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

In this study are considered the short-middle term results of anterior mitral leaflet prolapse repair obtained by means of a personal operative technique: chordal shortening and free edge remodeling. In our institution since 1993 34 consecutive patients with degenerative myxomatous mitral regurgitation, (mean age 63.3 years, range 25 to 83 years), underwent surgery. Before the operation 22 patients (64.7%) were in NYHA functional class III or IV. Mitral insufficiency, evaluated by echocardiogram, was severe in all patients; a prolapse of only anterior leaflet was present in 10 patients, both leaflets prolapsed in the others. Patients with chordal rupture of anterior mitral leaflet were excluded. Anterior mitral leaflet prolapse repair was performed with two continuous sutures including the free edge as well as the chordae for a variable length (2 mm up to 5 mm) depending on the degree of the elongation. A concomitant posterior leaflet quadrangular resection was performed in 24 patients (70.5%), and the procedure was almost always completed by a posterior suture annuloplasty reinforced by a glutaraldehyde-tanned strip of autologous pericardium. There were no perioperative deaths. The postoperative course was uneventful in all cases, and there were no hospital deaths. Postoperative echocardiographic evaluation showed satisfactory valve function. The mean valvular regurgitation before surgical procedure was 3.67 +/- 0.4, after repair 0.30 +/- 0.5 (p < 0.01). Follow-up was completed in all patients (mean 16.5 months) with no late deaths. One patient required early reoperation for recurrent mitral regurgitation resulting for a recurring anterior leaflet prolapse. We conclude that this technique is a safe, effective and easy procedure for the repair of anterior mitral leaflet prolapse without rupture. Nevertheless, a larger number of patients and a longer follow-up are required to confirm our results.
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PMID:Treatment of anterior mitral leaflet prolapse: chordal suture plication and free-edge remodeling in 34 patients. 967 75

Although there are many surgical procedures available to treat urinary incontinence, obtaining the best results depends on a thorough preoperative evaluation of the patient. Traditional urodynamic evaluation of stress urinary incontinence (SUI) focusing on maximum urethral closing pressures has been found to be less useful than the abdominal leak point pressure (ALPP) test in detecting intrinsic sphincter deficiency (ISD). An ALPP less than or equal to 60cm H2O indicates a significant degree of ISD, whereas a leak point pressure greater than or equal to 90cm H2O is usually associated with pure urethral hypermobility. When combined with the history, physical examination, and a filling cystometrogram, the additional objective data obtained from ALPP permit an accurate classification of the stress incontinence and are useful to the clinician in choosing the most appropriate treatment. Anterior colporrhaphy is still commonly used by gynecologists to treat SUI, but the narrow indications (type I SUI only) and poor long-term results have decreased its popularity. It is a poor choice for treating SUI related to urethral hypermobility. Retropubic urethropexy is the treatment standard for SUI procedures against which all other procedures have been compared. Five-year cure rates are in the range of 80% to 90%. Other procedures for treating SUI related to urethral hypermobility include laparoscopic bladder neck suspension, abdominal paravaginal repair, and needle bladder neck suspension. Surgical treatment for ISD differs from that for urethral hypermobility and includes pubovaginal sling procedures, injectable agents, and insertion of the artificial urinary sphincter. Concurrent pelvic prolapse conditions should be treated simultaneously and may dictate the surgical approach. When the proper procedure is utilized, good long-term results can be expected.
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PMID:Selecting the Best Surgical Option for Stress Urinary Incontinence. 974 41

