Talk:Uterine prolapse

Uterine prolapse in elderly women
what is the main reasion for uterine proplase in elderly women? — Preceding unsigned comment added by 255.255.255.255 (talk) 00:00, 01 January 2000 (UTC)
 * Weakening of the muscles in the abdominal cavity and looser connective tissues. OjdvQ9fNJWl (talk) 04:17, 24 May 2012 (UTC)

Wiki Education assignment: WikiProject Medicine Winter 2023 UCF COM
— Assignment last updated by DLEMERGEBM (talk) 00:27, 27 January 2023 (UTC)

Medical Student Wiki Project 2023
Hello everybody! I will be editing this page on uterine prolapse and hopefully adding some useful information for readers. I just wanted to post the draft of my workplan here, which will likely evolve over time as I research the topic. I followed the Manual of Style that Wiki prefers for medical conditions. I'll also add my reference list here as I find new sources. I'd appreciate any feedback to the workplan since this is my first time editing a Wikipedia article!

Workplan:

Classification: As mentioned in the header, this is a form of pelvic organ prolapse. I believe that it can be categorized by extent of prolapse but I will research possible classification styles. If there is no specific classification used here, I'll omit this section.

Presentation: The header discusses signs and symptoms fairly well but to keep with the style of this article, the presentation can be its own section as well

Pathophysiology: Add image for clarification

Diagnosis: As mentioned, it is based on physical exam but we can discuss findings for positive diagnosis

Prevention: Mentioned in header but may be useful if this is a separate section with referenced statistics if that information is available

Management: Conservative vs surgical management; outcomes associated with each type, and best candidates for each type. It might be helpful to add images of pessaries being used for treatment or an diagram of sacrohysteropexy surgery

Outcomes and Prognosis: Describe outcomes and short/long-term prognosis of uterine prolapse with and without management

Epidemiology: May discuss epidemiology of uterine prolapse in the United States and potentially broaden this section depending on availability of data worldwide

History: Would be interesting to very briefly discuss the history of uterine prolapse as it relates to women's health if I can find that information through reliable sources

Society and Culture: article mentions lawsuits related to the mesh used during surgery. It may be interesting to expand on that section a bit to add clarification for readers. --PPatel224 (talk) 16:22, 12 January 2023 (UTC)


 * Hi PPatel224 - I completed a peer review of your article changes. The link for the review is below, but I'm also including the text below. Overall, I just wanted to say that I think your contributions have been terrific and add greatly to the understanding and flow of this article. My suggestions are relatively minor, identifying lines without references and small changes you might consider for increased understanding/clarity and grammar/spelling.


 * https://en.wikipedia.org/wiki/User:PPatel224/Uterine_prolapse/Typemd21_Peer_Review

Evaluate the drafted changes


 * You've made some incredible contributions to this page - thank you for your work and for such enlightening material that is sure to help many individuals. My feedback with the guiding review is below:


 * Lead


 * Guiding questions:

Has the Lead been updated to reflect the new content added by your peer?


 * Yes, I can clearly see that you've updated the lead and have in fact made it very efficient and precise with pertinent details.

Does the Lead include an introductory sentence that concisely and clearly describes the article's topic?


 * Yes, it does.

Does the Lead include a brief description of the article's major sections?


 * It does in most cases - I understand not including so much of the history or social/cultural aspects of the disease, especially as these points are not very detailed or necessarily pertinent to the point of the article. You may consider adding a very brief mention of the major cause of prolapse, as well as the predominantly shared value for incidence of prolapse (perhaps with a short statement saying that the values appear to be exam-dependent) and statement of typical outcome.

Does the Lead include information that is not present in the article?


 * I wasn't initially certain where risk factors were found in the article, but I did eventually find it embedded in the Causes section. I don't think it needs to be more clearly distinguished, but in the event that you think it's important for readers to be able to find those factors quickly, it's something to consider. Otherwise, no, the lead covers details of the article very well.

Is the Lead concise or is it overly detailed?


 * It is perfectly concise - enough detail is provided to answer quick questions a reader might have about the topic, but it does not go into greater specifics that would be better covered in the article body.

Content


 * Guiding questions:

Is the content added relevant to the topic?


 * Yes, it is incredibly relevant. The detailed but efficient discussion in Management was an excellent contribution for afflicted individuals who are likely very concerned about next steps in their care. Likewise, the images included really elevate the article so that anyone reviewing this topic has a much easier understanding of what is happening, both in the pathophysiology and in the treatment of this disorder.

