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

Procidentia, vaginal vault prolapse and severe cystocele may be associated with potential urinary incontinence, which becomes overt only after surgical repair of the genital prolapse. The normal support of the pelvic organs is provided by the pelvic diaphragm (levator ani and coccygeus muscles). The levator plate is a firm, muscular plate between the coccyx and anus formed by fusion of the levator ani muscles on each side. Recent investigators have indicated that the main mechanism for weakening the pelvic muscles occurs as a result of childbearing, when stretch injury of the pudendal nerve causes denervation of the muscles. This injury is aggravated with the changes of aging and has effects on anogenital prolapse and stress incontinence. There may be iatrogenic causes of both prolapse and stress incontinence when an operation produces a change in the direction of tissue forces or removes a prior barrier to incontinence. The evaluation of patients must include the actual and potential aspects of genital prolapse and incontinence. Testing for stress incontinence must be performed before and after reduction of the genital prolapse. Surgical repair should be planned carefully to correct all the significant and potential defects in the urogenital tract. Ideally a normal vaginal axis with adequate length will be restored, and urinary function will not be compromised.
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PMID:Genital prolapse with and without urinary incontinence. 221 41

We report a case of uterine lithiasis in a 73-year-old Latin American woman. The patient underwent vaginal hysterectomy and colporrhaphy for complaints related to secondary uterine prolapse and cystocele. The 70-g, 8 x 5 x 3.5 cm uterus had a normal shape. Ten white, starlike, 0.5 x 0.5 x 0.2 cm, calcified structures were found within the endometrial cavity. Chemical analysis of one of these by x-ray diffraction showed it to be composed of calcite, one of the crystalline forms of calcium carbonate. To our knowledge, this is the first report of human uterine lithiasis in the literature.
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PMID:Uterine lithiasis. 195 48

The authors report their experience of the surgical treatment of stress urinary incontinence. They underline the value of urodynamic tests in the examinations for urinary continence and prolapses. In the presence of a transmission defect, three different techniques are used: indirect colpopexy by strips (Loffredo) in the absence of prolapse, mixed route using vaginal strips (Bologna) in case of cystocele, sub-urethral plication reserved for elderly patients presenting a prolapse with stress urinary incontinence revealed by the urodynamic tests. The follow-up of the patients treated by the Loffredo technique is studied: 92% of good middle-term results (after 5 years).
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PMID:[Treatment of stress urinary incontinence. Experience at the Gynecology-Obstetrics Center of Amiens]. 229 Oct 51

One hundred forty-nine consecutive patients who had surgery from May 1890 through December 1986 were evaluated to assess the functional and anatomic results of the paravaginal defect repair for stress urinary incontinence. All patients had their preoperative assessment, operative procedure, and postoperative follow-up managed by the authors. Twelve percent of the patients had one or more previous surgical procedures for urinary incontinence. Sixteen percent of the patients had the preoperative diagnosis of urinary incontinence with mixed components of true stress incontinence and detrusor instability. Postoperatively, 6% of all patients developed evidence of cuff prolapse; 5% had an enterocele. In none of those patients did the defect prolapse to the hymen. Five percent of the patients had postoperative evidence of a persistent cystocele, all of which were smaller than they had been preoperatively. An assessment of the anatomic results of the repair demonstrates that meticulous attention must be paid to the proper repair of the paravesical defect, to support of the vaginal cuff, and to management of the cul-de-sac of Douglas to minimize postoperative anatomic defects. Ninety-seven percent of patients had excellent functional results with no postoperative complaints of stress urinary incontinence.
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PMID:A six-year experience with paravaginal defect repair for stress urinary incontinence. 266 May 70

The classical approach to cystocele repair involves the approximation of lax pubocervical fascia through the anterior vaginal wall with narrowing of the bladder neck and proximal urethra by the Kelly-type plication. This procedure corrects the prolapse but when performed for the treatment of incontinence it has a high failure rate because the bladder neck and urethra are not placed into a high, supported, nonobstructed retropubic position. Furthermore, due to elevation of the bladder base without simultaneous elevation of the bladder neck and urethra, de novo stress urinary incontinence may occur. We developed a transvaginal needle suspension operation for the bladder and urethra that repairs anterior vaginal wall prolapse with excellent support of the bladder base and repositions the bladder neck in the high retropubic position, all during a simple and rapid operation that is tolerated well by the patient.
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PMID:Four-corner bladder and urethral suspension for moderate cystocele. 267 13

