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PubMed2002

[Prolapse in the young woman: study of risk factors].

OBJECTIVE: To determine the risk factors for genital prolapse in a group of 37 young women less than 45 years old. PATIENTS AND METHODS: We studied 37 young women who had been operated for genital prolapse, whereas the control group consisted of women operated for benign gynaecologic disorders. RESULTS: In the study group the number of pregnancies and deliveries, the babies' weight, the positive family history of prolapse were heavier than in the control group. The women with prolapse had more often chronic pulmonary diseases, asthma, as well as operations for abdominal hernias. The mode of delivery, be it a cesarean section or the use of forceps, and the active second stage of labor had no effect whatever on the occurring of genital prolapse in young women. CONCLUSION: Our data support the suggestion that multiparity, babies' weight and congenital factors are responsible for a higher rate of genital prolapse in young women.

Adult↗
PubMed2003

Triple compartment prolapse: sacrocolpopexy with anterior and posterior mesh extensions.

Post-hysterectomy vault prolapse may be accompanied by anterior (cystocele) and posterior (rectocele) pelvic compartment prolapse. We describe our results with sacrocolpopexy with anterior and posterior polytetrafluoroethylene mesh (SCAPM) extensions. A prospective on-going study is presented of 12 consecutive, complicated patients referred to our tertiary referral unit with a median age of 60 years (range 39-69) who underwent SCAPM between April 1997 and June 1999. All patients had a history and physical examination, International Continence Society Prolapse Staging (ICS) and pre-operative multichannel urodynamics testing with their prolapse reduced. All patients had an ICS grade 2, triple compartment prolapse or worse for inclusion into this study. The operative results were assessed with a 10-point visual analogue scale (VAS) for personal satisfaction and the (non-validated) St George's Hospital symptom questionnaire assessing urgency, urge incontinence, stress incontinence, splinting, digitation, sexual activity and function. All patients were reviewed during February 2002 by an independent observer (B.G. gynaecologist) no longer associated with the Department of Urogynaecology. All patients were followed post-operatively for a median of 39 months (range 32-58). One patient had a recurrent grade 1 cystocele and another a grade 1 rectocele. The median VAS score for personal satisfaction with the operative results was 8 (range 6-10). There was one patient with de novo urgency and one with de novo stress incontinence. Four of the five patients who needed to splint or digitate to empty the rectum no longer required these measures post-operatively. There were no reports of de novo dyspareunia, and two patients had improved vaginal lubrication. Two patients, each with more than five prior vaginal procedures, had a total of three episodes of mesh erosion through the posterior vaginal wall. The SCAPM is an effective treatment for triple compartment prolapse and incomplete rectal emptying. Patient satisfaction is good.

Adult↗
PubMedDate not supplied

[Repair of mucosa stomal prolapse with circular stapler. Technical note].

Mucosal stomal prolapse is a frequent complication of end colostomies. We describe here an original mucosal colostomy prolapse repair technique using a circular stapling device. This technique stems from the recent introduction of stapled muco-haemorrhoidectomy and was employed on a 68-year-old male patient who had undergone a Miles abdominoperineal excision 17 years earlier. On clinical inspection the patient presented a 5-cm. mucosal stomal prolapse on straining. The surgical procedure was performed under i.v. sedation with midazolam and propofol. After draping the abdomen, the stomal mucosa was gently everted with the aid of three Allis forceps, and a 1.0 prolene purse string suture was created 4-6 cm. cephalad to the cutaneous rim of the stoma. The head of a 33-mm circular stapler was introduced and the purse string suture was tied. The mechanical stapler was prepared and fired, thus obtaining a resection anastomosis of the prolapsed stomal mucosa. No bleeding occurred. A 24-F bladder catheter was placed cephalad to the stapled line and removed on postoperative day one. The patient was discharged from hospital the day after surgery. During a 16-month follow-up neither complications nor relapses have so far been observed. Our technique appears to be simple and safe. We believe it is indicated only for mucosal stomal prolapses, while full-thickness stomal prolapses should be managed by conventional techniques. A larger cohort of patients is needed to confirm our preliminary results.

