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PubMed2003

Biomechanical and biochemical assessments for pelvic organ prolapse.

PURPOSE OF REVIEW: It is generally believed that pelvic organ prolapse is multifactorial in etiology. It is still an enigma that some women develop prolapse while others with similar risk factors do not. Assessment of supports of the pelvic organs biomechanically and biochemically may provide the clinician with further insight into the etiology of this complex condition. Furthermore, biomechanical and biochemical studies may prove to be vital in the development of prostheses utilized in the augmentation of surgery for pelvic organ prolapse. RECENT FINDINGS: When compared with clinical studies on pelvic organ prolapse, there is a paucity of recently published literature on biomechanical and biochemical studies of pelvic organ supports. The results on collagen content of vaginal/pelvic tissues in women with prolapse are variable. The amount of smooth muscle in vaginal tissue appears to be lowered in women with prolapse regardless of age compared with controls. Biomechanical analysis of prolapsed tissue in pre and postmenopausal women demonstrates only age-related differences. SUMMARY: Further research is required to ascertain the role of connective tissue components, including smooth muscle, in the support of pelvic organs. Knowledge of biomechanical properties of normal vaginal connective tissue may enhance the development of prostheses designed for use during vaginal prolapse surgery.

Biomechanical Phenomena↗
PubMed2004

Clinical examination and dynamic magnetic resonance imaging in vaginal vault prolapse.

OBJECTIVE: To estimate the role of dynamic magnetic resonance imaging (MRI) as a diagnostic tool in the evaluation of vaginal apex prolapse in women with previous hysterectomy. METHODS: Clinical examinations were performed on 51 women presenting with symptoms of prolapse. A preoperative dynamic MRI assessment was performed. The mid pubic line was the reference level used for prolapse grading. The parameters of analysis included 1). correlation by compartments of clinical and MRI grading of prolapse, 2). assessment of the accuracy of clinical examination of the middle compartment, and 3). identification of any additional information provided by MRI. All MRI films were analyzed and validated by the same two observers. RESULTS: Analysis of each compartment separately revealed poor correlation between clinical and MRI assessment. Of the 51 cases with clinical vault prolapse, 27 (52.9%) cases were clinically overdiagnosed, 3 (6%) were underdiagnosed, and there was agreement in 21 (41.1%) when compared with MRI findings. Postoperative follow-up of the 18 (85%) patients who underwent colposacropexy after intraoperative assessment revealed the presence of cystocele in 4 (26.6%) occasions and rectocele in 3 (20%), which had been detected on MRI but not confirmed intraoperatively. CONCLUSION: There is poor correlation between clinical and MRI findings when assessing vaginal apex prolapse. Magnetic resonance imaging allows the identification of other prolapsing compartments and may be a complementary diagnostic tool for the diagnosis of complex vaginal apex prolapse.

Adult↗
PubMed2005

Remodeling of vaginal connective tissue in patients with prolapse.

OBJECTIVE: As pelvic organ prolapse progresses, the morphology of the vagina dramatically changes. The objective of this study was to determine whether these changes observed clinically correlate with histologic and biochemical evidence of tissue remodeling METHODS: After informed consent, full-thickness biopsies of the vaginal apex were obtained at the time of surgery from 77 women. The tissue of 15 premenopausal women with less than stage II prolapse (controls) was compared with that of 62 women with prolapse divided according to their menopausal status. All specimens were examined histologically. Scanning confocal microscopic analysis of fluorescent micrographs was used to quantitate collagen subtypes I, III, and V. Collagen fiber orientation was analyzed by scanning electron microscopy. Gelatin zymography was used to quantitate the expression of the proenzyme and active forms of matrix metalloproteinases (MMP) -2 and -9. Median values were compared using Mann-Whitney U or Kruskal-Wallis tests, where appropriate RESULTS: Vaginal collagen fibers are arranged in a whorled pattern, with collagen III as the predominant fibrillar collagen. The amount of total collagen in the vagina was increased in women with prolapse relative to women without prolapse (P = .054) primarily due to increased expression of collagen III (P = .031). There was no difference in the expression of proMMP-2, active MMP-2, or proMMP-9; however, active MMP-9 was increased in patients with prolapse (P = .030) CONCLUSION: The increase in collagen III and active MMP-9 expression in the vaginal tissues of patients with prolapse suggests that this tissue is actively remodeling under the biomechanical stresses associated with prolapse. LEVEL OF EVIDENCE: II-2.