Is the content added up-to-date?


 * Yes - based on guidelines I'm familiar with and in evaluating the references provided, the added content is current.

Is there content that is missing or content that does not belong?


 * I noticed that the draft article includes a little more detail in some areas (specifically, one sentence in the Diagnosis section that describes the physical exam in slightly greater detail). I think that the content could be valuable for the main page, particularly for readers who are not familiar with pelvic exams or who may not be expecting that a pelvic exam is part of the physical exam process - especially if you link them to other wikiarticles that go through the process in even greater detail.


 * I wouldn't classify this as content that does not belong but this particular line in Outcomes (For apical prolapse specifically, a meta-analysis found the reoperation rates for traditional vaginal vault suspension (meaning sacrospinous ligament fixation and uterosacral ligament vaginal vault suspension), sacrocolpopexy, and transvaginal mesh procedure were 3.9%, 2.3%, and 1.3% respectively) may be a little too technical for the common reader. An image that demonstrates these anatomical features may be beneficial, otherwise it might be best to condense this down to a very simple statement like...multiple types of surgical procedures for suspension also have low reoperation rates?

Does the article deal with one of Wikipedia's equity gaps? Does it address topics related to historically underrepresented populations or topics?


 * Yes, this disorder is predominantly faced by women but may also occur in transsexual individuals following sexual reassignment surgeries or in transgender males. The latter two populations are not addressed yet in the article, so this is an area that could strengthen the article in the future! I do appreciate that it covers some of the more worrisome complications that occurred with transvaginal mesh for full disclosure and neutrality on the topic.

Tone and Balance


 * Guiding questions:

Is the content added neutral?


 * Yes, the content is neutral - you use several qualifiers to suggest neutrality (e.g., "normally", "typical procedure", "may include") and in cases where consensus does not exist or data is conflicting, you make this clear while providing only factual statements for the reader to make their own judgments.

Are there any claims that appear heavily biased toward a particular position?


 * No claims that were added appeared to be heavily biased toward a particular position.

Are there viewpoints that are overrepresented, or underrepresented?


 * No viewpoints appeared to be over or underrepresented. History had more content change than other sections, but it seems that this was due to the nature of the existing article having very little in this section.

Does the content added attempt to persuade the reader in favor of one position or away from another?


 * The content does not sound persuasive - statements appear either factual or neutral when multiple choices are available. I think you did a particularly great job with the management discussion of surgeries, where it might be easy to bias patients toward a particular procedure: instead, you provide what is generally preferred but qualify that the alternative is preferred for certain conditions (e.g., abdominal procedures may reduce risk of postoperative intercourse pain).

Sources and References


 * Guiding questions:

Is all new content backed up by a reliable secondary source of information?


 * Yes, nearly every reference is either a textbook or systematic review, except where appropriate (e.g., historical news discussions reference appropriate news articles). Only a few lines were not supported by any reference:

- (Causes) The causes of uterine prolapse are generally the same as the causes of other forms of pelvic organ prolapse.

- (Management) Pessaries are a mechanical treatment that supports the vagina and elevates the prolapsed uterus to its anatomically correct position.

- (Management) In severe cases of prolapse where the person no longer desires vaginal intercourse and has contraindications to more invasive surgery, vaginal closure procedures may be offered.

- (Management) Also taken into consideration prior to surgery is use of native, or one's own, tissue versus a synthetic mesh.

- (History) By the early 20th century, different techniques for vaginal hysterectomies had been described and performed.

- (History) Throughout history, the management of uterine prolapse has been hampered by a poor understand of female pelvic anatomy.

- (History) During the first century C.E., the Greek physician Soranus would disagree with many of these practices and recommend the use of wool, dipped in vinegar or wine and inserted into the vagina, to lift the uterus back into place.

- (History) Pessaries were usually made out of wax, metal, glass, or wood.

- (History) In 1861, Choppin in New Orleans reported the first instance in which vaginal hysterectomy was performed for uterine prolapse.

- (History) In 1957, Arthure and Savage of London's Charing Cross Hospital, suspecting that uterine prolapse could not be cured with hysterectomy alone, published their surgical technique of sacral hysteropexy.

Does the content accurately reflect what the cited sources say? (You'll need to refer to the sources to check this.)


 * Spot-checking several of the sources, the content was consistent with cited references.