Aged↗
PubMed1992

[Individualization of operative procedures for uterine prolapse based on categorization using X-ray urethrocystohysterography and postoperative outcomes evaluated with a scoring system].

A urethrocystohysterography (UCHG) and a prolapse scoring system (PSS) have been used to assess the types of uterine prolapse and postoperative outcomes since 1979. UCHG was useful in identifying the type of uterine prolapse and in selecting operative procedure. UCHG was done by injecting contrast medium into the bladder and uterine cavity and inserting a metallic bead chain into the urethra. A lateral pelvic X-ray was then taken at rest and during straining. The length of the uterus (UL), distance from the pelvic outlet (PO) to the bladder base (BB), distance from PO to the uterine fundus (UF), and distance from the ischial spine (IS) to UF were measured on the UCHG. We found that there were three types of uterine prolapse on the UCHG findings, type 1: cervical elongation without descent of uterine fundus and cystocele, type 2: uterine prolapse with moderate descent of uterine fundus and cystocele, and type 3: giant vaginal eversion including completely prolapsed uterus, marked cystocele, enterocele and rectocele. The operative time of vaginal hysterectomy with anterior and posterior colporthaphy (VH with AP repair) correlated well with UL and PO-UF distance on UCHG, and blood loss. Operating time was significantly shorter and amount of blood loss was significantly smaller in cases of Machester operation (cervical amputation, fixation of cardinal ligament stumps to the anterior wall of the remaining cervix and AP repair) than in those of VH with AP repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2003

Is prolapse gastropathy a cause of upper gastrointestinal bleeding?

BACKGROUND/AIMS: Prolapse gastropathy is a clinical syndrome involving the invagination of a part of the gastric mucosa into the lower esophagus resulting in well demarcated hemorrhagic mucosa and sometimes bleeding. The importance of this syndrome is that it has been reported as a cause of hematemesis. As this syndrome is considered to be seen in patients with retching and vomiting and to be one of the causes of upper gastrointestinal bleeding, this study was undertaken to evaluate its frequency and importance in our patients. METHODS: The study groups comprised of 941 patients with hematemesis and 54 with recurrent retching and vomiting. Biopsies were obtained from the prolapsing mucosa when detected. Hematoxylin and eosin stained specimens were reviewed by an experienced histopathologist. RESULTS: Prolapse gastropathy was detected in 20 patients (2%), of whom six (0.6%) were in the hematemesis group and 14 (25.9%) in the retching and vomiting group. The location of the lesion was the greater curvature in 10 patients (50%), lesser curvature in seven patients (35%) and anterior wall in three patients (15%). In all six cases from the hematemesis group, bleeding was not related to prolapse gastropathy because other causative lesions were identified. Histologic evaluation of the biopsies revealed acute inflammation, chronic inflammation and submucosal hemorrhage. CONCLUSIONS: According to the results of this study, prolapse gastropathy is not a cause of hematemesis. Other causes should be identified when prolapse gastropathy is detected in a patient with hematemesis.

Adolescent↗
PubMed1992

Clinical and histologic evaluation of the prolapsed third eyelid gland in dogs.

Eighteen prolapses of the gland of the third eyelid in 17 Beagles were randomly allocated to 3 groups, which included nontreated (group 1, n = 6), excised (group 2, n = 4), and surgically repositioned (group 3, n = 8) glands. A schirmer tear test (STT) was performed on affected and normal (control) eyes for 5 consecutive days on weeks 0 (baseline), 2, 4, 6, 8, 10, 12, 16, 18, 20, and 24. All prolapsed third eyelid glands were excised and examined histologically. Ten female and 7 male Beagles were used in the prospective study. Mean age at prolapse was 35.1 weeks (range, 6 to 89 weeks). Control STT data revealed a population mean of 22.2 +/- 2.1 mm/min. Complications developed in 4 of 6 eyes when the gland was allowed to remain in a prolapsed position. Complications for group-1 eyes were significantly (P < 0.005) greater than those for eyes in groups 2 and 3 (0 of 12). Comparison of affected and control eye baseline data revealed decreased STT values for eyes with prolapsed glands (P < 0.01). Mean differences between affected and control eyes were 2.2, 2.0, and 3.4 mm/min for groups 1, 2, and 3, respectively. A significant (P < 0.001) decrease in lacrimation (0.2 to 3.1 mm/min) in group-2 eyes was detected after removal of the gland. Tear production for affected eyes of nontreated dogs fluctuated above and below that of control eyes prior to excision of the prolapsed gland of the third eyelid; however, with time, affected and control eye STT values were not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2004