Adult↗
PubMed2000

Vault prolapse and rectocele: assessment of repair using sacrocolpopexy with mesh interposition.

OBJECTIVE: To assess the sacrocolpopexy with mesh interposition in women with pelvic organ prolapse. DESIGN: A prospective study. SETTING: Tertiary referral urogynaecology and pelvic floor reconstruction unit. POPULATION: Twenty-nine consecutive women with symptomatic vault prolapse and rectocele. MAIN OUTCOME MEASURES: Subjective and objective success rates and complications. RESULTS: The mean age was 57 years. The mean number of past prolapse operations was 2.6 which included two past sacrospinous ligament fixations and 17 past posterior repairs. The mean follow up was 14 months. There was an increase in constipation from 41% to 50%, a decrease in faecal soiling from 21% to 10%, and an increase in incomplete defecation from 24% to 36% . Dyspareunia decreased from 38% to 17%, and there was some improvement in the stress and urge incontinence. There was a significant reduction of vault prolapse and rectocele (P < 0.001). All women with Stage II and Stage III vault prolapse were corrected, with an increase in Stage I prolapse from 20% to 27%. All women with Stage II and Stage III rectocele were corrected with a decrease in Stage I prolapse from 36% to 7% . The only significant interoperative complication was a cystotomy. One mesh became infected post-operatively which required removal. CONCLUSIONS: Sacrocolpopexy and mesh interposition is a safe and reliable operation for the correction of vault prolapse and rectocele. A long term follow up is necessary to detect any late complications.

Adult↗
PubMed2005

Bilateral iliococcygeal fixation for vaginal vault prolapse and enterocele repair using a new suturing device--the digital needle driver.

The objective of our study was to evaluate the surgical feasibility, efficacy and safety of the digital needle driver (DND 202), a modified, flexible surgical device, during iliococcygeal fixation (ICF) for vaginal vault prolapse and enterocele repair. A prospective longitudinal study was carried out among 21 consecutive patients who underwent bilateral iliococcygeal fixation at St George's Hospital, London. All patients filled a comprehensive questionnaire for pre- and post-operative prolapse, urinary, bowel and sexual symptoms and underwent pre- and post-operative site-specific vaginal examination, following the standardized International Continence Society scoring for prolapse, pre-operative urodynamic studies and analysis of the surgical results. The outcome measures were the feasibility of the procedure, the time needed, intra- and post-operative complications, short-term post-operative prolapse-associated symptoms and pelvic organ prolapse quantification. The mean age of the patients was 65 [5] years and the mean body mass index (kg/m(2)) was 23 [2.7]. In addition to ICF, 8 patients underwent vaginal hysterectomy, 18 had posterior repairs, 7 had anterior repairs and 6 had TVT. The mean time for ICF was 20 [11] minutes, the mean blood loss per surgical procedure was 264 [225] mL and the mean hospitalization time was 4.6 [1.2] days. Postoperatively, one patient had mesh erosion. At short-term post-operative evaluation none of the patient had prolapse symptoms. There was a statistically significant improvement in all stages of the apical and posterior walls prolapse (p < 0.001). The mean total vaginal length was significantly shorter postoperatively (7.8 [1.0] cm vs 6.6 [1.4] cm, p < 0.001). Thus, we can conclude that the use of DND device may facilitate the vaginal approach for vaginal vault prolapse and enterocele repair.

Aged↗
PubMed1980

Effect of atrial septal defect repair on left ventricular geometry and degree of mitral valve prolapse.

To ascertain the effects of surgical closure of atrial septal defect on left ventricular geometry and degree of mitral prolapse, 14 patients with atrial septal defect were studied by cross-sectional and M-mode echocardiography preoperatively and 7 days postoperatively. Seven of the 14 patients (50%) had mitral valve prolapse preoperatively by cross-sectional echocardiography. To quantitate the degree of prolapse, we measured the net algebraic area subtended by the apposed mitral valve leaflets in systole (MVAS) with respect to the mitral ring. The mitral valve prolapse group had an MVAS of 0.3 +/- 3.1 units (mean +/- SEM) preoperatively, while the group without mitral valve prolapse had an MVAS of 12.5 +/- 3.1 units (p less than 0.02). Postoperatively, prolapse either decreased in degree or was abolished in six of seven patients (86%), associated with an increase in MVAS to 14.7 +/- 4.4 units (p less than 0.02). In all patients, septal curvature in diastole on short-axis view normalized either partially or completely postoperatively, resulting in decreased left ventricular eccentricity (1.34 +/- 0.06 preop vs. 1.06 +/- 0.07 postop, p less than 0.001). Atrial septal defect closure, therefore, leads to normalization of left ventricular geometry and in patients with evidence of mitral valve prolapse, is associated with a decrease in the degree of prolapse.

