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

A controlled radiologic study of anorectal function was performed with the use of defecography in 19 patients with constipation and 13 with incontinence. All patients were age and sex matched to control subjects who were referred for barium enema study and who had no defecation disorder. There were no statistically significant differences between either patient group and the control group in anorectal angle and excursion of the anorectal junction. In the 32 patients and 155 consecutive patients referred for defecography because of a variety of defecation disturbances, approximately twice as many rectal wall abnormalities were seen compared with findings in the control group. These findings included intussusception, rectal prolapse, rectocele, mucosal prolapse, spastic pelvic floor, descending perineum syndrome, and solitary rectal ulcer syndrome. In conclusion, the main role of defecography is to document rectal wall changes during defecation straining as possible causes of evacuation difficulties. Clinical symptoms should also be taken into account when treatment is contemplated.
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PMID:Anorectal function in patients with defecation disorders and asymptomatic subjects: evaluation with defecography. 229 37

Two hundred eight patients with retention disorders have been studied. Most frequent causes were idiopathic (107), iatrogenic (57), and obstetric (33). Twenty-five patients experienced soiling, 31 had insufficient function, and 152 complained of incontinence. Seventy percent of patients with idiopathic incontinence did not experience urge, compared with 38 percent with iatrogenic and only 3 percent with obstetric incontinence. The incidence of prolapse was 58 percent in patients with idiopathic incontinence, 20 percent in patients with iatrogenic incontinence, and only 3 percent in patients with obstetric incontinence. The authors conclude that the function of the puborectalis sling is to create the anorectal angle to evoke the feeling of urge and to support intra-abdominal contents and, furthermore, that fecal incontinence after anorectal surgery was likely caused by denervation. Anal resting and squeeze pressures varied widely. There was a huge overlap in the different groups. Mean resting and squeeze pressures were 9.5 kPa and 9.4 kPa, respectively, in controls, 4.8 kPa and 10.3 kPa, respectively, in the soiling group, 7.1 and 6.1 kPa, respectively, in the insufficient group, and 5.1 and 2.7 kPa, respectively, in the incontinent group. An incontinent external sphincter function could be defined as a function of the external sphincter causing a pressure increase of 5 kPa or less during straining. The ability to retain feces, therefore, is based on external sphincter function. Anal manometry is, indeed, a suitable technique to determine anal sphincter functions, but the presence of a retention disorder cannot definitely be determined. Its clinical application remains under discussion.
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PMID:Disorders of impaired fecal control. A clinical and manometric study. 231 64

Stenosis of the rectum after surgery is a rare complication of low anastomosis. Infection, ischemia, foreign body reaction, technical faults or recurrence of neoplasms are the most important causes. Dilatation is attempted either manually or by instrument, if the stenosis causes discomfort and in particular if diarrhea results. Rarely resection of the stenosed segment is necessary. Stenosis in conjunction with incontinence is the most feared complication of anorectal surgery. It develops exceptionally after scarring of a large mucocutaneous defect after hemorrhoidectomy, correction of an anal fistula, a mucosal prolapse, electro-resection, infection or trauma. Anal stenosis leads to increasing constipation, a reduction of stool volume, abdominal cramps and rectal bleeding.
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PMID:[Postoperative anorectal stenosis]. 236 80

Mucosal prolapse is a frequent sequela after surgical treatment of the high type of anorectal malformation whatever was the technic used for the pull-through operation. The authors report six cases treated with the spiral flap described by Millard. The initial procedures had been a Romualdi-Rehbein pull through in three cases with secondary revision of anoplasty and a Stephan's operation in the three other cases. Before Millard's plasty, all the patients were continent and two of them had an associated stricture. The anatomical result was good in all the cases with reconstruction of a cutaneous anal funnel and no stricture. Improvement of continence was noted in two cases, uncertain in two. Incontinence remained unchanged in two other cases. The advantages of the Millard's plasty are analysed. The prevention of mucosal prolapse is possible in the initial pull through operation using the same plasty or whatever plasty which provides a cutaneous anal canal.
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PMID:[Millard's flap for sequelae of high anorectal malformations. Apropos of 6 cases]. 238 6

