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

Forty-five patients with soiling but without faecal incontinence were evaluated by means of anorectal function investigations (anal manometry, rectal capacity and saline infusion test). The causes of soiling and the effect of treatment on both soiling and anorectal function were studied. The results were compared with a control group of 161 patients without soiling or incontinence. The diagnoses were haemorrhoids (10), mucosal prolapse (7), rectal prolapse (6), fistulae (5), proctitis (3), faecal impaction (2), rectocele with intussusception (2), scars after fistulectomy (2) and others (8). Simple inspection and proctoscopy were generally sufficient to establish a diagnosis. For two patients the diagnosis rectocele was made after defaecography. Anorectal test results did not differ between the soiling and control group, did not contribute to establish a diagnosis and did not change after treatment. Only patients with a rectal prolapse had abnormal results in anorectal function tests: a low basal sphincter pressure and a limited continence reserve. Appropriate therapy resulted in complete recovery (44%) or improvement of symptoms (29%).
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PMID:Soiling: anorectal function and results of treatment. 270 80

One hundred sixty-five cases of abdominal rectopexy using polypropylene (Marlex) mesh for rectal prolapse were reviewed. Six patients were men and 159 were women. Thirty patients have not been evaluated after surgery, 22 having died of interrecurrent disease and 8 have had their surgery during the last two months. Incontinence was observed in 95 patients (58 per cent) before surgery, whereas it persisted in only 21 of 135 patients (16 percent) after surgery. Forty patients (24 percent) claimed constipation before surgery, whereas 60 of 135 patients (44 percent) had constipation after rectopexy. Recurrence of full-thickness rectal prolapse was found in only 2 patients-(1.5 percent). Mucosal prolapse occurred in 9 patients (7 percent) after surgery. These results indicate that abdominal posterior rectopexy using Marlex mesh is an effective operation for rectal prolapse, but persistent incontinence occurs in one third of patients and almost half become constipated after the procedure.
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PMID:Functional results after posterior abdominal rectopexy for rectal prolapse. 279 67

This technique has been applied to 224 female patients over 9 years with a mean follow-up to the last control of 2 years 3 months. The sub-urethral fold of the fascia, the inferior and infero-lateral aspects of the urethra are dissected, the length and the width of the tube are restored by direct resuture, the sub-urethral fascia is doubled by overlapping. No suspension nor foreign tissue. Genito-urinary ptosis is treated by the same time. Application to stress incontinence, diverticulae, abscesses, periurethritis and a few cases of non malignant pathology. In stress incontinence, selected by suprapubic expression test, full success in 76.3%, primary failure in 5.4% and imperfect result with no permanent or necessary padding in 18.2%. In these imperfect results and failures as well as in periurethral pathology the importance of relapsing inferior of the low tract suggests that sexual infections be more investigated and that mechanical causes of infection, such as reflux be more operated on. On the 224 cases, 1 fistula and 1 urethral avulsion, in particular conditions which do not affect the general principle. No fistula in 12 cases of urethral diverticulae and abscesses. The suprapubic expression test in simple and valuable in selecting before and testing after operation the static mechanical incontinence.
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PMID:[Repair of the female urethra and its natural support. Another surgical concept. 224 cases over 9 years]. 280 46

The authors report 1,000 cases (357 cesarean sections, 230 hysterectomies for benign lesions, 157 conservative utero-adnexal procedures, 128 tubal plasties, 58 prolapse or incontinence procedures, 70 cancers) ,of laparotomies performed according to the technique described by Mouchel in 1980, i.e. strictly supra-pubic and transverse, from skin to peritoneum, including section of the rectus abdominis. This incision enables to perform in ideal technical conditions, with a minimal complication rate (3 hematomas, 2 incisional hernias for 1,000), and satisfactory esthetic results, almost all of the gynecological and obstetrical surgical procedures (90% of two among the authors' practice). The only contra-indications are, except for cases of previous median laparotomy, ovarian tumors. Neither the high risk of infection, nor obesity, extended hysterectomy, nor fetal distress, represent contra-indications, which is a definite advantage over the Pfannenstiel incision. As compared with the median incision which at some time offered similar results, the esthetics and mainly the strength of the abdominal wall are markedly superior.
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PMID:[Low transverse laparotomy with rectus abdominus section in gynecology and obstetrics. Apropos of 1,000 cases]. 296 66

