Publications by authors named "Tegerstedt Gunilla"

19 Publications

  • Page 1 of 1

Posterior compartment symptoms in primiparous women 1 year after non-assisted vaginal deliveries: a Swedish cohort study.

Int Urogynecol J 2021 Mar 1. Epub 2021 Mar 1.

Karolinska Pelvic Floor Centre, Karolinska University Hospital Huddinge, Stockholm, Sweden.

Introduction And Hypothesis: This is a prospective cohort follow-up study based on the hypothesis that primiparous women with non-assisted vaginal deliveries and a second-degree perineal tear have more posterior compartment symptoms 1 year after delivery than those with no or first-degree tears.

Methods: A follow-up questionnaire, including validated questions on pelvic floor dysfunction, was completed 1 year postpartum by 410 healthy primiparas, delivered without instrumental assistance at two maternity wards in Stockholm between 2013 and 2015. Main outcome measures were posterior compartment symptoms in women with second-degree perineal tears compared with women with no or only minor tears.

Results: Of 410 women, 20.9% had no or only minor tears, 75.4% had a second-degree tear, and 3.7% had a more severe tear. Of women presenting with second-degree tears, 18.9% had bowel-emptying difficulties compared with 20.0% of women with minor tears. Furthermore, almost 3% of them with second-degree tears complained of faecal incontinence (FI) of formed stool, 7.2% of FI of loose stool compared with 1.2% and 3.5% respectively in women with no or only minor tears.

Conclusions: Symptomatic pelvic floor dysfunction is common among primiparous women within 1 year following uncomplicated vaginal delivery, and there are no significant differences between second-degree perineal tears and minor tears. These symptoms should be addressed in all women after delivery to improve pelvic floor dysfunction and quality of life.
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http://dx.doi.org/10.1007/s00192-021-04700-6DOI Listing
March 2021

Risk factors for perineal and vaginal tears in primiparous women - the prospective POPRACT-cohort study.

BMC Pregnancy Childbirth 2020 Dec 2;20(1):749. Epub 2020 Dec 2.

School of Medical Sciences, Faculty of Health and Medicine, Örebro University, SE-701 82, Örebro, Sweden.

Background: The aim of this study was to estimate the incidence of second-degree perineal tears, obstetric anal sphincter injuries (OASI), and high vaginal tears in primiparous women, and to examine how sociodemographic and pregnancy characteristics, hereditary factors, obstetric management and the delivery process are associated with the incidence of these tears.

Methods: All nulliparous women registering at the maternity health care in Region Örebro County, Sweden, in early pregnancy between 1 October 2014 and 1 October 2017 were invited to participate in a prospective cohort study. Data on maternal and obstetric characteristics were extracted from questionnaires completed in early and late pregnancy, from a study-specific delivery protocol, and from the obstetric record system. These data were analyzed using unadjusted and adjusted multinomial and logistic regression models.

Results: A total of 644 women were included in the study sample. Fetal weight exceeding 4000 g and vacuum extraction were found to be independent risk factors for both second-degree perineal tears (aOR 2.22 (95% CI: 1.17, 4.22) and 2.41 (95% CI: 1.24, 4.68) respectively) and OASI (aOR 6.02 (95% CI: 2.32, 15.6) and 3.91 (95% CI: 1.32, 11.6) respectively). Post-term delivery significantly increased the risk for second-degree perineal tear (aOR 2.44 (95% CI: 1.03, 5.77), whereas, maternal birth positions with reduced sacrum flexibility significantly decreased the risk of second-degree perineal tear (aOR 0.53 (95% CI 0.32, 0.90)). Heredity of pelvic floor dysfunction and/or connective tissue deficiency, induced labor, vacuum extraction and fetal head circumference exceeding 35 cm were independent risk factors for high vaginal tears (aOR 2.32 (95% CI 1.09, 4.97), 3.16 (95% CI 1.31, 7.62), 2.53 (95% CI: 1.07, 5.98) and 3.07 (95% CI 1.5, 6.3) respectively).

