Incidence of pelvic organ prolapse in Nigerian women.

OBJECTIVE: To establish the incidence and types of utero-vaginal prolapse.
METHODS: Retrospective medical records analyses of women who were subjected to reconstructive pelvic surgery for various types of pelvic relaxation at the Nnamdi Azikiwe University Teaching Hospital, Nnewi and the University Of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. The study was conducted from January 1996 to December 1999 during which there were 7515 surgical admissions. The inclusion criteria were those women who complained of feeling a mass in the vagina with demonAstrable descent of the anterior and/or posterior and/or apical vaginal walls and/or perineal descent. Excluded were patients who had other symptoms other than utero-vaginal prolapse and those whose grades and sites of prolapse were not determinable from the clinical or surgical notes. Also excluded were patients with nerve injury or disease, connective tissue disorders and neuromuscular diseases. The subjects were divided into two groups. Group I consisted of 54 women (age < or = 40 years), and group II included 105 women (age > or = 40 years). The findings between those two groups were compared with reference to sites, types and degree of prolapse. Also, coexistence of pelvic relaxation and underlying medical conditions were evaluated.
RESULTS: A total of 159 subjects out of 492 charts studied met the inclusion criteria for the study. In group I, mean age was 32.839 with a standard deviation (SD) of +/- 6.012 years; and in group II the mean age was 56.543 with a SD of 8.094. Hypertrophic (elongated) cervix was determined in 15 (6.3%) subjects in group I for an incidence of 1.58% per year, cystocele (vaginal anterior wall descent) was present in 21 (8.9%) women for an incidence of 2.2% per year; rectocele (posterior vaginal wall descent) was identified in 15 (6.3%) women for an incidence of 1.58% per year; vaginal cough prolapse (apical descent) was present 21 (8.9%) women for an incidence of 2.2% per year. Perineal descent was absent in this group. In group II, there was no hypertrophic cervix; cystocele was present in 39 (16.5%) cases for an incidence of 4.13% per year; rectocele was identified in 27 (11.4%) women, amounting to an incidence of 2.85% per year; vaginal cough prolapse was present in 36 (15.%) women, an incidence of 3.75% per year; perineal descent was present in 63 (25.6%) women, for an incidence of 6.4% per year.
CONCLUSION: (1) The incidence of hypertrophic cervix without any other abnormality amounted to 1.58% per year. This medical entity can present as uterine prolapse and was noted only in group I. (2) The annual incidence for hospital admission with a diagnosis of uterine prolapse was 2.1%. (3) The incidence of cystocele, and rectocele was not statistically different in the two groups; but the incidence of perineal descent and uterine prolapse were significantly more in group II than group I. (4) The etiology of hypertrophic cervix is not known, but it is of importance especially in the childbearing age when it may be related to prolonged pregnancy, cervical dystocia, etc.