Comparison of effectiveness of vaginal and abdominal routes in treating severe uterovaginal or vault prolapse.

INTRODUCTION: This study compares the efficacy of abdominal and vaginal routes in correcting severe uterovaginal or vault prolapses by examining their primary surgical outcomes. METHODS: A retrospective study was conducted on operations performed from March 1998 to December 2001. The classifications of uterovaginal prolapse and vault prolapse were based on the Halfway system. It involved 177 women with at least grade 4 uterovaginal prolapse or grade 3 vault prolapse, and had undergone vaginal sacrospinous ligament fixation or abdominal sacrocolpopexy. The subjects were divided into two groups: 113 women who had an abdominal sacrocolpopexy and 64 women who had a vaginal sacrospinous ligament fixation. The primary surgical outcome measures was classified as cured, improved or failure according to our definition at their last follow-up. RESULTS: The abdominal sacrocolpopexy group had significantly greater intra-operative blood loss, operating time, haematuria, longer postoperative catheterisation and hospitalisation. Vaginal sacrospinous ligament fixation had more suture erosion. 95.6 percent of women with abdominal sacrocolpopexy were cured compared to 79.7 percent with vaginal sacrospinous ligament fixation. Five (4.4 percent) patients in the abdominal sacrocolpopexy group and six (9.4 percent) in the vaginal sacrospinous ligament fixation group defaulted their six-month follow-up with a mean follow-up of 18.1 months (range 0.9-48.1 months) and 13.2 months (range 1.1-29.1 months), respectively. CONCLUSION: Abdominal sacrocolpopexy is more effective in correcting severe uterovaginal or vault prolapses but it is associated with higher intra- and post-operative morbidity compared to vaginal sacrospinous ligament fixation. Vaginal sacrospinous ligament fixation is preferred in patients with medical disorders.

Female↗
PubMedDate not supplied

Devadhar's operation for complete rectal prolapse: 25 years' experience.

BACKGROUND: Numerous abdominal and perineal operations have been described for the treatment of complete rectal prolapse. We describe our results with Devadhar's rectopexy, which avoids dissection in the presacral space and hence may be expected to have a low risk of sexual and urinary disturbances. METHODS: Case records of 72 consecutive patients (40 men), aged above 18 years, with complete rectal prolapse who were treated with Devadhar's operation were reviewed. RESULTS: The only complication observed was mucosal prolapse in 3 patients. None of the 40 men had erectile dysfunction or retrograde ejaculation after a median follow-up of 10 (range 3-48) months. No patient had disturbance in micturition. Two patients (2.7%) had recurrence of rectal prolapse. In four patients (8.5%), constipation persisted. CONCLUSION: Devadhar's rectopexy for complete rectal prolapse was not associated with disturbances in sexual or micturition function, and low rates of recurrence of prolapse.

Adult↗
PubMed2005

Risk factors for failure of transvaginal sacrospinous uterine suspension in the treatment of uterovaginal prolapse.