Conclusion: The present study corroborates previous findings of vacuum extraction and fetal weight exceeding 4000 g as risk factors of OASI. We found that vacuum extraction is a risk factor for second-degree tear, and vacuum extraction, fetal head circumference exceeding 35 cm and heredity of pelvic floor dysfunction and/or connective tissue deficiency were associated with increased risk of high vaginal tears. These findings have not been documented previously and should be confirmed by additional studies.
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http://dx.doi.org/10.1186/s12884-020-03447-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709229PMC
December 2020

Identification of amino acid residues of nerve growth factor important for neurite outgrowth in human dorsal root ganglion neurons.

Eur J Neurosci 2019 11 1;50(9):3487-3501. Epub 2019 Aug 1.

AlzeCure Foundation, Huddinge, Sweden.

Nerve growth factor (NGF) is an essential neurotrophic factor for the development and maintenance of the central and the peripheral nervous system. NGF deficiency in the basal forebrain precedes degeneration of basal forebrain cholinergic neurons in Alzheimer's disease, contributing to memory decline. NGF mediates neurotrophic support via its high-affinity receptor, the tropomyosin-related kinase A (TrkA) receptor, and mediates mitogenic and differentiation signals via the extracellular signal-regulated protein kinases 1 and 2 (ERK1/2). However, the molecular mechanisms underlying the different NGF/TrkA/ERK signalling pathways are far from clear. In this study, we have investigated the role of human NGF and three NGF mutants, R100E, W99A and K95A/Q96A, their ability to activate TrkA or ERK1/2, and their ability to induce proliferation or differentiation in human foetal dorsal root ganglion (DRG) neurons or in PC12 cells. We show that the R100E mutant was significantly more potent than NGF itself to induce proliferation and differentiation, and significantly more potent in activation of ERK1/2 in DRG neurons. The W99A and K95A/Q96A mutants, on the other hand, were less effective than the wild-type protein. An unexpected finding was the high efficacy of the K95A/Q96A mutant to activate TrkA and to induce differentiation of DRG neurons at elevated concentrations. These data demonstrate an NGF mutant with improved neurotrophic properties in primary human neuronal cells. The R100E mutant represents an interesting candidate for further drug development in Alzheimer's disease and other neurodegenerative disorders.
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http://dx.doi.org/10.1111/ejn.14513DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899756PMC
November 2019

Fetal CD103+ IL-17-Producing Group 3 Innate Lymphoid Cells Represent the Dominant Lymphocyte Subset in Human Amniotic Fluid.

J Immunol 2016 10 2;197(8):3069-3075. Epub 2016 Sep 2.

Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital, 141 86 Stockholm, Sweden;

Amniotic fluid (AF) surrounds the growing fetus, and cells derived from AF are commonly used for diagnosis of genetic diseases. Intra-amniotic infections are strongly linked to preterm birth, which is the leading cause of perinatal mortality worldwide. Surprisingly little is known, however, about mature hematopoietic cells in AF, which could potentially be involved in immune responses during pregnancy. In this study, we show that the dominating population of viable CD45 cells in AF is represented by a subset of fetal CD103 group 3 innate lymphoid cells (ILCs) producing high levels of IL-17 and TNF. Fetal CD103 ILC3s could also be detected at high frequency in second-trimester mucosal tissues (e.g., the intestine and lung). Taken together, our data indicate that CD103 ILC3s accumulate with gestation in the fetal intestine and subsequently egress to the AF. The dominance of ILC3s producing IL-17 and TNF in AF suggests that they could be involved in controlling intra-amniotic infections and inflammation and as such could be important players in regulating subsequent premature birth.
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http://dx.doi.org/10.4049/jimmunol.1502204DOI Listing
October 2016

Ascl1 Is Required for the Development of Specific Neuronal Subtypes in the Enteric Nervous System.

J Neurosci 2016 Apr;36(15):4339-50

Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, S-17177 Stockholm, Sweden,

Unlabelled: The enteric nervous system (ENS) is organized into neural circuits within the gastrointestinal wall where it controls the peristaltic movements, secretion, and blood flow. Although proper gut function relies on the complex neuronal composition of the ENS, little is known about the transcriptional networks that regulate the diversification into different classes of enteric neurons and glia during development. Here we redefine the role of Ascl1 (Mash1), one of the few regulatory transcription factors described during ENS development. We show that enteric glia and all enteric neuronal subtypes appear to be derived from Ascl1-expressing progenitor cells. In the gut of Ascl1(-/-) mutant mice, neurogenesis is delayed and reduced, and posterior gliogenesis impaired. The ratio of neurons expressing Calbindin, TH, and VIP is selectively decreased while, for instance, 5-HT(+) neurons, which previously were believed to be Ascl1-dependent, are formed in normal numbers. Essentially the same differentiation defects are observed in Ascl1(KINgn2) transgenic mutants, where the proneural activity of Ngn2 replaces Ascl1, demonstrating that Ascl1 is required for the acquisition of specific enteric neuronal subtype features independent of its role in neurogenesis. In this study, we provide novel insights into the expression and function of Ascl1 in the differentiation process of specific neuronal subtypes during ENS development.