Adult↗
PubMed1989

Can the parasternal long axis plane replace the apical four-chamber plane in diagnosing mitral valve prolapse?

Since the mitral anulus is now known to be saddle-shaped, use of the qualitative motion of the mitral valve (MV) leaflets in the apical four-chamber plane to diagnose mitral valve prolapse (MVP) may be unsound, in that superior systolic displacement of the MV leaflets would occur in normal subjects, as well as in patients with MVP. It has therefore been suggested that the parasternal long axis (PLAX) plane should be used to diagnose MVP. To test the feasibility of this approach, the authors examined the predictive accuracy of PLAX prolapse and other isolated echocardiographic abnormalities versus a multivariate decision tree approach. PLAX prolapse, which was significantly associated with marked (greater than 0.7 cm) apical four-chamber prolapse, mitral regurgitation, the presence of a thick mitral valve, and low relative body weight, was 100% specific for MVP but only 44% sensitive. Similarly, marked apical four-chamber prolapse was 100% specific but only 53% sensitive. Apical four-chamber prolapse, if gauged only qualitatively as present or absent, was 94% sensitive but only 50% specific. By contrast, the decision tree classified all 32 initial patients correctly, and in a second, test set, selected 6 additional patients; these 6 patients had many of the clinical features of MVP. These observations suggest that: (1) if prolapse is seen in the PLAX plane, the patient does have MVP; on the other hand, lack of prolapse in this plane does not exclude the diagnosis of MVP and (2) the apical four-chamber plane, used qualitatively, does not reliably distinguish patients with MVP from those without MVP.

Adult↗
PubMed2003

Some characteristics of vaginal prolapse in Nepali buffaloes.

Prolapse of vagina is one of the important maternal abnormalities during pregnancy in cattle and buffaloes. A field investigation was carried out on 26 Murrah graded buffaloes to study clinical characteristics of vaginal prolapse in buffaloes in Nepal. Fifty-seven percent of the 26 buffaloes with vaginal prolapse were either heifers or in first lactation. Sixty-five percent of the cases were in seventh month of pregnancy or later. About three quarters of the cases occurred between June and October. Twelve cases (63%) of the 19 animals excluding 7 heifers had a history of vaginal prolapse in previous gestations. A half of the buffaloes were showing prolapse of the vagina even when they were in standing position and showing moderate or vigorous straining. After the conventional treatments, twenty-three buffaloes retained the replaced vagina and calved normally. One animal aborted although the vagina was retained. Two buffaloes had severest degree of vaginal prolapse complicated with edema, injury and cyanosis, and they did not respond to the treatment. The two buffaloes had frequently recurrent prolapse and subsequently died. Early detection and prompt treatment may be imperative to control the vaginal prolapse in buffaloes.

Animals↗
PubMed1995

Evacuation proctography in patients with solitary rectal ulcer syndrome: anatomic abnormalities and frequency of impaired emptying and prolapse.

