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

There is a surprising lack of prospective data on genital and pelvic prolapse and the relation of these conditions to incontinence. Several abnormalities may be important: uterine prolapse, rectoceles, enteroceles, total vaginal eversion, and cystoceles. The authors describe their experience in 65 cases of various etiologies.
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PMID:Treatment of incontinence with pelvic prolapse. 201 16

In a 44-year old woman a severe case of prolapse of the rectum was complicated by complete incontinence and rectal stenosis. Continence was restored by colo-anal anastomosis between an oral smooth-muscle-plasty and the anal skin introduced in a newly created anal canal by a distal voluntary muscle-plasty. The successfully applied one-stage technique in reestablishing non-voluntary and voluntary muscular continence is described in detail.
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PMID:[Complete reconstruction of the natural anus in complicated rectal prolapse]. 202 70

What is the value of the case history in diagnosing urinary incontinence in general practice? A total of 103 women with urinary incontinence presented to their general practitioner (GP) and underwent a standard history-taking, physical examination and urodynamic testing. The urodynamic diagnoses were analysed against symptoms and symptom complexes. Symptoms of stress incontinence in the absence of symptoms of urge incontinence had a sensitivity of 78%, specificity of 84% and predictive value of 87%. Symptoms of urge incontinence in the absence of symptoms of stress incontinence excluded genuine stress incontinence. Information on age, parity, enuresis, nocturia, frequency, urgency, cystocele, prolapse and hysterectomy did not contribute to a correct diagnosis. It was concluded that urodynamics are unnecessary in most women presenting with urinary incontinence in general practice.
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PMID:Value of the patient's case history in diagnosing urinary incontinence in general practice. 207 Jan 99

In order to avoid mean term failures of colposuspension and short term obstructive complications of sling procedure, the author present a technique of urethropexy combining the two principles: reinforced colposuspension. A series of 67 consecutive procedures is subdivided in 45 stress incontinence and 22 incontinence with prolapse simultaneously treated by spinofixation. Continence is obtained in 97.6% and 91% respectively. Severe obstruction is observed in 3%, all of the first group. There is no infection due to this combined approach. The closure pressure remains similar or increases in 75% of the cases. Compared to others colposuspensions, this technique offers a conceptual advantage, without added morbidity. It is especially indicated when the closure pressure is low, the vaginal wall is weak, or when combined with a spinofixation.
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PMID:[Reinforced colposuspension (modified Cukier's operation). Immediate results, complications, indications]. 209 99

The currently available methods of anorectal functional investigation are critically reviewed. The clinical utility of manometry has not yet been precisely defined, and the method is not standardized. The principal role of manometry is comparison between defined groups, such as preoperative and postoperative, whereas determination of the degree of continence has proven not more accurate than clinical digital investigation. The latter serves to determine qualitatively all important functions of the anal sphincter components. Radiological dynamic investigations may detect and differentiate various forms of anorectal constipation (outlet obstruction, internal prolapse, rectocele). While electrophysiological studies are not currently used in clinical practice, they demonstrate the importance of pudendal nerve damage in pelvic floor disorders and incontinence. Electromyography may be used to identify the activity of the sphincter components. Clinical investigation may provide detailed and adequate qualitative information on anorectal function.
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PMID:[Methods of anorectal functional studies]. 219 83

Procidentia, vaginal vault prolapse and severe cystocele may be associated with potential urinary incontinence, which becomes overt only after surgical repair of the genital prolapse. The normal support of the pelvic organs is provided by the pelvic diaphragm (levator ani and coccygeus muscles). The levator plate is a firm, muscular plate between the coccyx and anus formed by fusion of the levator ani muscles on each side. Recent investigators have indicated that the main mechanism for weakening the pelvic muscles occurs as a result of childbearing, when stretch injury of the pudendal nerve causes denervation of the muscles. This injury is aggravated with the changes of aging and has effects on anogenital prolapse and stress incontinence. There may be iatrogenic causes of both prolapse and stress incontinence when an operation produces a change in the direction of tissue forces or removes a prior barrier to incontinence. The evaluation of patients must include the actual and potential aspects of genital prolapse and incontinence. Testing for stress incontinence must be performed before and after reduction of the genital prolapse. Surgical repair should be planned carefully to correct all the significant and potential defects in the urogenital tract. Ideally a normal vaginal axis with adequate length will be restored, and urinary function will not be compromised.
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PMID:Genital prolapse with and without urinary incontinence. 221 41