Are the sources thorough - i.e. Do they reflect the available literature on the topic? Are the sources current? Are the sources written by a diverse spectrum of authors? Do they include historically marginalized individuals where possible?


 * Yes, I think you did a terrific job with the variety of sources, including multiple textbooks and systematic reviews. The sources are generally all published within the last 7 years (the oldest is 2007, but most range from 2016-2022 and I was really impressed with the number of included texts that were published just in the past 2 years). The textbooks are written by numerous different authors, introducing good variety in professional opinion and experience; different specialties are also included to provide greater detail regarding specific aspects of the disorder (e.g., urogynecology textbooks vs more general textbooks in the field of OBGYN).

Are there better sources available, such as peer-reviewed articles in place of news coverage or random websites? (You may need to do some digging to answer this.)


 * I think in the rare instances you used news coverage, your article source was appropriate (The New York Times); however, you may be interested in this systematic review that did a little bit of a deeper dive into the FDA approval process for mesh products![1]

Check a few links. Do they work?


 * Yes they do! My only additional comment is that you had one duplicate source: 22/23 in your sandbox article are both Culligan's Urogynecology in Primary Care (2007).

Organization


 * Guiding questions:

Is the content added well-written - i.e. Is it concise, clear, and easy to read?


 * Generally yes, it is very well-written with great flow. I found it very easy to read most sections, though there are areas in Management and Outcomes relating to specific anatomical areas or procedures that may be a little too technical for readers. I know you already introduced several great images, but those particular sections might benefit from a reminder of the anatomy in question to help guide readers if you think the terminology cannot be reduced down further!


 * Here are a few sections where you might reconsider some word choice to make it easier for readers to understand - these are just suggestions! I think generally, you did a really great job of making it accessible to the majority of readers:

- (From Signs and Symptoms) The severity of prolapse symptoms does not necessarily correlate with the degree of prolapse...

- (Causes) Operative vaginal delivery, such as when forceps are used, has been found to increase the odds of pelvic organ prolapse when compared to non-operative vaginal delivery [you might consider linking operative vaginal delivery so readers can understand better what this entails]

- (Causes) Age also plays a significant role in uterine prolapse, with prevalence increasing with each decade of life due in part to age-related changes to pelvic support structures and estrogen depletion during menopause.

- (Pathophysiology) The uterosacral ligaments are especially important in providing support to the uterus by suspending and anchoring the uterus, cervix, and upper vagina to parts of the pelvic wall.[2]

- (Management) Laparoscopic and robotic approaches to abdominal procedures in prolapse surgery have become more common as they require smaller incision sites, result in less blood loss, and have shorter hospital stays [consider linking "Laparoscopic" so readers can understand what that means]

- (Management) However, the use of synthetic mesh transvaginally, or within the vaginal tissue itself, is not indicated and is not routinely used due to a lack of safety and efficacy data, higher rate of mesh erosion compared with native tissue repair, and lack of data regarding long-term outcomes and complication rates

Does the content added have any grammatical or spelling errors?


 * Yes, just a few - here are the ones that stood out to me:

- (From signs and symptoms): People may also report sexual dysfunction symptoms, such as pain with sexual intercourse and decreased libido...

- (From signs and symptoms): The severity of the symptoms associated with prolapse seems to have a negative effect on sexual activity and reported satisfaction.

- (Pathophysiology) The levator ani muscle plays the most significant role in pelvic organ support by acting as a basket that keeps the pelvic organs suspended.

- (Pathophysiology) Problems with the vaginal wall, such as [delete through] trauma or loss of smooth muscle support in the wall, can lead to the uterus collapsing downward due to a loss of support.

- (Pathophysiology) Estrogen deficiency, [delete such as] [add which can occur] during menopause, can affect the production of collagen that is needed to build connective tissue...

- (History) Throughout history, the management of uterine prolapse has been hampered by a poor understanding of female pelvic anatomy.

- (History) During the Hippocratic era, approximately 460 B.C.E., it was thought that the uterus was similar to [that of] an animal's.

- (History) During the first century C.E., the Greek physician Soranus would disagree with many of these practices and recommended the use of wool, dipped in vinegar or wine and inserted into the vagina, to lift the uterus back into place.

- (History) He would also go on to recommend surgical treatment of gangrenous portions of a prolapsed uterus.

- (History) However, even into the 1800s, alternative practices were still used, such as [add the] use [add of] astringents, sea-water douches, postural exercises, and leeching.

