Prevalence and management of pelvic organ prolapse. A retrospective cohort study

Abstract

Background: Pelvic organ prolapse (POP) is a major public health problem. It corresponds to the descent of female pelvic organs, such as the bladder, uterus or post-hysterectomy vaginal cuff, and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. The objective of this study was to determine the incidence, socio-demographic profile of patients, the management and outcomes of POP in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent management of POP between 1 January 2015 and 31 December 2022 at the Mother and Child Health Centre (MCHC) in Maradi, Niger. The epidemiological data, treatment, and outcomes of POP were collated and subjected to analysis using the statistical software package Epi infos 7.2.5. Comparisons were made using the Chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 358 cases of POP were recorded out of a total of 12536 patients treated in the department, representing a frequency of 2.8%. The mean age of the patients was 46.14 years (range: 17–90 years). The patients were identified as married (307 cases, 85.75%), unemployed (353 cases, 98.6%) and not attending school (332 cases, 92.74%). The largest number of cases were observed in large multiparous women (i.e., those with more than five children), representing 60.05% of the total number of cases (215 patients). The average parity among this group was 6.5 children. The vast majority of patients (269 cases, 75.14%) lived in rural areas. The most frequent motif for consultation were the sensation of mass in the vagina (146 acs,40.78%) and vulvar swelling (138 cas, 38.55%). The most frequent genital prolapses type was middle, made of the hysterocele essentially (150 cases, 41,90%). The stage III of genital prolapses was the most frequent in 76.51% (274 cases). All patients underwent surgical treatment (100%), and the vaginal access was most used in 57.55% (206 cases) of cases. Conservative treatment was performed in the majority of patients (197 cases, 55.02%). The most frequent intraoperative complications were the vesical lesions in 0.56% (2 cases) and ureteral and vascular lesion in 0,28% (1 case). The post-therapeutical evolution was marked by the disappearance of genital prolapses in 100% of cases, no cases of recurrence of prolapse have been observed. Conclusion: Our findings are in close alignment with those previously documented in the literature. POP is a common occurrence in our region. Surgical treatment is the most practiced and hysterectomy by vaginal surgical approach is the most practiced. Treatment by transvaginal polypropylene prostheses is not available in our region.