Genital prolapse in Port Harcourt, Nigeria

Damage to the genitourinary supports from repeated pregnancies and labour is the most important predisposing aetiological factor in genital prolapse, a chronic gynaecological disorder that causes distressing morbidity (stress urinary incontinence, micturitional difficulties and problems of defecation).

To determine the pattern of presentation and management of genital prolapse at the University of Port Harcourt Teaching Hospital, and compare with experience elsewhere.

Retrospective review of all cases of genital prolapse admitted and operated upon during the period January 1990 to December 1999. Data collected and analyzed by simple percentages included sociodemographic characteristics, aspects of clinical presentation, management modality and outcome.

Genital prolapse (118 cases) accounted for 37.5 per 1,000 gynaecological admissions during the study period. Seventy percent of the study subjects were above age 45 years, while seventy-three percent were grandmultiparous. Thirty percent were of reproductive age. The commonest symptom was "something coming down the vagina" (95% of the study subjects). Only 4% had stress incontinence. Second degree prolapse was the commonest finding on presentation (68.6%) while vaginal hysterectomy with pelvic floor repair was the main operative procedure (undertaken in 73.7% of the subjects). Postoperative deaths occurred in two patients, both diabetics (case fatality ratio 1:59) from septicaemia and intestinal obstruction respectively following vaginal hysterectomy. Postoperative morbidity following vaginal hysterectomy was also higher than that following Manchester Repair.

This study's results are similar to previous findings in Nigeria and other developing countries. Measures to reduce grandmultiparity, difficult deliveries and postoperative morbidity and mortality are advocated.