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

Sacrospinous ligament fixation of the prolapsed vaginal vault has proved very useful, but the complications of failure, hemorrhage, infection, nerve damage, incontinence and dyspareunia are reported. Experience with 51 operations performed by staff, and residents with supervision, has shown the value of certain preoperative and technical steps to avoid complications, including candidate selection; repair of enterocele; retropubic positioning of the bladder neck; repair of all pelvic support defects, and perineorrhaphy. Technical modifications are described. Results in these instances are tabulated: no recurrent prolapse; no transfusions; four narrow vaginas; two with stress incontinence; one pelvic cellulitis, and one ventricular fibrillation on the third postoperative day. We believe that most complications are preventable.
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PMID:Success with sacrospinous suspension of the prolapsed vaginal vault. 144 Jan 69

We reviewed the charts of 206 patients who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 15 months. Overall, our results demonstrated a successful outcome (cure or rare stress urinary incontinence not requiring protection) in 186 of 206 patients (90.3%). Cox multivariant analysis showed that the only predictor of outcome was the degree of preoperative stress urinary incontinence (mild, moderate or severe, p less than 0.001). When the results were stratified by degree of incontinence preoperatively 20 of 21 patients (95%) with mild, 151 of 162 (93%) with moderate and 15 of 23 (65%) with severe incontinence had a successful outcome. No statistical correlation was found with patient age, number of prior operations, hysterectomy, urgency incontinence or menopause. For the patients who failed, the mean interval to recurrent stress urinary incontinence was 5 months. Significant urgency incontinence was present preoperatively in 58 of the 204 patients (29%), with postoperative resolution in 66%. De novo urgency incontinence occurred in 7.5%. Complications included secondary prolapse (6% of the patients), prolonged retention (2.5%) and suprapubic pain (3%). In summary, the Raz bladder neck suspension for correction of stress urinary incontinence has been successful in more than 90% of this patient population.
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PMID:The Raz bladder neck suspension: results in 206 patients. 151 37

Procedures for treating rectal prolapse may constitute some of the best applications for colorectal laparoscopic techniques. Although the condition is benign, rectal prolapse is often debilitating and frequently progressive in terms of functional limitations. Moreover, many patients are elderly, medically unfit, or both. A technique that afforded relief of prolapse and of incontinence by laparoscopic rectal sacropexy, performed without sutures, using a newly designed laparoscopic sacral tacker and laparoscopic staples, is described. Indications, contraindications, technical details, and surgical implications are discussed. Laparoscopic pelvic suspension procedures are presented as realistic and appropriate objectives for colon and rectal surgeons.
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PMID:Sutureless laparoscopic rectopexy for procidentia. Technique and implications. 153 9

Twenty-two clinically continent women with severe genitourinary prolapse were evaluated urodynamically to determine the prevalence of urodynamic abnormalities that could lead to potential urinary incontinence. Urodynamic testing found an occult incontinence disorder in 13 women (59%), of whom four had urine loss during cough pressure profiles after pessary placement, four had uninhibited detrusor contractions during retrograde medium-fill water cystometry, and five had both stress urinary incontinence and an unstable bladder. Therefore, nine of the 22 patients (41%) had uninhibited detrusor contractions during urodynamic testing. However, uroflowmetry did not reveal voiding dysfunction in this group, although peak flow rates appeared to be lower in the subgroup of women manifesting uninhibited detrusor contractions. Associated symptoms of frequency, nocturia, and urgency occurred in 41% of the women in this study; four of nine (44%) who had normal urodynamic test results, five of 13 (38%) who had abnormal test results, and five of nine (56%) who had an unstable bladder. Therefore, associated symptoms could not be used to determine which women would have abnormal urodynamic test results. These preliminary results suggest that women with genitourinary prolapse may be at risk for an occult incontinence disorder that is masked by the prolapse and that could manifest after corrective surgery for prolapse. Urodynamic testing is suggested for women with genitourinary prolapse who present with or without symptoms of incontinence, so that more data can be obtained to determine the importance of abnormal test results.
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PMID:Prevalence of abnormal urodynamic test results in continent women with severe genitourinary prolapse. 155 72

Treatments for urge incontinence associated with uninhibited bladder contractions include medications with anticholinergic and smooth muscle relaxant properties as well as habit training, bladder retraining, contingency therapy, and biofeedback. Pelvic floor (Kegel) exercises improve stress incontinence in 60 to 90% of female patients. For patients who fail to improve with pelvic floor exercises, a combination of an alpha-adrenergic agent and conjugated estrogen is recommended. Surgery is particularly effective in elderly women with significant pelvic prolapse. Management of overflow incontinence requires surgery or intermittent/chronic catheterization. Functional incontinence may be improved with correction of the underlying disorder and availability of a motivated caregiver.
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PMID:Urinary incontinence in the aged, Part 2: Management strategies. 159 67

