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PubMed2001

Combined tension-free vaginal tape and prolapse repair under local anaesthesia in patients with symptoms of both urinary incontinence and prolapse.

OBJECTIVE: To study the combination of tension-free vaginal tape (TVT) and prolapse repair under local anaesthesia in patients suffering from stress incontinence and prolapse. STUDY DESIGN: The study was designed as a prospective, open, nonrandomized study. A standardized protocol was used for pre- and postoperative evaluation. Check-ups were performed after 2, 6, 12 and 24 months. The protocol included medical history, stress test (supine and standing position with a comfortably filled bladder), life quality assessment including a visual analogue scale, 24- to 48-hour pad test, and 48-hour micturition diary. PATIENTS: In total 32 patients participated. All suffered from urinary stress incontinence (grade 1-3) and prolapse (grade 1-3). 2 patients had previously undergone surgery 2 and 3 times, respectively, for urinary incontinence with methods other than TVT (traditional anti-incontinence surgery). 3 patients had a history of total hysterectomy. 1 patient had a large rectocele with urinary and faecal incontinence. Mean age was 54 (range 31-74) years, mean parity 2 (range 0-5), and mean duration of incontinence 13 (range 2-29) years. SURGICAL TECHNIQUE: TVT was carried out according to the standardized technique as originally described. The prolapse repair included anterior and/or posterior colporrhaphy. All operations could be performed under local anaesthesia. RESULTS: 30 of 32 patients (93%) were cured. One patient (3%) was considerably improved, and 1 patient (3%) was considered a failure. Mean urinary leakage in 24 h was 96 (range 12-355) g preoperatively, and postoperatively 2.7 (range 0-28) g. Mean intraoperative bleeding was 75 (range 25-300) ml. Mean residual urine preoperatively was 15 (range 0-85) ml, and postoperatively 7 (range 0-40) ml. The mean stay in hospital after surgery was 2 (range 1-5) days. No postoperative urinary retention, no defective healing, and no tape rejection occurred. There was one uneventful bladder perforation in a patient who had previously undergone traditional incontinence surgery. This patient left the hospital the day after surgery without postoperative catheterization. CONCLUSION: The study clearly demonstrates that TVT can be combined with prolapse surgery to effectively treat symptoms of prolapse and urinary stress incontinence.

Adult↗
PubMed1988

[Idiopathic mitral valve prolapse and prolapse leakage. Study using Doppler ultrasound in 51 cases].

This study concerns 51 cases of mitral valve prolapse demonstrated on bidimensional 4 cavities sonography according to Gilbert's criteria and aims to determine the frequency of the associated valvular involvement, anatomically with sonography and functionally with the Doppler test. Sonography demonstrates a tricuspid valve prolapse in 79 p. cent of the cases and an aortic valve prolapse in 10 p. cent. The Doppler test demonstrates a tricuspid leakage in 52 p. cent of the cases, a pulmonary leakage in 62 p. cent, and an aortic leakage in 18 p. cent. The myxoid degeneration found in 60 p. cent of the cases is a major factor in the occurrence of complications, especially progressive cardiac insufficiency (A). The myxoid degeneration defines therefore the "isolated prolapse disease" as opposed to "the prolapse without myxoid degeneration" which is a pure sonographic entity and probably a variation of the normal (A). This cardiac insufficiency occurs late during the 6th or 7th decade and is due to mechanical factors: prolapse, chords rupture and annular dilatation.

Adolescent↗
PubMed1989

[Prevalence of tricuspid and aortic valve prolapse in patients with mitral valve prolapse].

Two-dimensional echocardiograms were performed in 30 patients with mitral valve prolapse (15 females and 15 males, with an average of 33.3). The main objective was to observe the prevalence of involvement of tricuspid and aortic valves. Tricuspid valve prolapse was observed in 43.3% with anterior and septal involvement in 92.3% and posterior involvement in 15.3%. The incidence of aortic prolapse was 10% with involvement of both right coronary and non-coronary leaflets. All patients with aortic valve prolapse showed involvement of both mitral leaflets and at least two tricuspid leaflets. It is concluded that involvement of other valves such as tricuspid (43.3) and aortic (10%) is a common finding in patients with mitral valve prolapse.

