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

Twenty-one patients suffering from rectal prolapse (n = 15) or internal rectal procidentia (n = 6) were investigated clinically and by anorectal manometry prior to and six months following retopexy. Rectal prolapse was associated with incontinence in 67% (10/15) of the patients preoperatively. The moderately or severely incontinent patients had lower than normal maximum anal resting pressures (MAP) and those with severe incontinence also had lower than normal maximum squeeze pressure (MSP). Postoperatively only 20% (3/15) of the patients remained incontinent and none of them suffered severe incontinence. MAP values increased significantly indicating that improvement of the function of the internal anal sphincter may be one of the factors contributing to better continence. Rectal sensibility was impaired in patients with rectal prolapse as compared to 15 controls. There was no postoperative change. Patients with internal rectal procidentia had normal MAP and MSP and no postoperative change could be demonstrated.
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PMID:Recovery of the internal anal sphincter following rectopexy: a possible explanation for continence improvement. 336 Dec 20

There are two muscular mechanisms of fecal continence. The anal sphincter squeezes the anal canal, thus lengthening it and increasing its resistance. The puborectalis kinks the distal rectum, preventing the transmission of intra-abdominal pressures into the anal canal. Balloon sphincterography simultaneously records the shape of the anal canal and distal rectum and measures the strength of the puborectalis and anal sphincter muscles. This allows the physician to evaluate the function of these important muscles in patients with symptomatic defecation disorders such as constipation, incontinence, and rectal prolapse. A cylindrical balloon is connected by a hose to a fluid reservoir filled with liquid barium. The deflated balloon is placed into the anal canal and inflated by raising the fluid reservoir in increments. Fluoroscopy visualizes the balloon's shape and video records the results. Quantitative sphincterogram measurements in patients with defecation disorders include (the three measurements in each category refer respectively to incontinent patients [N = 87], prolapse patients without incontinence [N = 26], and constipated patients [N = 65]); anorectal angle (degrees + S.D.): 114 + 28, 103 + 18, 95 + 19; anal canal length (mm + S.D.): 33 + 11, 38 + 10, 39 + 10; squeeze pressure (cm H2O + S.D.): 68 + 23, 80 + 16, 91 + 22, and opening pressure (cm H2O + S.D.): 52 + 25, 67 + 22, 81 + 24. The method is useful in identifying specific defects, such as paradoxic puborectalis contractions, that can cause constipation, and injuries to the sphincters that can cause incontinence. In over 280 patients with a wide variety of defecation disorders, sphincterography has yielded information not available by standard manometric techniques. It augments the findings of defecography.
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PMID:Balloon sphincterography. Clinical findings after 200 patients. 336 32

Transabdominal posterior rectopexy with resection of the redundant left colon (Frykman-Goldberg operation) was performed on 48 selected patients with complete rectal prolapse. Uterine suspension was also performed on most of the women. The 30-day mortality rate was 2.1%. Prolapse recurred in 4 (9%) of the 45 patients followed up for 1-10 (mean 4.3) years. There were no complications attributable to bowel resection or anastomosis. Adequate data on both preoperative and postoperative anal function and bowel habit were available in 41 cases. All but two of the 32 patients with associated incontinence experienced improved anal control after the operation (9 regained normal continence). Bowel habit improved in 23 patients (56%), especially in those with chronic constipation. No patient reported increased problems of bowel management. The operation does not involve the risks associated with implantation of foreign material and can be especially beneficial for constipated patients with rectal prolapse who are fit for major abdominal surgery.
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PMID:Abdominal rectopexy and sigmoid resection (Frykman-Goldberg operation) for rectal prolapse. 337 79

In this study we report about 172 patients who underwent modified anterior repair in the time from october 1983 up to april 1985 because of vaginal prolapse and/or incontinence. 125 patients could be examined clinically, in the middle 14.2 months after operation. In 64% the modified anterior repair was combined with a colporrhaphia anterior and hysterectomy, and in 20% a colporrhaphia posterior was made additionally. Dehiscence of the anterior vaginal wall occurred in 19.2%, severe pelvic infections in 8.8%. Because of bleeding complications a chirurgical intervention was necessary in 5.6%. A descent of the anterior vaginal wall was seen in 30.4%, 76.8% of the women developed a descent of the posterior vaginal wall, and 8% a stenosis of the vagina. Problems at sexual intercourse were frequent, followed by pain in the lower abdomen. The principle of the operation is presented including the changed anatomy. Many of the adverse effects can be understood and the necessity of prophylaxis of a descensus of posterior vaginal wall was described.
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PMID:[Results following anterior levator-plasty]. 337 93

Over a 2 1/2 year period a prospective study was undertaken to evaluate the occurrence and symptoms of rectal intussusception (internal procidentia). The condition was found in 28 female patients. 17 patients were operated on due to severe obstruction during defaecation, perineal pain, solitary rectal ulcer syndrome, and partial incontinence. The endopelvic findings were similar to those encountered in patients with complete, external rectal prolapse, and the operative procedure was identical (rectal mobilization, elevation, fixation, with rectosigmoid resection in most cases). Results were favorable. Conservative treatment seemed to be adequate in 7 of the 11 remaining patients.
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PMID:[Internal rectal prolapse]. 338 80

Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.
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PMID:The pathogenesis and pathophysiology of rectal prolapse and solitary rectal ulcer syndrome. 353 17

Between January 1982 and December 1985, 355 fiberoptic pouchoscopies were performed in 123 patients with a continent ileostomy. These examinations have been reviewed to determine the effectiveness of the technique as a diagnostic and therapeutic tool. The Olympus GIF-XP pediatric endoscope was used after pouch lavage, and the afferent loop of ileum, the pouch, and (by retroflexion) the nipple valve were examined on each occasion. There were 63 males and 60 females, with a median age of 35 years (range, 16 to 71 years). The median length of follow-up after pouch construction was 36 months (range, 6 to 120 months), and an average of three examinations were performed per patient (range, 1 to 12). Of 127 examinations performed in asymptomatic patients, the pouch was normal in 117 cases, and there was mesh erosion into the pouch in 10 cases. The remaining 228 examinations were for symptoms that included pouchitis (56), difficulty in intubation (47), incontinence (35), follow-up of treated pouchitis (18), parastomal sepsis (22), blood in the stool (13), anemia (8), excess mucus discharge (6), valve prolapse (4), and purulent discharge from the stoma (1). Eighty-four examinations were normal; 144 revealed a likely cause for the symptoms and led to appropriate treatment, which in 45 patients was surgical. Fiberoptic endoscopy was therapeutic in 6 patients in whom it was used on 10 occasions to intubate a pouch with a slipped valve. Radiographic studies were seldom used, with pouchograms being carried out in 16 patients and fistulograms in 5. Only the fistulograms contributed to the assessment of each patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The role of fiberoptic endoscopy in the management of the continent ileostomy. 359 85

Bologna's operation to relieve stress incontinence in patients with large cystoceles uses two vaginal strips to form a subcervical sling. Of 60 patients treated in this way, urodynamic exploration was performed preoperatively in 83% and postoperatively in 50%, while 42% underwent lateral retention and pressure cystography. All patients presented at least a stage II cystocele and hysteroptosis, 47% a patent and 93% a potential stress incontinence and 40% a sphincter incompetence. Anatomic results were excellent: 77% of total relief and 23% improvement in the cystoceles. Of greatest interest was efficacy against urinary incontinence: all patent stress incontinences were cured; none occurred after correction of cystocele, and only two cases of potential incontinence due to anatomic failure were observed. These good clinical results could be correlated with postoperative urodynamic exploration findings: the lack of persistent dysuria was related to the correction or even hypercorrection of the transmission anomaly without alteration of sphincter function. Paradoxically, images of pressure cystography showed elevation of the bladder neck in relation to symphysis pubis to be limited in extent. In 26% of cases the neck was in fact below this limit. These findings raise the question of the mechanism of re-establishment of pressure transmission. Because of the simplicity of technic of Bologna's operation, its low morbidity and it very great reliability with respect to urinary results, this method is now practised routinely in cases of prolapse with marked cystocele and patent or potential stress incontinence, even in the presence of major sphincter incompetence.
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PMID:[Results of the treatment and prevention of urinary stress incontinence by Bologna's operation in prolapse with voluminous cystoceles]. 369 37

In this follow-up study we demonstrate the clinical and urodynamic results in 46 patients who underwent modified anterior repair because of vaginal prolapse or incontinence. Besides frequent inflammations of the lower urinary tract (70%), dehiscence of the anterior vaginal wall was quite common (30%). Considering the patient pre- and postoperative anamnestic data, we found a significant increase in continent patients (4 preoperative-18 postoperative). The urodynamic parameters showed a change in the first urge to void at significant higher bladder volumes, and a significant increase of the functional length of the urethra. After surgery a negative stress profile and a positive clinical stress test were seen less often.
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PMID:[Anterior levatorplasty in prolapse and incontinence: a clinical and urodynamic study]. 372 Nov 65

Clinical and urodynamic effects of a new modification of the Marshall-Marchetti-Krantz procedure for correction of urinary stress incontinence were studied 3-6 years after surgery. A clinical follow-up was made in 239 patients, and 39 had a urodynamic assessment. The subjective cure rate for incontinence was 69% while in another 20% there was improvement. Symptoms caused by the prolapse were relieved in 83%. The incidence of late complications was below 1%. Urodynamic measurements indicated a cure rate of 66%. Pressure transmission to the urethra was significantly improved. At follow-up, the functional length of the urethra and urethral closure pressure values were significantly higher than before operation. The incidence of urge (incontinence) and voiding difficulties was unchanged.
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PMID:Follow-up of a new modification of the Marshall-Marchetti-Krantz (MMK) procedure. 374 Sep 59


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