BACKGROUND AND PURPOSE: The purpose of this study was to elucidate the risk factors for failure of transvaginal sacrospinous uterine suspension (SSUS) in the treatment of uterine prolapse and to examine methods for controlling these risk factors. METHODS: Sixty patients with second degree uterine prolapse or greater were included in this 2-stage study, with 33 in the risk factor assessment and 27 in the clinical study of a modified treatment to eliminate identified risk factors. Patients were followed for at least 5 years. The first part of the study evaluated the risk factors for operative failure and the efficacy of the operative procedure. The second part of the study evaluated a modified treatment plan to eliminate risk factors identified in the first part of the study. RESULTS: The failure rate for those with an elongated cervix (3 of 4, 75%) and those with third degree uterine prolapse (3 of 4, 75%) was significantly higher than for patients without either of these risk factors (6.9%, 2/29) [p = 0.007]. Concomitant partial trachelectomy for those with elongated cervix significantly reduced the failure rate from 75% to 0% (0/7) [p = 0.024]. In the risk factor study, SSUS was successful in 84.8% (28/33) of patients. In the clinical study of modified therapy to prevent significant risk factors, the success rate was 96.3% (26/27). CONCLUSIONS: This study found that an elongated cervix and third degree uterine prolapse were the 2 main risk factors for recurrent uterine prolapse after SSUS. Concomitant partial trachelectomy as an adjuvant treatment of SSUS for treatment of uterovaginal prolapse in patients with an elongated cervix significantly reduces the rate of failure in these patients.

Adult↗
PubMed2005

[Chronic renal failure secondary to uterine prolapse].

Acute and chronic renal failure secondary to bilateral severe hydroureteronephrosis is a rare sequela of uterine prolapse. We report a case of neglected complete uterine prolapse in a 72-year-old patient resulting in bilateral hydroureter, hydronephrosis, and chronic renal failure. In an attempt to diminish the ureteral obstruction a vaginal pessary was used to reduce the uterine prolapse. Finally, surgical repair of prolapse by means of a vaginal hysterectomy was performed. In conclusion, all patients presenting with complete uterine prolapse should be screened to exclude urinary tract obstruction. If present, obstructive uropathy should be relieved by the reduction or repair of the prolapse before irreversible renal damage occurs.

Aged↗
PubMed2005

Umbilical cord prolapse in current obstetric practice.

OBJECTIVE: To assess the incidence, risk factors and outcomes of umbilical cord prolapse in current obstetric practice. STUDY DESIGN: This study was a retrospective chart review at both a community hospital and a tertiary referral center. RESULTS: There were 52 cases of cord prolapse in our patient population, for an incidence of 3.0/1,000, similar to that in the literature. Of viable singleton pregnancies with frank prolapse, the rate was 1.6/1,000. In this series we found an approximately 40% higher rate of frank cord prolapse in induced patients at the community hospital than in the general population. Other than 2 fetal deaths related to extreme prematurity, all mothers and infants did well. CONCLUSION: The higher incidence of cord prolapse among women with induction of labor in this population merits further study. The lack of significant morbidity and mortality in the study suggests that modern obstetric practices may influenced the natural history of umbilical cord prolapse.

Adult↗
PubMed2004

A rare case of rectal prolapse associated with rectal adenocarcinoma: case report.

Despite the fact that colorectal polyps and solitary rectal ulcers may be present in conjunction with rectal prolapse, association between rectal prolapse and rectal cancer is very rare. As far as we could determine, there are only a few articles concerning rectal cancer in association with rectal prolapse in the literature. This case, a 63-year-old female patient, had suffered from a rectal prolapse since childhood and presented as a case of rectal cancer. At presentation, she complained of constipation and rectal bleeding for the previous six months. At physical examination there was a relaxed anal sphincter and a large reddish mass protruding via the anal canal when the patient strained. There was a fungating lesion in the upper left part of the rectal mucosa. An incisional biopsy was performed, the histopathological result of which was adenocarcinoma of the rectum. Changes in bowel habits, chronic constipation and chronic irritation seen in rectal prolapse may be responsible for the development of rectal cancer. Thus, a detailed history, digital rectal examination and rectosigmoidoscopic examination are important, particularly in patients with long-term rectal prolapse.

Adenocarcinoma↗
PubMed2006

Vaginosacral colpopexy (VSC)--a new modification of the Mc Call operation using vaginosacral ligaments as autologous sliding grafts in posthysterectomy vault prolapse.

