Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0033377 (prolapse)
 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy were studied in 73 patients, of whom 29 had incontinence due to urethral sphincter incompetence. Pre-and post-operative urodynamic assessment was made and follow-up continued for 2 years. Symptoms of urge incontinence, stress incontinence and prolapse were significantly reduced following surgery. Urodynamic data showed no significant change. The incidence of detrusor instability and voiding difficulties was not increased.
 ...
PMID:Clinical and urodynamic effects of anterior colporrhaphy and vaginal hysterectomy for prolapse with and without incontinence. 708 3

From a series of 212 cases of urinary stress incontinence in women, the author analyses the results of 41 operations by retro-pubic vaginal fixation and 110 operations by aponeurotic support of the bladder neck. From this second group of 110 operations, 100 cases were reviewed with 93 successes, 3 improvements and 4 failures. The results obtained after one year were definitive. The author stresses the importance of the pre-operative assessment of the clinical signs and symptoms. Out of 90 cases of pure stress incontinence, with no other associated disturbance of micturition, there was a 95,5% success rate. 16,6% of cases had post-operative retention which was easily treated by simple measures. However, out of the 10 cases of mixed stress incontinence, with associated symptoms of urinary urgency, the results were favorable in only 70%. The author believes that urodynamic studies have a certain role in the investigation of the cause for a failed operation. They may even be useful in the investigation of the urodynamics of the vesicosphincteric apparatus of the woman with stress incontinence associated with other disturbances of micturition. However, clinically pure urinary stress incontinence does not require urodynamic investigation and can be corrected by lifting up the anterior vaginal wall (Bonney's manoeuvre). According to the author, the aponeurotic sling is the best way of treating these patients. The results are better when there is not a simultaneous cure of cystocele. Retro-pubic vaginal fixation is only used in cases of minor, discrete stress incontinence in elderly women and to complete surgery for prolapse.
 ...
PMID:[Urinary incontinence in women, without urodynamic studies]. 716 49

In a retrospective study of 54 cases of prolapse in the menopausal woman the authors noted problems of urinary continence, in particular stress incontinence and incontinence due to bladder instability, in 40 p. cent of these women. Unfortunately, the clinical diagnosis is often misleading, and is in 65 p. cent of the cases later rectified by urodynamic investigation. Serious therapeutic errors, such as operating a bladder instability mistaken for stress incontinence, or neglecting a potential stress incontinence that could have been easily corrected at the same time as the prolapse operation, can thereby be avoide. In conclusion, the authors stress that an urodynamic exploration, including cystometry and sphincterometry, is absolutely necessary in the regular work-up of the menopausal women with prolapse.
 ...
PMID:[Interest of urodynamic exploration in the women with prolapsus]. 745 93

Of 420 female patients examined by means of colpo-cysto-urethrography 51 patients presented posterior bladder suspension defects. Two distinct forms were seen:1. Trigonocele (22 patients)--a downward herniation of the trigone between the postero-inferiorly displaced vagina and the bladder neck, which is retained in a nearly normal position by muscle fibers from the pubococcygeal muscle and the pubovesical ligaments. Symptoms were mostly those associated with prolapse. Stress incontinence was rare, while urge incontinence, cystitis and retention of urine were seen. The morphology varied from cases where the herniation disappeared during detrusor contraction (compensated trigonocele) through typical forms to transitional forms between trigonocele and posterior bladder descent. 2. Posterior bladder descent (29 patients) comprises postero-inferior displacement of the vagina and bladder base together. Two subgroups are discernible: A. Bladder descent even at rest (16 patients). B. Bladder descent only during micturition (13 patients). Symptoms were varied, but stress incontinence was found in 31 per cent in group A, and 62 per cent in group B. Morphological forms varied from two cases that were normalized in position during detrusor contraction (compensated descent) to total prolapse during micturition.
 ...
PMID:Posterior bladder suspension defects in the female. A radiological classification with urodynamic and clinical evaluation. 745 99

Pelvic organ prolapse presents a wide array of distressing symptoms to the female patient. Stress urinary incontinence is often considered a normal phenomenon of aging and tolerated for years before seeking medical attention. A detailed history outlining specific complaints and a targeted pelvic examination can usually elucidate the anatomic problems responsible for producing symptoms. Nonsurgical therapy can be initiated, often with great improvement in symptoms. If the results are not satisfactory, the patient can be referred for further evaluation and possible surgical intervention.
 ...
PMID:Pelvic organ prolapse and stress urinary incontinence. 747 1

