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

It is accepted that pelvic organ prolapse impairs voiding, in particular as regards the anterior vaginal wall. The influence of central and posterior prolapse is more controversial. Mechanical effects, i.e. urethral distortion and compression, have been advanced as causative mechanisms. This study attempts to further elucidate the effect of prolapse on voiding. We investigated 228 patients with symptoms of lower urinary tract dysfunction and/or prolapse using independent flowmetry, clinical and ICS prolapse assessment and translabial ultrasound. As expected, age ( P<0.001), previous hysterectomy ( P = 0.002) and/or incontinence surgery ( P<0.001) negatively influenced flow. As regards prolapse, only enterocele had a consistently negative effect on flow ( P<0.001 for clinical staging, P = 0.002 for ICS assessment, P = 0.005 for ultrasound imaging). The relationship between anterior vaginal wall prolapse and voiding was complex: funneling and opening of the retrovesical angle on ultrasound was associated with improved voiding ( P<0.001), but a cystocele with intact retrovesical angle had the opposite effect ( P<0.001).
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PMID:Female pelvic organ prolapse and voiding function. 1235 86

The aim of this study was to evaluate the risk factors, investigations and treatments for vaginal wind. A prospective longitudinal study was carried out at a tertiary care referral centre at St George's Hospital, London. Six consecutive women with symptomatic vaginal air were enrolled in the study, which used a comprehensive questionnaire for vaginal air, prolapse, urinary, bowel and sexual symptoms, vaginal examination following the Standardized ICS Scoring System for prolapse, physiotherapist evaluation, and analysis of the treatment. Main outcome measures were the effect of the patient's age, weight, parity, mode of delivery, fetal weight, and the treatment (conservative and surgical) on the frequency of vaginal wind. The mean age of the six women was 32.8+/-9.9 years (range 21-52), the mean BMI was 23.1+/-5.5 (range 15.2-32.2), all women were premenopausal and five were parous. The mean estimated frequency of the symptoms was 20.0+/-8.1 per day (range 10-40). All the patients completed a course of pelvic floor physiotherapy and one patient had a posterior repair and later a Fenton operation without improvement. A modified 'Bard' pessary was the main form of treatment and resolved the symptoms in two women. Vaginal wind causes significant distress and embarrassment to sufferers. Further information on risk factors, evaluation and treatment modalities should be obtained.
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PMID:Vaginal wind - a new pelvic symptom. 1723 60

The authors performed a web-based questionnaire survey of 667 members of the ICS and AUGS to determine the current use of the pelvic organ prolapse quantification (POPQ) system by members of the professional societies which have advocated its use. Three hundred and eighty (57%) gynecologists responded. This international survey shows that only 40.2% of ICS and AUGS members who responded routinely use the POPQ system in their clinical practice and provides information on the most common reasons for not using it. The results highlight some of the concerns regarding the complex nature of the system and its acceptance and use by specialists worldwide. It also suggests the need for a simplified version of the classification system that is user-friendly and can be adopted by all practitioners.
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PMID:Is the pelvic organ prolapse quantification system (POPQ) being used? A survey of members of the International Continence Society (ICS) and the American Urogynecologic Society (AUGS). 1558 Apr 17

