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

Women who have been injured should be examined for possible gynecological injury within 24 hours of the accident. Injuries to pregnant women do not usually cause an obstetrical crisis. When such an event does occur, there is positive evidence which relates it to the accident if there was such relationship. Metrorrhagia and menorrhagia are common sequelae of physical and psychological injury, but they are of temporary nature in cases in which there is no demonstrable pathologic change upon pelvic examination. Uterine prolapse, cystocele and rectocele are not caused by a single injury except in extremely rare instances. When vaginal vault injury has occurred as a result of a single injury, there is plentiful evidence of severe tissue damage.
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PMID:Accidental injuries to women; obstetrical and gynecological problems associated with damage claims. 1439 7

We describe the triple operation for prolapse with prosthesis in patients with pelvic organ prolapse using a vesicovaginal mesh for the cystocele, a rectovaginal mesh for the rectocele and a posterior retro-and trans levatory vault suspension sling. Preliminary results in a consecutive series of 92 patients who underwent surgery between June 2001 and December 2002 showed three cases of vaginal erosion in contact with the prosthetic material, and one hematoma of the pararectal fossa with secondary abscess formation requiring ablation of the implant. There was one immediate anatomic failure. Function was good with no reports of dyspareunia or dyschesia.
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PMID:[Three-way prosthetic repair of the pelvic floor]. 1459 3

In patients with genital prolapse involving several compartments simultaneously, radiologic investigation can be used to complement the clinical assessment. Contrast medium in the urinary bladder enables visualization of the bladder base at cystodefecoperitoneography (CDP). The aim of the present study was to evaluate the correlation between clinical examination using the Pelvic Organ Prolapse Quantification system (POP-Q) and CDP. Thirty-three women underwent clinical assessment and CDP. Statistical analysis using Pearson's correlation coefficient ( r) demonstrated a wide variability between the current definition of cystocele at CDP and POP-Q ( r=0.67). An attempt to provide an alternative definition of cystocele at CDP had a similar outcome ( r=0.63). The present study demonstrates a moderate correlation between clinical and radiologic findings in patients with anterior vaginal wall prolapse. It does not support the use of bladder contrast at radiologic investigation in the routine preoperative assessment of patients with genital prolapse.
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PMID:Diagnosis of cystocele--the correlation between clinical and radiological evaluation. 1475 91

Transabdominal sacrocolpopexy is an excellent treatment option for patients with high-grade vaginal vault prolapse, with long-term success rates ranging from 93% to 99%. However, it is associated with increased morbidity compared with vaginal repairs. In this article, we describe a novel minimally invasive technique of vaginal vault prolapse repair and present our initial experience. The surgical technique involves placement of 4 laparoscopic ports, 3 for the surgical robot and 1 for the assistant. A prolene mesh is then attached to the sacral promontory and to the vaginal apex using nonabsorbable expanded polytetrafluoroethylene sutures. At the end of the case, the mesh material is covered by the peritoneum. A total of 20 patients underwent a robot-assisted laparoscopic sacrocolpopexy at our institution in the past 18 months for severe symptomatic vaginal vault prolapse; 8 of the 20 (40%) underwent a concomitant anti-incontinence procedure. Mean follow-up was 5.1 (range, 1-12) months and mean age was 66 (range, 47-82) years. The mean total operative time was 3.2 (range, 2.25-4.75) hours. Of these patients, 1 was converted to an open procedure secondary to unfavorable anatomy. All but 1 patient, who left on postoperative day 2, were discharged from the hospital after an overnight stay. Complications were limited to mild port-site infections in 2 patients, which resolved with oral antibiotic therapy. Recurrent grade 3 rectocele developed in 1 patient, but there was no evidence of cystocele or enterocele. Significant incontinence (>1 pad/day) was present in 2 patients. All 18 patients reported being satisfied with the outcome of their surgery and all 10 would recommend it to a friend. This novel technique for vaginal vault prolapse repair combines the advantages of open sacrocolpopexy with the decreased morbidity and improved cosmesis of laparoscopic surgery. It is associated with decreased hospital stay, low complication and conversion rates, and high rates of patient satisfaction. Although our early experience is encouraging, long-term data are needed to confirm these findings and establish longevity of the repair.
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PMID:Gynecologic use of robotically assisted laparoscopy: Sacrocolpopexy for the treatment of high-grade vaginal vault prolapse. 1547 52

This study reviews our experience with sacrospinous colpopexy done at the time of vaginal hysterectomy over a period of 3 years, and discusses the indications, outcome and safety of the technique. Between January 1996 and December 1998, 75 patients had sacrospinous colpopexy at the time of vaginal hysterectomy. The mean age of patients was 57.1 years. Simultaneous bilateral vaginal oophorectomy was done in 36 patients, anterior colporrhaphy in 56, and posterior colporrhaphy in 24. All patients underwent perineorrhaphy. Dissection and obliteration of the enterocoele sac was performed whenever encountered. Patients were seen at 2, 6 and 12 months following surgery and then yearly thereafter. The mean operative time was 85 minutes, mean uterine weight was 101 grams and mean blood loss was 137 ml. The mean follow-up period was 15 months. The vaginal vault remained well supported in 96.7%, with recurrent cystocoele in six patients (9.8%), recurrent rectocoele in 1.3%, and shortvagina in 3.3%. At 1-year follow up, 28% of those who were sexually active prior to surgery reported an improvement in sexual function. When dealing with uterovaginal prolapse, sacrospinous colpopexy performed at the time of vaginal hysterectomy is an effective treatment option for vaginal vault support.
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PMID:Sacrospinous colpopexy at vaginal hysterectomy: method, results and follow up in 75 patients. 1551 69

