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)

Management of vault prolapse in a patient who has previously undergone successful colposuspension has not been considered in the literature. The two cases presented highlight the risk of incontinence and illustrate measures that should help to reduce it. The approach aims to reveal potential stress incontinence and to prevent excessive stretching of the upper anterior vaginal wall during surgical correction. Potential stress incontinence is revealed by a cough stress test while reducing the prolapse without a speculum, a 'pessary test' for a few days, and urodynamics both with and without a pessary. Patients with potential incontinence undergo perineal ultrasound to assess bladder neck position. If sacrospinous fixation is used, epidural anesthesia is recommended so as to allow the patient to cough during the procedure to ensure accurate suture placement. When sacrocolpopexy is done, preoperative assessment of the degree of 'safe elevation' ensures accurate suture placement.
 ...
PMID:Recurrence of stress incontinence after vault suspension: can it be prevented? 965 81

A case of adult Bochdalek hernia in a naturally healthy 49-year-old woman is described. She was seen at our hospital because of cough lasting for about one month. The chest X-ray film revealed a gastrointestinal gas image in the left thoracic cavity. In addition, the CT scan and upper gastrointestinal series showed prolapse of the stomach, small intestine and a part of transverse colon. Operation was performed through a mini-thoracotomy using a thoracoscope assistedly. No hernia sac was observed and the diaphragmatic defect was 6 x 5 cm in size. After the organs was restored, the defect was closed with continuous over-and-over suture and the diaphragm was enhanced by PROLEN MESH.
 ...
PMID:[A surgical case of adult Bochdalek hernia assisted by thoracoscopic surgery]. 1084 71

The aim of the study was to determine whether urodynamic testing improves the outcome of retropubic surgery in women aged 50 or younger. A retrospective study was undertaken of 212 women aged 50 or younger who underwent retropubic surgery at a medical school-affiliated hospital between February 1991 and July 1997. Excluded were patients with prior retropubic urethropexy and known low urethral closure pressures. The surgery was performed by one urogynecologist and two urologists. The minimal evaluation by the urogynecologist was a focused incontinence questionnaire, pelvic neurologic examination, pelvic floor grading, cough stress test, urinalysis, postvoid residual, cotton swab test and supine empty stress test. Full urodynamics consisted of uroflowmetry, subtracted cystometry, urethral closure pressure, cough leak-point pressure and cystourethroscopy. Subjective postoperative follow-up at 14 years was by annual questionnaire. The urogynecologist's patients were in group I (95 women with full urodynamic studies) and group II (36 women with minimal testing). The urologists' patients were in group III (81 women with a very minimal workup and cystourethroscopy). A review of seven variables revealed no difference between the groups. In terms of cured, improved and failed, there was also no difference in outcome. There was a difference in postoperative voiding problems (though not stress incontinence) in group III compared to group I (P= 0.005) and group II (P=0.002). Our conclusion was that all women with stress incontinence should undergo a careful minimal evaluation. In women aged 50 or younger urodynamic studies may be avoided unless there is significant stress incontinence, complex symptoms, a positive supine empty stress test, marked prolapse, or a history of prior retropubic urethropexy.
 ...
PMID:Stress incontinence in women under 50: does urodynamics improve surgical outcome? 1105 63

The purposes of this article are to report a case with temporal arteritis (TA) and to summarize and reanalyze the cases of temporal arteritis associated with fever in published articles for understanding better the clinical features of TA. A case with biopsy-proven TA is reported. The publications with TA and fever were searched by using MEDLINE in English from 1966 to 1999. Three hundred sixty cases of temporal arteritis associated with fever were reanalyzed. The results showed that a case of biopsy-proven TA with typically clinical manifestation was initially misdiagnosed and that the reanalysis of 360 cases revealed that the common clinical findings at presentation were abnormal temporal arteries, headache, low fever, loss of weight, polymyalgia rheumatica, jaw claudication, vision disorder, arthralgis or myalyias, and ear pain and that the uncommon clinical findings at presentation were high fever, malaise, anorexia, breast pain, transient ischemic attack/stroke, cough, mental disorder, diarrhea, and uterine prolapse, etc. Laboratory findings were the range of erythrocyte sedimentation rate (ESR) 14 to 149 with a mean of 97.0 mm/hr, white blood cells being normal or increased in the range of 10.9 to 22.9 x 10(9)/L, hemoglobin level 7 to 16 g/dL, the platelets count increased to 785 x 10(9)/L, and microscopic hematuria. The diagnosis was made by a combination of clinical features, an increased ESR, a response to steroids, and, most specifically, temporal artery biopsy. The initial diagnosis was misdiagnosed in 38.2% of patients. In conclusion, the features of TA associated with fever have not been widely appreciated yet. TA is a common cause of fever of unknown origin (FUO) in the elderly. TA should be considered when patients complain of common and uncommon manifestations. An elevated ESR will aid in the diagnosis of TA, and temporal artery biopsy will provide certainty.
 ...
PMID:Temporal arteritis and fever: report of a case and a clinical reanalysis of 360 cases. 1110 64

