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

Hysterectomy is the commonest major operation performed by gynaecologists and is the definitive cure for many of it's indications which include dysfunctional uterine bleeding, fibroids, utero-vaginal prolapse, endometriosis and adenomyosis, pelvic inflammatory disease, pelvic pain, gynaecological cancers and obstetric complications. It is a successful operation in terms of relieving women of their presenting symptoms and high levels of satisfaction are reported by patients. However, it has a high risk of complications, involves a prolonged convalescence, is expensive and to some women represents a loss of femininity. It should only be employed after trying conservative treatments first if appropriate. If this fails, currently only endometrial ablation and myomectomy are valid alternatives to hysterectomy. If ultimately hysterectomy is required, there is considerable evidence that patient care can be improved by increasing the proportion of operations that are done vaginally and laparoscopically and decreasing the number of laparotomies.
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PMID:Indications and alternatives to hysterectomy. 915 36

We describe the epidemiology of hysterectomy, overall as well as for specific indications. Data were obtained from the Epidemiologic Follow-up to the First National Health and Nutrition Examination Survey, a nationally representative cohort followed prospectively from the mid-1970s through 1992. Black and white women 25-49 years of age, interviewed during follow-up, were included in the analyses. The probability of undergoing a hysterectomy was estimated by demographic and reproductive factors. Hysterectomy as confirmed by hospital records was our main outcome measure. We found that women who had completed 9-11 years of education were more likely to have undergone a hysterectomy than were women with either more or less education. Women who had completed 9-11 years of education were also more likely to have had a hysterectomy because of menstrual problems. Three or more miscarriages, especially if caused by uterine prolapse, increased the probability of hysterectomy. Having had no live births decreased the probability of hysterectomy for menstrual disorders and uterine prolapse, but women who had their first child before age 20 were at increased risk of hysterectomy because of endometriosis. Hysterectomy appears to be associated with low education, high parity, and a history of multiple miscarriages. The influence of these factors varies depending on the primary indication for the hysterectomy.
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PMID:Epidemiology of hysterectomy in the United States: demographic and reproductive factors in a nationally representative sample. 920 65

Hysterectomy is the second most commonly performed major operation in the United States. Approximately one in three women will have this operation, resulting in 590,000 procedures per year. The most common indications for hysterectomy are leiomyomata uteri, abnormal uterine bleeding, endometriosis, pelvic pain, and pelvic organ prolapse. Although hysterectomy is an appropriate therapeutic option for some women with these conditions, in many instances less radical alternatives may be offered. Leiomyomata may be managed expectantly if symptoms are not bothersome; for women with troubling leiomyomata symptoms, alternatives to hysterectomy include: endoscopic removal or destruction of myomas, arterial embolization, or hormonal therapy to inhibit or modify bleeding. Endometriosis and abnormal uterine bleeding of leiomyomata are both amenable to hormonal therapy. Pelvic pain is most effectively approached with a thorough evaluation (particularly for nongynecologic illness), with specific therapy directed at the cause of the pain. Pelvic organ prolapse may respond symptomatically to pelvic floor exercises, or to the use of a pessary. After alternatives to removal of the uterus are discussed, the informed woman may decide that hysterectomy is the option best suited to her. It is unusual for hysterectomy to be her only option.
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PMID:Alternatives to hysterectomy for benign conditions. 972 46

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

Endometriosis of the intestinal tract may mimic a number of diseases both clinically and pathologically. The authors evaluated 44 cases of intestinal endometriosis in which endometriosis was the primary pathologic diagnosis, and evaluated them for a variety of gross and histologic changes. Cases with preneoplastic or neoplastic changes were excluded specifically because they were the subject of a previous study. The patients ranged in age from 28 to 56 years (mean age, 44 years), and presenting complaints included abdominal pain (n = 15), an abdominal mass (n = 12), obstruction (n = 8), rectal bleeding (n = 2), infertility (n = 3), diarrhea (n = 2), and increasing urinary frequency (n = 1). The clinical differential diagnoses included diverticulitis, appendicitis, Crohn's disease, tubo-ovarian abscess, irritable bowel syndrome, carcinoma, and lymphoma. Forty-two patients underwent resection of the diseased intestine and two patients underwent endoscopic biopsies. In 13 patients there were predominantly mural masses, which were multiple in two patients (mean size, 2.6 cm). In addition, 11 cases had luminal stenosis or strictures, six had mucosal polyps, four had submucosal masses that ulcerated the mucosa (sometimes simulating carcinoma), three had serosal adhesions, one had deep fissures in the mucosa, and one was associated with appendiceal intussusception. Involvement of the lamina propria or submucosa was identified in 29 cases (66%) and, of these, 19 had features of chronic injury including architectural distortion (n = 19), dense lymphoplasmacytic infiltrates (n = 7), pyloric metaplasia of the ileum (n = 1), and fissures (n = 1). Three cases had features of mucosal prolapse (7%), ischemic changes were seen in four (9%), and segmental acute colitis and ulceration were seen in four and six cases (9% and 13%) respectively. In 14 patients, endometriosis formed irregular congeries of glands involving the intestinal surface epithelium, mimicking adenomatous changes. Mural changes included marked concentric smooth muscle hyperplasia and hypertrophy, neuronal hypertrophy and hyperplasia, and fibrosis of the muscularis propria with serositis. Follow-up of 20 patients (range, 1-30 years; mean, 7.8 years) revealed that only two patients had recurrent symptoms. None of the patients developed inflammatory bowel disease. Endometriosis can involve the intestinal tract extensively, causing a variety of clinical symptoms, and can result in a spectrum of mucosal alterations. Because the endometriotic foci may be inaccessible to endoscopic biopsy or may not be sampled because of their focality, clinicians and pathologists should be aware of the potential of this condition to mimic other intestinal diseases.
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PMID:Endometriosis of the intestinal tract: a study of 44 cases of a disease that may cause diverse challenges in clinical and pathologic evaluation. 1125 18

