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

Vaginal prolapse may occur following hysterectomy or may evolve with the uterus in place. Current treatment options for vaginal prolapse have a limited success rate or are associated with significant morbidity. In this retrospective review, we present our experience with a new procedure for repair of vaginal prolapse. This technique relies on anterior suspension of the vaginal vault to the anterior rectus sheath in a fashion similar to bladder neck suspension. Forty patients have undergone this procedure. All patients had vaginal prolapse, cystocele, and urinary incontinence. In addition, 34 patients had enterocele, six had uterine prolapse, 33 had rectocele, and two had urethral diverticula. All patients had anterior vaginal suspension (AVS), with cystocele repair and bladder neck suspension. Six patients had vaginal hysterectomy, 34 had enterocele repair, 33 had rectocele repair, and two had urethral diverticulectomy. The mean hospital stay was 2.5 days (range, 1-7 days), and their mean follow-up was 30 months (range, 12-54 months). Thirty-six (90%) patients have excellent support of the vagina with no evidence of recurrent cystocele, enterocele, or rectocele. Four (10%) patients have recurrent enterocele. Thirty-three (82.5%) patients are dry or have rare episodes of urinary incontinence (less than one episode/month), whereas four (10%) patients have recurrent stress incontinence and three (7.5%) have urge incontinence. Constipation and fecal incontinence were resolved in all patients. All patients who were sexually active preoperatively remained so postoperatively, and none reported dyspareunea. Vaginogram in 10 patients demonstrated that posterior angulation of the vaginal axis was retained in all patients. AVS is associated with an excellent success rate in terms of resolution of symptoms and correction of prolapse. Morbidity is minimal, and hospital stay is short. The technique is simple and relies on anatomy that is familiar to all urologists. In addition, the vaginal approach allows for simultaneous correction of all components of vaginal prolapse and any associated vaginal pathology.
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PMID:Anterior vaginal suspension for vaginal vault prolapse. 911 84

Pregnancy, labor, delivery, and the puerperium cause many changes in the urinary and genital tracts. The management of lower urinary tract symptoms, disease, and genital prolapse during and after pregnancy is controversial. Patients treated surgically for incontinence, genital prolapse, and lower urinary tract reconstruction present a challenge to the obstetrician and other doctors caring for them during pregnancy. This article reviews the literature on the effect of pregnancy, labor, delivery, and the puerperium on lower urinary and genital tract disease. Preventive methods to reduce subsequent pelvic floor muscle damage and urinary and fecal incontinence are reviewed. The management of pregnant women with antecedent urinary and genital tract abnormalities also are summarized.
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PMID:Pregnancy and intercurrent diseases of the urogenital tract. 920 7

Complex examinations of 682 children with fecal incontinence including the colonodynamic investigation, computed tomography of the pelvis and endorectal sonography have shown that disturbance of the reservoir function and defecation urge mainly take place in cases of functional disorders. Anal incontinence of an organic type can also arise without an injury of the sphincter apparatus as a result of prolapse of the mucose membrane or stenosis of the distal portion of the rectum. In such cases the operative treatment is indicated. In patients with the incompetent internal and partially injured external sphincter treatment should be started by conservative measures. When the function of the pubo-rectal muscle or of all the elements of the closing apparatus is disturbed the operative treatment is indicated. The operative correction is possible for neurogenic incontinence in order to create the ano-rectal angle. A classification of anal incontinence in children is proposed which takes into account the etiology, pathogenesis and allows the optimum treatments to be chosen.
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PMID:[The classification and choice of the method of treatment in fecal incontinence in children]. 923 76

The successful management of faecal incontinence can dramatically improve the quality of life of affected children. The introduction of the non-refluxing, catheterisable appendico-caecostomy provides the opportunity to treat previously resistant patients. Over a 6-year period, 29 children had a Malone antegrade continent stoma for enema administration (MACE). Incontinence was related to spina bifida in 12 children, ano-rectal anomaly in 12, Hirschprung's disease in 2, followed excision of a pelvic tumour in 2, and was secondary to intractable chronic constipation in 1. The conduit was fashioned from the appendix (20), a caecal tube (8), or a gastric tube (1). Surgical complications were stomal stenosis (11), wound infection (1), anastomotic leak (1), MACE stoma prolapse (1), and a pressure sore (1). Colonic irrigation was achieved with washouts of saline (24), saline plus phosphate (4), and saline plus Picolax (1). Twenty-three patients have complete control of bowel function, but 4 still soil. Two remain incontinent, 1 of whom is still being instructed. One child subsequently had a colostomy, but still uses the MACE stoma. Successful bowel management requires motivation, dedication, commitment, and the input of a clinical nurse specialist. The MACE is a relatively straightforward operative procedure that provides an effective washout technique that is acceptable to both parents and children.
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PMID:The Malone antegrade colonic enema procedure: outcome and lessons of 6 years' experience. 963 20

