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Results for “UTERINE PROLAPSE”

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PubMed2004

Changes in gonadal steroid receptors in the cardinal ligaments of prolapsed uteri: immunohistomorphometric data.

BACKGROUND: The precise mechanism of uterine prolapse is poorly understood. This immunohistochemical study was performed on paraffin-embedded sections of the cardinal ligaments in an attempt to evaluate the differential expression of gonadal steroid receptors in human cardinal ligaments of prolapsed uteri compared with non-prolapsed controls. METHODS: Specimens from women with pelvic organ prolapse (POP) stage III (n = 33), together with the appropriate controls (n = 25), were stained for estrogen receptor alpha (ERalpha), ERbeta, progesterone receptor (PR), androgen receptor (AR) and Ki-67. The control materials were samples of the cardinal ligaments obtained from pre- and post-menopausal women with no prolapse, who were not using hormonal therapy. RESULTS The prolapsed ligaments expressed 1.5-2.5 times more ERalpha-positive cells (statistically significant in post-menopausal women not taking HRT, P < 0.001), a 3-4 times greater percentage of AR-positive cells (P = 0.004 and P = 0.008 in pre-menopausal and post-menopausal women not taking HRT, respectively) and twice the percentage of PR-positive cells (statistically significant in the pre-menopausal group, P = 0.03) compared with the no prolapse group. Expression of ERbeta was twice as high in the ligaments of pre-menopausal women with no prolapse compared with those with prolapse (P = 0.02), and no significant difference was found in the post-menopausal groups. The use of HRT was significantly associated with low AR and high PR expression. Ki-67 expression was not detected in these specimens. CONCLUSIONS: The clearly discernible levels of expression of ERalpha, ERbeta, AR and PR in the prolapsed cardinal ligaments may suggest a relationship to the process of tissue stretch 'trauma', rather than an effect of the menopausal status, HRT use or cell proliferation. The use of HRT in post-menopausal women appears to offset some of the changes observed with the prolapse.

Adult↗
PubMed2000

The outcome of pelvic examinations in women 40-60 years of age with lower urinary tract symptoms.

We set out to assess the outcome of pelvic examination in women 40-60 years of age with one or more lower urinary tract symptoms. This was an ongoing longitudinal cohort study set in one rural and one urban county in Denmark. One hundred and ninety-six women with one or more lower urinary tract symptoms occurring at least weekly were selected at random. Ages ranged from 40 to 60 years. Pelvic findings involving genital prolapse, signs of vaginal atrophy, and pelvic mass as well as a history of hormonal status and estrogen deficiency symptoms were documented and assessed. One hundred and six women (54.1%) were recruited. First degree cystocele, rectocele, and uterine prolapse occurred in 24 (22.6%), seven (6.6%), and six (5.7%), women respectively. No significant association between first-degree genital prolapse and subtypes of lower urinary tract symptoms (LUTS) was observed. The number of women with second or third degree cystocele, rectocele, and uterine prolapse was three (2.8%), two (1.9%), and two (1.9%), respectively. The positive predictive vaginal findings in each subtype of LUTS indicating an oestrogen deficiency were in the interval 72.0- 90.0 while the negative predictive vaginal findings were in the interval 24.7-27.6%, respectively. In six women (5.7%) a leiomyoma was observed. In one woman the size of the uterus exceeded the size of a 12-week pregnancy. Genital prolapse more than first degree and pelvic masses were infrequent findings among women with LUTS. Signs of vaginal atrophy associated poorly with a history of hormonal depletion and symptoms indicating oestrogen deficiency. However even an infrequent pathologic finding is significant. Therefore we still recommend pelvic examinations in all women with LUTS.

Journal Article↗
PubMed1990

[Morphological substantiation of selection of the method of surgical treatment of patients with prolapse of internal genital organs].

Morphology of uterine ligaments and the vaginal mucosa has been examined in 61 patients with uterine prolapse in order to provide guidelines for an optimum management with respect to tissue functional status. Specimens were obtained intraoperatively and examined in a usual microscope and a S-570 Hitachi scanning electron microscope (Japan). The study suggests that morphologic evaluation of the vaginal walls and uterine ligaments provides an exact measure of tissue status, offering an optimum choice of treatment in these patients.

Adult↗
PubMed2006

[Treatment of female stress urinary incontinence with tension-free vaginal tape].