Pregnancy-related pelvic girdle pain (PRPGP) has a prevalence of approximately 45% during pregnancy and 20-25% in the early postpartum period. Most women become pain free in the first 12 weeks after delivery, however, 5-7% do not. In a large postpartum study of prevalence for urinary incontinence (UI) [Wilson, P.D., Herbison, P., Glazener, C., McGee, M., MacArthur, C., 2002. Obstetric practice and urinary incontinence 5-7 years after delivery. ICS Proceedings of the Neurourology and Urodynamics, vol. 21(4), pp. 284-300] found that 45% of women experienced UI at 7 years postpartum and that 27% who were initially incontinent in the early postpartum period regained continence, while 31% who were continent became incontinent. It is apparent that for some women, something happens during pregnancy and delivery that impacts the function of the abdominal canister either immediately, or over time. Current evidence suggests that the muscles and fascia of the lumbopelvic region play a significant role in musculoskeletal function as well as continence and respiration. The combined prevalence of lumbopelvic pain, incontinence and breathing disorders is slowly being understood. It is also clear that synergistic function of all trunk muscles is required for loads to be transferred effectively through the lumbopelvic region during multiple tasks of varying load, predictability and perceived threat. Optimal strategies for transferring loads will balance control of movement while maintaining optimal joint axes, maintain sufficient intra-abdominal pressure without compromising the organs (preserve continence, prevent prolapse or herniation) and support efficient respiration. Non-optimal strategies for posture, movement and/or breathing create failed load transfer which can lead to pain, incontinence and/or breathing disorders. Individual or combined impairments in multiple systems including the articular, neural, myofascial and/or visceral can lead to non-optimal strategies during single or multiple tasks. Biomechanical aspects of the myofascial piece of the clinical puzzle as it pertains to the abdominal canister during pregnancy and delivery, in particular trauma to the linea alba and endopelvic fascia and/or the consequence of postpartum non-optimal strategies for load transfer, is the focus of the first two parts of this paper. A possible physiological explanation for fascial changes secondary to altered breathing behaviour during pregnancy is presented in the third part. A case study will be presented at the end of this paper to illustrate the clinical reasoning necessary to discern whether conservative treatment or surgery is necessary for restoration of function of the abdominal canister in a woman with postpartum diastasis rectus abdominis (DRA).
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PMID:Stability, continence and breathing: the role of fascia following pregnancy and delivery. 1908 92

The prevalence of pelvic organ prolapse (POP) varies between 2.9 and 11.4% in questionnaire-based studies and from 31.8 to 97.7% according to the ICS Pelvic Organ Prolapse Classification (POPQ) anatomical classifications. The cumulative incidence of surgery for POP is as high as 70% in women more than 70-year-old. Aging is significantly associated with the prevalence and severity of POP. Pelvic disorders are a health economic challenge for the future due to the longer life expectancy of women and to an increasing demand for a better quality of life. Identification of risk factors will be critical in order to develop strategies to prevent the disease and limitate the need for surgical intervention.
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PMID:[Update on the epidemiology of genital prolapse]. 1996 58

The results of extraperitoneal pelvic floor reconstruction using synthetic prostheses implanted Prolift of 86 patients with genital prolapse III-IV(POP-Q; ICS, 1996) are presented. Analysis of treatment, intraoperative and postoperative complications, factors influencing the choice of a rational method of surgical intervention is performed. The results show the high efficiency of the method--no recurrence genital prolapse in 97.7% of patients in the observation period from 6 months to 6 years. However, in 27.9% of cases, surgery is accompanied by complications of varying severity, which requires a comprehensive assessment and balanced approach to the choice of method of surgical treatment.
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PMID:[Experience of use of synthetic cellular implants for correction of genitals prolapse]. 2301 82

The purpose of this study is to compare the anatomical outcome of robotic sacrocolpopexy for pelvic organ prolapse in women with a body mass index (BMI) of 30 and higher to those with a BMI under 30. This is a retrospective chart review. POP-Q measurements preoperatively and 12 months postoperatively were evaluated using non-parametric statistical analysis. The primary outcome was to compare postoperative POPQ measurements at 12 months following surgery. Secondary outcomes were age at the time of surgery, mesh erosion rate, blood loss, length of hospital stay, and baseline anatomical support. A total of 71 patients were identified: 44 patients had a BMI below 30, and 27 had a BMI equal to or greater than 30. We found no significant relationship between BMI and anatomical support at 12 months post operation. However, obese patients were younger at the time of prolapse surgery (53.6 versus 60.6 years of age, p=0.0022). In regards to the ICS prolapse stage, no difference was found between obese and non-obese patients (2.81 versus 2.95, p=0.17).
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PMID:The anatomical outcome of robotic sacrocolpopexy for treatment of pelvic organ prolapse: a comparison of obese and non-obese patients. 2470 Feb 27