[Current technic in genital prolapse and uterine retrodeviation].
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Disease↗
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[Delivery complicated by uterine cervix prolapse in pregnancy].
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Adult↗
Incidence of pelvic organ prolapse in Nigerian women.
OBJECTIVE: To establish the incidence and types of utero-vaginal prolapse. METHODS: Retrospective medical records analyses of women who were subjected to reconstructive pelvic surgery for various types of pelvic relaxation at the Nnamdi Azikiwe University Teaching Hospital, Nnewi and the University Of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. The study was conducted from January 1996 to December 1999 during which there were 7515 surgical admissions. The inclusion criteria were those women who complained of feeling a mass in the vagina with demonAstrable descent of the anterior and/or posterior and/or apical vaginal walls and/or perineal descent. Excluded were patients who had other symptoms other than utero-vaginal prolapse and those whose grades and sites of prolapse were not determinable from the clinical or surgical notes. Also excluded were patients with nerve injury or disease, connective tissue disorders and neuromuscular diseases. The subjects were divided into two groups. Group I consisted of 54 women (age < or = 40 years), and group II included 105 women (age > or = 40 years). The findings between those two groups were compared with reference to sites, types and degree of prolapse. Also, coexistence of pelvic relaxation and underlying medical conditions were evaluated. RESULTS: A total of 159 subjects out of 492 charts studied met the inclusion criteria for the study. In group I, mean age was 32.839 with a standard deviation (SD) of +/- 6.012 years; and in group II the mean age was 56.543 with a SD of 8.094. Hypertrophic (elongated) cervix was determined in 15 (6.3%) subjects in group I for an incidence of 1.58% per year, cystocele (vaginal anterior wall descent) was present in 21 (8.9%) women for an incidence of 2.2% per year; rectocele (posterior vaginal wall descent) was identified in 15 (6.3%) women for an incidence of 1.58% per year; vaginal cough prolapse (apical descent) was present 21 (8.9%) women for an incidence of 2.2% per year. Perineal descent was absent in this group. In group II, there was no hypertrophic cervix; cystocele was present in 39 (16.5%) cases for an incidence of 4.13% per year; rectocele was identified in 27 (11.4%) women, amounting to an incidence of 2.85% per year; vaginal cough prolapse was present in 36 (15.%) women, an incidence of 3.75% per year; perineal descent was present in 63 (25.6%) women, for an incidence of 6.4% per year. CONCLUSION: (1) The incidence of hypertrophic cervix without any other abnormality amounted to 1.58% per year. This medical entity can present as uterine prolapse and was noted only in group I. (2) The annual incidence for hospital admission with a diagnosis of uterine prolapse was 2.1%. (3) The incidence of cystocele, and rectocele was not statistically different in the two groups; but the incidence of perineal descent and uterine prolapse were significantly more in group II than group I. (4) The etiology of hypertrophic cervix is not known, but it is of importance especially in the childbearing age when it may be related to prolonged pregnancy, cervical dystocia, etc.
Adult↗
Pelvic organ prolapse and urinary incontinence in women with surgically managed rectal prolapse: a population-based case-control study.
PURPOSE: This study aimed to investigate the prevalence of genital prolapse surgery and urinary incontinence in female patients operated on for rectal prolapse compared with a matched control group without rectal prolapse. METHODS: Fifty-two patients with a history of abdominal rectal prolapse surgery and 200 randomly selected age-matched and gender-matched control subjects without rectal prolapse received an extensive health care history survey. RESULTS: Response rate in the patient group was 48 of 52 (92 percent) and 165 of 200 (82 percent) in the control group. Rectal prolapse was associated with an increased risk of surgery for uterine prolapse (odds ratio = 3.1; 95 percent confidence interval = 1.4-6.9) and vaginal wall prolapse (odds ratio = 3.2; 95 percent confidence interval = 1.3-7.8). Mean age at hysterectomy because of uterine prolapse was 54.7 years in the patient group compared with 62.6 years in the control group (P < 0.01). Mean age at vaginal wall prolapse surgery was 60.2 years in the patient group compared with 66.6 years in the control group (P < 0.05). There were no significant differences between the cohorts regarding prevalence or age at debut of urinary incontinence. CONCLUSION: Our results indicate a strong association between rectal and genital prolapse surgery suggesting that diagnosis of rectal prolapse necessitating surgical intervention should prompt a multidisciplinary pelvic floor assessment.
Adult↗
[Inventory and follow-up of patients with surgery for (uterine) vaginal prolapse, combined with or without, (masked) stress incontinence].
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Female↗
[Imaging pelvic floor prolapse].
OBJECTIVES: Dynamic MR imaging (MRI) may be used as an alternative to dynamic cystoproctography for the evaluation of pelvic floor prolapse. Our study aimed to define the range of dynamic pelvic MRI aspects observed during the exploration of pelvic prolapse. MATERIAL: Fascial and anatomic defects can include a combinaison of cystocele, rectocele, uterine prolapse, enterocele and vault prolapse. Acute diagnosis of the coexisting abnormalities is essential in planning reconstructive procedures so that the risks of recurrence and reoperation can be minimized. At this time colpocystography is the study of choice to evaluate pelvic floor dysfunction. Dynamic magnetic resonance imaging for exploration of pelvic floor dysfunction is under evaluation. RESULTS: Pubococcygeal line and puborectalis muscle were the references points. The grading system is based on degree of organ prolapse through the hiatus and the degree of pubo-rectalis descent and hiatal enlargement. Unfortunately, there is a real discordance between the reality of the prolapse and its imaging. However, a new reference line, the mid pubic line, was drawn on the magnetic resonance image to correspond to the hymeneal ring marker used in clinical staging. Intra-operative findings were considered the gold standard against which physical examination, dynamic colpocystodefecography and MRI were compared. Using these criteria the sensitivity, specificity and positive predictive value of MRI were 70%, 100%, 100% for cystocele; 42%, 81%, 60% for vaginal vault or uterine prolapse; 100%, 83%, 75% for enterocele; 87%, 72% and 66% for rectocele. CONCLUSION: MRI appears to be an important adjunct in the comprehensive evaluation of the female pelvis. Except for vaginal vault, pelvic prolapse is accurately staged and pelvic organ prolapse reliably detected. The technique is rapid, non invasive and cost effective, it allows the clinician to visualize the whole pelvis using a single dynamic study that provides anatomical details.
Adult↗
Surgical reinforcement of support for the vagina in pelvic organ prolapse: concurrent iliococcygeus fascia colpopexy (Inmon technique).
To reinforce the support of the vagina, concurrent use of iliococcygeus fascia colpopexy with the McCall culdeplasty was scheduled for primary uterine prolapse. Forty-five women with primary uterine prolapse without stress urinary incontinence were treated by McCall culdeplasty alone or McCall culdeplasty plus iliococcygeus fascia colpopexy for suspension of the upper portion of the vagina. Recurrence of vaginal support defects were carefully followed for 15-50 months. Additional iliococcygeus fascia colpopexy did not change with the axis of the vagina obtained by McCall culdeplasty, although it prolonged total operation time by 32 min and increased blood loss by 94 ml. Two cases (8.3%) had postoperative vaginal defects in the group undergoing combined procedures and seven recurrent cases (33.3%) were observed in the group undergoing McCall culdeplasty alone. The durability of the combined procedures was superior to that of the modified McCall culdeplasty alone by Kaplan-Meier analysis. These results suggest that iliococcygeus fascia colpopexy is reasonably safe and strengthens not only the attachment of the upper part of the vagina but also that of the anterolateral vaginal wall.
Aged↗
Management of genital prolapse in neonates and young women.
