Abdool Zeelha, Dietz Hans Peter, Lindeque Barend Gerhardus
Division of Urogynaecology, Department of Obstetrics and Gynaecology, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.
Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Int Urogynecol J. 2018 May;29(5):745-750. doi: 10.1007/s00192-017-3391-7. Epub 2017 Jun 17.
There is a lack of epidemiological studies evaluating female pelvic organ prolapse in developing countries. Current studies have largely focused on women of white ethnicity. This study was designed to determine interethnic variation in pelvic floor functional anatomy, namely, levator hiatal distensibility and pelvic organ descent, in women with symptomatic pelvic organ prolapse in a multi-ethnic South African population.
This prospective observational study included 258 consecutive women referred for pelvic organ prolapse assessment and management at a tertiary urogynaecological clinic. After a detailed history and clinical examination, including POPQ assessment, patients underwent a 4D transperineal ultrasound. Offline analysis was performed using 4D View software. Main outcome measures included levator muscle distensibility, pelvic organ descent, and levator ani defects (avulsion).
Mean age was 60.6 (range, 25-91) years, mean BMI 29.83 (range, 18-53). Points Ba and C were lower and the genital hiatus more distensible in black women (all p < 0.05). They were found to have greater hiatal area (p = 0.017 at rest, p = 0.006 on Valsalva) compared with South Asians and whites and showed greater pelvic organ mobility (all p < 0.05) than Caucasians on ultrasound. Levator defects were found in 32.2% (n = 83) of patients and most were bilateral (48.2%, n = 40), with significant interethnic differences (p = 0.014).
There was significant variation in clinical prolapse stage, levator distensibility, and pelvic organ descent in this racially diverse population presenting with pelvic organ prolapse, with South Asians having a lower avulsion rate than the other two ethnic groups (p = 0.014).
发展中国家缺乏评估女性盆腔器官脱垂的流行病学研究。目前的研究主要集中在白人女性身上。本研究旨在确定南非多民族人群中，有症状盆腔器官脱垂女性盆底功能解剖结构的种族间差异，即提肌裂孔扩张性和盆腔器官下移情况。
这项前瞻性观察性研究纳入了在一家三级泌尿妇科诊所连续转诊进行盆腔器官脱垂评估和治疗的258名女性。在进行详细的病史询问和临床检查（包括盆腔器官脱垂定量分期系统评估）后，患者接受了经会阴四维超声检查。使用4D View软件进行离线分析。主要观察指标包括提肌扩张性、盆腔器官下移情况以及肛提肌缺陷（撕裂）。
平均年龄为60.6岁（范围25 - 91岁），平均体重指数为29.83（范围18 - 53）。黑人女性的Ba点和C点较低，生殖裂孔更易扩张（均p < 0.05）。与南亚人和白人相比，她们在静息时（p = 0.017）和做瓦尔萨尔瓦动作时（p = 0.006）的裂孔面积更大，并且超声检查显示其盆腔器官活动度比白种人更大（均p < 0.05）。32.2%（n = 83）的患者存在提肌缺陷，大多数为双侧（48.2%，n = 40），种族间差异显著（p = 0.014）。
在这个呈现盆腔器官脱垂的种族多样化人群中，临床脱垂阶段、提肌扩张性和盆腔器官下移情况存在显著差异，南亚人的撕裂率低于其他两个种族（p = 0.014）。
