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

The management and results of treatment of eight cases of implant infection after a Wells' rectopexy for rectal prolapse are reported. Most infections presented within 3 months of the rectopexy. Fever, abdominal or pelvic pain, diarrhoea, and the passage of pus per rectum were common presenting features. Removal of the infected implant per rectum or per vaginum was successful in four of five attempts and is the recommended initial approach, particularly in cases occurring early after surgery. Despite removal of the implant early after rectopexy recurrent prolapse did not occur.
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PMID:Management of infection after prosthetic abdominal rectopexy (Wells' procedure). 275 71

Nd-YAG laser photocoagulation was performed on ten patients with chronic menorrhagia in an attempt to either decrease the menstrual flow sufficiently to obviate the need for hysterectomy or to obtain amenorrhea. The entire endometrial lining was treated, from the fundus down to 4 cm from the external cervical os. A blanching technique was accomplished by holding the fiber tip 5-10 mm from the endometrial surface. Patients were followed for an average of 12 months. All noted a marked reduction in the amount of menstrual flow; two became amenorrheic. One patient subsequently underwent hysterectomy for a preexisting uterine prolapse and progressive symptoms of dyspareunia and pelvic pain.
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PMID:Photocoagulation of the endometrium with the Nd:YAG laser for the treatment of menorrhagia. A report of ten cases. 375 83

Occult prolapse, a syndrome of pelvic pain, sacral ache, dyspareunia, irritable bladder, but not severe dysmenorrhoea, has been studied in 180 young parous women. Organic disease was not present, but the uterus was very mobile and descended easily down the vagina. The pain was worse in the upright posture and was relieved by lying down, supporting, elevating or removing the uterus in 87% of cases.
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PMID:Psychogenic pelvic pain or occult prolapse syndrome? 395 67

From May 1986 to May 1992, 55 patients with genitourinary prolapse were treated by total hysterectomy, sacral fixation using a prosthetic band and colposuspension. The mean age was 55.5 years (range: 38-78 years). Ten patients (18.8%) developed early postoperative complications: 2 wall haematomas, one surgical revision for haemorrhage, one case of haematemesis secondary to a duodenal ulcer, one intestinal obstruction due to dehiscence of the peritonealisation, two cases of acute urinary retention, one case of complete urinary incontinence, one septic shock and one wall abscess. Three patients (5.4%) developed late postoperative complications: intestinal obstruction secondary to a mesenteric band, one incisional hernia, and one case of pelvic pain. The mean length of hospital stay was 8.9 days (range: 7-25 days) and the mean follow-up was 36 months (range: 6-72 months). The anatomical result was excellent (complete correction of the prolapse and absence of recurrence) in 96.4% of cases. In terms of the functional results, 3 patients (5.4%) remained dysuric and 5 (9.1%) have persistent stress incontinence, either moderate (3 cases) or disabling (2 cases). Marked sphincter insufficiency was demonstrated on the urethral pressure profile in these last two cases. The combination of total hysterectomy with vaginal opening and sacral fixation using a prosthetic band prevents the risk of subsequent disease of the remaining cervix and does not appear to increase the risk of infection or the postoperative morbidity. Without advocating systematic hysterectomy in the sacral fixation technique, we nevertheless believe that it is preferable to perform total hysterectomy rather than supraisthemic hysterectomy when this procedure is indicated.
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PMID:[The treatment of genito-urinary prolapse with promonto-fixation using a prosthetic material combined with complete hysterectomy: complications and results apropos of a series of 55 cases]. 771 68

The existence of combined rectal and vaginal prolapse is more common than the literature would suggest. This paper outlines a further development in the operative management which has been applied to 24 patients with this problem. All had had a hysterectomy and most had had in addition one or more vaginal repairs. The common mode of presentation was one of pelvic pain (19 patients), sometimes severe, crippling and intractable and some form of protrusion (14 patients), difficult or unsatisfied defaecation and rectal incontinence (9 patients). The vaginal prolapse which always involved the vault and usually involved the lower vagina was usually found to be incomplete and the rectal prolapse complete (but occult). The operative procedure essentially consists of a Wells type rectopexy which has a new modification in which the sling is extended to anchor the vaginal vault after correction of the enterocele by the abdominal approach. A vaginal repair is subsequently performed at the same operation where anterior or posterior vaginal prolapse persists. Important points in the procedure are the avoidance of sepsis (the vaginal vault is not opened during the procedure) and protection of the ureters by careful assessment of the lateral margins of the vaginal vault which is illuminated by transvaginal vault endoscopy. At this early stage operative morbidity has been minimal, relief of the pelvic symptoms has been most encouraging, but the length of follow-up is short (range 6-30 months, average 15.6) and long-term evaluation will be necessary as with all surgery for prolapse.
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PMID:Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem. 830 99