- (History) Although the use of surgery in [delete the] the treatment of uterine prolapse...

- (History) in [capitalize first word] 1877, LeFort described the process

Is the content added well-organized - i.e. broken down into sections that reflect the major points of the topic?


 * Yes - the content follows the manual of style and does reflect major points in the topic that should be addressed.

Images and Media


 * Guiding questions: If your peer added images or media

Does the article include images that enhance understanding of the topic?


 * Yes, the articles included were terrific and enhanced the understanding of the topic in this article. I made some suggestions above in the areas that discuss different types of surgical procedures - I'm not sure if images exist to either demonstrate the surgical procedure or highlight the anatomical features involved, but those images may contribute greatly to the understanding of those sections.

Are images well-captioned?


 * The captions are good - my only suggestion might be that "bilaterally paired" (uterosacral ligaments) may be a little too advanced for some readers to understand. You might also clarify what the sacrum is in more layman's terms!

Do all images adhere to Wikipedia's copyright regulations? Are the images laid out in a visually appealing way?


 * Yes, the images follow copyright regulations and are laid out in a way that makes sense and flows with the article.

Overall impressions


 * Guiding questions:

Has the content added improved the overall quality of the article - i.e. Is the article more complete?


 * Yes, the article has significantly improved with your additions, particularly clarifying management and providing graphics that help improve understanding.

What are the strengths of the content added?


 * Your content is relevant for afflicted individuals who may be looking for next steps in their care and is easy enough to understand that the average reader can understand the disorder very well.

How can the content added be improved?


 * I think just making a few of the recommended changes above for minor things (references after the lines identified above, grammar changes, rephrasing for improved understanding) would make this absolutely stellar, but overall I think you did an amazing job and have really helped anyone who's interested in learning more about this topic.


 * Heneghan, Carl J.; Goldacre, Ben; Onakpoya, Igho; Aronson, Jeffrey K.; Jefferson, Tom; Pluddemann, Annette; Mahtani, Kamal R. (2017-12-06). "Trials of transvaginal mesh devices for pelvic organ prolapse: a systematic database review of the US FDA approval process". BMJ open. 7 (12): e017125. doi:10.1136/bmjopen-2017-017125. ISSN 2044-6055. PMC 5728256. PMID 29212782.
 * Hoffman, Barbara L.; Bradshaw, Karen D.; Schaffer, Joseph I.; Halvorson, Lisa M.; Corton, Marlene M. (2020). Williams Gynecology (Fourth ed.). New York: McGraw-Hill Education. ISBN 978-1-260-45687-5. OCLC 1120727710. Retrieved Jan 17, 2023.


 * I hope this helps! Great job! Typemd21 (talk) 17:30, 31 January 2023 (UTC)


 * Thank you so much for the wonderful feedback, Typemd21! I very much appreciate the time and effort that you put into it! I did edit the lead to include a bit more information and also edited the article in general based on your recommendations to improve readability. I also included the transvaginal mesh study that you referenced since I hadn't come across it in my research. I agree that this article can be greatly improved by adding information about uterine prolapse as it relates to transgender men. Unfortunately, I could not find a credible source with that information, and all of the included studies focused on cisgender women. The studies that included trans individuals centered around pelvic organ prolapse with regards to transgender women who underwent gender reassignment surgery, which I think would be better suited for the POP wiki page. There was also a surprisingly lack of images available for pelvic organ surgeries in general, so I couldn't add more photos to the surgical section. But I think that this article is much better now than it was a few days ago all thanks to your amazing feedback and recommendations! --PPatel224 (talk) 17:19, 2 February 2023 (UTC)

Socioeconomic status
There is a well known association between uterine prolapse and socioeconomic status. For example see (1), where the rate of severe prolapse falls of sharply for income above poverty level.

Moreover, obstetricians have known about this for a very long time. It was not discussed openly.

It is a little disturbing to see it omitted from this page in 2024. To the student editor, please educate yourself and add it to the page.

(1) Woodman, P.J., Swift, S.E., O’Boyle, A.L. et al. Prevalence of severe pelvic organ prolapse in relation to job description and socioeconomic status: a multicenter cross-sectional study. Int Urogynecol J 17, 340–345 (2006). https://doi.org/10.1007/s00192-005-0009-2 96.225.84.78 (talk) 17:29, 26 April 2024 (UTC)