Color Doppler ultrasound is a new method for documenting fluid leakage in the setting of videourodynamic testing. In order to compare color Doppler ultrasound with traditional fluoroscopic imaging we performed a prospective blinded comparative clinical study. Fifty-two consecutive patients undergoing urodynamic investigations for symptoms of incontinence or prolapse were examined using fluoroscopy and translabial color Doppler ultrasound to document stress leakage. The investigators were blinded to each other's results. Both tests were performed at maximum bladder capacity and with an indwelling 5 Fr microtransducer catheter, in both the supine and the erect positions. Equivalent results for both methods were obtained in 48 out of 52 patients (Cohen's kappa = 0.82). It was therefore concluded that translabial color Doppler ultrasound imaging can reliably demonstrate leakage through the female urethra on Valsalva maneuver or coughing.
 ...
PMID:Translabial color Doppler urodynamics. 1171 95

FROM PHYSIOPATHOLOGY TO TREATMENT: Urinary incontinence on effort in women is due to a default in sub-urethral anatomical structure, which leads to incontinence on effort (coughing, laughing, carrying heavy weights, physical activity). When re-education fails, surgical treatment using Burch's technique or the placing of sub-urethral TVT (Tension free Vaginal Tape) is generally proposed. BURCH'S TECHNIQUE: Burch's technique consists in an upper tract colposuspension via coelioscopy or laparotomy, under rachis or general anaesthesia. In the literature, the following rates of complete cure have been presented: 64 to 87%, 75 to 95% and 63 to 89% respectively in the short, median and long term together with the cure of certain complications (vesicular instability, dysuria, secondary prolapse, infections). THE TVT TECHNIQUE: Developed in the early nineties, the placing of TVT is a mini-invasive technique requiring the use of polypropylene tape inserted vaginally under the urethra under rachis or local anaesthesia. It is associated with over 80% median term clinical efficacy and rare complications (vesicular perforation, arterial wounds, perineal haematoma, dysuria, infections).
 ...
PMID:[Stress urinary incontinence in women. Physiopathology and surgical treatment using Burch's technique and TVT]. 1185 Sep 91

The bulbocavernosus muscle (BCM) surrounds the vaginal introitus and covers the vestibular bulb. Its role in erection is known. However, as it surrounds the vaginal introitus, it may also have a role in intravaginal pressure regulation and in the pathogenesis of uterovaginal prolapse. We investigated the effect of increased intra-abdominal pressure (IAP) on the BCM, aiming to assess its possible function in supporting the uterus, vagina and anorectum. The intrarectal (representative of the IAP) and intravaginal pressures were measured by manometric catheters in 19 healthy women volunteers (mean age 46.2 +/- 10.4 years). The EMG activity of the BCM and its response to straining at different pressures were recorded by a concentric needle electrode. Two types of straining were tested: sudden momentary and slow sustained. The procedure was repeated in 11 of the women after individual anesthetization of the BCM, rectum and vagina. Sudden straining (coughing) produced a significant increase in intrarectal ( P<0.0001) and intravaginal ( P<0.0001) pressure as well as BCM EMG activity. Slow straining effected a similar but lower response: the BCM responded gradually with pressure elevation, whereas the latency exhibited a gradual decrease. The BCM did not react to straining after individual anesthetization of the BCM, vagina and rectum, but did respond to saline administration. The results were reproducible. BCM contraction on straining postulates a reflex relationship, which we call the 'straining-bulbocavernosus reflex'. We hypothesized that this reflex is evoked by straining and results in BCM contraction and closure of the vaginal introitus. The vagina is believed to become a closed cavity, counteracting the increased intra-abdominal pressure and the uterine tendency to prolapse. The high pressure in the closed vaginal cavity presumably supports the rectovaginal septum against the high intrarectal pressure, and is suggested to share in the prevention of rectocele. The role of BCM in the pathogenesis of uterovaginal prolapse and rectocele needs further study.
 ...
PMID:Study of the effect of straining on the bulbocavernosus muscle with evidence of a straining-bulbocavernosus reflex and its clinical significance. 1235 88

