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PubMed2005

Tension-free polypropylene mesh for vaginal repair of anterior vaginal wall prolapse.

OBJECTIVE: To study the ongoing results of the repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh (GyneMesh, Gynecare, Ethicon, Issy-Les-Moulineaux, France). STUDY DESIGN: A case series of 87 consecutive women with anterior vaginal wall prolapse who underwent a transvaginal procedure using polypropylene mesh between October 1999 and August 2002. The mean age (+/-SD) was 62.4+/-13.4 years. Before the operation, patients underwent physical examination staging of the prolapse with the International Pelvic Organ Prolapse staging system. Thirteen women had stage 2 anterior vaginal wall prolapse (14.9%), 59 had stage 3 (67.9%), and 15 had stage 4 (17.3%). The polypropylene mesh was placed from the retropubic space to the inferior part of the bladder in a tension-freefashion. Patients were followed for 9-43 months, with a median follow-up (+/-SD) of 24+/-9.6 months. We defined "cure" as satisfactory (stage 1) or optimal (stage 0) outcome for point Ba in the staging system. RESULTS: Eighty-four patients returned for follow-up (96.6%). At follow-up, 77 women were cured (91.6%), 5 women had asymptomatic stage 2 anterior vaginal wall prolapse, and 2 had a recurrent stage 3 (2.4%). There were no postoperative infections. There were a total of 7 vaginal erosions of the mesh (8.3%); 4 necessitated a second procedure for partial excision of the mesh. CONCLUSION: Vaginal repair of anterior vaginal wall prolapse reinforced with tension-free polypropylene mesh is effective and relatively safe. Vaginal erosion occurred in 8.3% of the study population but was easily manageable, with no sequelae.

Age Distribution↗
PubMedDate not supplied

[Surgery for urogenital prolapse].

Urogenital prolapse can have a significant impact on quality of life. As the population continues to age, the prevalence of urogenital prolapse is increasing, and the lifetime risk of requiring surgery for urogenital prolapse or incontinence is now approximately 11%. The majority of women presenting with symptomatic prolapse suffer from multiple defects of pelvic support and require comprehensive repair to relieve symptoms. An understanding of normal pelvic support structures provides the basis for the anatomic approach to repair. Many appropriate options exist for surgical correction of urogenital prolapse. Procedures to reestablish apical support include culdoplasty techniques, uterosacral ligament suspension, sacrospinous suspension and colpopexy. Repair of the anterior compartment can be achieved with colporrhaphy and paravaginal repair. Posterior compartment defects are repaired with colporrhaphy, site-specific rectovaginal repair and perineorrhaphy. Most often, surgical correction of urogenital prolapse can be performed vaginally, which avoids the risks associated with laparotomy. Laparoscopic approaches for apical support and paravaginal repair may reduce the risks associated with laparotomy, but long-term follow-up data are not yet available with these techniques. The use of graft reinforcement for anterior and posterior repairs may offer improved success rates, particularly in patients with recurrent prolapse. However, further outcome studies are needed and the risks associated with the use of mesh must be considered.

Female Urogenital Diseases↗
PubMed2006

[Correlativity of the therapeutic effect of acupuncture on prolapse of lumbar intervertebral disc with the area location of image].

OBJECTIVE: To probe into the correlativity of the therapeutic effect of acupuncture combined with traction on prolapse of lumbar intervertebral disc with the three-dimensional location. METHODS: According to the three-dimensional location developed by HU You-gu, the position of the prolapse of lumbar intervertebral disc in the spinal canal was located from the sagittal plain, frontal plain and horizontal plain. One hundred and thirty patients with prolapse of lumbar intervertebral disc and completion of clinical data were treated with acupuncture, and the therapeutic effects were analyzed with three-dimensional location. RESULTS: Among 98 cases in the effective group, 73 cases had the prolapse at the I plane in sagittal location, accounting for 74.49%, 82 cases had the prolapse at the 1, 2 zone in horizontal location, accounting for 83.68%, 52 cases had the prolapse at the a area in frontal location, accounting for 53.06%; among the 32 cases in the ineffective group, 10 cases had the prolapse at the I plane, accounting for 31.25%, 12 cases in the 1, 2 zone, accounting for 37.50%, 3 cases in the a area, accounting for 9.38%. There was a statistically significant difference between the two groups in the location. CONCLUSION: The three-dimensional location can objectively show the size, direction, position, and the characteristics of the protruded discs, and correctly infer the pathological changes of the affected nerve root. Acupuncture combined with tract has a better effect on I plane, 1-2 zone, and a area.

