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International Urogynecology Journal

, Volume 29, Issue 10, pp 1435–1440 | Cite as

Functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic

  • Friyan Turel
  • Delena Caagbay
  • Hans Peter Dietz
Original Article

Abstract

Introduction and hypothesis

Limited existing evidence suggests that there is a high prevalence of female pelvic organ prolapse (POP) amongst Nepali women. However, to date, no comprehensive assessment of pelvic floor functional anatomy has been undertaken in this population. Our study aimed to determine functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic.

Methods

One hundred and twenty-nine consecutive women attending the clinic were offered an interview, clinical examination [International Continence Society Pelvic Organ Prolapse Quantification system (ICS/POP-Q)] and 4D translabial ultrasound (TLUS). Most presented with general gynaecological complaints. Five were excluded due to previous pelvic surgery, leaving 124.

Results

A POP-Q exam was possible in 123 women, of whom 29 (24%) were diagnosed with a significant cystocele, 50 (41%) significant uterine prolapse and seven (6%) significant posterior compartment prolapse. Evaluation of 4D TLUS data sets was possible in 120 women, of whom 25 (21%) had a significant cystocele, 45 (38%) significant uterine prolapse and ten (8%) significant descent of the rectal ampulla. In 13 cases, there was a rectocele with a mean depth of 14 (10–28) mm. Of 114 women in whom uterine position could be determined, 68 (60%) had a retroverted uterus associated with significant uterine prolapse (P 0.038).

Conclusions

POP is common in Nepali women attending a general gynaecology clinic, with a high prevalence of uterine prolapse (40%). Uterine retroversion was seen in 60% and was associated with uterine prolapse. Patterns of POP in Nepal seem to be different from patterns observed in Western populations.

Keywords

Nepal Pelvic floor Pelvic organ prolapse Translabial ultrasound Uterine prolapse 

Abbreviations

ICS/POP-Q

International Continence Society, Pelvic Organ Prolapse Quantification system

TLUS

4D Translabial ultrasound

POP

Pelvic organ prolapse

VAS

Visual analogue scale

PFM

Pelvic floor muscle

PFMC

Pelvic floor muscle contraction

LAM

Levator ani muscle

EAS

External anal sphincter

SP

Symphysis pubis

COPD

Chronic obstructive pulmonary disease

Notes

Acknowledgements

The authors thank the women who participated in this study. We also thank staff at Kathmandu Model Hospital for their assistance and generosity with their limited space. We are especially grateful to Dr. Vishal Kumar Trivedi for excellent assistance during data collection.

Compliance with ethical standards

Conflict of interest

H.P. Dietz has received unrestricted educational grants from GE Medical. F. Turel and D. Caagbay have no conflict of interest to declare.

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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  • Friyan Turel
    • 1
  • Delena Caagbay
    • 2
  • Hans Peter Dietz
    • 1
  1. 1.Department of Obstetrics, Gynecology & Neonatology, Sydney Medical School NepeanThe University of SydneyKingswoodAustralia
  2. 2.The University of Sydney, AustraliaSydneyAustralia

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