Reviewer’s report
Title: 
"Locus minoris resistentiae" and connective tissue weakness in older
women: a case report and literature review on pelvic organ prolapse with
inguinal bladder hernia
Version: 
0 
Date: 
04 Oct 2020
Reviewer's report:
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BMC Women's Health
Locus minoris resistentiae and connective tissue weakness in old age - a case
series of female pelvic organ prolapse combined with inguinal bladder hernia
and review of the literature.
Manuscript Number:BMWH-D-20-00784
Generally
The title reflects the case report. 
It is an exciting subject in gynaecology 
It will be helpful in treatment. 
The study is (not Original)
The message of the study has additional knowledge of medical literature. 
Background: 
short and well written
Case presentation: 
Three cases of medial 3 
rd 
grade inguinal bladder hernia
(MIII,Aachen classification)
at follow-up after stage IV pelvic organ prolapse repair at a university Pelvic
Floor Centre 
Patients age was 80.1 years; all were postmenopausal > 10 years.
The longest follow up interval was five years, in two patients6 months.
A medial 3 
rd grade inguinal hernia had developed or enlarged after successful
reconstructive surgery for POP.
In all patients the hernia sac as detected by ultrasound was containing urinary
bladder having herniated through the inguinal hernia orifice.
The literature search revealed only one case report on female inguinal bladder
hernia and few scientific investigations on the simultaneous condition POP and
hernia in general.
Conclusion: 
Simultaneous occurrence of inguinal hernia and female POP can lead to bladder
hernias after prolapse surgery in the sense of a "locus minoris resistentiae".
Clinical examination for simultaneous signs of connective tissue weakness and
counselling before pelvic reconstructiveupd help to increase patient ́scompliance
for further surgical hernia treatment
The cases reports are written in (English language with few spelling and
grammar mistakes.)
The aim of the presentation is not clear. 
There are few figures apparent and illustrates the cases very well. 
The length of the cases reports appropriate.
Plagiarism .. There are a few sentences in the manuscript taken from the web. 
No conflicts of interests
Ethically approved and patients have consented. 
References; 22 references, some references are old before 2010 not verified or
not checked)
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