epidemiology and prevalence of pelvic organ prolapse. Curr Opin Urol. 2013;23(4):293-8. PubMed | Google Scholar

  28. Chiaffarino F, Chatenoud L, Dindelli M. Reproductive factors, family history, occupation and risk of urogenital prolapse. Eur J Obstet Gynecol Reprod Biol. 2009;82(5):63-7. PubMed | Google Scholar

  29. Blanc Benoit, Deval Bruno. Prolapsus génital: contexte nosologique et pathogénie commune. https: // link.springer.com consulté le 22 juillet 2017 à 18h00´.

  30. Amblard J, Fatton B, Savary D, Jacquetin B. Examen clinique et classification du prolapsus génital. Pelv Perineol. 2008;3,155–165. Google Scholar

  31. Thomin A, Touboul C, Hequet D, Zilberman S, Ballester M, Daraï E. Genital prolapse repair with Avaulta Plus® mesh: Functional results and quality of life. Prog Urol. 2013;23(4):270-5. PubMed | Google Scholar

  32. Miaadi N, Ferhi K, Descargue G, Grise P. Traitement des prolapsus vaginaux antérieurs par voie vaginale avec implant de collagène et fixation transobturatrice. Prog en Urol. 2005;15(6):1110-13. Google Scholar

  33. Sze EHM, Sherard 3rd GB, Dolezal JM. Pregnancy, labor, delivery, and pelvic organ prolapse. Obstet Gynecol. 2002;100(5):981-6. PubMed | Google Scholar

  34. Boulanger L, Lucot J-P, Giraudet G, Virginie BR, Chrystèle R, Pierre C et al. Le prolapsus génital: état des lieux de la chirurgie par voie vaginale. J Méd Liban. 2013;61(1):48-54. PubMed | Google Scholar

  35. Boulanger L, Lucot J-P, Boukerrou M, Collinet P, Cosson M. Transvaginal surgery for genital prolapse in women aged over 80 years: Results in 48 procedures. J Gynecol Obstet Biol Reprod. 2006;35(7):685-90. PubMed | Google Scholar

  36. De tayrac Rénaud, Labaki Madj, Letouzey Vincent, Fatton Brigitte, Mares Pierre. Indications respectives de différentes techniques de cure de prolapsus génital. www.cngof.fr consulté le 22 juillet 2017 à 18h30´.

  37. Villet R. Principes du traitement chirurgical des prolapsus génitaux. E-mém Acad National de Chir. 2006;5(1):11-13.

  38. Schweitzer KJ, Vierhout ME, Milani AL. Surgery for pelvic organ prolapse in women of 80 years of age and older. Acta Obstet Gynecol Scand. 2005;84(3):286-9. PubMed | Google Scholar

  39. Nieminen K, Heinonen PK. Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years. BJOG. 2001 Aug;108(8):817-21. PubMed | Google Scholar

  40. Clemons JL, Aguilar VC, Tillinghast TA, Jackson ND, Myers DL. Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse. Am J Obstet Gynecol. 2004;190(4):1025-9. PubMed | Google Scholar

  41. Maher C, Baessler K, Glazener C, Adams E, Hagen S. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013 Apr 30;(4):CD004014. PubMed | Google Scholar

  42. Korahanis N, Goron A, Farache C, Panel L, Courtieu C. Traitement du prolapsus génital par renfort prothétique léger par voie vaginale. Prog Urol. 2014;24(8):518-25. Google Scholar

  43. Hefni MA, El-Toukhy TA. Long-term outcome of vaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse. Eur J Obstet Gynecol Reprod Biol. 2006;127(2):257-63. PubMed | Google Scholar

  44. Lovatsis D, Drutz Hp. Vaginal surgical approach to vaginal vault prolapse: considerations of anatomic correction and safety. Curr Opin Obstet Gynecol. 2003;15(5):435-7. PubMed | Google Scholar

  45. Roberta B, Adil B, Joseph M, Cathy S, Ebenezer B, Alan Z. Incidence of pelvic floor repair after hysterectomy: a population-based cohort study. Am J Obstet Gynecol. 2007;197(6): 664-9. PubMed | Google Scholar

  46. Smith FJ, David H, Romaric M, Nicolas T. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010;116(5):1096-104. PubMed | Google Scholar

  47. Jean-Philippe L, Virginie B-R, Geraldine G, Chrystèle R, Loïc B, Bernard D. Vaginal mesh for pelvic organ prolapse repair. Gynecol Obstet Fertil. 2011;39(4):232-44.

  48. Gunilla T, Marrianne M-s, Olof N, Margareta H. Prevalence of symptomatic pelvic organ prolapse in a Swedish population. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(6):497-503. PubMed | Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Search

Volume 49 (Sep - Dec 2024)

This article authors

On Pubmed
On Google Scholar

Citation [Download]

Zotero
EndNote XML
Reference Manager
BibTex
ProCite

Navigate this article

Similar articles in

Key words

Article metrics

Countries of access

PlumX Metrics

Genital prolapse: epidemiology, clinic and therapeutic at Saint Joseph Hospital of Kinshasa

Recently from the PAMJ

Déterminants de l´acceptation de la vaccination à Makokou au Gabon

Testicule non descendu chez l´enfant: aspects épidémiologique, diagnostique et thérapeutique dans trois hôpitaux de référence de Douala, Cameroun

Allergy to the fistula needle: a rare cause of allergy in hemodialysis (a case report)

Pediatric ocular tuberculosis: a case report of complex clinical manifestations and its successful management

Effets de la desmopressine versus l´acide tranexamique sur la réduction du saignement dans l´arthroplastie du genou: étude prospective randomisée en double aveugle

Observance de la deuxième et troisième dose de la chimioprévention du paludisme saisonnier chez les enfants de 3 à 59 mois et 6-9 ans dans la commune de Guidimouni, Niger

Authors´ services