OBJECTIVE: To investigate the indication, approaches and prevention of complications in treatment of female stress urinary incontinence (SUI) with tension-free vaginal tape (TVT). METHODS: From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3 years. The disease course was 1-42 years (7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. RESULTS: All patients achieved satisfactory results. The complications included slight dysuria (2 cases), vesical perforation (1 case) and pelvic hematoma (1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. CONCLUSION: TVT is effective for SUI.

Adult↗
PubMed1999

Treatment of vaginal vault prolapse with abdominal sacral colpopexy using prolene mesh.

BACKGROUND: We report our experience on abdominal sacral colpopexy (CSP) with a prolene mesh in women with vaginal vault prolapse. METHODS: From 1994 to 1997 15 patients (average 57 years), underwent CSP. All patients suffered from a serious vaginal vault prolapse. Eight of them also had a uterine prolapse. Seven patients had already been operated for hysterectomy (5 vaginal, 2 abdominal). Four of them had already been operated for urinary incontinence: (3 Raz, 1 Burch). In 6 cases we have a colposuspension according to Burch associated with CSP. Average follow-up was 15 months. RESULTS: All the patients have carried a bladder catheter for 4-12 days (average 5 days). The patients who were sexually active have begun having normal sexual intercourse again. Neither relapses of the treated prolapses, no infections or rejections of the prosthesis have been verified. In 1 patient pollakiuria insensitive to anticholinergics has persisted. Four patients have complained of hypogastric "sense of weight", without any clinical evidence of pathology. CONCLUSION: Our survey confirms the information and the good result of this technique in the treatment of the total vaginal dome prolapse, also in comparison with our operations for sacrospinosous ligament fixation. This kind of treatment through the vagina, is not always possible, above all after hysterectomy with a very short vagina.

Female↗
PubMed1990

Giant-cell arteritis of the uterus with associated temporal arteritis: a case report.

Giant-cell arteritis involving the uterus was identified incidentally upon hysterectomy and anterior colporrhaphy for uterine prolapse. Subsequently, the patient was found to have giant-cell temporal arteritis presenting with fever of unknown origin. Fourteen previous cases involving the female genital tract have been reported. There appears to be an association between constitutional symptoms of fever, weight loss, malaise, headache, and polymyalgia rheumatica in elderly women with uterine prolapse and giant-cell arteritis of the genital tract. The rare presentation of giant-cell arteritis in the female genital tract does not support invasive costly evaluation in asymptomatic patients. However, a thorough investigation for involvement of other sites, including appropriate treatment for generalized disease, should be undertaken.

Aged↗
PubMed2005

Role of pelvicography and colpocystodefecography in diagnosis of outlet obstructive constipation.

AIMS: The aim was to research the changes in pelvic floor morphology and corresponding visceras in patients with outlet obstructive constipation (OOC). PATIENTS AND METHODS: Thirty-eight patients with OOC and 12 healthy volunteers were enrolled in this study. With simultaneous pelvicography and colpocystodefecography (PCCD), including pelvicography, vaginal opacification, voiding cystography and defecography, pelvic floor morphology was observed and the anorectal angle, the level of the perineum, peritoneum and bladder were measured. RESULTS: Thirty-seven cases of internal rectal prolapse (IRP), 5 cases of rectocele (RC) and 5 cases of spastic pelvic floor syndrome SPFS were diagnosed by PCCD. 12 IRP, 4 RC and 1 SPFS were detected by common physical examination. All of these were confirmed by PCCD. Moreover, PCCD found 9 pelvic floor hernia or peritoneoceles, 6 cystoceles, 3 descending perineum syndromes and 10 uterine prolapses. Compared with controls, OOC patients had a significantly large anorectal angle during defecation, abnormal descending of the perineum at rest and during defecation, and a deep pouch of Douglas during defecation. Some patients with urinary system symptoms may have had an abnormal descent of the bladder during rest and defecation. CONCLUSION: Simultaneous PCCD has a higher positive ratio than the common physical examination in diagnosing IRP and RC, and provides information for the diagnosis of pelvic floor hernia or peritoneocele, cystocele or uterine prolapse. PCCD is helpful in the selection of a proper surgical procedure.

Adult↗
PubMed2000

Treatment of vaginal vault prolapse with abdominal sacral colpopexy using prolene mesh.