To assess the important factors for successful primary closure in staged reconstruction of bladder exstrophy, 25 patients (18 males, 7 females) underwent primary bladder closure during the years 1993-1997. Twenty-one were more than 72 h old; all of these underwent bilateral posterior iliac osteotomies followed by primary bladder closure during the same anesthetic. Bladder closure was done in a double layer. The ureteric catheters were removed after 2 weeks and the bladder catheter after 3.5-4 weeks. Only 1 patient had a bladder dehiscence on the 10th postoperative day due to infection; 3 had partial wound dehiscences but no bladder dehiscence. One had a partial bladder prolapse. The osteotomies needed no drainage, and no complications occurred. One patient needed a urinary diversion 3 years after surgery as the bladder capacity did not increase. Eleven important factors play a pivotal role for successful primary bladder closure: (1) Proper patient selection; (2) A staged approach; (3) Anterior approximation of the pubic bones with placement of the bladder and urethra in the true pelvis; (4) Posterior bilateral iliac osteotomies in all indicated cases; (5) Double-layered closure of the bladder; (6) Two weeks' proper ureteric catheter drainage; (7) Prevention of infection; (8) Prolonged and proper postoperative immobilization; (9) Prompt treatment of bladder prolapse; (10) Prevention of abdominal distension postoperatively; and (11) Ruling out bladder-outlet obstruction before removing the bladder catheter.
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PMID:Factors responsible for successful primary closure in bladder exstrophy. 1078 80

Anterior vaginal prolapse is often caused by defects in the paravaginal fascia. The purpose of this article is to review the current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. Articles related to paravaginal defects were identified through a MEDLINE search of English-language medical journals published between June 1909 and August 2000. Physical examination is usually used to diagnose paravaginal defects, but this method may have low specificity and low positive predictive value. Magnetic resonance imaging may be used to examine the pelvic anatomy, but it is expensive and may not be readily available to all physicians. Transabdominal ultrasound does not appear to be useful for detection of paravaginal defects. Paravaginal repair, both transvaginal and transabdominal approaches, appears to offer favorable cure rates and low recurrence rates of anterior vaginal prolapse. Paravaginal repair does not appear to be as effective as Burch colposuspension for treatment of stress urinary incontinence. The efficacy of laparoscopic paravaginal repair requires additional investigation. Complications including voiding dysfunction, hemorrhage, and urinary tract injury are uncommon. The long-term efficacy of paravaginal repair requires further investigation.
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PMID:Current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. 1128 37

Degenerative mitral valve disease is the most common cause of mitral regurgitation in North America. Using techniques developed by Carpentier and others, up to 90% of degenerative mitral valves can be repaired. These valves are characterized by annular dilatation and chordal rupture or elongation; chordal changes are mainly localized to the posterior leaflet. The most common repair technique for posterior leaflet prolapse is quadrangular resection. When the leaflet is >1.5 cm long, a sliding repair is added to reduce the risk of systolic anterior motion. Anterior leaflet prolapse is usually treated by transfer of chords from the posterior leaflet or adjacent areas of the anterior leaflet. Other useful techniques for correction of anterior leaflet prolapse are creation of artificial chords and the Alfieri edge-to-edge repair. Chordal shortening is rarely employed as it jeopardizes repair durability. Annuloplasty accompanies all repairs. A posterior annuloplasty provides results equivalent to those obtained with a circumferential annuloplasty. Flexible annuloplasty has theoretical advantages, but clinical benefits have not been shown. After mitral valve repair for degenerative disease, 10-year freedom from reoperation is 93%. Risk of reoperation is increased by anterior leaflet prolapse, chordal shortening, failure to use an annuloplasty, and lack of intraoperative echocardiography. In the ideal situation, when posterior leaflet resection is corrected by quadrangular resection with annuloplasty and the result is confirmed by intraoperative echocardiography, the 10-year durability is 98%.
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PMID:Mitral valve repair for degenerative disease. 1184 14

The aim of the study was to compare the anterior colporrhaphy and the Bologna operation for the treatment of anterior vaginal wall prolapse associated with genuine urinary incontinence (GSI). Sixty-two women undergoing surgery for GSI and concurrent grade 2-3 cystocele were the subjects of the study. Anterior colporraphy was performed on 31 women (group A) and the Bologna operation on another 31 (group B). The mean follow-up was 3 years (range 2-7). Perioperative complications, including urinary tract infections, occurred in 16% of group A versus 42% of group B (P<0.001). Anatomic success regarding the prolapse was, respectively, 92.9% (26/28) and 84.6% (22/26) (P = 0.25). Subjective cure rates of GSI (patient history) were 57.1% in group A (16/28) and 87% in group B (23/26) (P<0.05). Objective cure rates of GSI (negative stress test result) were 53.6% in group A (15/28) and 84.6% in group B (22/26) (P<0.02). We concluded that the Bologna operation was more effective for treating GSI associated with anterior vaginal prolapse than was anterior colporraphy, with an increased rate of morbidity and postoperative urinary retention.
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PMID:Comparison of anterior colporrhaphy versus Bologna procedure in women with genuine stress incontinence. 1199 3