The presence of genital prolapse in neonates and young women poses a challenging management problem to the gynecologist. Neonatal uterine prolapse is associated with congenital spinal defects, and successful correction has been achieved mainly with simple digital reduction or the use of a small pessary. Uterine prolapse can also occur in young or nulliparous woman who wish to preserve their fertility. Operations using sling, sacral cervicopexy, or transvaginal sacrospinal fixation techniques seem to provide excellent repair for these patients, including the possibility of childbearing. A review of the pathophysiology of genital prolapse in neonates and young women with emphasis on the surgical and nonsurgical options for management is presented.
Adolescent↗
[Inventory and follow-up of patients with surgery for (uterine) vaginal prolapse, combined with or without, (masked) stress incontinence].
OBJECTIVE: Evaluation of the development or persistence of urinary stress incontinence in patients operated on because of prolapsed uterus, with cooperation between gynaecologists and urologists. DESIGN: Retrospective. SETTING: Department of Gynaecology and Obstetrics, Leyenburg Hospital, The Hague, the Netherlands. METHODS: In 178 patients subjected to prolapse correction in the period 1992-1996, presence of urinary incontinence was analysed by means of a written enquiry after an average of 22 months. The 91 patients who had visited the gynaecological outpatient clinic and were seen together with a urologist, were subjected to urodynamic examination in the absence of symptoms of stress incontinence and were operated in cooperation with the urologist. Four groups were distinguished on the basis of preoperative features: group I (n = 37) with manifest stress incontinence, group II (n = 22) with masked stress incontinence, group III (n = 32) in whom no (masked) stress incontinence could be demonstrated and group IV (n = 87) not subjected to urodynamic examination. The patients of groups I and II, in addition to prolapse correction, were also subjected to urethral suspension. RESULTS: Twenty-five (68%) of the group with manifest stress incontinence were free of stress incontinence after the operation, while eight patients (22%) reported improvement (a total of 89%). In 22 of the 54 patients (41%) who preoperatively had no incontinence symptoms, urodynamic examination revealed a masked stress incontinence. Sixteen of them (73%) did not develop symptoms of stress incontinence after the operation, while eight (15%) did develop such symptoms. Thirty of the 32 patients (94%) who preoperatively had no (masked) stress incontinence remained symptom-free. Out of 64 patients without preoperative incontinence, who were operated without urological cooperation, 12 (19%) developed stress incontinence.
Aged↗
Determinants of urinary incontinence in a population of young and middle-aged women.
BACKGROUND: Urinary incontinence and genital prolapse are prevalent conditions in the female population. The aim of this study was to study possible determinants of female urinary incontinence in a population-based sample of young and middle-aged women. METHODS: Of 641 eligible women aged 20-59 years in a primary health care district, 487 (76%) responded to a questionnaire and accepted an invitation to a gynecological examination. The examination included digital assessment of the pelvic floor muscle strength (PFMS). Genital prolapse presence (cystocele, rectocele, uterine prolapse or absence of the urethrovesical crease) was graded in relation to the vaginal introitus. RESULTS: The prevalence of urinary incontinence was 28%, 3.5% having daily leakage. Stress urinary incontinence was the dominant type. The odds ratio (OR) of having incontinence increased from 1 to 3.5 with increasing age and from 1 to 2.7 with increasing parity. The OR also increased with decreasing PFMS; from 1 in the group with the best PFMS to 3.4 in the group unable to contract their pelvic musculature. In addition, women with cystocele and/or absence of the urethrovesical crease had a 2.5-fold increased OR of incontinence (95% CI 1.5-4.2), smoking increased the OR 1.9 times (95% CI 1.1-3.2) and estrogen replacement therapy (ERT) increased the OR 2.9 times (95% CI 1.4-5.9). There were no significant correlations with the presence of chronic disease, episiotomy or the birth weights of children but small non-significant correlations with performed hysterectomy and the woman's weight. CONCLUSIONS: Urinary incontinence is a frequent symptom in the female general population and related to age, pelvic floor muscle strength, genital prolapse, smoking, parity and estrogen replacement therapy.
Adult↗
Current aspects of gynecological pathology in postmenopause.