The aim of this study was to test a surgical technique for the treatment of stress urinary incontinence associated with genital prolapse through a transvaginal suspension anchored to the pubic bone. Thirty-seven patients with severe genital prolapse and urodynamically proven stress incontinence were operated on with this procedure from February 1998 to May 2000. Preoperatively a detailed history, pelvic examination and urodynamic studies were carried out. The degree of prolapse was assessed pre- and postoperatively in the lithotomy position in accordance with the classification proposed by Baden and Walker [8]. Two titanium bone screws with no. 1 polypropylene sutures attached to them and a battery-operated screw inserter are used to fix the vaginal sutures to the pubic bone bilaterally. The procedure is performed transvaginally with no abdominal or suprapubic incisions. Objective outcomes were assessed by symptom assessment, clinical examination and a full urodynamic evaluation at 6 months postoperatively, and annually by clinical evaluation. Subjective outcomes were assessed by directly interviewing the patients about their postoperative urinary symptoms and asking them to classify their level of satisfaction. An objective cure rate (no objective loss of urine during coughing in the absence of a simultaneous detrusor contraction) at the 6-month postoperative urodynamic evaluation was observed in 23 of 37 patients (62%). Recurrent anterior vaginal wall prolapse (grade 2) had developed in 7 of 37 patients (27%). Subjectively, 73% of the patients expressed satisfaction with the procedure. Early results using two bone screws into the pubis to fix the periurethral and perivesical tissues and vagina to the posterior surface of the pubic bone were disappointing. Based on our results we have abandoned the use of this procedure to correct stress incontinence associated with severe genital prolapse.
 ...
PMID:Pubic bone anchoring devices for the surgical treatment of urinary stress incontinence in patients with severe genital prolapse. 1235 92

Prolapse of rectum usually occurs in the children with insufficient qi and blood, in the elders with declined qi and blood or deficiency of qi in the middle jiao (burner), in the women who made qi exhausted during labor resulting in deficiency of qi and blood, and in those with chronic diarrhea, habitual constipation and long-standing cough. All these may cause sinking of qi in middle jiao and induce the disorder. Therefore in treating the disorder, the primary causes should also be treated simultaneously.
 ...
PMID:Treatment of prolapse of rectum with acupuncture combined with TCM drugs in 38 cases. 1287 74

Coughing or straining evokes reflex bulbocavernosus (BCM) and puborectalis (PRM) muscle contraction, which apparently transforms the vagina into a closed high-pressure cavity. This elevated vaginal pressure counteracts the increased intra-abdominal pressure and the tendency of the uterus to prolapse, and also supports the rectovaginal septum against the high straining-induced intrarectal pressure and possible consequent rectocele (posterior vaginal prolapse) formation. We investigated the hypothesis that a weak BCM and PRM share in the genesis of rectocele by changing the rectovaginal pressure gradient. Twenty-three women with rectocele (mean age 43.2+/-6.6 years) and 12 healthy women volunteers (mean age 41.6+/-6.2 years) were studied. The response of the intrarectal (intra-abdominal) and intravaginal pressure, as well as the EMG activity of the BCM and PRM to straining or coughing, was recorded. In the healthy volunteers the rectal and vaginal pressures showed a significant increase on coughing or straining, with no significant difference between the rectal or vaginal pressures. Also, the BCM and PRM EMG activity exhibited a significant increase. Rectocele patients showed a significantly low resting vaginal pressure. The increase in rectal and vaginal pressure, as well as of the EMG activity of the BCM and PRM on straining or coughing, was significantly lower and the latency of the EMG response was significantly longer than those of the healthy volunteers. A difference in the rectovaginal pressure gradient showing a significant increase in the rectal against the vaginal pressure, particularly on coughing or straining, is suggested to be the basic factor in the genesis of rectocele. This pressure difference appears to be caused by diminished BCM and PRM contractile activity. A disrupted rectovaginal septum is not a prerequisite for rectocele formation, as the septum appears normal in obstructed defecation despite the common occurrence of rectocele. A histopathologic study of the septum in rectocele seems necessary.
 ...
PMID:On the pathogenesis of rectocele: the concept of the rectovaginal pressure gradient. 1461 6


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