Adolescent↗
PubMed2006

Can urethral mobility be assessed using the pelvic organ prolapse quantification system? An analysis of the correlation between point Aa and Q-tip angle in varying stages of prolapse.

OBJECTIVES: To determine whether the Pelvic Organ Prolapse-Quantification (POP-Q) system can be used as a replacement for Q-tip testing to assess urethral mobility in women. METHODS: We performed a retrospective review of a clinical database of 1490 patients presenting to a urogynecology clinic. The evaluation included both Q-tip straining angle and POP-Q examination. Urethral hypermobility was defined by the Q-tip test as a straining angle of 30 degrees or greater relative to the horizontal. The correlation between point Aa of the POP-Q system and the maximal Q-tip straining angle was determined using the Spearman correlation coefficient. RESULTS: The mean age of the 1490 patients was 59.5 +/- 13.1 years; the median parity was 2. A total of 62 patients (4.2%) reported prior surgery for incontinence or prolapse. The mean Q-tip straining angle was 44.7 degrees +/- 21.8 degrees. The point Aa values were +3 to -3 cm (median -2). The correlation coefficient between the Q-tip straining angle and point Aa was 0.54 (P <0.001). Urethral hypermobility was observed in 93.3% patients with stage 3 prolapse, 92.5% with stage 2, 88.9% with stage 1, and 55.8% with stage 0. Only in patients with stage 4 prolapse was urethral hypermobility observed 100% of the time. CONCLUSIONS: The correlation between point Aa of the POP-Q and the Q-tip straining angle was moderately strong when analyzed across all degrees of prolapse. However, urethral hypermobility could not be reliably predicted from POP-Q measurement alone. Therefore, the Q-tip test remains an essential part of the urogynecologic evaluation.

Adult↗
PubMed1998

Uterovaginal prolapse associated with rectal prolapse.

A case of combined genital prolapse and rectal prolapse in a 55-year-old multipara is reported. The mixed prolapse was treated by vaginal hysterectomy with pelvic floor repair and laparoscopic rectopexy at the same sitting. The feasibility of combined treatment of genital prolapse by the vaginal route and of rectal prolapse by laparoscopic rectopexy is emphasized.

Feasibility Studies↗
PubMed2004

Patient satisfaction and changes in prolapse and urinary symptoms in women who were fitted successfully with a pessary for pelvic organ prolapse.

OBJECTIVE: Our purpose was to estimate, in women after 2 months of pessary use, patient satisfaction and the percentage of prolapse and urinary symptoms that improve or worsen. STUDY DESIGN: In a prospective study, 100 consecutive women with symptomatic pelvic organ prolapse were fitted with a pessary, and 73 women had a successful 2-week pessary fitting trial. Prolapse and urinary symptoms were assessed at baseline and at 2 months. Patient satisfaction was assessed at 2 months. Risk factors for patient dissatisfaction were assessed. RESULTS: Nearly all prolapse symptoms resolved from baseline to 2 months, respectively: bulge (90% to 3%; P<.001), pressure (49% to 3%; P<.001), discharge (12% to 0%; P=.003), and splinting (14% to 0%; P=.001). Among women with concurrent urinary symptoms at baseline, stress incontinence improved in 45%, urge incontinence improved in 46%, and voiding difficulty improved in 53%, after 2 months. However, among women without urinary symptoms at baseline, occult (de novo) stress incontinence occurred in 21%, de novo urge incontinence occurred in 6%, and de novo voiding difficulty occurred in 4%. At 2 months, 92% of the women were satisfied with their pessary. Six women (8%) were dissatisfied and discontinued use of the pessary. Dissatisfaction was associated with occult stress incontinence (odds ratio, 17.1; 95% CI, 1.9, 206; P=.004). CONCLUSION: After 2 months, 92% of women with a successful pessary fitting trial were satisfied. Nearly all prolapse symptoms resolved after 2 months; 50% of urinary symptoms improved, but occult stress incontinence was a common side effect.

Adult↗
PubMed2000

The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse.