Women with incontinence were divided into 30 with anorectal incontinence and 63 with complete rectal prolapse. The former group comprised 14 with a sphincter disruption and the remainder with intact sphincters. After anterior sphincter repair 70% were restored to acceptable continence. Success was associated with a rise in resting and voluntary contraction pressures and improved anal sensation. Patients with prolapse underwent either anterior and posterior rectopexy, or resection rectopexy. Continence was improved in both groups. Postoperatively, 90% following resection rectopexy and 80% following anterior and posterior rectopexy were restored to acceptable continence. Postoperative defaecatory straining and incomplete evacuation were reduced, with no significant differences between the two procedures. Restoration of continence was not associated with any change in sphincter pressures. However, rectal sensory threshold and anal sensation were both improved.
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PMID:The physiological evaluation of operative repair for incontinence and prolapse. 222 61

Primary repair of acute anal sphincter injuries by direct apposition of the severed external sphincter without tension is advisable whenever feasible. However, the majority of patients who are candidates for surgical treatment of anal incontinence will undergo a secondary repair, the type of which will depend on the underlying aetiology and the surgeon's preference and experience. The most successful of these procedures is sphincter reconstruction with or without levatoroplasty for a disrupted anal sphincter (due to surgical, obstetrical or other trauma) in the absence of underlying neurological damage. Success rates are reported at 80-90%. Post-anal repair is advocated for patients with a poorly functioning sphincter with an obtuse anorectal angle, most of whom have a neurogenic basis for their incontinence. Success rates vary from 60 to 75% of cases but long-term results have been less satisfactory. Rectal procidentia is associated with faecal incontinence in 65-75% of cases. Abdominal repair (we favour suture rectopexy with sigmoid resection) restores continence in 50-80% of such patients. Patients with persisting incontinence are candidates for post-anal repair. Anal encirclement with an elastic, Dacron-impregnated Silastic sleeve has a limited role in selected patients. For more severe incontinence, muscle transfers (gracilis, gluteus maximus, etc.) can achieve some success but continence is less than perfect. We are currently assessing the use of an artificial anal sphincter (a modification of the AMS 800 urinary sphincter). For patients who fail all therapeutic options, a stoma will provide a better lifestyle than coping with the consequences of faecal incontinence.
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PMID:Surgical approaches to anal incontinence. 222 62

A review based on a follow up of 215 patients who had been treated operatively for genital prolapse and urinary incontinence after observation for 5-10 year is presented. The operation regime was predominantly conventional and the various vaginal methods involved 182 patients (80%). The Kelly-Kennedy plastic operation (K-K-pl) was employed for stress incontinence and slighter cases of prolapse. In more severe degrees of both of these conditions, K-K-pl was combined with the Manchester operation. The operative method of election in this department for marked cases of utero-vaginal descent was the Manchester operation supplemented by colpo-perineal plastic. The most advanced cases of prolapse were treated either with the Moschowitz operation or colpocleisis. This investigation revealed that the late results of the individual methods at primary operative treatment of both prolapse and incontinence showed the same high results of treatment with satisfactory results in 75-100%. On the other hand, the results of secondary operation showed great variation, depending upon the method, with satisfactory results from 25-85%.
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PMID:[Genital prolapse and urinary incontinence. A clinical assessment of patients with prolapse with particular emphasis on surgical methods and their long-term effects]. 223 41

Based on a series of 209 cases, the authors investigate the aetiological factors responsible for vesical instability in adult females. Fifty five p. cent of patients suffered from incontinence due to isolated urgency. These patients presented a history of neurological disturbances in 21 cases, total hysterectomy in 22 cases and surgery for incontinence in 54 cases. Sixty p. cent of cases presented with genital prolapse. There were 7 cases of urinary tract infection, 2 cases of renal stones and 2 bladder tumours. Urodynamic studies revealed 60 dysuric syndromes. The responsibility of urinary tract infection or genital prolapse in the development of vesical instability is questionable. Nevertheless, the frequency of genital prolapse in the present series argues in favour of deficiency of the perineal musculature which decreases the capacity for inhibition of the detrusor. Lastly, 40% of patients did not have any neurological causes or any vesical or adjacent pathology. These cases were described as idiopathic vesical instability for which the aetiopathogenesis remains unknown.
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PMID:[Female vesical instability: etiologic problems in 209 cases]. 225 43


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