The contribution of evacuation proctography (EP) to the evaluation of pelvic prolapse was assessed in 74 consecutive patients. A rectocele was demonstrated in 73 patients (99%); large rectoceles frequently showed barium trapping, but there was no correlation between these findings and rectal symptoms. An enterocele was detected at evacuation proctography in 13 patients (18%) (including two enteroceles seen only retrospectively), and a sigmoidocele was shown in four patients (5%). Physical examination resulted in detection of only seven enteroceles and of none of the sigmoidoceles. In 48 patients (65%), additional findings were evident at EP, including excessive pelvic floor descent, anal incontinence, rectal intussusception, and spastic pelvic floor. These data suggest that EP is particularly useful in the preoperative evaluation of pelvic prolapse if the patient has anorectal symptoms or is at risk for an enterocele. EP contributes to surgical planning by enabling identification of clinically unsuspected enteroceles and sigmoidoceles and coexistent disorders of rectal evacuation.
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PMID:Pelvic prolapse: assessment with evacuation proctography (defecography) 843 Feb 10

We reviewed the long-term functional results of colon resection and suture rectopexy for complete rectal prolapse in 47 patients followed for more than 3 yr (mean 65 months). Thirty-three patients underwent sigmoidectomy, eight patients underwent subtotal colectomy, and four patients underwent sigmoidectomy with subsequent subtotal colectomy. Three patients (6.3%) developed recurrent full-thickness prolapse, and four patients (8.5%) developed rectal mucosal prolapse. Twenty patients presented with constipation, 10 (50%) of whom improved after surgery. Constipation improved in seven (70%) patients who underwent subtotal colectomy. Twenty-one patients presented with incontinence, eight (38%) of whom improved. Continence worsened in six patients, and four patients developed significant diarrhea. These complications did not correlate with the extent of bowel resection. Three patients required subsequent stomas. Colon resection and rectopexy provides long-term control of rectal prolapse with an acceptable recurrence rate. Subtotal colon resection is frequently helpful in patients with associated constipation. However, colon resection of any magnitude entails a small risk of chronic diarrhea and/or diminished continence.
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PMID:Long-term functional results of colon resection and rectopexy for overt rectal prolapse. 172 5

The effect of abdominal rectopexy on bowel function is difficult to assess in retrospective studies because preoperative bowel habit cannot be determined accurately. This study examined bowel symptoms and physiologic tests of anorectal function prospectively in 23 patients before and at three months after rectopexy. Rectopexy eliminated complete prolapse in all and stopped bleeding in 16 of 18 patients. Incontinence improved significantly. Constipation (less than 3 bowel actions per week or straining for more than 25 percent of defecation time) was relieved in 4 of 11 affected patients but developed in 5 of the 12 who were not constipated preoperatively. Since the median bowel frequency was 21 motions per week before surgery and 17 afterward, the main determinant of constipation was straining. Abdominal pain was relieved after rectopexy in 6 of 12 patients but developed in 3 of 13 who were pain-free before surgery. Three patients (13 percent) had a first-degree relative with rectal prolapse. Perineal descent decreased significantly. Maximal anal resting pressure increased significantly, but this did not correlate significantly with improved continence. Twenty-one patients (91 percent) could expel a 50-ml balloon preoperatively; 18 of those 21 could still do so postoperatively. The two patients who could not expel the balloon preoperatively were able to do so postoperative. This study shows that rectal prolapse is associated with profoundly abnormal defecation and abdominal pain. While abdominal rectopexy improved continence, it may improve or worsen other bowel symptoms, including constipation.
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PMID:Abdominal rectopexy for complete prolapse: prospective study evaluating changes in symptoms and anorectal function. 173 83

32 women with genuine stress urinary incontinence were operated on via the transvaginal approach during 1989-1990. They ranged in age from 27-72 years, with a mean of 55.7. In 26, in addition to the urine leakage, vaginal wall prolapse of various degrees was diagnosed. 6 underwent Raz modified Pereyra bladder neck suspension, 26 had Raz 4-corner bladder and bladder neck suspension, and in 17 rectocele and perineal repair were also performed. 2 with uterine prolapse also underwent vaginal hysterectomy. At follow-up 2-12 months later 29 of the 32 were completely cured of stress incontinence (90.6%). In 7 urge incontinence persisted in various degrees, and 3 had developed urge incontinence de novo. All but 1 of them responded favorably to anticholinergic medication. There were postoperative complications in 5 (15.6%), including wound infection that required removal of Prolene sutures in 2, urethrovaginal fistula requiring reoperation in 1, perioperative myocardial infarction in 1, and in 1 voiding dysfunction initially treated with self-intermittent catheterization, but later cured by removal of a pair of Prolene sutures.
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PMID:[Surgical treatment of urinary stress incontinence in women]. 175 77

Abdominal Marlex-mesh rectopexy was used for surgical treatment of rectal prolapse in 54 consecutive patients. Anal incontinence was observed in 43 patients (80%) before surgical treatment. The degree of anal incontinence was more severe in women as compared with men. Operative treatment corrected the pathologic anatomy effectively as only one recurrent prolapse developed. At the follow-up examination three patients had symptomless anal mucosal prolapse during maximal straining. 75% of the incontinent patients regained continence for faeces and the rest had some improvement in continence. Seventeen patients (31%) had postoperative constipation, that required lactulose treatment. In conclusion, abdominal Marlex-mesh rectopexy can be recommended as safe and effective treatment for rectal prolapse, despite some patients developing constipation and some remaining incontinent.
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PMID:Clinical results of abdominal rectopexy for rectal prolapse. 175 94


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