Laparoscopic treatment of urinary stress incontinence and urogenital prolapse is a recent development. We describe the progress of the ideas and techniques, in this field. However, the literature lacks prospective randomized studies with sufficient follow up. So there is a need for these techniques, which seem attractive at first glance, to be fully assessed before they can be adopted as standard practice.
 ...
PMID:Laparoscopic procedures for stress incontinence and prolapse. 757 74

The establishment of a linear relationship between perineal descent (PD) and pudendal nerve motor terminal latency (PNMTL) is important in understanding the pathophysiology of pudendal neuropathy. The amount of stretching of the pudendal nerve resulting from the extent of PD, should correlate with the amount of injury sustained (PNMTL). The two key previous studies which used different techniques to measure PD, have differed on this vital issue. A prospective study was undertaken in 141 consecutive patients with PD (M:F = 57:84; mean age 46.3 SEM 1.6 years) to clarify this discrepancy. The patients had chronic constipation (81), neurogenic faecal incontinence (31), rectal mucosal prolapse (17) or female urinary stress incontinence (9). All underwent measurements of PD (by perineometry), anal sphincter pressures, single fibre anal sphincter electromyography and PNMTL. These variables, as well as age were analyzed for a linear relationship with PD by multiple regression analysis. Age was the only independent variable predicting PD at rest (T = -3.2; p < 0.005). PNMTL was the only independent variable predicting PD on straining (T = -3.0; p < 0.005). In conclusion, a linear relationship between PD on straining and PNMTL was confirmed, supporting the previous study which also measured PD by perineometry. The other study which refuted such a relationship measured PD radiologically, and it is likely that the difference was in the measurement technique.
 ...
PMID:The neurophysiological significance of perineal descent. 763 69

Imaging has increased our ability to understand stress incontinence and prolapse and has advanced our existing concepts of pathophysiology. Once these conceptual contributions have been made, imaging modalities may fade from current use, but the lessons learned will remain. It is the relationship of clinical imaging to conceptual development that is important. Conventional radiographic studies are well understood and can be obtained in most facilities. Sonographic units are currently available in many urologic and gynecologic clinics and offices and can be adapted for stress incontinence studies. The benefits of real-time studies and soft-tissue detail at the urethrovesical junction and office-based convenience make this an attractive new technique. The global pelvic approach offered by MR imaging offers spectacular imaging possibilities, which can help in complex cases and in future concepts in the field. MR imaging is rapidly evolving and may continue to offer new insights as technology permits. In accordance with Hodgkinson's earlier observations, imaging should not be routinely required in all patients undergoing evaluation for stress incontinence, but should certainly be considered in failed operations, complex prolapse, and when clinical diagnosis is in doubt. It is always better to use an imaging technique, no matter how expensive, than to end up with a bad surgical result.
 ...
PMID:Radiography, sonography, and magnetic resonance imaging for stress incontinence. Contributions, uses, and limitations. 764 55

A careful history points the urodynamic examination in the right direction and enables the examiner to ask the correct questions. The individual who does the test is the only reliable interpreter of the results of that study. No urodynamic technique is as sensitive or specific as a blood glucose, or even an electrocardiogram. A history of urgency and urge incontinence suggests uninhibited contractility and is a better index of that condition than a cystometrogram. Leakage occurring shortly after a previous operative procedure for stress incontinence suggests type III stress incontinence. A past history of radiation, prior pelvic surgery, neurologic disease, herniated disc conditions, or prior chemotherapy all require a simple cystometrogram to rule out abnormal bladder compliance. Following a simple history and urodynamic evaluation, a physical examination should be performed, searching for urethra hypermobility and genital prolapse. Abdominal leak-point pressure testing is useful to assign broad categories of incontinence. Relatively high leak-point pressures with hypermobility suggest suspension operations will be effective. Low leak-point pressures with hypermobility often require a sling, and very low leak-point pressures with no hypermobility indicate a suitable candidate for a trial of injection therapy.
 ...
PMID:Urodynamic evaluation of stress incontinence. 764 56

The surgical procedure of choice to correct stress urinary incontinence using a vaginal approach depends not only on the anatomic origin of the incontinence (hypermobility or intrinsic sphincter dysfunction) but also on the degree of coexistent anterior vaginal wall prolapse. The grade of coexistent cystocele and the finding of a central or lateral defect are important observations that help the surgeon plan the optimum surgical approach. Grade 4 cystocele with central and lateral defects represents the most severe form of anterior vaginal wall prolapse. In this case, the surgical goals are to correct both central and lateral defects, as well as hypermobility related to the mid-urethra and bladder neck.
 ...
PMID:Vaginal reconstructive surgery for female incontinence and anterior vaginal-wall prolapse. 764 62


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>