Use of a diaphragm plus spermicide provides effective protection against pregnancy in motivated women and decreases the risk for some sexually transmitted diseases. Potential risks of this contraceptive method include the development of urinary tract infections and the possible teratogenic effects of nonoxynol-9, the active agent in most spermicides. Contraindications include a large cystocele or rectocele, uterine prolapse and recurrent urinary tract infections.
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PMID:The diaphragm. 271

Bologna's procedure allows the curative or preventive treatment for urinary stress incontinence during surgical cure of prolapse with large cystocele (2nd or 3rd degree). An infra-cervical sling is created with 2 vaginal bands dissected from the anterior colpocele, passed through the retropubic space on either side of the bladder neck and fixed to the abdominal wall, after making a suprapubic approach to the aponeurosis of the rectus abdominis muscle. This colposuspension technique, performed via a mixed approach, is generally accompanied by vaginal hysterectomy and colpectomy designed to treat the various elements of the prolapse. This operation is easily reproducible and the postoperative course is generally uneventful. The intermediate term anatomical and functional results are very satisfactory in women over the age of 60 years. There is not sufficient follow-up at the present time to consider this procedure for young women.
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PMID:[Treatment and prevention of urinary stress incontinence by the Bologna procedure in prolapse with large cystocele. Surgical technic]. 323 Jan 11

A total of 67 female patients with pelvic relaxation (cystocele beyond the vaginal orifice) and with no urinary incontinence were clinically and urodynamically evaluated before and after a reconstructive surgical procedure. Of these, 24 patients had a significant decrease in abdominal pressure transmission to the urethra once the cystocele was reduced by vaginal pessary (abdominal pressure transmission ratio to urethra: bladder of less than 1.0). All 24 had a revised Pereyra procedure in addition to the cystocele repair. The other 43 patients had adequate abdominal pressure transmission to the urethra once the cystocele was reduced by vaginal pessary (abdominal pressure transmission ratio to urethra: bladder of greater than or equal to 1.0). These 43 patients underwent cystocele repair only with no surgical repair to the urethra or urethrovesical junction. Evaluation was repeated at 3 to 6 months after the operation. No patient developed urinary incontinence after operation. All 67 patients had urodynamically good abdominal pressure transmission to the urethra while coughing. Women with significant genitourinary prolapse may be continent in spite of a weak urethral sphincter because of kinking of the poorly supported urethra. Urodynamic testing can identify those women at risk of developing postoperative urinary incontinence so that prophylactic measures can be undertaken.
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PMID:Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapse. 336 1

Bologna's operation to relieve stress incontinence in patients with large cystoceles uses two vaginal strips to form a subcervical sling. Of 60 patients treated in this way, urodynamic exploration was performed preoperatively in 83% and postoperatively in 50%, while 42% underwent lateral retention and pressure cystography. All patients presented at least a stage II cystocele and hysteroptosis, 47% a patent and 93% a potential stress incontinence and 40% a sphincter incompetence. Anatomic results were excellent: 77% of total relief and 23% improvement in the cystoceles. Of greatest interest was efficacy against urinary incontinence: all patent stress incontinences were cured; none occurred after correction of cystocele, and only two cases of potential incontinence due to anatomic failure were observed. These good clinical results could be correlated with postoperative urodynamic exploration findings: the lack of persistent dysuria was related to the correction or even hypercorrection of the transmission anomaly without alteration of sphincter function. Paradoxically, images of pressure cystography showed elevation of the bladder neck in relation to symphysis pubis to be limited in extent. In 26% of cases the neck was in fact below this limit. These findings raise the question of the mechanism of re-establishment of pressure transmission. Because of the simplicity of technic of Bologna's operation, its low morbidity and it very great reliability with respect to urinary results, this method is now practised routinely in cases of prolapse with marked cystocele and patent or potential stress incontinence, even in the presence of major sphincter incompetence.
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PMID:[Results of the treatment and prevention of urinary stress incontinence by Bologna's operation in prolapse with voluminous cystoceles]. 369 37

The operative technique of our own modified sacral colpopexy with a fascial strip for the repair of posthysterectomy vaginal prolapse is described. The complete removal of the enterocele is important. The fascial strip remains extraperitoneal. Only absorbable sutures have been used. Excellent vaginal support was achieved in all cases operated on with the method described. Possible cystocele and rectocele must be corrected separately prior to sacral colpopexy.
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PMID:Operative technique for the repair of posthysterectomy vaginal prolapse. 377 32


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