OBJECTIVES: This study was undertaken to assess the depth of the pouch of Douglas among nulliparous women and to compare it with those among parous women and patients with genital prolapse. STUDY DESIGN: The depth of the pouch of Douglas was measured in 22 nulliparous women and 28 parous women without genital prolapse and in 18 patients with prolapse of the posterior vaginal wall. RESULTS: The pouch of Douglas extended from 11% to 89% of the total vaginal length among nulliparous and parous women, without significant difference between these groups (mean, 49% and 45%, respectively). It was significantly deeper in patients with prolapse, ranging from 25% to 96% (mean, 72%). CONCLUSION: There is an extensive variation in the depth of the pouch of Douglas. A deep pouch of Douglas is frequently present in young nulliparous women and may increase the risk for development of a posterior vaginal wall prolapse.

Adult↗
PubMed2005

Sexual function in women with pelvic organ prolapse compared to women without pelvic organ prolapse.

PURPOSE: We compared sexual function in women with pelvic organ prolapse to that in women without prolapse. MATERIALS AND METHODS: We collected sexual function data using a standardized, validated, condition specific questionnaire. The study group consisted of 30 women with pelvic organ prolapse and it was compared with 30 unmatched controls without evidence of prolapse. RESULTS: The 2 groups were similar in age, race, parity and postmenopausal hormone use. Subjects in the study group were more likely to have undergone previous pelvic surgery. Mean total Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire scores +/- SD were lower in the study group compared with controls (81.4 +/- 7.3 vs 106.4 +/- 15.5, p <0.001). In the study group total questionnaire scores in women with prior pelvic surgery were similar to those in women without prior pelvic surgery (79.3 +/- 14.9 vs 82.9 +/- 10.2, p = 0.61). CONCLUSIONS: Pelvic organ prolapse appears to have a significant negative impact on sexual function.

Coitus↗
PubMed2004

Combined genital prolapse repair reinforced with a polypropylene mesh and tension-free vaginal tape in women with genital prolapse and stress urinary incontinence: a retrospective case-control study with short-term follow-up.

BACKGROUND: To evaluate the tension-free vaginal tape (TVT) in both stress urinary incontinence (SUI) and occult SUI as an associated procedure at the time of tension-free polypropylene mesh repair for the treatment of genitourinary prolapse. METHODS: Forty-eight consecutive women undergoing surgery for genital prolapse and concurrent SUI from November 1999 to September 2002. Preoperatively, SUI was symptomatic in 29 women and occult in 19, with a positive stress test during repositioning of the prolapse. All patients had urethral hypermobility and none had intrinsic sphincter deficiency. The cystocele repair was performed in all patients according to the technique of tension-free polypropylene mesh. Twenty-six women had an associated TVT and 22 had no associated procedure for SUI (control group). The main outcome measures were postoperative SUI, voiding dysfunction, and recurrence of prolapse. RESULTS: The median follow-up was 20 +/- 10.1 months (range 7-41). Patient characteristics and preoperative urodynamic evaluation were similar in the two groups. In patients with preoperative SUI, postoperative SUI occurred in 1/15 of the TVT group (6.7%) vs. 5/14 (35.7%) in the control group (p < 0.05), and voiding dysfunction occurred in 2/15 patients of the TVT group (13.3%) vs. 0/14 in the control group (p > 0.05). In patients with preoperative occult SUI, postoperative SUI occurred in 0/11 of the TVT group vs. 1/8 (12.5%) in the control group (p > 0.05), and voiding dysfunction occurred in 3/11 patients of the TVT group (27.3%) vs. 0/8 in the control group (p < 0.05). Anatomic success on prolapse was 88.5% (23/26) and 86.4% (19/22) in the TVT and the control group, respectively (p > 0.05). CONCLUSION: In patients with preoperative SUI, TVT is more efficient than prosthetic cystocele repair alone to prevent postoperative SUI, without differences in voiding dysfunction. In patients with preoperative occult SUI, prosthetic cystocele repair is as efficient as TVT, with a decreased risk of voiding dysfunction.

Aged↗
PubMed1988

[Systolic clicks in mitral valve prolapse: their pathophysiological relationship to the grade and causes of prolapse].