OBJECTIVE: Solitary rectal ulcer syndrome is characterized by rectal bleeding, tenesmus, and difficult evacuation. Evacuation proctography can be used in patients with solitary rectal ulcer syndrome to diagnose associated internal or external rectal prolapse and delayed or incomplete rectal emptying. The objective of this study was to determine the proctographic abnormalities and the frequency of rectal prolapse and incomplete or delayed emptying in a large group of patients with solitary rectal ulcer syndrome. MATERIALS AND METHODS: Proctographic examinations of 53 patients with histologically proved solitary rectal ulcer syndrome were reviewed retrospectively. Evacuation proctography was done by a standard technique. The rate and completeness of rectal emptying and structural abnormality of the rectum were recorded. Comparison was made with a control group of 20 subjects who had no anorectal symptoms. RESULTS: Fourteen patients (26%) with solitary rectal ulcer syndrome had rectal irregularity at rest compared with none in the control group. Rectal prolapse developed on evacuation in 36 patients (68%) with solitary rectal ulcer syndrome: internal prolapse in 24 patients (45%), and external prolapse in 12 (23%). Descent of the pelvic floor on evacuation was greater in the solitary rectal ulcer syndrome group (median, 4.4 cm; range, 0-10.0 cm) than in the control group (median, 3.3 cm; range, 0.6-5.3 cm; p = .006). Thickened rectal folds were seen in 11 (55%) of 20 patients with solitary rectal ulcer syndrome examined with posteroanterior proctography. Evacuation was prolonged and incomplete in patients with solitary rectal ulcer syndrome (median, 15 sec; range, 3-60 sec) compared with control subjects (median, 10 sec; range, 3-30 sec; p = .012). All control subjects evacuated more than two thirds of the contrast material in less than 30 sec compared with only 41 patients with solitary rectal ulcer syndrome (77%). Overall, evacuation proctography disclosed delayed or incomplete emptying and/or rectal prolapse in 40 patients (75%) with solitary rectal ulcer syndrome compared with two control subjects who showed low-grade internal rectal prolapse only (p < .0001). CONCLUSION: Solitary rectal ulcer syndrome is significantly associated with prolonged and incomplete evacuation and with an increased prevalence of internal and external rectal prolapse.

Adolescent↗
PubMed2003

Length of docked tail and the incidence of rectal prolapse in lambs.

A multistate cooperative study was conducted to study the current issue of tail length in docked lambs and its relationship to incidence of rectal prolapse. A total of 1,227 lambs at six locations were randomly allocated to two or three tail dock treatments: 1) short--tail was removed as close to the body as possible, 2) medium--tail was removed at a location midway between the attachment of the tail to the body and the attachment of the caudal folds to the tail, and 3) long--tail was removed at the attachment of the caudal folds to the tail. Short-docked lambs had a greater (P < 0.05) incidence of rectal prolapse (7.8%) than lambs with a medium (4.0%) or a long (1.8%) dock. Female lambs had a higher (P < 0.05) incidence of rectal prolapse than male lambs. At two stations, lambs were finished either in a feedlot on a high-concentrate diet or on pasture with no grain supplementation. At one station, with a very low incidence of rectal prolapse, there was no difference in incidence between lambs finished in the feedlot or on pasture; however, at the station with a relatively high incidence of rectal prolapse, lambs in the feedlot had a higher (P < 0.05) incidence than lambs on pasture. The half-sib estimate of heritability for the incidence of rectal prolapse was low (0.14). The results of this study strongly implicate short dock length as a cause of rectal prolapse in lambs finished on high-concentrate diets. Furthermore, the results of this study and the only other study known conducted on this issue strongly suggest that docking lambs at the site of the attachment of the caudal folds to the tail will result in a negligible incidence of rectal prolapse.

Animal Husbandry↗
PubMed2003

The effect of pelvic organ prolapse on lower urinary tract function.

Pelvic organ prolapse (POP) is a process in which the pelvic contents, including the reproductive organ, bladder, rectum, and/or small intestines become herniated through defects in the vaginal wall. The pelvic organs are closely related to the urinary tract and thus various urinary functions can be affected. The purpose of this study was to evaluate the relationship between pelvic organ prolapse and lower urinary tract function by urodynamic studies. From March 1999 to May 2000, 40 patients with pelvic organ prolapse who underwent urodynamic studies (uroflowmetry, filling cystometry, urethral pressure profile) without barrier reduction of prolapse were analyzed. The majority of the cases of low grade POP involvedpatients with anterior wall prolapse, whereas the higher POP stages were more frequent in women with cervical cuff prolapse. Symptoms of stress urinary incontinence and hesitancy were more frequent in the patients with anterior wall prolapse. The urodynamic study showed a statistically significant increase in MUCP in patients with POP stage IV and the leading point of POP was cervical cuff. The subjective urinary symptoms of patients with POP appear to be less reliable as a diagnostic tool. POP had no adverse effect on the bladder storage function. However, POP affected the voiding function through an increase in MUCP, especially in patients with stage IV prolapse and when the leading point of POP was cervical cuff. Following the surgical correction of POP, an evaluation of the preoperative changes in the urodynamic study parameters should be performed.

Aged↗
PubMed2005

The relationship between maximal urethral closure pressure and functional urethral length in anterior vaginal wall prolapse patients according to stage and age.

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.

Adult↗
PubMed2000

Rectal prolapse during pregnancy. A case report.