Acupuncture Therapy↗
PubMed2006

Abdominal sacrohysteropexy in young women with uterovaginal prolapse: results of 20 cases.

OBJECTIVE: To report the results of abdominal sacrohysteropexy with polypropylene mesh in young women who wish to retain their uteri following uterovaginal prolapse. STUDY DESIGN: Twenty young women underwent abdominal sacrohysteropexy and concomitant reconstructive surgery. The preoperative and postoperative protocols included a urogynecologic history, physical examination, voiding diary, 1-hour pad test, cough stress test, multichannel urodynamic studies and administration of a validated, prolapse-specific symptom inventory and quality of life instrument. RESULTS: Of the 20 patients with marked uterovaginal prolapse, 13 had urodynamic stress incontinence. Anterior and posterior vaginal wall prolapse and urodynamic stress incontinence recurred in 1 of 20 patients (5%) at a mean follow-up of 25 months. Nineteen patients stated that their sex life had improved, although 3 of them had dyspareunia. One patient was dissatisfied owing to persistent dyspareunia. The postoperative values on the symptom inventory and quality of life scores were significantly lower than the preoperative values. The low scores suggest satisfaction and no symptoms of prolapse. CONCLUSION: Abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women who wish to retain their uteri. It maintains a durable anatomic restoration, normal vaginal axis and sexual function. The success rate is excellent for correcting prolapse, and the complications are minimal.

Adult↗
PubMed1990

Lack of association between thyroid function and mitral valve prolapse in Graves' disease.

1. To determine whether the association between mitral valve prolapse and Graves' disease is related to thyroid function, three groups of individuals were studied: 16 patients with Graves' disease and hyperthyroidism (hyperthyroid: T4 greater than 11.5 micrograms/100 ml), 16 patients with Graves' disease without hyperthyroidism (euthyroid: T4 less than 11.5 micrograms/100 ml), and 40 healthy individuals. The three groups were similar in age, sex distribution, and anthropometrical characteristics. 2. All patients were evaluated clinically and by M-mode and two-dimensional echocardiography to determine the presence of mitral valve prolapse. 3. The frequency of mitral valve prolapse was similar in the hyperthyroid (31%) and euthyroid patients (25%), but was higher than in the normal individuals (5%). The frequency of systolic murmur was higher in the hyperthyroid patients (75%) than the euthyroid patients (19%) or the normal subjects (0%); however, the presence of a murmur was not associated with mitral valve prolapse. Hyperthyroid (13%) and euthyroid (13%) patients had a higher frequency of clicks than the normal individuals (0%), and the presence of click was associated with mitral valve prolapse. 4. Although patients with Graves' disease have a higher frequency of mitral valve prolapse, this is not associated with thyroid function. The presence of a click but not the presence of a systolic murmur may be a clinical indicator of mitral valve prolapse in Graves' disease.

Adult↗
PubMed1989

Platelet activation in patients with mitral valve prolapse.

An increased frequency of thromboembolic events in patients with mitral valve prolapse has been demonstrated. It has been suggested that this association may be related to increased systemic platelet activity. Beta-thromboglobulin (BTG) is a platelet specific protein secreted during the platelet release reaction, with BTG levels reflecting ongoing platelet activation. Plasma BTG levels were measured in 14 normal volunteers, 23 patients with mitral valve prolapse and nonthickened mitral leaflets (group 1) and 13 patients with mitral valve prolapse and thickened mitral leaflets (group 2). The BTG level was 8.1 +/- 4.6 ng/mL (mean +/- SD) in normal subjects, 9.6 +/- 5.5 ng/mL in the nonthickened mitral valve prolapse group and 10.0 +/- 5.7 ng/mL in thickened mitral valve prolapse group. There was no significant difference in the BTG levels between groups. Five patients with multiple valvular prolapse did not show elevation of BTG levels. The present study did not demonstrate increased BTG levels in neurologically asymptomatic mitral valve prolapse patients.