Significance Statement: The molecular mechanisms underlying the generation of different neuronal subtypes during development of the enteric nervous system are poorly understood despite its pivotal function in gut motility and involvement in gastrointestinal pathology. This report identifies novel roles for the transcription factor Ascl1 in enteric gliogenesis and neurogenesis. Moreover, independent of its proneurogenic activity, Ascl1 is required for the normal expression of specific enteric neuronal subtype characteristics. Distinct enteric neuronal subtypes are formed in a temporally defined order, and we observe that the early-born 5-HT(+) neurons are generated in Ascl1(-/-) mutants, despite the delayed neurogenesis. Enteric nervous system progenitor cells may therefore possess strong intrinsic control over their specification at the initial waves of neurogenesis.
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http://dx.doi.org/10.1523/JNEUROSCI.0202-16.2016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601778PMC
April 2016

Clinical efficacy of a trocar-guided mesh kit for repairing lateral defects.

Int Urogynecol J 2013 Feb 16;24(2):249-54. Epub 2012 Jun 16.

Division of Obstetrics and Gynaecology, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.

Introduction And Hypothesis: The optimal surgery for lateral defects is not well defined. Our objective was to assess the effects of anterior trocar-guided transvaginal mesh repair versus anterior colporrhaphy in women with lateral defects.

Methods: This subanalysis from a randomized controlled trial of mesh kit versus anterior colporrhaphy assessed 99 patient diagnosed at baseline with lateral defects in the anterior vaginal wall. Thirty-nine patients underwent anterior colporrhaphy and 60 anterior trocar-guided transvaginal mesh surgery.

Results: One year after surgery, a persistent lateral defect was significantly more common after colporrhaphy compared with transvaginal mesh [11/32 (34.4 %) vs 1/42 (2.4 %), risk ratio (RR) 14.4, 95 % confidence interval (CI) 2.0-106.1; P < 0.001)] However, there were no significant differences between treatment groups with regard to subjective symptoms as reflected by the overall Urogenital Distress Inventory scores, with mean difference from baseline 37.3 ± 50.6 in the colporrhaphy group vs 39.0 ± 45.8 in the mesh group (p = 0.61).

Conclusions: Use of a transvaginal mesh kit increases the odds for anatomical correction of lateral defects compared with anterior colporrhaphy but does not necessarily improve lower urinary tract symptoms.
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http://dx.doi.org/10.1007/s00192-012-1833-9DOI Listing
February 2013

Two-year follow-up of an open-label multicenter study of polyacrylamide hydrogel (Bulkamid®) for female stress and stress-predominant mixed incontinence.

Int Urogynecol J 2012 Oct 25;23(10):1373-8. Epub 2012 Apr 25.

Department of Urogynaecology, Birmingham Women's Hospital, Methchley Lane, Edgbaston, Birmingham B15 2TG, UK.

Introduction And Hypothesis: Polyacrylamide hydrogel (PAHG, Bulkamid®) is a promising urethral bulking agent. This article presents the 2-year follow-up results of a multicenter study of PAHG injections for treating stress and stress-predominant mixed urinary incontinence.

Methods: Submucosal injection of PAHG was performed in 135 women with urinary incontinence, with subjective and objective assessment of the efficacy and safety 24 months postinjection.

Results: At 24 months, the subjective responder rate was 64 % (a statistically non-significant reduction from 67 % at 12 months). The decreased number of incontinence episodes and urine leakage were maintained compared with the result from the 12-month evaluations, as were objective result rates and quality of life data. No safety issues occurred.

Conclusions: PAHG is an effective and safe treatment option for women with stress-predominant mixed urinary incontinence, with maintained medium-term responder rates.
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http://dx.doi.org/10.1007/s00192-012-1761-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3448051PMC
October 2012

Short-term natural history in women with symptoms indicative of pelvic organ prolapse.

