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

The aim of the study was to introduce an anatomical classification for the management of urinary dysfunction based on the Integral Theory, a new connective tissue theory for female incontinence. Eighty-five unselected patients, aged 27-83 years, 12 with pure stress symptoms and 73 with mixed incontinence symptoms, were classified as having laxity in the anterior, middle or posterior zones of the vagina, using specific symptoms, signs and urodynamic parameters summarized in a pictorial algorithm. Special ambulatory surgical techniques, which included the creation of neoligaments, repaired specific connective tissue defects in the anterior (intravaginal slingplasty (IVS), n = 85), middle (cystocele repair, n = 6), or posterior zones (uterine prolapse repair, n = 31, or infracoccygeal sacropexy, n = 33). Almost all patients were discharged within 24 hours of surgery, without postoperative catheterization, returning to fairly normal activities within 7-14 days. At (mean) 21-month follow-up cure rates were: stress incontinence 88% (n = 85), frequency 85% (n = 42), nocturia 80% (n = 30), urge incontinence 86% (n = 74), emptying symptoms 50% (n = 65). Mean objective urine loss (cough stress test) was reduced from 8.9 g preoperatively to 0.3 g postoperatively, and mean residual urine >50 ml from 110 ml to 63 ml, P = <0.02. Pre- and postoperative urodynamics indicated that detrusor instability was not associated with surgical failure. Two new directions, based on the Integral Theory, are presented for the management of female urinary dysfunction, an anatomical classification which delineates three zones of vaginal damage, and a series of ambulatory surgical operations which repair these defects. The operations are fairly simple, safe, effective and easily learnt by any practising gynecologist.
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PMID:New ambulatory surgical methods using an anatomical classification of urinary dysfunction improve stress, urge and abnormal emptying. 955 90

The aim of the study was to evaluate the effectiveness of transabdominal wedge colpectomy as surgical treatment for cystocele. One hundred and sixty-three women with either first or second-degree cystocele (Beecham classification), rectocele and concomitant stress urinary incontinence or benign pelvic masses were submitted for a combined operation. Transabdominal repair of the cystocele was performed by wedge colpectomy employing two different absorbable sutures, Vicryl and PDS. The choice of suture was not random but depended on the period at which surgery was performed. Data obtained were analyzed with Student's t-test and Fisher's exact test. The cystocele cure rate was 90.2% (110 out of 122) at 3-year follow-up and was significantly associated with the preoperative degree, being 95.5% and 76.5% in first and in second degree, respectively (P = 0.003). At 1-year follow-up the cure rate was significantly associated with the type of the suture employed (P = 0.01). At 2-year follow-up rectocele cure rate was 97.2% and vaginal vault prolapse appeared in 3.5% of cases. Stress urinary incontinence relapsed in 10% of patients after Burch colposuspension. After the operation 94.1% of the women declared normal coitus. In the present series wedge colpectomy was found to be effective in repairing first-degree cystocele, whereas a high incidence of relapse was observed when second-degree cystocele was present preoperatively. The suture material employed influenced the cure rate.
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PMID:Transabdominal repair of cystocele by wedge colpectomy during combined abdominal-vaginal surgery. 955 91

The transvaginal sacrospinous fixation, called Richter operation was initially aimed to cure vaginal vault prolapse after hysterectomy. The results are as good as those of the abdominal promontory fixation with the well known advantages of the vaginal route. Indications way be extended to V3 U3 R3 prolapse and cure of elytrocele with good results in our practice. In few cases remnant cystocele may be a trouble some problem.
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PMID:[Richter's spinofixation in vaginal prolapse]. 958 65

Generic guidelines are applied to reconstructive vaginal operations, so as to convert them to ambulatory procedures. Prototype operations are described and analyzed. These included conceptualizing vaginal prolapse as a type of intussusception caused by vaginal and ligamentous laxity in the middle or posterior parts of the vagina; the avoidance of vaginal excision, excessive tension, and refashioning excess vaginal tissue from width to length or into a partial double-layered repair; the creation of artificial neoligaments; the prevention of urinary retention by avoiding tightness in the bladder neck area; local anesthetic infiltration; and buttressing vaginal tissue during wound healing. A total of 108 patients underwent vaginal surgery on an ambulatory or overnight stay basis, 72 under local anesthesia/midazolam. Minimal postoperative pain and the absence of catheterization reduced hospital stay from a statewide mean of 8 days to 1 day, and return to normal activities from 6 weeks to 7-10 days. Cure rates (18 months) were: uterovaginal prolapse 22/22, infracoccygeal sacropexy 21/23, rectocele 36/38, cystocele/anterior vaginal wall prolapse 21/25. Applied as prototypes to reconstructive vaginal surgery, the operations appear to be as effective as traditional techniques but far less invasive. They have the potential to assist working mothers, the old and infirm, and save the community up to $5,500 per patient. It is hoped that the generic models presented may act as a basis for the future development of ambulatory vaginal surgical techniques.
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PMID:Development of generic models for ambulatory vaginal surgery--a preliminary report. 965 74

