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

Eleven continent women with severe degrees of uterovaginal prolapse underwent a complete urodynamic evaluation that included passive and dynamic urethral pressure profilometry with and without careful barrier reduction of their prolapse. The aim of barrier placement was to reduce, but not overcorrect, the prolapse and to restrict stress-induced mobility of the viscera posterior and superior to the urethra. Each of the women had very high pressure transmission ratios in each quarter of the urethra (means of 257, 187, 170, and 166% from internal to external quarters) that were significantly reduced with barrier placement (means of 78, 84, 85, and 101%). Eight of 11 subjects had pressure transmission ratios less than 90% in the proximal three-quarters of the urethra with the barrier in place, a finding in nearly all subjects with genuine stress urinary incontinence. Maximum urethral closure pressure on passive urethral pressure profilometry also decreased significantly from a mean of 75 to 45 cm H2O with the barrier in place. We conclude that the stress continence mechanism in women with severe prolapse results from posterior-superior visceral descent with stress, causing mechanical obstruction of the less mobile urethra. The evaluation methods described may be useful in predicting which of these patients may require concurrent urethropexy at the time of prolapse reduction surgery to prevent postoperative stress urinary incontinence.
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PMID:The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies. 340 46

From a series of 40 cases and with a 2 to 8 years follow-up, the authors have analyzed the results of the surgical treatment via abdominal approach and with the use of prosthetic material, of severe genital prolapses. A stress urinary incontinence was associated in 77.5% of the cases. Post-operative complications and recurrences are few. As far as urinary incontinence is concerned, the true corrected failure rate is close to 10% and an urodynamic exploration prior to surgery is mandatory. The main indications of this type of surgery are defined especially in case of recurring prolapse or a previous history of hysterectomy.
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PMID:[Treatment of genital prolapse via abdominal approach and using prosthetic material. Analysis of a series of 40 cases]. 358 52

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

Partial colpocleisis, in comparison with complete colpocleisis, offers several advantages. The most obvious advantage is the avoidance of recurrent prolapse in sexually nonactive, older patients. Historically, colpocleisis has been reported to produce stress incontinence, which may be avoided by partial colpocleisis. Careful attention to avoiding anterior wall adhesions by leaving anterior and posterior vaginal walls separated and a very small, nonfunctional vagina will prevent scarring with fixation at the bladder neck, which in most instances will result in stress incontinence. To leave a functional vagina in an elderly widow, not active for many years and with no plans for sexual activity, will leave the patient with the possibility of recurrent prolapse. Partial colpocleisis, a relatively short procedure with minimal blood loss and with careful attention to the avoidance of scarring between the anterior and posterior walls, will obviate the reported stress incontinence following complete colpocleisis. One hundred two cases from 1970 will be analyzed and reported.
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PMID:Partial colpocleisis. 371 30

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

The value of colpo-cysto-urethrography (CCU) in female stress- and urge incontinence was measured. In a prospective series of 172 consecutive females with stress- or urge incontinence, CCU was performed and assessed with regard to no suspension defects, anterior defects, or posterior defects, respectively. Six months following operative repair for stress incontinence, CCU was repeated in 97 patients and compared with operative success. CCU was of minor value in the differentiation between stress- and urge incontinence. In stress incontinence, CCU was of greater value for the preoperative planning of operative technique, vaginal or abdominal, but could be omitted when pelvic examination did not disclose genital prolapse, as this excluded posterior suspension defects at CCU. Postoperative CCU was of minor value, and poorly correlated to operative success or failure. Stress incontinence with anterior suspension defects was best treated by abdominal colposuspension, even when complicated by genital prolapse. With no suspension defect at CCU, vaginal and abdominal repair were equally good alternatives. Posterior suspension defects had the lowest cure rate.
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PMID:The value of colpo-cysto-urethrography in female stress- and urge incontinence and following operation. 377 82

In an epidemiological health survey, 515 45-year-old women were interviewed about urological problems, particularly incontinence. A pelvic examination was also conducted on 509 of the women. Twenty-two per cent or 114 women stated that they experienced incontinence, which took the form of stress incontinence in 75%, urge incontinence in 11% and a mixture of the two in 14%. Only 14 women, 3% of all the women interviewed, desired medical treatment for incontinence. In the incontinent women, the pelvic examination significantly more often revealed a cystocele, uterine prolapse or impaired function of the levator muscles. No correlation was found between an enlarged uterus and incontinence. In 211 women with one or more of these findings at the gynaecological examination, the frequency of incontinence was 35%; in 298 women with no pathological findings, the frequency was 15%. The frequency of urinary incontinence was not increased in women with higher parity or in postmenopausal women.
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PMID:Urinary incontinence in 45-year-old women. An epidemiological survey. 378 95

A Lyodura sling operation for urinary stress incontinence was performed on 36 patients. The success rate was 89%, when success was defined as absence of objective urine loss at coughing or straining, with full bladder in the upright position and during a Urilos test, at least 6 months after surgery. Full urodynamic assessment, including urethral rest and stress profiles, were performed before, and 6 months after, surgery. Success of the operation depended mainly on enhancement of urethral pressure transmission. Functional length of the urethra and maximal urethral pressure did not influence the success rate. The procedure is especially suitable in patients with some degree of uterine or vaginal prolapse.
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PMID:Urodynamic and clinical assessment of the Lyodura sling operation for urinary stress incontinence. 404 Jul 71

Three abdominal procedures were combined to suspend the prolapsed vagina in patients with post-hysterectomy vault prolapse and a narrow vagina and uterine prolapse with pelvic diseases (such as fibroids) necessitating laparotomy. We used Moschcowitz's method (obliteration of the cul-de-sac by purse-string sutures) Burch's method (fixation of the anterior vaginal wall to Cooper's ligament) and Williams and Richardson's method (suspension of the vaginal stump using fascial strips from the external oblique aponeurosis. The postoperative outcome of 8 operations was judged by a scoring system and by X-ray colpography with superimposition of films obtained at rest and during straining (subtraction technic). The scoring system indicated that the anterior vaginal wall and the vaginal vault were well supported by this combination procedures. However, the prolapse of the lower posterior vaginal wall needed an additional vaginal repair. The X-ray colpogram showed that the axis of the repaired vagina was slightly more vertical than normal. But displacement of the vagina on straining was within the normal range. Neither dyspareunia nor stress urinary incontinence were seen as complications of our procedures.
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PMID:Abdominal repair of vaginal prolapse and the postoperative outcome as judged by a scoring system and X-ray colpography. 405 81

Urinary stress incontinence was treated by the Marshall-Marchetti-Kranz (MMK) procedure in 42 and by Burch coloposuspension in 44 women. All were assessed preoperatively and for greater than 1 year postoperatively, both clinically and by urodynamic tests. Cure of incontinence was achieved to a similar extent by both procedures, in 71% after the MMK and 79% after the Burch operation. Results were better than average if there was no prolapse and if the bladder was stable preoperatively.
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PMID:Marshall-Marchetti-Krantz procedure and Burch colposuspension in the surgical treatment of female urinary incontinence. 405 46


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