Int Urogynecol J 2011 Apr 20;22(4):461-8. Epub 2010 Oct 20.

Department of Obstetrics and Gynaecology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.

Introduction And Hypothesis: Information about the natural history of pelvic organ prolapse (POP) is scarce.

Methods: This was a prospective cohort study of 160 women (mean age 56 years), whose answers in a population-based survey investigation indicated presence of symptomatic prolapse (siPOP), and 120 women without siPOP (mean age 51 years).

Results: Follow-up questionnaire was completed by 87%, and 67% underwent re-examination according to pelvic organ prolapse quantification (POP-Q) system after 5 years. Among re-examining siPOP women, 47% had an unchanged POP-Q stage, 40% showed regression, and 13% showed progression. The key symptom "feeling of a vaginal bulge" remained unchanged in 30% of women with siPOP, 64% improved by at least one step on our four-step rating scale, and 6% deteriorated. Among control women, siPOP developed in 2%. No statistically significant relationship emerged between changes in anatomic status and changes in investigated symptoms.

Conclusion: Only a small proportion of women with symptomatic POP get worse within 5 years.
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http://dx.doi.org/10.1007/s00192-010-1305-zDOI Listing
April 2011

Effects of anterior trocar guided transvaginal mesh surgery on lower urinary tract symptoms.

Neurourol Urodyn 2010 Nov;29(8):1419-23

Division of Obstetrics and Gynaecology, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.

Aims: To assess the effects of trocar guided transvaginal mesh on lower urinary tract symptoms after anterior vaginal wall prolapse repair.

Methods: One hundred twenty-one patients undergoing anterior transvaginal mesh surgery was prospectively evaluated at baseline and 1 year after surgery using the urogenital distress inventory (UDI).

Results: Overall UDI scores declined from 91 before surgery to 31 one year after surgery (P < 0.001). UDI subscales for obstructive and irritative symptoms improved 1 year after surgery (P < 0.001 for both) while stress symptoms did not (P = 0.11).

Conclusion: Trocar guided transvaginal mesh surgery for anterior vaginal wall prolapse was associated with an overall resolution of most symptoms associated with overactive bladder syndrome and bladder outlet obstruction. These beneficial effects should be weighed against an increased risk for stress urinary incontinence related to the procedure.
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http://dx.doi.org/10.1002/nau.20880DOI Listing
November 2010

Urodynamic assessment of anterior vaginal wall surgery: a randomized comparison between colporraphy and transvaginal mesh.

Neurourol Urodyn 2010 Apr;29(4):527-31

Division of Obstetrics and Gynaecology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.

Aims: To investigate the urodynamic effects of anterior vaginal wall prolapse surgery using either trocar guided transvaginal mesh or colporraphy.

Methods: A prospective, randomized multicenter trial enrolling 50 patients: 27 underwent anterior colporrhaphy and 23 anterior trocar guided transvaginal mesh. Urodynamic assessment was performed pre- and two months postoperatively.

Results: De novo stress urinary incontinence was significantly more common after trocar guided transvaginal mesh surgery compared to colporraphy. In comparison to baseline urodynamics, transvaginal mesh surgery resulted in a significant decrease in maximal urethral closing pressures (MUCP) whereas conventional anterior colporraphy had no significant effect on urodynamic parameters.

Conclusion: Trocar guided transvaginal mesh of anterior vaginal wall prolapse results in a lowering of MUCPs and increases the risk for de novo stress urinary incontinence compared to colporraphy.
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http://dx.doi.org/10.1002/nau.20811DOI Listing
April 2010

Nonobstetric risk factors for symptomatic pelvic organ prolapse.

Obstet Gynecol 2009 May;113(5):1089-1097

From the Department of Obstetrics and Gynaecology and Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden; Statisticon AB, Uppsala, Sweden; and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.

Objective: To identify possible nonobstetric risk factors for symptomatic pelvic organ prolapse in the general female population.

