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Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Twenty-five women (mean age 72.8 years) with massive eversion of the vagina were treated with transvaginal sacrospinous ligament colpopexy between 1986 and 1990. Nine of them had a posthysterectomy vaginal prolapse; 16 had complete genital prolapse and coincident vaginal hysterectomy was performed. The operation was performed under spinal anesthesia in all cases except one with general anesthesia. Simultaneous anterior colporrhaphy was done in 88%, repair of enterocele in 72% and posterior colpoperineorrhaphy in 88% of all cases. There were no intra- or post-operative complications. Vaginal vault prolapse did not recur during a mean follow-up period of 2.8 years in 22 cases. Three patients developed asymptomatic cystocele or enterocele, and 5 (23%) women had a curtailed vagina. Sacrospinous ligament colpopexy under regional anesthesia is an effective and suitable operation for aged women with vaginal vault and complete genital prolapse. The operation is also a safe and fairly simple procedure if the anatomic relationship of the nearby structures is known.
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PMID:Transvaginal sacrospinous colpopexy for vaginal vault and complete genital prolapse in aged women. 132 14

A urethrocystohysterography (UCHG) and a prolapse scoring system (PSS) have been used to assess the types of uterine prolapse and postoperative outcomes since 1979. UCHG was useful in identifying the type of uterine prolapse and in selecting operative procedure. UCHG was done by injecting contrast medium into the bladder and uterine cavity and inserting a metallic bead chain into the urethra. A lateral pelvic X-ray was then taken at rest and during straining. The length of the uterus (UL), distance from the pelvic outlet (PO) to the bladder base (BB), distance from PO to the uterine fundus (UF), and distance from the ischial spine (IS) to UF were measured on the UCHG. We found that there were three types of uterine prolapse on the UCHG findings, type 1: cervical elongation without descent of uterine fundus and cystocele, type 2: uterine prolapse with moderate descent of uterine fundus and cystocele, and type 3: giant vaginal eversion including completely prolapsed uterus, marked cystocele, enterocele and rectocele. The operative time of vaginal hysterectomy with anterior and posterior colporthaphy (VH with AP repair) correlated well with UL and PO-UF distance on UCHG, and blood loss. Operating time was significantly shorter and amount of blood loss was significantly smaller in cases of Machester operation (cervical amputation, fixation of cardinal ligament stumps to the anterior wall of the remaining cervix and AP repair) than in those of VH with AP repair.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Individualization of operative procedures for uterine prolapse based on categorization using X-ray urethrocystohysterography and postoperative outcomes evaluated with a scoring system]. 140 22

During 1985 to 1989, 177 vaginal hysterectomies were performed in the Department of Gynecology, Kaplan Hospital, Rehovot, Israel, using the Porges technique with some modifications. Ninety patients had some degree of loss of the pelvic support--anterior or posterior wall relaxation, enterocele or uterine prolapse in various degrees. The patients were allocated to two groups, in which two different techniques were compared: group 1, with repair of the pubocervical and pararectal fascia and group 2 without the repair. The repair of the pubocervical and pararectal fascia after vaginal hysterectomy prevented vaginal vault prolapse (zero versus 15 percent, p < 0.01) and reduced the incidence of recurrent rectocele (23 versus 55 percent, p < 0.05) and recurrent cystocele (14 versus 45 percent, p < 0.005). Recurrent genuine stress incontinence was found in 9 percent of patients in group 1 and 18 percent of patients in group 2 (not statistically significant; p = 0.163). Optimal management of relaxation of the vaginal wall during vaginal hysterectomy requires clinical suspicion and precise preoperative diagnosis and therapeutic plan. In the present study, the need for careful repair of the pubocervical and pararectal fascia during vaginal hysterectomy to prevent vaginal vault prolapse is emphasized. This procedure does not prolong the operation significantly (92 +/- 15 versus 84 +/- 17 minutes) and has no deleterious postoperative complications.
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PMID:The importance of the endopelvic fascia repair during vaginal hysterectomy. 144 37

From 1984 to 1988, we corrected and prevented the prolapse of the vaginal vault of patients who wanted to maintain a satisfactory sexual function. This was done by adopting two different surgical techniques. The first, generally favored technique, was performed upon 179 patients and consisted of a colposuspension to the sacrospinous ligaments. The second technique, a colposacropexis, was performed upon 71 patients, in which abdominal associated pathologic changes required an abdominal surgical approach. Colposacropexis was performed, whenever possible, directly to the anterior longitudinal vertebral ligament or using synthetic materials (Mersilene [polyester fiber], Teflon [polytetrafluoroethylene] and Gore-Tex [expanded, reinforced polytetrafluoroethylene]). Both colposacropexis and vaginal suspension to sacrospinous ligaments have had comparable results in vaginal accommodation and long term fixation. Vaginal approach has a lower incidence of operative complications than the abdominal approach and seems to ensure a lower risk of recurrent cystocele, even if simple and asymptomatic.
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PMID:Surgical management and prevention of vaginal vault prolapse. 151 57

