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Does the vaginal wall thin as prolapse increases?

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Title: Does the vaginal wall thin as prolapse increases?
Authors: Bray, R
Derpapas, A
Fernando, R
Khullar, V
Panayi, DC
Item Type: Journal Article
Abstract: Introduction and hypothesis The pathophysiology of prolapse is not well understood. However, two main theories predominate: either the fibromuscular layer of the vagina develops a defect/tears away from its supports, or its tissues are stretched and attenuated. The aim of this study was to assess how vaginal wall thickness (VWT) is related to vaginal prolapse. Methods The study group comprised 243 women with symptomatic prolapse recruited from the Outpatient Department of a tertiary referral centre for urogynaecology. A history was taken and women were examined to determine their POP-Q score. Using a previously validated technique, ultrasonography was used to measure the mean VWT at three anatomical sites on the anterior and posterior walls. Scores were then compared using t tests, the Kruskal-Wallis test and the Friedman test. Results The mean age of the patients was 59.7 years (SD 12.0 years range 38 – 84 years). For each measurement VWT reduced as prolapse grade increased until the prolapse extended beyond the hymen. Women with grade 3 prolapse had a significantly higher mean VWT than women with grade 1 or 2 contained prolapse. Menopause status did not have a significant effect on the VWT. Conclusions VWT is lower in women with vaginal prolapse until the prolapse extends beyond the hymen and then VWT is thicker and comparable with women without prolapse. This may be explained by changes in the vaginal tissue including reduction of collagen, elastin and smooth muscle, as well as fibrosis in exposed tissues, rather than by defects in the vagina.
Issue Date: 27-Sep-2016
Date of Acceptance: 1-Sep-2016
URI: http://hdl.handle.net/10044/1/40786
DOI: https://dx.doi.org/10.1007/s00192-016-3150-1
ISSN: 1433-3023
Publisher: Springer Verlag (Germany)
Start Page: 397
End Page: 402
Journal / Book Title: International Urogynecology Journal
Volume: 28
Issue: 3
Copyright Statement: © 2016 The Authors. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Keywords: Science & Technology
Life Sciences & Biomedicine
Obstetrics & Gynecology
Urology & Nephrology
Prolapse
Ultrasonography
Vaginal wall thickness
PELVIC ORGAN PROLAPSE
CONNECTIVE-TISSUE
SMOOTH-MUSCLE
WOMEN
THICKNESS
INCONTINENCE
METABOLISM
ULTRASOUND
EXPRESSION
Adult
Aged
Aged, 80 and over
Collagen
Elastin
Female
Humans
Middle Aged
Muscle, Smooth
Severity of Illness Index
Uterine Prolapse
Vagina
1114 Paediatrics And Reproductive Medicine
Obstetrics & Reproductive Medicine
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer