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

Setting forth their experience in over 800 colpocystographies applied in genital prolapse and stress incontinence, the authors propose an original classification of changes in urinary stress incontinence with a view to unifying clinical and radiological findings. Along with classical, wellknown radiological aspects (urethral vesicalization and the prolapse of the urinary bladder) one new type of changes is described. It is named the slipping prolapse of the urinary bladder and is determined by the deterioration of the urethro-vaginal septum leading to a completely isolated dislocation of the lower urinary organs and the frontal vaginal wall. The combination of these aspects gives the three types and six variants of stress incontinence which, from the clinical point of view, may be manifest, masked, and potential. The pathogenesis of different types of the disease is analysed, as well as the principles of their therapy. The authors plead for the widest possible use of colpocystography in the preoperative preparation on patients, especially in relapses, since the method is simple and harmless, yielding extremely useful informations in the study of the morphotopography of pelvic organs.
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PMID:[New radiologico-clinical classification of changes in stress incontinence in women]. 97 37

The authors present the results of an inquiry into urinary stress incontinence in 415 women chosen at random, in whom the genital prolapse or stress incontinence were not complaints for hospitalization. The analysis also excluded all states of pregnancy or puerperium. As in other statistics, the frequency of urinary stress incontinence proved very high (39.2%). It is particularly interesting that 52.8% of the women questioned considered it as a completely normal event. A progressive increase in the frequency of stress incontinence related to aging. Stress incontinence was also twice as frequent in manual workers and housewives as in office workers, school girls, and students. In relation to obstetric traumatism, the disease is more frequent in parous women, showing a progressive increase with parity and the delivery of higher-weight newborns, whereas, quite unexpectedly, it proved rare in women with deliveries in intervals shorter than three years. A high incidence was recorded of stress incontinence having appeared in pregnancy for the first time (23.9%); in 59.0% of these women it persisted also after childbirth, which is very significant. Although the trouble is more frequent in menopausal patients, the effect of this period can hardly be separated from the effects related to senile involution. Besides emphasizing the role of the gynecologist, urologist, and general practitioner in the diagnosis of urinary stress incontinence in women, the data obtained raise the question of the revision of the existing views on the physiology of this disorder.
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PMID:[Results of an inquiry on stress urinary incontinence in women]. 100 2

Experience with colpocystography used routinely in 586 cases of genital prolapse and urinary stress incontinence is described. Radiologic aspects are discussed and related to clinical findings by means of an original classification. The technique is described in detail. Systematic opacification of the urethra permits the study of changes in the urethrovaginal region. Contrary to prevailing opinion, the lower urinary system and the anterior vaginal wall do not participate concomitantly in the process of prolapse but sliding bladder prolapse, which may cause urinary stress incontinence, is often seen. Colpocystography is simple, easy, inexpensive, and safe. Its use in surgical gynecology assits in evaluation the tactical and technical indications, assessing the effectiveness of the operation, and studying recurrences and postoperative complications.
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PMID:Colpocystography in cases of genital prolapse and urinary stress incontinence in women. 115 11

Various surgical methods for the treatment of severe incontinence of urine II degrees can be used. The aim of the present study was to apply primarily in 255 cases of severe stress incontinence. II degrees the specific surgical procedure for treatment: 123 cases of cysto-rectocele repair including vaginal hysterectomy, 71 cases of puborectalis repair, 43 cases of urethrovesicosuspension operation with or without abdominal/vaginal supplementary procedures, till 1970 12 cases of combined operations and finally beginning in 1973 6 cases of dura-sling operation. Indications and principles of surgical intervention are described according to clinical intern procedures. Puborectalis repair (Franz operation) and pubococzygeus repair (Ingelman-Sundberg operation) in cases of missing prolapse combined with severe incontinence gave rather good results. The basis for optimum results after operative treatment of patients with stress incontinence is a detailed pre-operative diagnosis; The most specific operative procedure from the beginning seems to us more recommendable than routine cysto- rectocele repair including a second more specified operation in cases of relapse.
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PMID:[Severe incontinence of urine II degrees and its surgical treatment. (Indications for typical operations in cases of incontinence of urine and their results) (author's transl)]. 116 82