Methods: This was a population-based, cross-sectional study derived from a sample of 5,489 Stockholm women, 30 to 79 years old, who answered a validated questionnaire for the identification of symptomatic prolapse. The 454 women whose answers indicated the presence of such prolapse and the 405 randomly selected control participants with answers that gave no indication of prolapse received a 72-item questionnaire, which probed into a priori suspected risk factors. Only those women with intact uteri and no prior surgery for incontinence or prolapse were included. Multivariable logistic regression models estimated prevalence odds ratios (ORs) with 95% confidence intervals (CIs).

Results: In addition to age and parity, overweight (prevalence OR for body mass index [kg/m] 26-30 compared with 19-25 was 1.9, 95% CI 1.2-3.1), history of conditions suggestive of deficient connective tissue (varicose veins/hernia/hemorrhoids, prevalence OR for positive history compared with no history 1.8, 95% CI 1.2-2.8), family history of prolapse (prevalence OR for positive history compared with no history 3.3, 95% CI 1.7-6.4), heavy lifting at work (prevalence OR for 10 kg or more compared with no heavy lifting 2.0, 95% CI 1.1-3.6), and presence of constipation, hard stools, or difficult evacuation (prevalence OR relative to normal bowel habits 2.1, 95% CI 1.4-3.3) all were linked independently, significantly, and positively to the presence of symptomatic prolapse.

Conclusion: In this nonconsulting population, age and parity were the dominating risk factors, but significant independent associations with markers suggestive of congenital susceptibility (family history and conditions signaling weak connective tissue) and nonobstetric strain on the pelvic floor (overweight/obesity, heavy lifting, and constipation) imply that individual predisposition and lifestyle/environment also may play an important role. The causal direction of the association with bowel habits remains uncertain, and the link to family history could be partly because of information bias.
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http://dx.doi.org/10.1097/AOG.0b013e3181a11a85DOI Listing
May 2009

Sexual dysfunction after trocar-guided transvaginal mesh repair of pelvic organ prolapse.

Obstet Gynecol 2009 Jan;113(1):127-133

From the Department of Medical Epidemiology and Biostatistics, the Division of Obstetrics and Gynecology, and the Division of Surgery and Urology, Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden; the Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland; the Department of Obstetrics and Gynecology, Akershus University Hospital, University of Oslo, Lørenskog, Norway; and the Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.

Objective: To estimate sexual dysfunction before and after trocar-guided transvaginal mesh surgery for pelvic organ prolapse.

Methods: Sexually active women participating in a prospective multicenter study were recruited at 26 centers. All participants underwent a standardized surgical procedure and were evaluated before (n=105) and 1 year after (n=84) surgery using the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Nonparametric statistics were used for comparisons.

Results: Mean age at surgery was 61.5 years (standard deviation [SD] 7.6), median parity was 2 (range, 1-6), and mean body mass index was 26.8 (SD 4.3) (body mass index is calculated as weight (kg)/[height m]). Anterior transvaginal mesh repair was performed in 46 patients (44%), posterior in 26 patients (25%), and combined anterior and posterior in 33 patients (31%). Overall sexual function scores worsened from 15.5 (SD 8.0) at baseline to 11.7 (SD 6.9) 1 year after surgery (P<.001). The trend toward deteriorating sexual function scores was similar for all three surgical procedures. There was an overall worsening of all symptoms in the behavioral-emotive and partner-related items, whereas improvements were observed in physical function. Overall rates and severity of dyspareunia in specific neither improved nor worsened.

Conclusion: Sexual function scores deteriorate 1 year after trocar-guided transvaginal mesh surgery. The worsening was attributed primarily to a worsening in behavioral-emotive and partner-related items. Anatomical cure after surgery was not associated with improved PISQ scores.

Clinical Trial Registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00402844

Level Of Evidence: II.
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http://dx.doi.org/10.1097/AOG.0b013e3181922362DOI Listing
January 2009

Symptoms and pelvic support defects in specific compartments.

Obstet Gynecol 2008 Oct;112(4):851-8

Department of Obstetrics and Gynaecology, Södersjukhuset, Stockholm, Sweden.

Objective: To investigate whether the nature of the anatomic defects in pelvic organ prolapse (POP) correlates with the character of the symptoms.

Methods: This study was a cross-sectional investigation within a population-based sample. Two hundred eighty women who had completed a symptom questionnaire were examined according to POP quantification by two gynecologists blinded to symptom reports.