BACKGROUND: We report our experience of abdominal sacral colpopexy (ASC) with a prolene mesh in women with total vaginal vault prolapse. MATERIALS AND METHODS: From 1994 to 1997, 15 patients (average age 57 years), underwent ASC. All the patients suffered from a serious vaginal vault prolapse. Eight of them also had a uterine prolapse. Seven patients had already been operated on for hysterectomy (5 vaginal, 2 abdominal), and 4 of them had already undergone an operation for urinary incontinence (3 Raz, 1 Burch). In 6 cases ASC was associated with a colposuspension in accordance with Burch. Average follow-up was 20 months. RESULTS: All the patients carried a bladder catheter for 4 to 12 days (mean 5). The 11 patients who were sexually active began having normal sexual intercourse again. Neither relapses of the treated prolapses nor infection or rejections of the prostheses occurred. In 1 patient frequent micturition unresponsive to anticholinergics persisted. Four patients presented with hypogastric "sense of heaviness," with no clinical evidence of any pathology. CONCLUSION: ASC with a prolene net is confirmed as the most valid technique, with no complications, in the treatment of total vaginal vault prolapse, above all when there is also the need for other operations via the abdomen at the same time (colposuspension, culdoplasty, and so forth), or when the vagina is too short to fix the sacrospinal ligament transvaginally.

Abdominal Muscles↗
PubMed1994

Effects of calving-related disorders on prostaglandin, calcium, ovarian activity and uterine involution in postrartum dairy cows.

Postpartum ovarian activity, uterine involution and plasma concentrations of calcium and 15-keto-13, 14 dihydro-prostaglandin F2alpha (PGFM) were assessed in dairy cows with retained fetal membranes (n=10) and milk fever (n=10) at parturition. In addition, calcium and PGFM were evaluated in dairy cows affected with uterine prolapse (n=10) and pyometra (n=14). Cows with retained fetal membrane averaged 24.2+/-3.7 d until their first postpartum ovulation, while controls averaged 29.0+/-3.7 d (P>0.10). In cows with retained fetal membranes, the difference in follicular activity between the contralateral and ipsilateral ovaries in relation to the previously gravid uterine horn was appreciably greater post partum when compared with that of the controls. Cows with milk fever had an average of 30.8+/-3.1 d until their first postpartum ovulation, while control cows had an average of 20.4+/-3.3 d (P<0.05). The mean diameter of the uterine horns in cows with milk fever was greater (P<0.05) compared with that of the controls between Days 15-32 post partum. Concentrations of plasma calcium were lower in cows with retained fetal membranes within 24 h after parturition and during the first week post partum than in the controls (6.27+/-0.18 vs 7.40+/-0.18 mg/100ml, P<0.05). Concentration of calcium was lower (P<0.05) in cows with milk fever on Day 1 prior to treatment (4.68+/-0.40 < 5.8+/-0.45 mg/100ml) than in control cows; however, the calcium (Ca) level was not different during the subsequent 7 d post partum after treatment. Cows with uterine prolapse had lower concentrations of Ca during the first 7 d post partum than the controls (6.10+/-0.15 vs 7.33+/-0.12mg/100ml; P<0.01). Cows with pyometra had higher (P<0.05) concentrations of plasma PGFM than the controls (208.+/-13.2 > 138.1+/-15.2).

Journal Article↗
PubMed2003

Changes in extracellular matrix proteins in the cardinal ligaments of post-menopausal women with or without prolapse: a computerized immunohistomorphometric analysis.

BACKGROUND: The precise mechanism of uterine prolapse is poorly understood. There is evidence to suggest that abnormalities of connective tissue structure or its repair mechanism may predispose women to prolapse. METHODS AND RESULTS: This immunohistochemical study was performed on paraffin-embedded sections of the cardinal ligaments in an attempt to evaluate differences in the expression of extracellular matrix (ECM) proteins: collagen I, collagen III, elastin and tenascin, in the cardinal ligaments of prolapsed compared to non-prolapsed uteri. There appear to be discernable differences in the level of expression of ECM proteins in prolapsed compared to non-prolapsed cardinal ligaments. We found that the ligaments of the prolapsed uteri are characterized by a higher expression of collagen III and tenascin, and lower quantities of elastin. It appears that the use of HRT in post-menopausal women reverses some of the changes observed in cases of prolapse. Collagen I expression is directly related to the age and menopausal status rather than to prolapse. CONCLUSIONS: In contrast to collagen I, our findings clearly indicate that collagen III expression is directly related to the presence of prolapse rather than age or menopausal status and is suppressed with the use of HRT. The pattern of change may fit a picture of healing phase of traumatized tissue as evidenced by the raised tenascin expression. The trauma itself may have been initiated by events such as childbirth, and that the lack of estrogen following the menopause results in decompensation. In spite of ameliorating some of the changes such as suppression of collagen III expression, treatment with estrogen falls short of rectifying the expression of other necessary proteins. If these mechanisms can be elucidated, a supplementary drug therapy may help along with estrogens to rebuild these ligaments.