Solitary rectal ulcer, internal rectal intussusception, and complete rectal prolapse are a range of defaecatory disorders that may have a common aetiology, namely chronic straining. If the pelvic floor is weak, external prolapse is often complicated by faecal incontinence. Few patients, a lack of randomised trials, and difficulties in the interpretation of studies of anorectal physiology (the results of which often seem conflicting) have made the understanding of these disorders difficult. The basis for treatment is clear, however--patients who have symptomatic defaecatory disorders associated with an internal intussusception, or solitary rectal ulcer, or both should have a course of training of pelvic floor muscles, dietary advice, and should use fibre supplements as primary treatment. Operation should be reserved for those patients in whom medical treatment has failed, and it may be expected to relieve symptoms in above two thirds of patients. Defaecating proctography may be useful in assessing which patients may not benefit from operation. Operation is the primary treatment for external prolapse. The choice of surgical approach should be tailored according to the expertise available, the medical condition of the patient, and the presence or absence of pre-existing constipation or incontinence.
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PMID:Rectal prolapse and rectal invagination. 966 65

There is no single operative approach to correct pelvic organ prolapse in conjunction with urinary and/or fecal incontinence or rectal prolapse. Each case needs to be individualized and dealt with surgically following the principles outlined in Table 1. In postmenopausal women, it is not only important to pretreat patients with estrogen prior to reconstructive pelvic surgery, but also maintain patients on long-term treatment after surgery. The genitourinary and reconstructive pelvic surgeon should have the skills to offer patients alternative approaches tailored to their individual symptomatology, and anatomic and pelvic pathology. Long-term follow-up of all patients is imperative to ascertain the clinical and cost effectiveness of these procedures.
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PMID:Surgical management of pelvic organ prolapse and stress urinary incontinence. 974 74

Clinical and manometric results of Delorme's operation and sphincteroplasty were assessed retrospectively in patients undergoing this procedure for fecal incontinence and rectal prolapse. A series of 33 patients (11 males, 22 females; aged 18-83 years, mean 59) with external rectal prolapse were treated by Delorme's operation between 1989 and 1996. Mean follow-up was 39 months (range 7-84). Sphincteroplasty was associated in 12 cases with severe fecal incontinence due to striated muscle defects. Good results were achieved in 27 patients (79%); prolapse recurrence was observed in 6 (21%), the mean recurrence time being 9 months (range 1-24 months). There were no postoperative deaths. Minor complications occurred in 15 patients. Changes in preoperative and postoperative manometric patterns were as follows (mean +/- SEM): voluntary contraction from 59 +/- 6.9 to 66 +/- 7.1 mmHg (P = 0.05), resting tone from 33 +/- 5 to 32 +/- 4.3 mmHg, rectal sensation from 59 +/- 5 to 61 +/- 5.2 ml of air (n.s.). A solitary rectal ulcer syndrome was detected in five patients. The histological pattern demonstrated pathological changes in 40% of cases. Fecal incontinence was resolved in 6 of 20 cases (30%) and chronic constipation in 4 of 9 (44%). Failure (n = 3) was related primarily to postoperative sepsis. The incontinence score showed a mean improvement of 35% decreasing, from 4.5 +/- 0.39 to 2.9 +/- 0.44 after surgery (P < 0.01). In conclusion, Delorme's procedure did not lead to constipation and improved anal continence when associated with sphincteroplasty.
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PMID:Delorme's operation and sphincteroplasty for rectal prolapse and fecal incontinence. 987 Jan 65

The pelvic floor provides support for the bladder, rectum, and genital systems, as well as proper positioning and orientation of the urethral and anal sphincters. Impairment may result in prolapse, urinary and fecal incontinence, and sexual dysfunction. The impact is enormous in terms of personal, social, and financial burden. Pertinent anatomy is presented, followed by an overview of available electrodiagnostic techniques and a description of pudendal nerve conduction studies, sacral reflex testing and selected electromyographic techniques. Clinical applications are discussed throughout the text and the need for further research is addressed.
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PMID:Pelvic floor function/dysfunction and electrodiagnostic evaluation. 989 98

Urinary incontinence, fecal incontinence, and pelvic organ prolapse are common stigmatizing conditions that afflict women far more often than they afflict men. It has been suggested that childbirth is the most likely factor to explain this great epidemiologic discrepancy between the sexes. Because the widespread availability of high-quality obstetric care through-out the industrialized world has led to precipitous drops in maternal mortality during the 20th century, many of the pathophysiologic mechanisms by which such injuries might arise are not as obvious as they were in times past. It is suggested that by looking at obstetric complications in the developing world, where the natural history of unrelieved obstructed labor is most obvious, it may be possible to shed new light on the pathophysiology of childbirth injury and its relationship to incontinence and prolapse. The spectrum of childbirth injuries resulting from obstructed labor in developing countries is surveyed, and the potential relevance of these findings to the more subtle forms of pelvic floor dysfunction seen in Western women is discussed.
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PMID:Birth trauma and the pelvic floor: lessons from the developing world. 1010 Jan 28

Rectal procidentia is an uncommon but debilitating condition that often affects elderly patients with significant medical problems. Fecal incontinence is usually frequent. Abdominal rectopexy with or without sigmoid resection repeatedly demonstrate lower recurrence rates (2-4%) but in high-risk patients, morbidity and mortality may be significant. Perineal or transacral approaches may be used in these patients to avoid the complications of abdominal procedures and general anesthesia. The lack of experience with transacral approach has limited your utilization by colon and rectal surgeons. We describe a case of rectal procidentia in patient with severe liver disease (Child C) sucssefull treated with transacral rectopexy, detailing the technique used.
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PMID:[Transsacral rectopexy for treatment of bleeding rectal prolapse in a patient with severe liver disease: case report]. 1041 48


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