This communication documents experience with 200 Pereyra operations performed for stress urinary incontinence over a 9 year period. The majority of patients were 35 to 55 years of age, were obese, and had varying degrees of uterovaginal prolapse. More than one fourth also had excessive bleeding and all were best managed by vaginal surgery. Important points in surgical technique are emphasized. Of 188 patients followed, 82 per cent had complete symptomatic relief and another 10.5 per cent were improved. There was a 7.5 per cent failure rate and morbidity was minimal. We conclude that the Pereyra procedure should be considered for stress urinary incontinence whenever vaginal surgery is indicated.
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PMID:The Pereyra procedure. Favorable experience with 200 operations. 127 25

Genital prolapses are regularly constituted by multiple disorders such as primary stress incontinence anterior and posterior colpocele enterocele. All of these must be taken into account during the treatment by abdominal approach. The principles of treatment consist into a fixation of prolapse with mersilene mesh to the promontory. It could be laid on the anterior wall of the vagina and sometimes on posterior, if it's necessary. Uterus could be preserved but subtotal or total hysterectomy might be done; in this case, aseptic conditions are absolutely imperative. Vaginal section with stapling instrument and absorbable staples is useful. A colpopexy is always made.
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PMID:[Treatment of prolapse using the abdominal approach]. 141 34

Sacrospinous ligament fixation of the prolapsed vaginal vault has proved very useful, but the complications of failure, hemorrhage, infection, nerve damage, incontinence and dyspareunia are reported. Experience with 51 operations performed by staff, and residents with supervision, has shown the value of certain preoperative and technical steps to avoid complications, including candidate selection; repair of enterocele; retropubic positioning of the bladder neck; repair of all pelvic support defects, and perineorrhaphy. Technical modifications are described. Results in these instances are tabulated: no recurrent prolapse; no transfusions; four narrow vaginas; two with stress incontinence; one pelvic cellulitis, and one ventricular fibrillation on the third postoperative day. We believe that most complications are preventable.
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PMID:Success with sacrospinous suspension of the prolapsed vaginal vault. 144 Jan 69

During 1985 to 1989, 177 vaginal hysterectomies were performed in the Department of Gynecology, Kaplan Hospital, Rehovot, Israel, using the Porges technique with some modifications. Ninety patients had some degree of loss of the pelvic support--anterior or posterior wall relaxation, enterocele or uterine prolapse in various degrees. The patients were allocated to two groups, in which two different techniques were compared: group 1, with repair of the pubocervical and pararectal fascia and group 2 without the repair. The repair of the pubocervical and pararectal fascia after vaginal hysterectomy prevented vaginal vault prolapse (zero versus 15 percent, p < 0.01) and reduced the incidence of recurrent rectocele (23 versus 55 percent, p < 0.05) and recurrent cystocele (14 versus 45 percent, p < 0.005). Recurrent genuine stress incontinence was found in 9 percent of patients in group 1 and 18 percent of patients in group 2 (not statistically significant; p = 0.163). Optimal management of relaxation of the vaginal wall during vaginal hysterectomy requires clinical suspicion and precise preoperative diagnosis and therapeutic plan. In the present study, the need for careful repair of the pubocervical and pararectal fascia during vaginal hysterectomy to prevent vaginal vault prolapse is emphasized. This procedure does not prolong the operation significantly (92 +/- 15 versus 84 +/- 17 minutes) and has no deleterious postoperative complications.
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PMID:The importance of the endopelvic fascia repair during vaginal hysterectomy. 144 37

We reviewed the charts of 206 patients who underwent the Raz bladder neck suspension between January 1984 and June 1990 for stress urinary incontinence. Mean followup was 15 months. Overall, our results demonstrated a successful outcome (cure or rare stress urinary incontinence not requiring protection) in 186 of 206 patients (90.3%). Cox multivariant analysis showed that the only predictor of outcome was the degree of preoperative stress urinary incontinence (mild, moderate or severe, p less than 0.001). When the results were stratified by degree of incontinence preoperatively 20 of 21 patients (95%) with mild, 151 of 162 (93%) with moderate and 15 of 23 (65%) with severe incontinence had a successful outcome. No statistical correlation was found with patient age, number of prior operations, hysterectomy, urgency incontinence or menopause. For the patients who failed, the mean interval to recurrent stress urinary incontinence was 5 months. Significant urgency incontinence was present preoperatively in 58 of the 204 patients (29%), with postoperative resolution in 66%. De novo urgency incontinence occurred in 7.5%. Complications included secondary prolapse (6% of the patients), prolonged retention (2.5%) and suprapubic pain (3%). In summary, the Raz bladder neck suspension for correction of stress urinary incontinence has been successful in more than 90% of this patient population.
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PMID:The Raz bladder neck suspension: results in 206 patients. 151 37

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


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