Between 1982 and 1984 330 women in postmenopause for at least one year were admitted to the First Clinic of Obstetrics and Gynecology, Catania University Medical School, Catania, Italy, with a frequency of 10.04% of gynecological admissions. The most frequent pathologies were metrorrhagia (32.72%; 108 cases) from an atrophic endometrium or glandular hyperplasia of the endometrium, vaginoperineal lacerations with cystorectocoele with or without urinary incontinence (10.90%; 36 cases), cancer (11.21%; 37 cases) and ovarian cystoma (11.21%; 37 cases), uterine prolapse (9.30%; 31 cases), and endometrial polyps (9.09%; 30 cases). Uterine fibromyoma (3.93%; 13 cases) and carcinoma of the portio (3.93%; 13 cases) were among the rare pathologies. Uterine pathologies were the most prevalent (68.78%; 227 cases), followed by ovarian (15.15%; 50 cases), pathology of involving the pelvic and perineal containment (10.90%; 36 cases), vulvar pathology (2.72%; 6 cases), and vaginal pathology (1.51%; 5 cases). Malignant neoplastic pathology was reported in 25.45% of cases (84 cases) consisting only of uterine cancer (47.61%; 40 cases) and ovarian cancer (45.23%; 38 cases). In comparison with the study performed by Cetroni in 1952 one notes a net reduction in the frequency of uterine prolapse (by about three times), and a smaller reduction in cancer of the uterine cervix with a slight increase in cervical polyps, endometrial cancer, and above all in metrorrhagia from atrophic endometrium or glandular hyperplasia of the endometrium.
Adult↗
How to increase the proportion of hysterectomies performed vaginally.
OBJECTIVES: The main purpose of our study was to identify the patient characteristics of women undergoing hysterectomy and to estimate the proportion of hysterectomies that could be done vaginally by recognized surgical techniques. STUDY DESIGN: The records of 500 women who underwent hysterectomy were reviewed. The characteristics of patients without an absolute contraindication to vaginal hysterectomy were analyzed. RESULTS: Overall, 96 (19.2%) of our study group underwent vaginal hysterectomy. A total of 382 (76.4%) women were judged not to have an absolute contraindication to this route. The most frequent characteristics of this group were lack of uterine prolapse (76.4%), a myomatous uterus (44.5%), and a need for oophorectomy (43.2%). We did not exclude women who did not have significant uterine prolapse or a history of pelvic surgery or pelvic tenderness and we included those requiring oophorectomy or with a uterine size up to that of 14 weeks' gestation; with these criteria more than two thirds of the entire study population could undergo vaginal surgery. CONCLUSIONS: To maximize the proportion of hysterectomies performed vaginally, gynecologists need to be familiar with surgical techniques for dealing with nonprolapsed uteri, uterine leiomyomas, and vaginal oophorectomy.
Adult↗
Epidemiology of hysterectomy in the United States: demographic and reproductive factors in a nationally representative sample.
We describe the epidemiology of hysterectomy, overall as well as for specific indications. Data were obtained from the Epidemiologic Follow-up to the First National Health and Nutrition Examination Survey, a nationally representative cohort followed prospectively from the mid-1970s through 1992. Black and white women 25-49 years of age, interviewed during follow-up, were included in the analyses. The probability of undergoing a hysterectomy was estimated by demographic and reproductive factors. Hysterectomy as confirmed by hospital records was our main outcome measure. We found that women who had completed 9-11 years of education were more likely to have undergone a hysterectomy than were women with either more or less education. Women who had completed 9-11 years of education were also more likely to have had a hysterectomy because of menstrual problems. Three or more miscarriages, especially if caused by uterine prolapse, increased the probability of hysterectomy. Having had no live births decreased the probability of hysterectomy for menstrual disorders and uterine prolapse, but women who had their first child before age 20 were at increased risk of hysterectomy because of endometriosis. Hysterectomy appears to be associated with low education, high parity, and a history of multiple miscarriages. The influence of these factors varies depending on the primary indication for the hysterectomy.