We set out to assess the outcome of pelvic examination in women 40-60 years of age with one or more lower urinary tract symptoms. This was an ongoing longitudinal cohort study set in one rural and one urban county in Denmark. One hundred and ninety-six women with one or more lower urinary tract symptoms occurring at least weekly were selected at random. Ages ranged from 40 to 60 years. Pelvic findings involving genital prolapse, signs of vaginal atrophy, and pelvic mass as well as a history of hormonal status and estrogen deficiency symptoms were documented and assessed. One hundred and six women (54.1%) were recruited. First degree cystocele, rectocele, and uterine prolapse occurred in 24 (22.6%), seven (6.6%), and six (5.7%), women respectively. No significant association between first-degree genital prolapse and subtypes of lower urinary tract symptoms (LUTS) was observed. The number of women with second or third degree cystocele, rectocele, and uterine prolapse was three (2.8%), two (1.9%), and two (1.9%), respectively. The positive predictive vaginal findings in each subtype of LUTS indicating an oestrogen deficiency were in the interval 72.0- 90.0 while the negative predictive vaginal findings were in the interval 24.7-27.6%, respectively. In six women (5.7%) a leiomyoma was observed. In one woman the size of the uterus exceeded the size of a 12-week pregnancy. Genital prolapse more than first degree and pelvic masses were infrequent findings among women with LUTS. Signs of vaginal atrophy associated poorly with a history of hormonal depletion and symptoms indicating oestrogen deficiency. However even an infrequent pathologic finding is significant. Therefore we still recommend pelvic examinations in all women with LUTS.
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PMID:The outcome of pelvic examinations in women 40-60 years of age with lower urinary tract symptoms. 1551

An 85-year-old woman presented with genital prolapse (rectocele and cystocele) with stress urinary incontinence. Three days after laparoscopic promonto fixation, bowel became incarcerated in the opening of a 5-mm port site. This clinical case forces us to reconsider the harmlessness of 5-mm ports. We recommend making sure that their openings are well closed.
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PMID:Incarceration of bowel through opening of a 5-mm port. 1559 61

Forty-three patients with genital prolapse prospectively underwent blinded pre and postoperative MRI, with dynamic assessment of each compartment. MRI was significantly more accurate than physical examination for the diagnosis of posterior defects (rectocele, enterocele) but not for anterior defects or uterine prolapse (hysterocele, cystocele). Postoperative MRI confirmed the surgical outcome and also identified risk factors for recurrence. MRI was particularly reliable for recurrent prolapse and vault prolapse. The authors consider that dynamic MRI can advantageously replace colpocystodefecography, as it is rapid and well tolerated. Technical improvements should help to understand the role of muscular and fascia lesions.
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PMID:[Dynamic MRI in the preoperative management of genital prolapse. A prospective study]. 1565 38

Female incontinence and pelvic organ prolapse have been defined as contraindications to orthotopic bladder substitution. A 75-old-year woman with slight stress incontinence, Stage III cystocele, and vaginal vault prolapse after subtotal hysterectomy underwent radical cystectomy for Stage T2 bladder cancer. After radical cystectomy, pelvic floor integrity was restored by colposacropexy with a rectangular polypropylene mesh and an ileal reservoir to urethra was constructed. After 1 year of follow-up, she had complete daytime continence and only needed to wear a pad during the night. Her postvoid residual urine volume was constantly less than 100 mL.
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PMID:Pelvic floor reconstruction before orthotopic bladder replacement after radical cystectomy for bladder cancer. 1566 93

The use of slings in the cure of genital prolapse and urinary stress incontinence is justified by the large number of relapses after the classical surgical procedures, especially due to the poor quality of the perineal connective tissue. The ideal sling for vaginal surgery should have certain characteristics, i.e., resistance to infection, bio-stability, bio-compatibility, solidity, interstitial texture, porosity, elasticity, non-aggressive margins. The discussed techniques used in the cure of the stress urinary incontinence are the Tension-free Vaginal Tape (TVT), the Sparc-sling System, the Intra-vaginal sling-plasty tunneller (IVS), and Trans-obturator Tape (TOT). For the cystocele, the under-bladder meshes, either free or fixed to the abdominal wall or to TVT is recommended. For the rectocele, a posterior IVS with a tension-free inter-recto-vaginal prosthesis is suitable, while for the vaginal vault prolapse, hysterocele or isolated elitrocele we discuss the posterior IVS.
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PMID:[Use of slings in vaginal surgery]. 1568 57


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