The bladder closure mechanism works under the influence of a hydro-aerodynamic force that presses downward ("stress"). This "stress" is caused by the relative weakness of the pelvic floor. The structures running through the urogenital hiatus are compressed by the rectococcygeal and pubo-coccygeal muscles, which close the hiatus. The urogenital diaphragm bridges the slit in the levator ani muscles. It is made of the perineal membrane, the superior fascia, and the smooth and striated muscle lying between the two (M. sphincter urethrovaginalis, M. compressor urethrae). The superior fascia is an extension of the intraabdominal interior parietal fascia. The intraabdominal pressure stabilises the position of the urethrovesical region by pressing the intraabdominal contents and the subperitoneal connective tissue etc. closely together. The visceral fascia, the pubourethral ligaments, and above all, the connection to the superior fascia of the pelvis diaphragm anchor and regulate the paraurethro-vaginal region. The decompensation of this stress mechanism, usually caused by previous birth injury, leads to varied degrees of prolapse and incontinence. A rational therapy is the reconstruction of the damaged structures of the pelvis floor (diaphragma urogenitale, diaphragma pelvis, perineum etc.) in a complete individualised vaginal surgical reconstruction ("diaphragm repair"). This procedure makes a direct visualisation of the local situation and a control of the indication for surgery possible. If the suspensory apparatus is well anchored to the pelvis wall, reconstruction can be achieved. If this is not the case, a more sophisticated repair is necessary. If the indication is not correct and the limits of this method are ignored, or, if surgery is technically inadequate, this method will fall into disrepute.
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PMID:[Surgical anatomy of the bladder neck sphincter and its significance for vaginal surgery of stress incontinence]. 306 85

Anorectal manometric and electromyographic studies assess anorectal and pelvic floor neuromuscular disorders and can help in the diagnosis and management of incontinence, prolapse, megarectum, and other functional anorectal disorders. These studies can assess preoperative and postoperative anorectal function and help in the differential diagnosis of anorectal disorders, and thus they assist the surgeon in carrying out rational therapy.
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PMID:Diagnostic anorectal functional studies. Manometry, sphincter electromyography, and defecography. 319 19

Rectopexy in the sacral hollow or to the promontory with synthetic material is the most efficient method of reducing and fixing a complete rectal prolapse. However, this distressing condition occurs frequently in elderly patients, often with high operative risk. In these some surgeons have advocated a perineal approach. Eighteen female patients (mean age 74 years) with complete rectal prolapse have been treated by a modified Delorme's procedure which involves a mucosal stripping of the prolapse and longitudinal plication of the muscular wall of the rectum. There was no postoperative mortality or morbidity. After a mean follow-up of 18 months, two complete recurrences occurred. These were treated by the same technique with a good result at 3 years. One other patient presented a partial and intermittent recurrence. Incontinence has improved in four patients and was not made worse in the others. Our results and those previously published show that this procedure is safe in elderly high risk patients considered too unfit for transabdominal surgery.
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PMID:Treatment of rectal prolapse by Delorme's operation. 330

The authors present a retrospective study of 1,000 total abdominal hysterectomies performed between 1969 and 1975, and they report the main complications. Early complications are dominated by: rare thrombo-embolic accidents (2.2%) since the advent of prophylactic heparin therapy; infectious complications, dominated by the abscess of the abdominal wall and asymptomatic urinary infections, and for which simple measures prevent resorting to prophylactic antibiotherapy. The role of the hysterectomy seems minimal in the occurrence of a prolapse or a stress-related urinary incontinence: prolapses after hysterectomy (1.4%) seem more related to tissue aging than to the procedure which modifies very little the supporting system of the pelvis. A post-operative urinary incontinence is, most of the time, the result of an incomplete pre-operative work-up: failure to recognize a potential stress-related incontinence, or an incontinence secondary to an unstable bladder. Prolapse and incontinence must always be treated independently. In the psychological and sexual repercussion, age, ovariectomy and the distress related to the procedure, involving the heart of womanhood, seem to be the most important factors.
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PMID:[Complications of abdominal hysterectomy for benign gynecologic lesions. Apropos of 1,000 cases]. 331 61

A review of the new concepts of the anatomy of the anal sphincter mechanism and the physiology of defecation is presented. The external sphincter is a triple-loop system; each loop can function as a separate sphincter through voluntary inhibition action and mechanical compression. Stress defecation resulting from internal sphincter damage is described. A new technique for repair of rectal incontinence is presented, which depends on inducing continence not only by mechanical compression, but also by voluntary inhibition. The mechanism of defecation and rectal continence is described and four types of incontinence presented. Also, the mechanism of both the levator dysfunction syndrome and prolapse is demonstrated and a technique of repair is presented. The study defines two types of rectal anomalies; suprahiatal and infrahiatal. The role of the embryonic anorectal sinus, anorectal band, and epithelial debris in the genesis of perirectal suppuration, chronic anal fissure, pruritus ani, and hemorrhoids is described. The communicating veins, identified between the hemorrhoidal and vesical plexuses, offer an explanation for the vague pathologic aspects of recurrent bacteriuria, urethral discharge, cervicitis, and vaginitis, and provide a proper line for their treatment. They also serve to perform a new radiographic technique--anal cystography--and to administer drugs, including chemotherapeutics, in the treatment of pelvic malignancies.
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PMID:A concept of the anatomy of the anal sphincter mechanism and the physiology of defecation. 331 51

Between 1970 and 1985 (inclusive), 66 patients presented with complete rectal prolapse; 59 (89 per cent) were treated by extended abdominal rectopexy. Forty-four patients (75 per cent) have been followed for more than 2 years: all cases were cured of their complete prolapse, no patients died, and major complications were few. Constipation (47 per cent) and incontinence (19 per cent) caused serious problems for many patients postoperatively.
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PMID:Complete rectal prolapse: the anatomical and functional results of treatment by an extended abdominal rectopexy. 333 47


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