BACKGROUND: Rectal prolapse is a bothersome surgical problem that is relatively infrequent. It usually occurs in the fifth to seventh decades of life and is more common in women. CASE: A 33-year-old woman, gravida 3, para 2, was found to have a large rectal prolapse at 33 weeks' gestation. Manual reduction was successfully performed after injecting 2% lidocaine into and around the anal sphincter. Because she could not undergo definitive surgical repair during her pregnancy, the patient was managed with an aggressive stool softening regimen and self-reduction techniques. Labor was induced in the 40th gestational week. Epidural anesthesia was employed, and delivery was accomplished via low-outlet forceps application. The patient underwent definitive surgical repair of the rectal prolapse eight weeks postpartum. CONCLUSION: Rectal prolapse is a rare condition during the childbearing years. We found no prior case reports of rectal prolapse occurring during pregnancy. While childbirth itself is not considered a risk factor for rectal prolapse, a prior history of perineal lacerations may be a risk factor. To manage rectal prolapse that occurs during pregnancy, consideration should be given to passive forceps delivery under epidural anesthesia to avoid the possibility of worsening the prolapse.

Adult↗
PubMed2000

Pelvic organ prolapse: a review.

Pelvic organ prolapse is a common medical problem in parous women. This condition usually refers to a combination of deficiencies of the pelvic organs as they relate to support mechanisms of the vaginal wall. Symptoms vary--an accurate diagnosis requires a careful and complete physical examination with attention directed toward the pelvis and perineum. Although many patients will not require surgical treatment for pelvic organ prolapse, a comprehensive approach to repair in which all of the anatomic defects affecting support are addressed is necessary for successful treatment. Patients presenting with pelvic organ prolapse often provide some of the most complex, challenging, and rewarding cases in reconstructive pelvic surgery. This article addresses the definitions and classifications, prevalence and risk factors, and anatomy and pathophysiology relevant to pelvic organ prolapse. Discussion also includes diagnosis and approaches to management (surgical and nonsurgical) of anterior vaginal wall prolapse, cystourethrocele, apical vaginal prolapse, uterine prolapse and enterocele, posterior vaginal wall prolapse, rectocele, and pelvic floor relaxation and perineal laxity, with indications for and approaches to surgery, along with possible complications.

Female↗
PubMed2002

Abnormal clinical and urodynamic findings in women with severe genitourinary prolapse.

In order to investigate the effects of urogenital prolapse on lower urinary tract function, we studied 61 women with stage III to IV pelvic organ prolapse (prolapse group) and 40 volunteers without prolapse (control group). Each woman underwent urinalysis, urinary questionnaire, pelvic examination, and urodynamic study. The incidence of urinary symptoms, including urinary frequency and urgency, stress/urge incontinence, incomplete emptying, difficult voiding and nocturia, were significantly higher in the prolapse group compared to the control group (p < 0.05). Urodynamic parameters, including residual urine, total bladder capacity, and bladder volume at strong desire to void, were not significantly different between the two groups (p > 0.05). Maximal flow rate, bladder compliance at urgency, functional urethral length, and maximal urethral closure pressure, however, were significantly higher in the control group compared to the prolapse group (p < 0.05). In addition, there was a higher incidence of poor pressure transmission ratio in the prolapse group (p < 0.01). The results indicated that severe urogenital prolapse could produce abnormal clinical and urodynamic results.

Adult↗
PubMed2004

[Localization of mitral valve prolapse zones with multiplane transesophageal echocardiography].

CONTEXT: There are few literature data on the localization and extent of mitral valve prolapse zones with transesophageal echocardiography (TEE). AIM OF THE STUDY: To assess a standardized imaging technique for the localization and extent determination of prolapse zones, based on 3 easily reproducible views with multiplane TEE. METHODS: Seventy patients with severe mitral regurgitation due to valve prolapse requiring a multiplane TEE prior to surgery (valve repair or replacement) have been retrospectively assessed. Data of TEE on the localization and extent of prolapse zones have been confronted to per-operative anatomical observations (gold standard). RESULTS: The sensitivity of TEE for the identification of isolated P2 prolapse, prolapse with commisural extension, isolated rupture of the posterior commisure and bi-valvular prolapses were respectively at 96%, 88%, 86% and 80%. The corresponding specificities were from 98% to 100%. CONCLUSIONS: The use of a standardized technique with the use of 3 easily reproducible incidences with multiplane TEE allows a precise definition of the localization and extent of mitral valve prolapse zones, in order to potentially indicate valve repair.