The short-term complications of hysterectomy in 184 women have been documented over 12 months against a panel of clinical performance indicators in a district general hospital. One hundred and fifty-nine operations (159/184, 86.4%) were performed by the abdominal route; 25/184 (13.6%) by the vaginal route. Clinical indications for hysterectomy varied from menorrhagia (75/184, 40.7%) to Stage III/IV endometriosis (10/184, 5.4%). Clinical performance indicators (cPI) were triggered in 32/184 (17.4%) cases; 19/ 184 (10.3%) triggered a single performance indicator, 9/184 (4.9%) triggered two performance indicators and 4/184 (2.2%) triggered three performance indicators. Combining the number of hysterectomies performed per annum (HYST 1), with the proportion of cases triggering three or more clinical performance indicators (HYST 2) and the rate of hysterectomy for histologically normal uteri weighing less than 120 g excluding genital prolapse (HYST 3) provides a profile of the operation for comparison with other clinical services.
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PMID:Clinical performance indicators at hysterectomy. 1252 33

To ease intra-operative access to laterally at vaginal hysterectomy, we have developed the 'Purohit technique of vaginal hysterectomy' using a right angle forceps, electrocautery and 10 mm telescope with light source. A prospective study on consecutive 214 women with benign disease of the uterus without prolapse, including cases with relative contraindications (excluding endometriosis and uteri above 20 weeks size), demonstrated it to be easy, safe and effective. Vaginal hysterectomy was successfully completed in 213 (99.53%) cases, with one failure (0.46%) which needed laparoscopic assistance. Vaginal salpingo-oophorectomy was completed in all indicated cases. We believe that many abdominal and laparoscopic hysterectomies could be avoided by this technique. Details of the technique can be seen on the following website http://www.purohittechnique.com
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PMID:Purohit technique of vaginal hysterectomy: a new approach. 1466 83

Hysterectomy is one of the most frequently performed operations in the world, accounting for 500,000-600,000 procedures annually in the USA; the abdominal route for hysterectomy is the preferred route in 60-80% of these operations. Although the number of total abdominal hysterectomies performed annually has decreased, the number of subtotal abdominal hysterectomies increased by >400%. The major indications for abdominal hysterectomy include abnormal uterine bleeding, myomata uteri, adenomyosis, endometriosis, neoplasia, and chronic salpingitis. The basis for selection for subtotal versus total hysterectomy has little in the way of factual data to support it and may actually present some significant disadvantages, such as continued menstruation and cervical prolapse. The detailed technique for performing intrafascial abdominal hysterectomy relies heavily on precise knowledge of pelvic anatomy and compulsive detail to tissue handling. The consistent and correct usage of prophylactic antimicrobials, measures to prevent thromboemboli, and procedures to avoid urinary retention are key to the overall success of the surgery.
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PMID:Total and subtotal abdominal hysterectomy. 1598 51

Every year, many women all over the world will undergo a hysterectomy, the removal of their uterus. The majority of hysterectomies are performed to treat conditions such as fibroids, heavy bleeding, endometriosis, adenomyosis and prolapse. A hysterectomy is not often a procedure that needs to be performed urgently, except in the case of cancer. Therefore, a woman considering the procedure should take time to investigate all her options, including other possible treatments. Deciding whether to have a hysterectomy can be a difficult and emotional process. Signs of depression may include severe and prolonged feelings of sadness and hopelessness; diminished interest in activities; significant weight loss or gain; insomnia; fatigue; and thoughts of death or suicide. Every person reacts differently, and reactions are a combination of emotional and physical responses. We still have much to learn about the effects of hysterectomy on sexual function. We investigated many studies published in different journals relative to this subject and we compare their results. Women are more likely to report improved sexual functioning after the surgery when their symptoms have been alleviated. A new hysterectomy procedure that 'spares' abdominal ligaments and nerves is quicker and results in less blood loss and shorter hospital stays and seems to respect the tissues more, without affecting the sexuality of the women.
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PMID:The effect of hysterectomy on sexuality and psychological changes. 1654 13

Over the last ten years, progress in evidence-based medicine coupled with technological and surgical breakthroughs have deeply changed the management of our patients. Uterine bleeding is the first cause of gynaecological consultation and the intrauterine progestin delivery system as well as new hysteroscopic procedures have optimized the therapeutic approach to this problem. Introduction of magnetic resonance imaging and interventional procedures have improved breast disease diagnosis and management; likewise sentinel node localization, introduction of aromatase and growth factors inhibitors, new radiotherapy procedures and pharmacogenomics, have helped to ameliorate breast cancer treatment. Pelvic surgery has been switching more and more towards laparoscopic procedures not only in the field of benign lesions (eg endometriosis), of surgery of prolapse and incontinence with new prosthetic materials, but also for an improved management of gynaecological cancers.
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PMID:[Therapeutic progress in gynecology: organic diseases]. 1772 16


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