This prospective study highlights the result of a new technique for correction of recurrent lower lid entropion. The technique was designed to address the aetiological factors involved based on the pre- and per-operative findings. MATERIAL AND METHODS. 37 eyelids of 31 consecutive patients with recurrent entropion were enrolled. Under local anaesthesia, a horizontal incision was made at the lower border of the tarsus, involving the total width of the lower eyelid. Anterior lamellar (skin and orbicularis oculi muscle - OOM) inferior to the incision was dissected towards the orbital rim. An ellipse of the excess overriding OOM and overlying skin inferior to the incision was excised. The OOM was fixed to the lower border of the tarsus with three to four 6/0 Vicryl subcutaneous sutures. Skin was repaired with 6/0 silk sutures, which were removed five days post-operatively. Five cases underwent horizontal lid shortening and 15 had preaponeurosis fat sculpting in addition. RESULTS. 37 procedures were performed on 31 patients (23 M & 8 F). The mean age was 76.5 yrs. (range 63-90). The patients had had one to four (mean = 1.7) previous surgeries. All patients had OOM override. Fifteen had significant preaponeurosis fat prolapse. Lower lid laxity was not identified in all cases, in some due to previous lid surgery. There was no evidence of lower lid retractor laxity in the majority of cases. After a mean follow-up time of 18 months (5-36) there were three recurrences. One underwent further tarsal fixation and the other two had horizontal lid shortening with a favourable outcome. CONCLUSIONS. Excision of overriding OOM and tarsal fixation for recurrent entropion is simple and effective. Its success is due to direct tackling of the aetiological factors.
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PMID:Orbicularis oculi muscle stripping and tarsal fixation for recurrent entropion. 1204 22

Repair of degenerative mitral insufficiency has extensively been shown to be superior to replacement. In the majority of cases, the culprit lesion is limited to the posterior mitral leaflet (PML), which is treated with quadrangular resection of the prolapsing PML, annular plication of the corresponding segment of the annulus, and prosthetic annuloplasty. Anterior mitral leaflet (AML) prolapse is less common and is not always considered an indication for repair despite availability of a variety of surgical maneuvers specifically designed for its treatment. Although reliable if properly performed, chordal shortening at the papillary muscle level is technically demanding. Chordal transfer from the PML with the 'flip-over' technique is highly reproducible, but limited by the very frequent presence of an abnormal PML. Although feasible, transfer of an anterior basal chord to the prolapsing free edge assumes that the basal chords can be sectioned with impunity. More recently, chord replacement with expanded polytetrafluoroethylene (PTFE) sutures has become increasingly popular because of its availability, theoretical simplicity, and demonstrated long-term durability. Although papillary and leaflet anchoring of the neo-chord has not been shown to be a problem, the determination of its appropriate length remains intuitive and based on personal experience. Here, simple surgical maneuvers designed to ensure safe and reproducible results of single or multiple chord replacement with PTFE sutures are described.
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PMID:Techniques for ensuring the correct length of new mitral chords. 1270 86

Anterior enterocele is an uncommon finding in patients with pelvic organ prolapse. We reviewed 490 consecutive operations for pelvic organ prolapse . Three anterior enteroceles were identified in a series of 193 enterocele repairs (1.6%). The presentation and treatment of each of these patients is reviewed.
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PMID:Anterior enterocele: a report of three cases. 1527 50

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n = 13), 50s (n = 53), 60s (n = 54), and 70 and over (n = 16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n = 35), stage III (n = 76), and stage IV (n = 25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.
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PMID:The relationship between maximal urethral closure pressure and functional urethral length in anterior vaginal wall prolapse patients according to stage and age. 1598 14


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