A study was performed to find out how often continent women develop urinary stress-incontinence after a Manchester operation for genito-urinary prolapse, and to ascertain whether factors in the selection of patients, or steps in the surgical procedure are responsible for producing stress-incontinence postoperatively. Seventy-three of 102 consecutive patients were continent before operation. Sixteen of the 73 women (22%) became stress incontinent. Advanced age increased the risk of developing urinary stress-incontinence. Twenty-five per cent of the women more than 60 years old developed stress-incontinence, but only 1 of 13 below the age of 60. Preoperative urethral closure pressure was significantly lower in those developing urinary stress-incontinence, and closure pressure was further reduced by surgery in this group, significantly more than in the women remaining continent. Surgery significantly reduced the pressure transmission ratio in the patients who developed urinary stress-incontinence, and less in the continent ones. The preoperative pressure transmission ratio, however, was not related to the risk of developing urinary stress-incontinence after the operation. The urodynamic examinations pre- and postoperatively demonstrated important changes in the urodynamic parameters produced by the Manchester procedure, but did not prove useful in determining which patients will develop urinary stress-incontinence.
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PMID:The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. 252 Aug 12

The muscles of the pelvic floor form a complexly built sustaining structure, which bears the whole weight of the visceral column. The pelvic floor is reinforced by a supporting framework of fasciae. Some of the pelvic muscles are important sphincteric elements for occlusion of the anal canal, the vagina and the urethra. Any weakening of the ingenious construction of the pelvic diaphragm consequently reduces its functions of support or continence. Possible effects are visceral prolapse and incontinence.
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PMID:[Pathophysiology of pelvic floor insufficiency]. 257 33

Anal prolapse in adults is cured by the Milligan-Morgan procedure. Operation for the rectal prolapse has to repair procidentia, incontinence and obstipation. Procidentia and incontinence in low-risk patients are best repaired by abdominal rectopexy with or without plastic materials (Ripstein's procedure is preferred). Obstipation remains a long-term problem. Rectopexy in combination with sigmoid resection (Goldberg) improves obstipation, but there is leakage in 4% of the patients. The perineal approach offers no technical advantage. Perineal rectopexy, prolapse resection and Thiersch ring with modifications are preferred in high-risk cases. Posterior levator plastic improves remaining incontinence.
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PMID:[Surgical methods in anal and rectal prolapse]. 257 35

We report the results of a procedure aimed at correcting the disorders of rectal and perineal tone responsible for the descending perineum syndrome (DPS). The procedure, carried out by the perineal approach, combines a posterior intersphincteric sacro-rectopexy, an anterior perineoplasty via a pre-anal levator myorraphie, a posterior perineoplasty using a post anal repair technique and a mucosal resection aimed at freeing the anal canal. 22 F and 1 M, mean age 68 years, with DPS were operated on. Digitised rectography demonstrated pathological perineal descent (greater than 3 cm) in all cases and posterior rectal angulation at rest of more than 25 degrees (normal less than 10 degrees) confirming an important deterioration in perineal tone. Results after a mean follow up of 12 months (6 to 30 months) were excellent, with objective improvement in rectal bleeding, pain, mucosal prolapse and anal incontinence. In spite of an almost constant return to normal in the number of stools and their facility of evacuation improvement in the dyschesic syndrome (78% of patients) was subjectively variable. Improvement was judged to be very good in 34%, good in 33%, fair in 11%. Healing of mucosal lesions: solitary ulcer (n = 2), rectal inflammation (n = 2), ulcerated mucosal prolapse (n = 3) occurred in all cases within 1 month. Post operative rectography demonstrated a significant decrease in posterior rectal angulation and ano-coccygeal distance confirming the efficacy of the anatomical correction. No serious complications, in particular, infections, were noted under appropriate prophylactic antibiotic cover (Piperacillin) continued up to D5.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Sacro-rectopexy by a posterior intersphincteric approach with anteroposterior perineoplasty and mucosal resection. Therapeutic proposal in descending peritoneum syndrome. Apropos of 23 cases]. 265 13

The classical approach to cystocele repair involves the approximation of lax pubocervical fascia through the anterior vaginal wall with narrowing of the bladder neck and proximal urethra by the Kelly-type plication. This procedure corrects the prolapse but when performed for the treatment of incontinence it has a high failure rate because the bladder neck and urethra are not placed into a high, supported, nonobstructed retropubic position. Furthermore, due to elevation of the bladder base without simultaneous elevation of the bladder neck and urethra, de novo stress urinary incontinence may occur. We developed a transvaginal needle suspension operation for the bladder and urethra that repairs anterior vaginal wall prolapse with excellent support of the bladder base and repositions the bladder neck in the high retropubic position, all during a simple and rapid operation that is tolerated well by the patient.
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PMID:Four-corner bladder and urethral suspension for moderate cystocele. 267 13

Perineal approaches for rectal prolapse are particularly useful in high-risk patients or in patients presenting with strangulation. Each technique is useful in certain clinical situations. Altemeier's procedure, with the addition of rectopexy and levatorplasty (Dis Colon Rectum 29: 547-552, 1986) may be the best available perineal operation for long-term correction of prolapse and treatment of associated incontinence.
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PMID:Perineal approaches for the treatment of complete rectal prolapse. 269 20


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