OBJECTIVES: The effect of a new modification of the Mc Call operation, vaginosacral colpopexy (VSC) was evaluated in the group of 32 patients. BACKGROUND: Due to our bad experience with transabdominal lumbosacral colpopexy, we tried to find out another solution. METHODS: VSC using the mobilized vaginosacral ligaments as sliding grafts (two sutures through the vaginosacral ligaments and posterior vaginal wall and the third suture through the uterosacral ligaments) for vault prolapse was performed in the group of 32 patients. RESULTS: Before operation, the median stage of prolapse was: stage III (range, 0-IV) for anterior site; stage II (range, 0-IV) for posterior site; stage I (range, 0-IV) of the apical segment, and stage III (range 0-IV) for the most severe segment of prolapse. The mean follow-up was 24.5 months (range 9-42 months). There were no intraoperative injuries of the bladder, ureter, rectum or small bowel. At the final follow-up, the mean stage of the prolapse was following: stage 0 (range, 0-III) for anterior site, posterior site and the most severe segment of prolapse; and stage 0 (range, 0-I) of the apical segment. The total vaginal length (tvl) increased significantly (p < 0.001) (Valsalva maneuver) (Vm) and (p < 0.001) (Pozzi maneuver) (Pm) from the preoperative mean value of 3.20 +/- 1.18 (Vm) and 2.70 +/- 0.92 (Pm) to (- 8.33 +/- 0.77) (Vm) and (-7.82 +/- 0.89) (Pm). All 8 patients with genuine stress incontinence, became continent. 3 of 4 patients with potential urinary incontinence required Marshal-Marchetti operation for persistent stress incontinence. CONCLUSION: VSC seems to be quick, safe and effective procedure for vault prolapse (Tab. 5, Fig. 8, Ref. 31).

Female↗
PubMed2006

[A new minimally invasive procedure for the conservative treatment of uterine prolapse--the posterior IVS].

BACKGROUND: The risk of women who undergo surgery for the treatment of pelvic organ prolapse (POP) by the age of 80 is reported to exceed 10%, and is expected to rise with the increase in life expectancy. Most women affected are in their 5th or 6th decade, and the majority will suffer other medical problems. The current medical literature asserts that the vaginal surgical approach for POP operations are followed by less complications and provide a shorter rehabilitation period than the abdominal route. Hysterectomy is widely accepted as part of POP reconstructive surgery whenever the uterus is significantly prolapsed, however, there is no clear evidence to support the role of hysterectomy in improving surgery outcome. We present our experience with a new minimally invasive procedure - the posterior intravaginal slingplasty (IVS) for utero-suspension in the presence of moderate and advanced uterine prolapse. AIM: To evaluate the feasibility, intra- and post-operative complications and short term results of the posterior IVS procedure and uterosuspension for uterine prolapse. METHODS: Reconstructive surgery using the posterior IVS was performed on 18 women with moderate to severe uterine prolapse who chose to preserve their uterus. Patients were then followed 1,6,12 months and 2 years post-operatively to assess any recurrence of pelvic organ prolapse. RESULTS: No major intra- or post-operative complications were reported. Follow-up of one to 13 months showed good results. CONCLUSIONS: Reconstructive POP surgery may not necessitate hysterectomy. The posterior IVS is a novel safe, minimally invasive, simple and effective surgical procedure for the treatment of POP, permitting uterine preservation. A larger number of patients and a longer follow-up period are required for proper evaluation of the actual safety and efficacy of this procedure.

Female↗
PubMedDate not supplied

[Mitral valve prolapse. An echocardiographic study of 456 cases].

The prolapse of the mitral valve is an affection arousing much interest from the clinical and echocardiographical viewpoints. The present paper reports on the analysis of 456 cases (322 women--70% and 134 men--29.39%), suffering from prolapse of the mitral valve, selected out of 15,714 echocardiographic examinations (2.93%). All the patients were examined echocardiographically--Echo) in the M mode and bidimensionally; 256 cases underwent an Echo-Doppler examination, too and in 90 cases the phonocardiogram was also used. 983 cases were diagnosed as clinically suffering from prolapse, confirmed by Echo in 291 cases (29.62%), and in 165 cases the diagnosis was established only clinically. Phonocardiographically, the most frequent were recorded the mesotelesystolic click (40%), followed by click + holosystolic murmur (31.11%), telesystolic murmur (19.70%), holosystolic murmur (6.66%). The prolapse of the mitral valve was evidenced in 394 cases, both by M-Echo and by 2D-Echo; in 28 (6.1%) cases it was evidenced only by M-Echo, and in 34 cases (7.4%) only by 2D-Echo. In 62 cases (13.4%) the prolapse was better evidenced when the patients stood. The most affected was the anterior mitral valve, 203 cases (44.5%). The conclusion was drawn that the prevalence of the prolapse of the mitral valve is of 2.93% according to the Echo examination. A correct diagnosis requires the use of a rigorous examination technique and the observance of the clinical and Echo diagnosis criteria.