Adult↗
PubMed1996

Social integration, sexual behavior and fertility in patients with bladder exstrophy--a long-term follow up.

UNLABELLED: After primary bladder closure or urinary diversion, other factors apart from the reconstruction itself gain importance for individuals with the exstrophy-epispadias complex: social integration and, after reaching puberty, sexuality and fertility. Between 1968 and July 1994 115 patients with bladder exstrophy or incontinent epispadias underwent surgery at our institution. A total of 104 patients could be followed, 2 of whom died in the meantime. Of the remaining 102 patients 48 attend school, 4 are in college, 40 have completed or are currently undergoing vocational training, 3 are unemployed, 1 lives in a therapeutic centre and 6 are younger than 6 years of age. A total of 95% of the patients with continent urinary diversion are continent day and night, whereas only three of five patients with a sling plasty (incontinent epispadias) or with primary bladder closure followed by a Young-Dees procedure are continent. None of the patients showed deterioration or renal function. In 25 females the external genitalia were reconstructed. Fixation of the uterus was done in 13 to correct or prevent uterine prolapse. Of the 17 women older than 18 years of age with genital reconstruction, 16 are satisfied with the cosmetic result. All adults engage in sexual intercourse. Five women have delivered seven children by Caesarean section. Of the 35 male adults 32 underwent reconstruction of the external genitalia and 34 males achieve erection. One developed necrosis of the penis early in life following primary bladder closure performed at an outside hospital. Penile deviation was present in 11 of the 32 patients with genital reconstruction, which is distressing in only 2. Thirty patients are satisfied with the cosmetic result. After genital reconstruction 9 males developed epididymitis, necessitating two orchiectomies and three vasectomies. No patients with reconstruction of the external genitalia can ejaculate normally or has fathered children, whereas ejaculation was normal in the three men who did not undergo genital reconstruction and in two patients prior to post-pubertal reconstruction. Furthermore, two of these three men have fathered four children. CONCLUSION: Education, occupation and social development of patients with urinary diversion are uneventful. The cosmetic results achieved by genital reconstruction are satisfactory. In female patients, antefixation of the uterus should be performed before or together with an introitusplasty to prevent uterine prolapse. In male patients, however, surgery is performed at the expense of fertility. Detailed discussions with the patients and their patients should include not only the question of primary bladder closure versus urinary diversion, but also the pros and cons of correction of the external and-in females-the internal genitalia.

Adult↗
PubMed1998

Colpopexy: a modification of Shaw's technique.

The efficacy of colpopexy using an autograft is assessed. The method was used in patients with post-hysterectomy vaginal vault prolapse and/or suffering from uterine prolapse complicated by ovarian pathology. Thirty-five patients were subjected to a modified operative procedure based on Shaw's original method and completed with a posterior colporrhaphy. All patients are now free of urinary and/or pelvic symptoms with a functional vagina, after a 48 to 60 months post-operative follow-up. Pelvic cellulitis was observed in two patients and low abdominal pain in three others for a period of 1 month.

Journal Article↗
PubMedDate not supplied

Practical MR imaging of female pelvic floor weakness.

Pelvic floor weakness is common in middle-aged and elderly parous women and is often associated with stress incontinence, uterine prolapse, constipation, and incomplete defecation. Most patients with incontinence and minimal pelvic floor weakness can be treated based on physical examination and basic urodynamic findings. However, in women with symptoms of multicompartment involvement for whom a complex repair is planned or who have undergone previous repairs, magnetic resonance (MR) imaging can be a useful preoperative planning tool. The MR imaging evaluation is performed with the patient in the supine position, without contrast agents, and within 15 minutes. A multicoil array and a rapid half-Fourier T2-weighted imaging sequence are used to obtain sagittal images while the patient is at rest and during pelvic strain, followed by axial images. On these images, the radiologist identifies the pubococcygeal line (which represents the level of the pelvic floor), the H and M lines (which are helpful for confirming pelvic floor laxity), and the angle of the levator plate with the pubococcygeal line (which is helpful for identifying small bowel prolapse). In the appropriate patient, MR images provide relatively easy three-dimensional conceptualization of the pelvic floor and can significantly influence treatment planning.

Adult↗