Results: An age- and parity-adjusted logistic regression model, controlling for POP in other compartments, revealed that the feeling of vaginal bulge was specific to prolapse but not to any particular compartment, although the association was strongest with anterior-wall prolapse (odds ratio [OR] for the symptom among women with stage II-IV relative to stage 0 was 5.8, 95% confidence interval [CI] 2.5-13.3). Urge urinary incontinence tended to be linked to POP in either the anterior or posterior wall, but the association was stronger with anterior-wall prolapse. Stress urinary incontinence was strongly linked to posterior-wall prolapse (stage II-IV OR 5.4, 95% CI 1.9-15.2). Self-reports of hard/lumpy stool and difficult or painful defecation tended to be associated with anterior-wall prolapse but without consistent relationships with stage. Painful defecation was the only bowel symptom significantly linked to posterior-wall prolapse (P=.05).

Conclusion: Pelvic floor-related symptoms do not predict the anatomic location of the prolapse in women with mild to moderate prolapse.
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http://dx.doi.org/10.1097/AOG.0b013e318187c550DOI Listing
October 2008

A 5-year prospective follow-up study of vaginal surgery for pelvic organ prolapse.

Int Urogynecol J Pelvic Floor Dysfunct 2008 Dec 12;19(12):1593-601. Epub 2008 Aug 12.

Department of Clinical Science and Education, Södersjukhuset, Section of Obstetrics and Gynaecology, Karolinska Institutet, 118 83, Stockholm, Sweden.

The objective of this study was to evaluate anatomic, functional, short- and long-term outcome of vaginal surgery for pelvic organ prolapse. This was a prospective observational study of 185 consecutive women planned for vaginal prolapse reconstructive surgery. Stage of prolapse, urinary incontinence (UI), bowel and mechanical symptoms were assessed preoperatively and at 1, 3 and 5 years postoperatively. The mean follow-up time was 53 months. The anatomic recurrence rate was 41.1% but less than half of them were symptomatic. Anterior compartment was most prone for recurrence and the majority of the recurrences took place within the first year. UI remained at the same level at 1-year follow-up. De novo urge occurred in 22.6% and de novo stress incontinence in 6.0%. An improvement was seen in difficulty in emptying bowel 1 year after surgery (54%). Patients were primarily cured from mechanical symptoms. Re-operation rate was 9.7%; if additional operation for incontinence was included, it was13.5%.
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http://dx.doi.org/10.1007/s00192-008-0702-zDOI Listing
December 2008

Obstetric risk factors for symptomatic prolapse: a population-based approach.

Am J Obstet Gynecol 2006 Jan;194(1):75-81

Department of Obstetrics and Gynaecology, Stockholm Söder Hospital, Stockholm, Sweden.

Objective: The purpose of this study was to identify obstetric risk factors for symptomatic prolapse.

Study Design: This was a population-based case-control study of prolapse prevalence.

Results: Four hundred fifty-four women with self-reported symptomatic pelvic organ prolapse who were identified among 5489 women who participated in a population survey (cases) and 405 control subjects without symptoms were selected randomly from the same survey. All cases and control subjects received a mailed questionnaire with 72 questions about factors that were suspected to be linked to risk and that included obstetric history. The response rate was 76%. Among parous women, the odds for symptomatic pelvic organ prolapse increased with number of childbirths and were 3.3-fold higher among mothers of 4 than among mothers of 1. Indices of excessive stretching and tearing during labor (vaginal lacerations or episiotomies) were associated with increased risk for symptomatic pelvic organ prolapse. Instrumental delivery with forceps or vacuum did not seem to increase the risk of symptomatic pelvic organ prolapse, nor did length of delivery or maternal age at time for delivery. Abdominal deliveries appeared to be protective; the age- and parity-adjusted odds ratio of symptomatic pelvic organ prolapse after > or =1 abdominal deliveries was 0.5 (95% CI, 0.3-0.9), relative to women who had had only vaginal deliveries. A positive association with child birth weight in unadjusted analyses disappeared after adjustments for attained age and parity of the mother.

Conclusion: Excessive stretching and tearing and multiple deliveries seem to be the main predisposing obstetric factors for symptomatic pelvic organ prolapse. Abdominal delivery emerged as a comparably strong protective factor.
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http://dx.doi.org/10.1016/j.ajog.2005.06.086DOI Listing
January 2006

Prevalence of symptomatic pelvic organ prolapse in a Swedish population.