Adult↗
PubMed1988

[Mitral valve prolapse syndrome and arrhythmias].

In patients with mitral valve prolapse syndrome various disturbances of cardiac rhythm can be observed such as atrial arrhythmias, ventricular tachycardias and conduction disturbances. Of timely interest are the questions of which etiology is at the basis of the arrhythmias, what is their relevance with respect to sudden cardiac death, what are the indications for treatment and which therapeutic results can be anticipated. Cardiac arrhythmias represent the most frequent complication of mitral valve prolapse. Holter ECG monitoring has assumed the central role in detection of all types of arrhythmias. As compared with normal persons, in patients with mitral valve prolapse, both ventricular and supraventricular arrhythmias can be found more frequently. Atrial arrhythmias: Supraventricular arrhythmias can be found less frequently than ventricular arrhythmias (Table 1). Premature atrial contractions can be observed in 35% of those with mitral valve prolapse but also in a similar number of normal individuals such that their presence is not of clinical relevance. There is only a tendency to more frequently incurred supraventricular couplets in mitral valve prolapse. Supraventricular tachycardias can be observed in 10.5 to 32% of which sinus tachycardia (heart rate greater than 120 beats per minute), paroxysmal atrial tachycardia and intermittent atrial fibrillation at about 5 to 6% each are not more common than in control subjects. Atrial fibrillation was seen more frequently in mitral valve prolapse with mitral regurgitation or, conversely, in mitral regurgitation due to mitral valve prolapse more frequently than in mitral regurgitation due to other causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Arrhythmia Agents↗
PubMed1982

Treatment and prognosis of rectal prolapse in cystic fibrosis.

Rectal prolapse occurred in 112 (18.5%) of 605 cystic fibrosis patients. In 48 patients prolapse preceded diagnosis of cystic fibrosis, but physicians (pediatricians, pediatric and general surgeons, and proctologists) rarely appreciated its importance as a symptom of this disease. Prolapses frequently cease with institution of pancreatic enzyme replacement therapy following diagnosis of cystic fibrosis. However, even when the disease remains undiagnosed, the symptom is often transient and frequently resolves at 3-5 yr of age. Prolapse occurring initially after cystic fibrosis is diagnosed rarely responds to manipulation of diet or enzyme doses. Many patients develop a method of reduction which involves voluntary abdominal, perineal, and gluteal muscles and does not require manual pressure on the prolapsed segment. Most patients do not need specific treatment for the prolapse. Surgery is rarely necessary. A sweat test should be obtained on any child who has had even a single episode of rectal prolapse.

Adolescent↗
PubMed1981

Observations on uterine prolapse in beef cattle.

Serum samples were obtained from 26 beef cows with uterine prolapse and from 15 with minor dystocia (controls). The serum of animals with uterine prolapse had significantly lower calcium concentration (mean +/- S.D. = 8,22 +/- 0,69 mg/dL, P</=0,01), higher phosphorus concentration (mean +/- S.D. = 4,78 +/- 1,75 mg/dL, P</=0,05) and lower calcium to phosphorus ratios (mean +/- S.D. = 1,99 +/- 0,88, P</=0,01) than for the control animals (means +/- S.D. = 8,91 +/- 0,75 mg/dL, 3,54 +/- 1,41 mg/dL and 2,99 +/- 1,41 respectively). Mild hypocalcemia (6,9 mg/dL-7,9 mg/dL) was present in 11 (42,3%) of the cows with prolapse as compared to only one (6,7%) of the controls. Hypophosphatemia was present in 11 (42,3%) of the animals with prolapse and in ten (66,7%) of the controls. Eighteen (69,2%) of the animals with prolapse were alert and ambulatory when treated and 15 (57,7%) were known to have required help to deliver the calf. Of the cattle group with uterine prolapse, 14 (53,8%) were two years old, six (23,1%) were three years old, and six (23,1%) were four years of age or older. It was concluded that mild hypocalcemia and some degree of dystocia were associated with the uterine prolapses. The phosphorus results were equivocal but the high incidence of hypophosphatemia may reflect a phosphorus deficient diet.

