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

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

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

Conventional incontinence surgery was performed in 41 consecutive female patients despite the finding of motor urge incontinence. The patients were reinvestigated 6 months to more than 2 years after operation. Twenty-eight of the patients also had the symptom stress incontinence. Seventeen patients had coexisting symptomatic genital prolapse and were operated on without prior pharmacological treatment. The remaining 24 patients were all resistant to parasympatholytic treatment. The choice of operative procedure was based on vaginal examination as well as bladder suspension defect as demonstrated on voiding-colpo-cysto-urethrography. Subjective cure and improvement rate was 73%. At follow-up, 30% of the patients had normal detrusor reflex control, and a significant improvement in urge incontinence as well as frequency of micturition and nocturia was observed. Probably the primary treatment in females with motor urge incontinence should be pharmacological. However, in patients with symptomatic genital prolapse as well as in patients with ineffective medical treatment, conventional incontinence surgery seems to be well indicated in the absence of neurological disease-providing the patient has an associated bladder suspension defect.
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PMID:Incontinence surgery in female motor urge incontinence. 663 11

Urethral prolapse denotes the complete circular eversion of the urethral mucosa through the external meatus. Two different entities exist: premenarcheal and menopausal urethral prolapse. Premenarcheal prolapse is predominantly asymptomatic and is usually brought to medical attention by vaginal bleeding. Trauma and medical conditions predisposing a patient to increased abdominal pressure are associated with prolapse in children. The menopausal group seeks medical attention primary because of the severity of urinary symptoms, ie, nocturia, urgency, tenesmus, dysuria, and frequency. Therapy for both groups has been traditionally accomplished by surgical manipulation-excision, surgical ligation, cautery, fulguration, and cryosurgery. The authors treated 5 premenarcheal female children with antibiotics, estrogen cream, and sitz baths for 2 weeks. In all the patients prolapse was resolved. The results, with follow-up for 4 to 12 months without recurrence, suggest that urethral prolapse in children can be managed without surgical intervention.
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PMID:Medical treatment of urethral prolapse in children. 707 52

The aim was to evaluate the intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence. Fifty-four unselected patients, aged from 26 to 79 years, mainly with mixed incontinence symptoms, underwent this procedure. It works by tightening the suburethral vagina ('hammock'), and by creating an artificial pubourethral neoligament. Where indicated, repair of uterine prolapse (24 cases), or infracoccygeal sacropexy (17 cases) was also performed. Almost all patients were discharged on the day of, or day after surgery, without requirement for postoperative catheterization, and returned to fairly normal activities, including jobs, within 7 to 14 days. At a mean follow-up time of 15 months, the cure rates for preoperative symptoms were, frequency 88%, nocturia 77%, urge incontinence 89%, stress incontinence (SI) 85%, symptoms of abnormal emptying, 77%, and reduction of mean residual urine from 67.5 mL to 32 mL. The objective cure rate (exercise pad testing) for stress incontinence was 88.6%; taking the group as a whole, urine loss was reduced from a mean of 11.6 g preoperatively to a mean of 0.5 g postoperatively. Urodynamically diagnosed detrusor instability was not a predictor of surgical failure in this study. According to the concepts presented here, symptoms of urinary dysfunction are mainly symptomatic manifestations of abnormal laxity in the vagina or its supporting ligaments. The surgical methods used to correct these defects are fairly simple, safe and easily learnt by an practising gynaecologist.
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PMID:The intravaginal slingplasty operation, a minimally invasive technique for cure of urinary incontinence in the female. 942 24

The aim of the study was to introduce an anatomical classification for the management of urinary dysfunction based on the Integral Theory, a new connective tissue theory for female incontinence. Eighty-five unselected patients, aged 27-83 years, 12 with pure stress symptoms and 73 with mixed incontinence symptoms, were classified as having laxity in the anterior, middle or posterior zones of the vagina, using specific symptoms, signs and urodynamic parameters summarized in a pictorial algorithm. Special ambulatory surgical techniques, which included the creation of neoligaments, repaired specific connective tissue defects in the anterior (intravaginal slingplasty (IVS), n = 85), middle (cystocele repair, n = 6), or posterior zones (uterine prolapse repair, n = 31, or infracoccygeal sacropexy, n = 33). Almost all patients were discharged within 24 hours of surgery, without postoperative catheterization, returning to fairly normal activities within 7-14 days. At (mean) 21-month follow-up cure rates were: stress incontinence 88% (n = 85), frequency 85% (n = 42), nocturia 80% (n = 30), urge incontinence 86% (n = 74), emptying symptoms 50% (n = 65). Mean objective urine loss (cough stress test) was reduced from 8.9 g preoperatively to 0.3 g postoperatively, and mean residual urine >50 ml from 110 ml to 63 ml, P = <0.02. Pre- and postoperative urodynamics indicated that detrusor instability was not associated with surgical failure. Two new directions, based on the Integral Theory, are presented for the management of female urinary dysfunction, an anatomical classification which delineates three zones of vaginal damage, and a series of ambulatory surgical operations which repair these defects. The operations are fairly simple, safe, effective and easily learnt by any practising gynecologist.
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PMID:New ambulatory surgical methods using an anatomical classification of urinary dysfunction improve stress, urge and abnormal emptying. 955 90