To determine the effect of cystocele upon voiding, 30 women with various degrees of genitourinary prolapse were studied. The patients were divided into three groups depending on the severity of the cystocele and were evaluated with uroflowmetry, urethrocystoscopy, water cystometry, urethral pressure profilometry and voiding urethrocystometry. The three groups were similar in most parameters except maximum urethral closure pressure (P less than .05). The patients with cystocele did not demonstrate the abnormal voiding patterns characteristic of outflow obstruction.
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PMID:Urodynamic evaluation of voiding in women with cystocele. 153 62

Of continent women undergoing the Manchester procedure for genito-urinary prolapse, about 25% develop urinary stress-incontinence. In order to study whether this is due to pre-existing anatomical factors or to the surgical procedure itself, a prospective study was set up. Fifty-eight continent women operated on for genito-urinary prolapse, underwent urethrocystography prior to and 3 months following surgery. Sixteen of the 58 (28%) developed stress-incontinence following the operation. Radiological parameters preoperatively were of little help in distinguishing the patients developing incontinence from those remaining continent. The stress-incontinence following a Manchester procedure for genital prolapse seems to depend on two surgical factors: an insufficient elevation of the bladder-neck and a radical reduction of the cystocele. A parameter combining the two factors: the percentage reduction of the cystocele minus the percentage elevation of the bladder-neck, was significantly lower in women remaining continent than in those who developed stress-incontinence.
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PMID:Failure to predict and attempts to explain urinary stress incontinence following vaginal repair in continent women by using a modified lateral urethrocystography. 132 31

By careful observation of the physical findings in the patient complaining of one of the disorders of genital prolapse, it should be possible to discern the origin of the symptoms and therefore to devise an appropriate treatment that would remedy by reconstruction all of the signs of anatomic weakness. The goals of reconstructive surgery are three: to relieve the symptoms, to restore the anatomy to normal, and to restore the function to normal. When any element of weakness in the pelvic floor is found to be sufficient to produce symptoms that warrant repair, it is the responsibility of the surgeon to identify all the sites of weakness, so that all may be repaired at the same time, sparing the patient the expense, pain, and inconvenience of future readmission for further surgery. These weaknesses all relate to deficiencies of the six major organ systems that are involved in the support of the female pelvis, which may be damaged singly or in any combination. There are various types of cystocele, each of which must be carefully excised if an appropriate surgical treatment is to be given. This may involve correction of cystocele, enterocele, rectocele, prolapse of the uterus, and posthysterectomy prolapse of the vaginal vault. With enterocele, it is possible to correlate the four common types of enterocele with their location, which in turn correlates directly with their treatment. The prevention of complications is emphasized along with the treatment of certain mechanical complications easily recognized at the time of surgery.
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PMID:Surgery for pelvic floor disorders. 192 55

The authors present a new method for assessing pelvic prolapse with dynamic fast magnetic resonance (MR) imaging. Twenty-six women with signs and symptoms suggesting pelvic prolapse and 16 control subjects were studied with a series of fast (6-12-second) MR images. Sagittal and coronal images were obtained with graded increase in voluntary pelvic strain, allowing for dynamic display and quantification of the pelvic prolapse process. The distance from the pubococcygeal line was used as an internal reference for measurement of descent in the maximal strain position. With use of control results for normal limit values, prolapse involving the anterior pelvic compartment (cystocele), the middle compartment (vaginal prolapse, uterine prolapse, and enterocele), and the posterior compartment (rectocele) was easily demonstrated. Significant differences between control subjects and patients with prolapse were seen at maximal strain but not in the relaxed state. Quantification of the pelvic descent process with use of fast MR imaging may be of value in surgical planning and postsurgical follow-up.
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PMID:Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. 200 86

A sensible individualized approach should be applied to every patient undergoing transvaginal surgery for benign disease. This approach should attempt to correct every defect present in the pelvic supports. Uterovaginal prolapse is the result rather than the cause of genital prolapse. Not every vaginal hysterectomy should be treated like a cystocele-rectocele repair. Instead, every defect of the endopelvic fascial support should be evaluated in a patient both before and during surgery. As a result of these evaluations, more than just a hysterectomy and an anterior and posterior colporrhaphy may be performed. In a case in which a patient is found to have more than one defect at the time of examination, sacrospinous fixation of the vaginal apex at the time of transvaginal hysterectomy may be indicated. In the office, the patient can be examined in the supine and standing positions, both with and without Valsalva's maneuver, to determine if moderate to severe uterovaginal prolapse exists. Sacrospinous fixation should be performed in those cases as an adjunct to other steps taken to prevent postthysterectomy prolapse.
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PMID:Sacrospinous fixation--should this be performed at the time of vaginal hysterectomy? 155 Jan 39

What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history-taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence. Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis. It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.
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PMID:Value of the patient's case history in diagnosing urinary incontinence in general practice. 207 Jan 99


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