Uterine prolapse is often associated with a concomitant rectocele, cystocele, and/or an enterocele. Moderate degrees of prolapse are often associated with a feeling of pelvic heaviness or fullness or low back pain. The symptoms usually worsen with exertion and ease with bed rest. In severe prolapse, the cervix may descend outside the vaginal introitus, and patients may complain that a "mass" is protruding from the vagina. Bleeding from mucosal ulcerations or from the cervical os may occur due to rubbing of the prolapsed tissue against the patient's clothing. The commonly associated problems of cystoceles and rectoceles may lead the patient to complain of difficulty voiding, recurrent urinary infections, and/or "splinting" to defecate. Mild cases of uterine prolapse do not require therapy unless the patient is symptomatic; in most cases of second- or third-degree prolapse, however, patients may be quite uncomfortable and desire therapy. Nonsurgical options, such as a pessary, are usually tried first if the patient desires conservative therapy. Operative repair for uterine prolapse is usually approached vaginally if the uterus is small. An abdominal approach may be preferred if the uterus is large or if the woman has had multiple previous pelvic procedures or has extensive endometriosis or other processes that may obliterate the cul-de-sac. In either approach, the uterosacral and cardinal ligaments must be carefully ligated and tied together, and the cul-de-sac must be obliterated to reduce the risk of subsequent enterocele and to properly suspend the vaginal vault.
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PMID:Pelvic prolapse: diagnosing and treating uterine and vaginal vault prolapse. 973

This study assesses the use of Marlex mesh in conjunction with anterior colporrhaphy for the correction of cystocele with or without urinary stress incontinence. A retrospective review was carried out of 12 years' experience with 142 patients undergoing a modified anterior colporrhaphy reinforced with Marlex mesh. All patients had preoperative urodynamics. Pre- and postoperative symptoms were compared and patients were examined for recurrent prolapse and mesh complications. Mean follow-up time was 3.2 years. No patients experienced recurrent anterior vaginal wall prolapse. Three patients developed mesh erosions into the vagina. There was a 74% success rate in the treatment of urinary stress incontinence. Marlex mesh used as a reinforcement for anterior colporrhaphy is effective in preventing recurrent anterior wall descent, with minimal complications.
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PMID:Anterior colporrhaphy reinforced with Marlex mesh for the treatment of cystoceles. 979 24

The object was to study retrospectively the perioperative complications and results of the Bologna procedure for the treatment of stress urinary incontinence associated with cystocele grade 2 or more. In the study, 80 patients underwent a repair of all defects of pelvic support plus the Bologna procedure. Mean duration of follow-up was 40.2 months (range 3-127). The incidence of operative complications was 2.5% for inadvertent cystostomy and for hemorrhage. Mean hospital stay was 7.2 days (range 2-17). At 2-year follow-up 85% of the patients were completely free of incontinence symptoms (95% CI: 75-92) and 76% at 3-year follow-up (95% CI: 66-86). None of the parameters tested in a univariate analysis was independently linked with surgical failure. Further studies are needed to establish the place of this technique in the surgical management of urinary incontinence associated with genital prolapse.
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PMID:The Bologna bladder neck suspension procedure for treatment of stress urinary incontinence associated with cystocele. 989 58

Since the 1993, a series of 22 women with stress urinary incontinence underwent bladder neck suspension, according to Gittes (pubovaginal suspension). No patients had preoperative detrusor instability or intrinsic sphincter dysfunction; 14 pts had a significant cystocele (II-III degree). We followed up 20 pts at 6 months: 9 pts (45%) were cured, 3 were significantly improved and 8 were not improved. Disappearance or marked improvement of moderate or severe cystocele wasn't confirmed in all pts. No serious complications were recognized. We believe that this procedure is quick and easy to perform with low morbidity and is useful where the indication is correct: patients with stress incontinence without significant anterior vaginal wall prolapse.
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PMID:[Gittes' pubovaginal suspension in the treatment of stress urinary incontinence (SUI)]. 1002 32

The authors, after of the different techniques mostly used in surgery to correct the urinary incontinence, illustrate their original technique adapted for UI caused by genital prolapse. At present, the Marchall-Marchetti-Krantz's and Goebell-Stoeckel's techniques are commonly used in this field. Since uterus lowering is the main cause of cystocele and subsequent urinary incontinence, their new technique has the principal purpose of holding the uterus permanently in it natural position. The authors limited experience is actually of only five cases; all the patients underwent an intervention of cystopexy according to their new technique described. The results obtained encourage and promote the usage of such a method, consenting them to go on with their experience.
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PMID:[Surgical methods in the management of urinary incontinence caused by genital prolapse: a review]. 1005 16

The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.
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PMID:Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging. 1019 5


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