Animals↗
PubMed1995

[Vesical flexion and vaginal prolapse of sows as an obstetrical problem].

The evaluation of 523 clinically supervised parturitions of swine from the last ten years showed that vesical flexion and vaginal prolapse as a complex range together (with 9.4%) on place three of the causes of dystocia. There were 16 cases of vesical flexion (= 3.1% of dystocia) and 33 cases of vaginal prolapse (= 6.3% of dystocia). Both groups showed a lot of mutualities. For example most cases in both groups were shortly before the third parturition. 50% of vesical flexions and 78.8% of vaginal prolapses appeared within one week before parturition concerning the third pregnancy in 25 and 27.3% of the cases. Both kinds of illness often were accompanied by a further dislocation of rectal tissue. This concerned 31.2% of the patients with vesical flexion and 21.2% of those with vaginal prolapse. The patients in 81.2% of vesical flexions and in 72.7% of vaginal prolapses were not taken to the clinic before dislocation of tissue appeared stationary. To make sure the diagnosis "vesical flexion" and to differentiate it from vaginal prolapse several methods are available. The most important one is catheterization of the bladder. This was done in 56.2% of the cases for diagnostical as well as for therapeutical reasons. To avoid relapses the foley-catheter had to be left in the bladder for maximal 19 days and for 6 days on an average. The vaginal prolapse after reposition was treated in 60.6% of the cases by a vaginal fastening. This was done to 75% of these patients according to Bühner.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

[Strangulated urethral prolapse in a young woman: a rare urological emergency].

Total prolapse of the urethral mucosa in women is an uncommon lesion, observed at the two extremes of reproductive life. Strangulation of urethral prolapse is a rare complication whose emergency treatment is essentially surgical. The authors report a case of strangulated urethral prolapse in a 43-year-old woman, for which several pathophysiological mechanisms can be proposed: first delivery by forceps, poorly repaired perineal tear, untreated early menopause at the age of 40 years. Urethral prolapse in elderly women has become much less common since the introduction of hormone replacement therapy for menopause. Other physiopathogenic factors may be responsible for this prolapse, such as thrombosis of the juxtameatal submucosal veins, laxity between the mucosa and submucosa or uretrodetrusor dyssynergia. The diagnosis of strangulated urethral prolapse is based on the discovery of a very painful, violaceous, inflammatory circular mucosal tumour surrounding the urethral meatus. If rapid reduction of the prolapse is not obtained with systemic and topical oestrogen therapy, the strangulated mucosal flap must be resected surgically, followed by apposition of the urethral mucosal and submucosal planes. This suture, in tissues which are always inflamed, must be calibrated and the urine must be drained by bladder catheter for about ten days. Meatal stricture is the principal complication of this surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Incarcerated uterine prolapse associated with a cul-de-sac abscess.

BACKGROUND: Incarceration is a rare complication of uterine prolapse and is usually associated with bladder calculi. We report a case of uterine incarceration associated with an abscess in the cul-de-sac. CASE: A 64-year-old woman presented with complaints of vaginal prolapse. Pelvic examination on admission revealed an edematous, prolapsed uterus and eversion of the vagina. The bladder was catheterized, and subsequent attempts to reduce the prolapse were unsuccessful. Conservative treatments were initiated including Trendelenburg positioning, estrogen cream, and moist soaks. Failure to reduce the prolapse under general anesthesia necessitated a vaginal hysterectomy and anteroposterior repair. When the cul-de-sac was entered, there was purulent material draining from an abscess behind the uterus. Postoperatively, the patient received antibiotics for 3 days and was sent home on day 4. CONCLUSIONS: Irreducible uterine prolapse is a rare condition and may be attributed to a narrowed introitus, bladder calculi, or pelvic abscesses. Historically, conservative management has attempted to alleviate the edema and restore the prolapse, to allow definitive surgery at a later date. We believe that the pelvic abscess in our case exemplifies a danger of delaying surgery. We recommended that when the patient is in stable condition, a hysterectomy and plastic repair be performed promptly.