Int Urogynecol J Pelvic Floor Dysfunct 2005 Nov-Dec;16(6):497-503. Epub 2005 Jun 29.

Department of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm Söder Hospital, 118 83 Stockholm, Sweden.

Our aim was to estimate the prevalence of symptomatic pelvic organ prolapse (POP) in a Swedish urban female population. The cross-sectional study design included 8,000 randomly selected female residents in Stockholm, 30-79-year old. A postal questionnaire enquired about symptomatic POP, using a validated set of five questions, and about urinary incontinence and demographic data. Of 5,489 women providing adequate information, 454 (8.3%, 95% confidence interval 7.3-9.1%) were classified as having symptomatic POP. The prevalence rose with increasing age but leveled off after age 60. In a logistic regression model that disentangled the independent effects, parity emerged as a considerably stronger risk factor than age. There was a ten-fold gradient in prevalence odds of POP with parity, the steepest slope (four-fold) being between nulliparous and primiparous women. The prevalence of frequent stress urinary incontinence was 8.9% and that of frequent urge incontinence 5.9%. Out of the 454 women with prolapse, 37.4% had either or both types of incontinence.
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http://dx.doi.org/10.1007/s00192-005-1326-1DOI Listing
January 2006

A short-form questionnaire identified genital organ prolapse.

J Clin Epidemiol 2005 Jan;58(1):41-6

Department of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm Söder Hospital, Stockholm S-118 83, Sweden.

Objective: We constructed a simple questionnaire that, with a minimum of questions, could accurately and reliably identify women with genital organ prolapse.

Study Design And Setting: Two hundred women with confirmed genital organ prolapse and 199 outpatients with various gynecologic symptoms but no objective prolapse answered 13 questions perceived to be valuable for the diagnosis. With stepwise backward logistic regression, the discriminatory ability of a successively abbreviated set of questions was assessed. The resulting short questionnaire was tested in a new population-based sample of 282 women participating in a screening survey.

Results: A final five-item questionnaire retained 94% of the predictive value of all 13 questions and had 92.5% sensitivity and 94.5% specificity in the first group of women. When the questionnaire was used in the subsequent population-based survey, the sensitivity and specificity values were 66.5% and 94.2%, respectively. Most missed cases had stage I prolapse.

Conclusion: Although the sensitivity of the test was moderate, the specificity, and hence the ability to rule in cases, was satisfactory. The test is suitable for case finding in epidemiologic studies.
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http://dx.doi.org/10.1016/j.jclinepi.2004.06.008DOI Listing
January 2005

Operation for pelvic organ prolapse: a follow-up study.

Acta Obstet Gynecol Scand 2004 Aug;83(8):758-63

Department of Obstetrics and Gynecology, Karolinska Institutet, South Hospital, Stockholm, Sweden.

Objective: Long-term results of surgery for pelvic organ prolapse in terms of objective and subjective cure rates, postoperative complications and side-effects were studied retrospectively.

Methods: Two hundred and sixty-nine women underwent surgery between 1986 and 1988 and were invited to a follow-up visit in 1998-99. One hundred and twenty-eight (47%) women attended the follow-up. In the time between surgery and follow-up, 67 (25%) women had died. The medical records were reviewed for women not attending follow-up (n = 131), revealing a higher age and a more severe prolapse in the lost to follow-up group.

Results: The subjective cure rate, with cure of all symptoms of pelvic organ prolapse, was 46% (n = 59). The objective cure rate, with satisfactory anatomic outcome, was 56% (n = 72). If perfect results had been attained in the women who did not undergo follow-up examination, the subjective and objective cure rates would be 73% and 79%, respectively. Previous prolapse surgery, a traumatic delivery, urinary incontinence and a prolapse stage III or more seemed to be risk factors for an adverse outcome.

Conclusions: In evaluating the cure rate of pelvic floor surgery not only the anatomic outcome should be studied but also the outcome in terms of side-effects and/or symptoms as resolved, persistent or new onset. An unsatisfactory anatomic outcome was not necessarily associated with symptoms. The modest cure rate after surgery may be due to the aggravation with time of pelvic floor disorder, this confounding the results of surgery.
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http://dx.doi.org/10.1111/j.0001-6349.2004.00468.xDOI Listing
August 2004