To re-evaluate the clinical significance of non-ejection systolic clicks in mitral valve prolapse (MVP), 154 patients with idiopathic MVP (idiopathic group) and 54 patients with secondary MVP associated with atrial septal defect (secondary group) were studied using phonocardiography and two-dimensional echocardiography. There was no significant difference in the incidence of systolic clicks between the idiopathic (30%) and secondary (24%) groups. The severer the degree of prolapse, the higher the incidence of systolic clicks in both the groups. A systolic click was observed independently of age in the idiopathic group. In the secondary group, however, a systolic click was not observed in patients under 30 years old and increased with advancing age in frequency. The intensity of systolic click tended to increase in proportion to the increase of severity of prolapse in both the groups. These results suggested that systolic clicks may appear irrespective of the causes of prolapse and that the production and the intensity of systolic clicks may be related to the degree of changes in the mitral valve-chordal system and the degree of prolapse.

Adolescent↗
PubMed2005

A comparison of preoperative and intraoperative evaluation of patients undergoing pelvic reconstructive surgery for pelvic organ prolapse using the Pelvic Organ Prolapse Quantification System.

OBJECTIVE: To compare the pre- and intraoperative situation using the POP-Q system during optimally standardized conditions of both examinations. STUDY DESIGN: In a prospective observational study, 108 women were compared. The POP-Q in the outpatient department (preoperative) was compared with the situation just prior to surgery after full anesthesia was reached (intraoperative). During the intraoperative measurement, traction with 0.5 kg force was applied on all relevant places. RESULTS: The pre- and intraoperative measurements were all significant correlated with the R-values between 0.43 and 0.85. All six points, which are measured during the POP-Q, were more prolapsed in the intra- as compared with the preoperative situation. The points Bp, C, and D were significantly more prolapsed, but for the points Aa, Ba, and Ap this was not significant. Fifteen patients were upstaged by the intraoperative measurements and five patients were downstaged in the overall POP-Q grading system. CONCLUSIONS: Intraoperative evaluation of the prolapse can reveal significant changes as compared with the preoperative situation. In general, the prolapse is more pronounced especially in the middle and posterior compartment.

Adult↗
PubMed1990

[Genital prolapse and urinary incontinence. A clinical assessment of patients with prolapse with particular emphasis on surgical methods and their long-term effects].

A review based on a follow up of 215 patients who had been treated operatively for genital prolapse and urinary incontinence after observation for 5-10 year is presented. The operation regime was predominantly conventional and the various vaginal methods involved 182 patients (80%). The Kelly-Kennedy plastic operation (K-K-pl) was employed for stress incontinence and slighter cases of prolapse. In more severe degrees of both of these conditions, K-K-pl was combined with the Manchester operation. The operative method of election in this department for marked cases of utero-vaginal descent was the Manchester operation supplemented by colpo-perineal plastic. The most advanced cases of prolapse were treated either with the Moschowitz operation or colpocleisis. This investigation revealed that the late results of the individual methods at primary operative treatment of both prolapse and incontinence showed the same high results of treatment with satisfactory results in 75-100%. On the other hand, the results of secondary operation showed great variation, depending upon the method, with satisfactory results from 25-85%.

Adult↗
PubMed2005

Does pelvic organ prolapse quantification exam predict urethral mobility in stages 0 and I prolapse?

OBJECTIVE: To determine if women with anterior support stages 0 or I by pelvic organ prolapse quantification (POP-Q) system require Q-tip testing to assess urethral mobility. METHODS: A prospective study of 134 women presenting for urogynecologic evaluation were examined and assigned stages of anterior wall support according to the POP-Q system. A Q-tip test was performed and urethral hypermobility was defined as a straining angle > or =30 degrees. The Spearman correlation coefficient was used to assess degree of correlation between POP-Q point Aa position and Q-tip values. RESULTS: The correlation coefficient between point Aa position and Q-tip angle was r = 0.787 (P < 0.001). Urethral hypermobility was noted in 91% of stage I and 100% of stage II-IV patients. The positive predictive value of Q-tip angle > or =30 degrees in stage I-IV prolapse was 99%. CONCLUSION: The POP-Q system is highly predictive of straining urethral angle in all stages of prolapse.

Adult↗
PubMed2005

Pelvic organ prolapse and the lower urinary tract: the relationship of vaginal prolapse to stress urinary incontinence.

Vaginal prolapse and urinary incontinence frequently coexist. Rather than having a cause-and-effect relationship, these two common problems share etiologic factors. Specific tissue and functional deficiencies resulting in prolapse also are significant contributors to lower urinary tract symptoms, particularly stress urinary incontinence. This article reviews this relationship, the etiologic factors, and aspects of the clinical evaluation of the patient with prolapse and stress urinary incontinence.