According to whether uterine artery treatment takes place vaginally or laparoscopically, laparoscopy for hysterectomy can be considered according to two modalities: laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH). The indications for laparoscopy are defined by the limits and/or contraindications of the vaginal route. LAVH is indicated in the following situations: pelvic pain syndrome where diagnosis and treatment can be made at the same time as hysterectomy; minimal endometriosis; past surgical history favouring adhesions formation; necessity to perform an oophorectomy; existence of an ovarian pathology. The elective indications for TLH are the severe pelvic adhesions, deep endometriosis and especially a limited vaginal accessibility associating with a narrow vagina and a fixed or non prolapsed uterus. Laparoscopy thus allows to reduce the number of laparotomies. When on overage three quarters of the hysterectomies (excluding cases of uterogenital prolapse) were up till now performed abdominally, laparoscopy could reduce this rate to approximately 10%.
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PMID:[Complete hysterectomy for benign pathology and laparoscopy: respective indications of laparoscopic preparation and an exclusively laparoscopic approach]. 855 73

Hysterectomy, the most common major nonobstetric operation, is performed in more than 570,000 women in the United States each year. Although the number of hysterectomies has decreased in recent years, many authorities believe that hysterectomy is often unnecessary and unjustified. There is no universally accepted set of criteria regarding the appropriate indications for hysterectomy. The main indications for hysterectomy include the following conditions: uterine leiomyomas, dysfunctional uterine bleeding, endometriosis/adenomyosis, chronic pelvic pain and genital prolapse. Current literature, however, routinely recommends conservative management of most nonmalignant gynecologic conditions, with hysterectomy reserved for refractory cases. Several nonmedical factors, such as patient race, age, geographic location, medical history and background, as well as health care provider characteristics, such as time since completion of training, gender, and affiliation with teaching hospitals, are also associated with hysterectomy rates.
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PMID:Hysterectomy: indications, alternatives and predictors. 933 35

The Le Fort colpocleisis is an obliterative procedure used in the treatment of pelvic prolapse in elderly women where prolonged reconstructive surgery or general anesthesia may be medically contraindicated. Advantages include the ability to perform this procedure quickly under regional anesthesia with a low postoperative complication rate. The authors describe a previously unreported complication of partial colpocleisis requiring subsequent hysterectomy. A 92-year-old woman presented with a 10-day history of lower extremity edema and pelvic pain. She had recently undergone a second partial colpocleisis for recurrent pelvic prolapse in which the drainage channels were partially obliterated. Radiologic evaluation revealed an enlarged complex pelvic mass. At the time of laparotomy, an enlarged uterus filled with purulent material was noted which necessitated subsequent hysterectomy. It was concluded that, although uncommon, postoperative infection is a recognized complication of Le Fort colpocleisis. To minimize the chance of abscess, adequate lateral channels should be created and maintained during colpocleisis to allow drainage of postoperative secretions, bleeding and inflammatory exudate.
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PMID:Pyometra following Le Fort colpocleisis. 912 84

Hysterectomy is the commonest major operation performed by gynaecologists and is the definitive cure for many of it's indications which include dysfunctional uterine bleeding, fibroids, utero-vaginal prolapse, endometriosis and adenomyosis, pelvic inflammatory disease, pelvic pain, gynaecological cancers and obstetric complications. It is a successful operation in terms of relieving women of their presenting symptoms and high levels of satisfaction are reported by patients. However, it has a high risk of complications, involves a prolonged convalescence, is expensive and to some women represents a loss of femininity. It should only be employed after trying conservative treatments first if appropriate. If this fails, currently only endometrial ablation and myomectomy are valid alternatives to hysterectomy. If ultimately hysterectomy is required, there is considerable evidence that patient care can be improved by increasing the proportion of operations that are done vaginally and laparoscopically and decreasing the number of laparotomies.
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PMID:Indications and alternatives to hysterectomy. 915 36

Uterine tube prolapse into the vaginal vault is an uncommon complication after hysterectomy, and our 6 patients bring to 90 the number of cases reported in the literature. Symptoms consist almost exclusively of vaginal bloody discharge and/or leukorrhea, persistent pelvic pain, and dyspareunia. Surgical treatment must be individualized according to the patient's symptoms. In our series, sexually active women with pelvic pain and dyspareunia had the best outcome when a combined laparoscopic and vaginal approach was used.
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PMID:Management of tubal prolapse after hysterectomy. 945 79


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