The infracoccygeal sacropexy, or posterior intravaginal slingplasty, was first reported by Petros as a minimally invasive procedure for the treatment of vault prolapse. This report is a prospective observational study that confirms the efficacy and safety of this new procedure. In this operation the IVS Tunneller (Tyco Healthcare, USA) is used to insert an 8 mm polypropylene tape between the perineum and the vaginal vault. The resulting artificial neoligament reinforces the atrophied uterosacral ligaments. The rectovaginal fascia and perineal body are then repaired by a technique that includes using a bridge of vaginal epithelium to strengthen the central vaginal epithelium at the point of maximum weakness. The symptomatic cure rates for prolapse were 91%, urgency 79%, nocturia 82% and pelvic pain 78%. All patients were discharged home within 24 hours. There were minimal surgical complications and no transfusions were required. The technique is safe, minimally invasive, has a short learning curve, and the skills needed are those of any competent pelvic surgeon.
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PMID:Posterior intravaginal slingplasty (infracoccygeal sacropexy) for severe posthysterectomy vaginal vault prolapse--a preliminary report on efficacy and safety. 1199 4

The aim of the study was to assess the incidence of abnormal voiding in patients who had undergone tension-free vaginal tape (TVT) placement. Women who had undergone a TVT sling procedure for stress or mixed incontinence more than 3 months previously reported their voiding habits (frequency, urgency, nocturia, urinary stream quality and incontinence) over the previous 3 days. A pelvic examination and ultrasound postvoid residual (PVR) were performed. Normal voiding was classified as a PVR <100 ml, frequency of six or fewer voids per day and two or fewer per night, and a urinary stream considered normal by the patient. Subjects were classified as either 'normal' (group 1) or 'abnormal' (group 2) voiders. Demographic factors, pre-operative urodynamic testing and concomitant surgical procedures were compared between groups. From September 1999 to November 2000, 59 women underwent a TVT procedure. Two were excluded from analysis [cervical malignancy (1), interstitial cystitis (1)]. There were no healing abnormalities and no patients displayed a positive empty bladder stress test. Forty-two (74%) women were included in group 1 and 15 (26%) in group 2. Urinary continence was reported by 49 (86%): 93% in group 1 and 67% in group 2. Factors highly correlated with postoperative voiding dysfunction included abnormal preoperative uroflow pattern and configuration (P = 0.007), preoperative low peak flow rate <15 ml/s (P = 0.049), preoperative vault prolapse or enterocele (P = 0.001), concurrent vault suspension surgery (P = 0.03) and postoperative urinary tract infection (UTI) (P = 0.0006). Preoperative urinary retention (postvoid residual >100 ml) or detrusor instability, age and body mass index differences were not statistically significant. Multivariate analysis revealed that preoperative abnormal uroflow and postoperative UTI were related to group 2 (P = 0.02). Our conclusions were that the TVT sling procedure has success and voiding dysfunction rates similar to those of other proven anti-incontinence procedures. Various factors were shown to be associated with postoperative voiding difficulties. Tension-free placement of the tape may not prevent the development of post-operative voiding dysfunction.
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PMID:Voiding dysfunction following TVT procedure. 1246 5

In order to investigate the effects of urogenital prolapse on lower urinary tract function, we studied 61 women with stage III to IV pelvic organ prolapse (prolapse group) and 40 volunteers without prolapse (control group). Each woman underwent urinalysis, urinary questionnaire, pelvic examination, and urodynamic study. The incidence of urinary symptoms, including urinary frequency and urgency, stress/urge incontinence, incomplete emptying, difficult voiding and nocturia, were significantly higher in the prolapse group compared to the control group (p < 0.05). Urodynamic parameters, including residual urine, total bladder capacity, and bladder volume at strong desire to void, were not significantly different between the two groups (p > 0.05). Maximal flow rate, bladder compliance at urgency, functional urethral length, and maximal urethral closure pressure, however, were significantly higher in the control group compared to the prolapse group (p < 0.05). In addition, there was a higher incidence of poor pressure transmission ratio in the prolapse group (p < 0.01). The results indicated that severe urogenital prolapse could produce abnormal clinical and urodynamic results.
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PMID:Abnormal clinical and urodynamic findings in women with severe genitourinary prolapse. 1267 34

The objective of this study was to evaluate characteristics, satisfaction degree, and problems of patients using a pessary for pelvic organ prolapse. A total of 104 patients who had been fitted with a pessary and available for follow-up for pelvic organ prolapse management were enrolled. The patients answered questions on general characteristics, indications for pessary use, complications from pessary use, satisfaction degree, and frequency of removal. The results indicated that 76 (73.0%) patients had at least more than one medical illness and 86 (82.7%) patients complained of lower urinary symptoms such as incontinence, urgency, frequency, or nocturia. Eighty-four (80.7%) patients used pessaries as they were not surgical candidates due to poor medical status or old age. After using a pessary, 76 (73.1%) patients had symptoms such as bleeding, erosion, or foul odor; 70.2% of the women answered that they were satisfied or more than satisfied and 19.1% of the patients removed their pessaries, of whom 80.0% were unable to continue use due to repeated expulsion of the pessary and uncomfortable fitting. These data suggest that the pessary tends to be used for high-risk patients due to medical problems or old age. Despite the high frequency of complications from pessary use, it was seen that the frequency of removing the pessary was low and the satisfaction degree was high. Most of the complications were not thought to be serious. To decrease the frequency of complications, the regular follow-up visit and proper management of pessary use were thought to be needed. Further studies are warranted on tailor-fitting the pessary by variable use and relieving the symptoms associated with the lower urinary tract.
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PMID:Survey of the characteristics and satisfaction degree of the patients using a pessary. 1557 56


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