Aged↗
PubMed2005

Mitral valve prolapse: diagnosis, treatment and natural course.

This article analyzes data obtained from the medical records of the patients with primary mitral valve prolapse. The study population was the patients admitted to Kaunas University of Medicine Heart Center (KUMHC) between 1999 and 2003. The objective of our study was to analyze the natural course of mitral valve prolapse, complications and their frequency, treatment strategy in KUMHC, as well as to review the results of surgical treatment. We gathered data from the medical records of 160 patients and analyzed their age, medical history, complications, comorbidities, functional status and echocardiographic parameters. Patients who underwent mitral valve surgery were followed 7.9+/-8.4 months after procedure. On average, 32+/-14 patients with primary mitral valve prolapse were treated at KUMHC annually. Their mean age was 48.4+/-16.5 years, 44.4% of them were male. The most frequent complications of mitral valve prolapse were > or =II degrees mitral regurgitation (78.4%), various cardiac arrhythmias (68.1%) and heart failure of > or =II NYHA class (79%). Surgical treatment was recommended for 64 (40%) KUMHC patients with primary mitral valve prolapse. Surgical treatment was applied in 44 (28.1%) of study patients. The patients, who were recommended surgical treatment, were older (mean age 53.2+/-11.9 years, p<0.05) and predominantly male (62.5%, p<0.05) as compared to medically managed patients. The heart failure (62.5% had NYHA class III or IV), severe mitral regurgitation (95.3% had mitral regurgitation of > or =III degrees ) and worse left ventricle function (15% had ejection fraction of <50%) were more frequent in this group as compared to medically managed patients (all p<0.05). During the last five years the number of hospitalized patients with primary mitral valve prolapse increased 3.2 times, the number of mitral valve surgical procedures among these patients increased 2.8 times, and the number of mitral valve repair increased 15.8 times. 56.8% of patients had uncomplicated postoperative course. The most frequent postoperative complication was new arrhythmias and/or conduction disturbances. 1 patient died in early postoperative period. There was significant decrease in left ventricle and left atrium size and the severity of mitral regurgitation 2 to 6 months after mitral valve surgery. These positive changes remained during all study period. Taking in the consideration the large number of mitral valve repair procedures and good outcomes, the low postoperative mortality of the surgical mitral valve prolapse treatment in KUMHC, we can strongly recommend surgical treatment for the patients with severe mitral regurgitation secondary to mitral valve prolapse.

Adult↗
PubMed2001

Prevalence and factors associated with genital prolapse: a hospital-based study in Alexandria (Part I).

Most hospital-based studies on genital prolapse focus on the contribution of prolapse to the overall hospital incidence rate of hysterectomy. The present study targeted the outpatient clinic of a teaching and reference hospital (The Maternity University Hospital in Alexandria) to determine the prevalence and possible factors associated with genital prolapse among the attendants of the gynecological outpatient clinic. Through a cross sectional approach, a systematic random sample of 400 women (being non-pregnant, age 25 years and over), was selected from the outpatient clinic over a period of 6 months. They were subjected to: 1) a structured interview using a questionnaire, 2) clinical examination, and 3) measurement of body mass index (BMI). Pelvic examination revealed a high prevalence rate, moderate and large degrees were present in 40% of them. Cysto-rectocele was the commonest type (65.5% of the whole sample), followed by utero-vaginal prolapse (3.5%). The most commonly reported complaints (89.9%) were not related to genital prolapse. Symptoms specific to prolapse were reported on inquiry by a small proportion of cases (25.8%). Comparing women's report and diagnoses indicated a low sensitivity (33%) and very high specificity (100%). Stress incontinence and multiple sexual consequences were the most frequently reported complications (60.1% and 66.7% respectively). Stepwise logistic regression analysis revealed that five variables only were significant predictors of prolapse: parity 3+ (p = .0001, CI = 1.67-5.25), unskilled birth attendant (p = .0006, CI = 1.2-3.2), prolonged labor (p = .007, CI = 1.7-7.6), early resumption of routine activities during puerperium (p = 002, CI = 1.7-11.3) and history of obvious weight loss (p = .0026, CI = 1.19-17.2). The presence of many silent cases of prolapse among outpatients in spite of having moderate and severe degrees indicates that health education on different aspects of reproduction is highly required to encourage women to know and report their sufferings. Improving the skills of birth attendants, focussing on domiciliary obstetrics is also emphasized.

Adult↗