Female↗
PubMedDate not supplied

Mitral valve prolapse and cerebral ischemic events. A comparison between a neurology population with stroke and a cardiology population with mitral valve prolapse observed for five years.

Two populations of patients with mitral valve prolapse were analyzed to identify factors predisposing to the development of cerebral emboli. Of 760 patients followed for up to five years by our cardiologists with echocardiographically demonstrated mitral valve prolapse (MVP), only one, aged 82 years, has had a stroke. In contrast, of 43 patients admitted to our neurology service with a cerebral embolus and no evidence of carotid or other cardiac lesion and in whom echocardiography was performed, MVP was present in 9. No contributing etiologic mechanisms were uncovered to account for the disparity between the cardiology and neurology populations. However, with the apparent increased incidence of MVP in young patients with cerebral ischemia, both groups require longitudinal follow-up to understand better the factors that predispose a small percentage of patients with mitral valve prolapse to the development of cerebral ischemia.

Adult↗
PubMed1989

[Is this mitral valve prolapse? A case of mitral regurgitation with early systolic murmur due to early systolic prolapse of the posterior leaflet].

This paper reports the findings of phonocardiograms, echocardiogram and Doppler echocardiograms in a case of a 50-year-old man with early mitral valve prolapse with an early systolic murmur. A characteristic early systolic crescendo murmur was recorded at the apex. By amyl nitrite inhalation, the early systolic murmur was attenuated and a late systolic murmur was evoked. On the contrary, methoxamine injection increased the intensity of the early systolic murmur. Early systolic prolapse and early systolic buckling were recorded by two-dimensional and M-mode echocardiography. The phase of mitral regurgitation detected by M-mode color Dopper echocardiography coincided well in timing with the early systolic murmur and the early systolic buckling recorded on the M-mode echocardiogram. A discussion was made on the mechanism of the early systolic mitral regurgitation due to early mitral valve prolapse.

Amyl Nitrite↗
PubMed1979

[Rectal prolapse. Clinical studies on rectal prolapse].

A series of 164 patients with procidentia recti has been studied. Symptoms are sensation of obstruction, difficulties in emptying the bowel, proctitis, incontinence, reduced tonus of anal sphincters, and complete rectal prolapse. During I the rectum prolapses only under increased intraabdominal pressure and retracts spontaneously. Massive prolapse (stage II) often occurs without increased intraabdominal pressure and has to be reposited manually. Best results are obtained by fixing the mobilised rectum in the hollow of the sacrum as described by Wells in 1959 or by Ripstein in 1969. In bad risk patients a sublevatoric wire can be used. Most patients have satisfactory continence postoperatively without a corresponding physiological tonus of anal sphincters.

Adult↗
PubMed1998

[Value of postoperative urodynamic assessment for long-term urinary function results after treatment of genital prolapse. 103 examinations after treatment of genital prolapse].

OBJECTIVE: To evaluate the predictive value of postoperative urodynamic assessment on the apparition or the resurgence of genuine stress incontinence after a surgical procedure for genitourinary prolapse. SUBJECTS: 103 patients operated on for prolapse, with or without an associated surgical procedure for genuine stress incontinence. A review of the results of the urodynamic assessment carried out during the early post operative period was effected. RESULTS: 77.7% of the patients had an associated procedure for stress incontinence during surgery for prolapse. An urodynamic abnormality such as intrinsic sphincter deficiency and/or transmission ratio default was noted in 83.3% of the women who demonstrated incontinency during postoperative assessment, and in 76.7% of the patients without any problem of continence. During long term follow up, only 41.7% of the women who were incontinent shared intrinsic sphincter deficiency, and an abnormal cytometric parameter was noted in 74.4% of continent patients. 86% of the patients who were incontinent in the early postoperative period will remain so, whatever the result of the cystometric evaluation. CONCLUSION: Our results show that there is no correlation between the various cystometric parameters evaluated during the postoperative period, and the symptoms described by the patients. The absence of abnormal urodynamic assessment cannot consistently predict normal bladder function. Only postoperative symptoms can be considered to be predictive of a satisfactory surgical cure.

Adult↗