Abortion, Spontaneous↗
[Clinical characteristics of women with genital prolapse].
Clinical features of severe urogenital prolapse, were studied. Fifteen patients were included in a retrospective study between January 1990 and June 1995. The diagnosis of severe uterine prolapse (where the cervix precedes the inverted vaginal tube) was the sole inclusion criteria. Age, parity, hormonal stage, occupation, simptomatology, body mass index, and the results of histopathological examinations were evaluated. The mean age was 60 years, parity most frequently observed was more than three, 80% were postmenopausal, the body mass index was 23.5, all patients were housewifes, the symptomatology that was present in 100% of the patients was the sensation of an intravaginal foreign material. The surgical treatment performed was vaginal hysterectomy. The results of histopathological examinations were in the most inflammation. The parity and postclimaterium were the principal factors associated with the pathogenesis of uterine prolapse.
Aged↗
Bilateral hydroureter and hydronephrosis causing renal failure due to a procidentia uteri: a case report.
We report a case of complete uterine prolapse that resulted in bilateral hydroureter, hydronephrosis, and renal dysfunction. The nonoperative reduction of the prolapse with a vaginal pessary reversed the obstructive uropathy and ameliorated renal function. The lower urinary tract should be imaged in patients with complete uterine prolapse. If present, obstructive uropathy should be relieved by the reduction of the prolapse before irreversible renal damage occurs.
Aged↗
The retroverted uterus: ignored to date but core to prolapse.
The retroverted uterus has been largely ignored in urogynaecological research to date. The prevalence of the retroverted uterus is 79% more common in the urogynaecological patient population (34%) than in the general gynaecological population (19%). Its diagnosis requires the use of (a) transvaginal ultrasound with (b) an empty bladder. Recent data demonstrate that the prevalence of grade 2-4 uterine prolapse for a retroverted uterus is 4.5 times that for an anteverted uterus. Alternatively, 69% grade 2-4 uterine prolapse involves the retroverted uterus. The retroverted uterus, when diagnosed by transvaginal ultrasound (bladder empty), is far more common in urogynecology patients due to their higher incidence of prolapse.
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Melanosis of uterine cervix: a report of two cases.
Uterine prolapse is a common gynecological problem which is associated with complications like keratinisation, thickening and ulceration of cervical mucosal epithelium. Two cases of second degree uterine prolapse are being reported here showing heavy melanotic pigmentation of the basal layers of ectocervical epithelium. It appears to be a metaplastic change in response to local trauma or chronic irritation.
Adult↗
Dynamic pelvic three-dimensional computed tomography for investigation of pelvic abnormalities in patients with rectocele and rectal prolapse.
BACKGROUND: Dynamic three-dimensional computed tomography (D-3DCT: high-speed helical scanning during defecation) was used for morphological evaluation of intrapelvic structures in patients with rectal prolapse and rectocele. METHODS: Twenty-five patients with rectal prolapse or rectocele diagnosed by conventional defecography (CD) or clinical findings were additionally investigated with D-3DCT. D-3DCT images were acquired using a multislice CT system with a 16-row detector during simulated defecation. Helical scanning was performed with a slice thickness of 1 mm, a helical pitch of 15 s/rotation, and a table movement speed of 35 mm/s. The contrast medium, 100 ml of iopamidol (370 mg/ml), was injected at a rate of 2.5 ml/s to enhance contrast with other structures, and scan start was triggered by using a function for automatically determining the optimal scan timing. RESULTS: Among the eight patients with rectocele, additional intrapelvic disorders were diagnosed in five (enterocele, 4; cystocele, 1; and uterine prolapse, 1) with D-3DCT. In the 17 patients with rectal prolapse, concomitant intrapelvic disorders were found in six (intussusception, 3; cystocele, 2; uterine prolapse, 2; rectocele, 1; and vaginal prolapse, 1). CONCLUSIONS: D-3DCT can be a useful diagnostic tool for investigation of pelvic pathology in patients with rectocele and rectal prolapse.
Adult↗