Abscess↗
PubMed1999

Follow-up after repair of vaginal vault prolapse with abdominal colposacropexy.

BACKGROUND: Vaginal vault prolapse after hysterectomy is a rare complication, with a prevalence of less than 1/2%. The vaginal depth an axis can be restored by colposacropexy with preservation of coital function. The aim of this follow-up study was to assess the results of colposacropexy with special attention to recurrence of prolapse and urogenital symptoms. METHODS: During a 4-year period 35 patients with vault prolapse were operated by colposacropexy. At follow-up the patients were interviewed about bladder, bowel and sexual symptoms. A pelvic examination and measurement of residual urine was done. Perioperative complications and any interim surgery was recorded. RESULTS: The patients were multioperated, because of prolapse or incontinence prior to colposacropexy. No serious perioperative complications were seen, except one case of severe bleeding from the presacral veins. Subjectively, 82% were cured of prolapse symptoms, one had recurrent vault prolapse and was reoperated, four had rectocele. Five patients developed urge incontinence, while urge incontinence, frequency, nocturia and voiding problems were cured in 75%, 80%, 50% and 100%, respectively. One patient developed fecal incontinence. No patients had coital problems due to the colposacropexy. Three patients were reoperated because of intestinal obstruction. CONCLUSION: Colposacropexy has a cure rate of vault prolapse of 97% (85 100%) and a positive effect on irritative bladder symptoms.

Abdomen↗
PubMed2000

Long-term outcomes of minor plaque prolapsed within stents documented with intravascular ultrasound.

The direct relationship between minor plaque prolapsed within stents and late in-stent restenosis is unknown. Therefore, we evaluated the impact of minor plaque prolapse on late angiographic in-stent restenosis. Intravascular ultrasonography (IVUS)-guided single-coronary stenting was successfully performed on 384 consecutive patients with 407 native coronary lesions. Six-month follow-up angiographic evaluation was performed on 315 patients (82. 0%) with 334 lesions (82.1%). Minor plaque prolapsed within the stent was found in 75 of 334 lesions (22.5%). Results were evaluated using angiographic and IVUS methods. The development of minor plaque prolapse was significantly associated with infarct-related artery (P = 0.000) and small pre-intervention minimal lumen diameter (P = 0. 001). The overall angiographic restenosis rate was 23.1% (77/334)-21.3% (16/75) in the lesions with plaque prolapse vs. 23.6% (61/259) in the lesions without plaque prolapse (P = 0.806). In conclusion, minor plaque prolapsed within stents might not be associated with late angiographic in-stent restenosis.

Aged↗
PubMed1988

Intervertebral disk material: criteria for determining probable prolapse.

To develop histologic criteria that allow distinction of prolapsed from nonprolapsed intervertebral disk material, we reviewed the histologic features of curetted fibrocartilage from 100 consecutive patients having documented disk prolapse into the spinal canal and contrasted our findings to those in 40 intervertebral disks removed at autopsy from 20 patients without prolapse. Neovascularization, occurring at the edges of fibrocartilage fragments, was present in 50% of prolapsed disk specimens and in none of the control autopsy disks (p = 0.0004). Other histologic features sometimes used as evidence of degeneration and/or prolapse (i.e., fibrillation, chondrocyte "cloning," and granular change) were not helpful in distinguishing prolapsed from nonprolapsed control disks. Although this indicator was only 50% sensitive in our series, we propose that edge neovascularization of the fibrocartilage fragments is the only reliable histologic clue that intervertebral disk prolapse has occurred.

Adult↗
PubMed1986

Abnormal connective tissue degrading enzyme patterns in prolapsed intervertebral discs.

