Vaginal pessary is widely used in treating pelvic organ prolapse. It is a safe treatment option and well accepted by majority of women in Hong Kong. Our unit is conducting research projects studying the long term usage and complications in its use in women with pelvic organ prolapse with or without urinary incontinence.
Perineal or translabial ultrasound is a non-invasive technology studying the pelvic floor of women. It is easily assessable and well tolerated by women. Our unit is performing researches to study the pelvic floor biometry of women with pelvic floor dysfunction. We focus on the changes of pelvic floor biometry before and after different treatments and exploring the relationship of different pelvic floor parameters with the treatment outcome.
Our unit obtained grant Health and Medical Research Fund (HMRF) to conduct this prospective observational study. In addition to the women recruited in the study listed below, women who required instrumental delivery and studied previously are included in this study. The unit will focus on the prevalence of symptoms of pelvic floor disorders, quality of life of women and the pelvic floor biometry findings by perineal ultrasound. The mode of delivery in their first pregnancy, subsequent delivery, and other factors affecting the symptoms of pelvic floor disorders or the pelvic floor biometry findings will be evaluated.
Our unit obtained grant from Health and Health Services_ Research Fund to conduct this prospective observational study. Using perineal ultrasound technology, the pelvic floor biometries of women who carry their first singleton pregnancy are demonstrated to have changes as the pregnancy progress. Symptoms of pelvic floor disorders, such as urinary incontinence, increase as the pregnancy progress. And some of the pelvic floor biometries are associated with the symptoms. Shortly after delivery, about 22% of women have levator ani muscle injury. There is increase in pelvic organ mobility and hiatal area after vaginal delivery. With a longer follow-up till one year, some recovery of the pelvic floor is observed. Some changes persist even in women received elective caesarean delivery without labour. By one year after delivery, when compared women delivered vaginally with women delivered by caesarean section, the only more commonly reported symptom is stress urinary incontinence. There is also a larger hiatal area on perineal ultrasound. Although levator ani muscle injury is a risk factor for a larger hiatal area, there is no significant difference in symptoms of pelvic floor disorders or quality of life between women with or without this condition.
Both urinary incontinence and pelvic organ prolapse are common in women. Women suffering from these conditions have bothersome symptoms and even symptoms arising from different organs. Their quality of life is affected. Disease-specific quality of life questionnaires for these two conditions have been available in other languages but not in Chinese previously. Chinese validation of Urogenital Distress Inventory and Urinary Impact Questionnaire short form has been performed from 2008 to 2009 and they were available for use since 2010. Our unit obtained grant from Health and Health Service Research Fund to conduct Chinese validation of Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. They were available for use since 2011; and the responsiveness has also been established in 2012. Our unit has conducted many studies evaluating the symptoms and quality of life of Chinese women suffering from these conditions and objectively evaluated their treatment outcome after conservative or surgical treatment.
Our unit reviewed the outcome of treatments in women who received either conservative or surgical treatments for urinary incontinence and/or pelvic organ prolapse. These included pelvic floor exercises for women with urinary incontinence, e.g. stress urinary incontinence or urge urinary incontinence, different types of transobturator tension free transvaginal tape surgery for urinary stress incontinence, laparoscopic sacrocolpopexy with or without robotic assistance for vaginal vault prolapse, vaginal mesh repair surgery for pelvic organ prolapse. These provide us update-to-date information to counsel women suffer from these conditions and choose the appropriate treatment options.