[Year:2019] [Month:July-December] [Volume:7] [Number:2] [Pages:5] [Pages No:77 - 81]
Introduction: Pelvic organ prolapse (POP) has been documented in the oldest medieval literature as old as 2000 BC with its watershed moments. It affects millions of women worldwide. Since exact etiological data are not known, there is paucity of data regarding recommendations of surgeries, and apical prolapse in young women has concomitant stress urinary incontinence (SUI). Recurrences are more common in young women compared with old women, and choice of surgery thus becomes a dilemma and puts a surgeon in a quandary. Moreover, reconstructive surgeons are inspired and fascinated due to intricacies and challenges of POP in the young women. Hence, genital prolapse in young women is a topical issue.
Aim: To determine the characteristics of prolapse in young women with regard to grade, complexity, and associated etiological factors.
Materials and methods: This comparative descriptive study was conducted at a tertiary care hospital from June 2015 to December 2016 over a period of 18 months after obtaining adequate authorization from ethical committee. A nonprobability sampling convenience method was incorporated. All women attending gynecological outpatient department having symptoms of mass coming out of vagina were subjected to detailed history, examination, and investigations. They were divided into two groups: women less than 40 years were subjected to conservative surgery and women more than 40 years were subjected to anterior and posterior repair with concomitant hysterectomy. The results were compared.
Results: The mean age of women less than 40 years was 34.54 ± 3.136 years, and mean age for women between 40 years and 45 years was 43.83 ± 1.617 years. The mean parity is less in women less than 40 years of age compared with older women, and though not statistically significant, there is a strong presence of family history of similar complaints in parents or siblings in women less than 40 years of age (15.13%). This is consistent with studies by Jackson that there may be a correlation between development of prolapse and collagen defects. On comparing the preoperative and postoperative POP quantification (POP-Q) in younger and older women, there was a significant improvement in anterior compartment and apical defects when compared with posterior defects and changes in genital hiatus, perineal body, and total vaginal length. In total, 13% of young women who underwent conservative surgery for POP had recurrence, which though statistically insignificant, it is a high percentage compared with older women undergoing surgery for POP. Older women undergoing surgery for POP had more complications (4/18–22%), kinking of ureter after a vaginal hysterectomy with high uterosacral fixation (11%), and secondary hemorrhage (11%).
Conclusion: Young women have POP of low grade, usually have single-compartment defects, and are associated with low parity. A significant number of women have family history of POP contributing to low-density collagen as an etiological factor. Conservative surgeries in young women take shorter time, are associated with less complications, but are associated with more recurrence rates.