The collagenolytic enzyme systems in the human, normal, and prolapsed intervertebral discs have been studied. Normal discs obtained postmortem contained a novel collagenase with specificity toward Type II collagen and gelatin but with little or no activity against Type I collagen. A method whereby enzymes are detected quantitatively in extracts of human tissue using specific substrates, without prior chromatographic separation of the enzymes, has been developed and used to study 14 normal discs and 35 surgically excised prolapsed discs. No differences were observed between annulus and nucleus extracts of normal discs either in the pattern of enzymes or the quantity. The intermediate zone between nucleus and annulus was excised and was not tested. Highly significant differences were observed between the enzyme patterns of the normal and prolapsed discs. The major collagenolytic activity of normal discs is against Type II collagen and 1 alpha 2 alpha 3 alpha collagen, there is little activity toward Type I collagen and virtually none toward elastin. Conversely, the prolapsed disc is more highly active against the substrates elastin and Type I collagen than against Type II collagen or 1 alpha 2 alpha 3 alpha collagen. The individual patterns of enzymes of the 35 prolapsed discs were virtually identical. Similarly there was little internal variation between the patterns of enzymes extracted from discs, obtained postmortem, which were apparently normal. The striking difference between the normal and prolapsed disc could be an important factor in the pathogenesis of disc prolapse.

Chromatography, DEAE-Cellulose↗
PubMed1996

Prolapsed cervical intervertebral disc in male professional drivers in Denmark, 1981-1990. A longitudinal study of hospitalizations.

STUDY DESIGN: This study of professional drivers is a part of a longitudinal record linkage study of all economically active men in Denmark, identified on January 1, 1981. Information about the main occupation was identified in 1980. The cohort was followed for first hospitalization with prolapsed cervical intervertebral disc until December 31, 1990. OBJECTIVES: To examine the risk of prolapsed cervical intervertebral disc in all Danish professional drivers, and to analyze exposures of the male drivers in a sample of all Danish male drivers. SUMMARY OF BACKGROUND DATA: Only a few studies on occupation and prolapsed cervical intervertebral disc have been published. These studies suggest that professional driving may be a risk factor for development of prolapsed cervical intervertebral disc. Drivers are exposed to whole-body vibrations, heavy lifting, and a sedentary position. Other potential exposures are accelerations and decelerations and whiplash accidents. Such exposure may be involved in the causation of prolapsed cervical intervertebral disc. METHODS: A standardized hospitalization ratio was calculated for each subgroup of drivers using all economically active people as the standard. Additional exposure information was extracted from a national survey on work environment. RESULTS: Almost all men in occupations involving professional driving had a statistically significant elevated risk of being hospitalized with prolapsed cervical intervertebral disc. CONCLUSIONS: Professional driving is a risk factor for prolapsed cervical intervertebral disc.

Accidents, Occupational↗
PubMed1976

Mitral valve prolapse.

Mitral valve prolapse is a condition that is being recognized with increased frequency. It is not known whether its incidence is increasing, or whether we are better able to diagnose it today. In the idiopathic or familial variety, the mitral valve pathology is almost always that of myxomatous degeneration. Some authors have suggested the presence of a cardiomyopathy because of significant left ventricular dysfunction in many cases. Idiopathic prolapse occurs predominantly in females, often at a young age, and may be associated with chest pain, dyspnea, fatigue, presyncope, syncope, and/or sudden death. The clinical findings are variable and typically consist of a nonejection click and/or late systolic murmur, heard best at the cardiac apex. Diagnosis can be confirmed by echocardiography and/or ventricular cineangiography, the latter permitting accurate recognition of the anatomy of the prolapsed leaflets. The complications of infective endocarditis, severe mitral insufficiency, and life-threatening ventricular arrhythmias represent the major problems of management. It is important to distinguish the idiopathic form of mitral valve prolapse from that due to coronary artery disease and to realize that mitral valve prolapse may occur in Marfan's syndrome, Turner's syndrome, or in association with secundum atrial septal defect or ruptured chordae tendineae. Typical clicks and/or murmurs have also been described in patients with a history of rheumatic fever and in hypertrophic cardiomyopathy. Although much descriptive knowledge has accumulated over the past 15 years, many unanswered questions remain regarding the idiopathic type of prolapse. What is the nature and cause(s) of myxomatous degeneration? What is the relation of the valve pathology to the left ventricular dysfunction? What is the relation of both of these factors to disabling chest pain, electrocardiographic changes, and life-threatening arrhythmias? Hopefully, answers to these and other important questions regarding mitral valve prolapse will be forthcoming.

Electrocardiography↗