Adolescent↗
PubMedDate not supplied

[Mitral valve prolapse detected during hemodynamic studies].

To estimate frequency of the posterior mitral valve leaflet prolapse in routinely performed left ventriculography, 1000 consecutive ventriculograms of the right anterior oblique projection were analyzed. A group of patients consisted of 511 women and 489 men at mean age 46,5 years. Clinical diagnosis of heart lesions, myocardial disease, pulmonary hypertension or arrhythmias were indications for hemodynamic studies. In the investigated group of patients, there were no patients with clinical diagnosis of the coronary artery disease. Prolapse of the posterior mitral valve leaflet was diagnosed in 59 patients. Idiopathic mitral valve prolapse was diagnosed in 10 patients. Prolapse of the posterior mitral valve leaflet was most frequent in atrial septal defect (16.6%), myocardial lesion (12.5%), and after mitral commissurotomy (8.9%). Posterior mitral valve leaflet prolapse is not a frequent anomaly in routinely performed left ventriculography. Relatively often occurrence of the mitral valve prolapse in atrial septal defect and only occasional in the aortic lesions and dilated cardiomyopathy seems to point out at a role of the left ventricle size in pathogenesis of this syndrome.

Adult↗
PubMed1990

Genital prolapse with and without urinary incontinence.

Procidentia, vaginal vault prolapse and severe cystocele may be associated with potential urinary incontinence, which becomes overt only after surgical repair of the genital prolapse. The normal support of the pelvic organs is provided by the pelvic diaphragm (levator ani and coccygeus muscles). The levator plate is a firm, muscular plate between the coccyx and anus formed by fusion of the levator ani muscles on each side. Recent investigators have indicated that the main mechanism for weakening the pelvic muscles occurs as a result of childbearing, when stretch injury of the pudendal nerve causes denervation of the muscles. This injury is aggravated with the changes of aging and has effects on anogenital prolapse and stress incontinence. There may be iatrogenic causes of both prolapse and stress incontinence when an operation produces a change in the direction of tissue forces or removes a prior barrier to incontinence. The evaluation of patients must include the actual and potential aspects of genital prolapse and incontinence. Testing for stress incontinence must be performed before and after reduction of the genital prolapse. Surgical repair should be planned carefully to correct all the significant and potential defects in the urogenital tract. Ideally a normal vaginal axis with adequate length will be restored, and urinary function will not be compromised.

Female↗
PubMed1990

Histological changes in aging lumbar intervertebral discs. Their role in protrusions and prolapses.

To study the relationships between the changes due to aging in lumbar intervertebral discs and the development of protrusion or prolapse, we carried out histological studies on operative specimens of thirty-one discs, of which twenty-two had been protruded and nine, prolapsed. The specimens were obtained during twenty-nine operations for herniation of a lumbar intervertebral disc in patients who were sixty years old or older. Changes in the anulus fibrosus were more extensive in the nine prolapsed discs than in the twenty-two protruded discs. Of the nine prolapsed discs, myxomatous degeneration, fibrosis, and swollen anular fibers were found in all nine, and cysts were seen in five. Of the twenty-two protruded discs, only five showed myxomatous degeneration; ten, fibrosis; one, a cyst; and sixteen, swollen fibers. For comparison, we also studied specimens that had been obtained at operation from twenty-one other patients, twenty to fifty-nine years old, who had a prolapsed disc. The anulus showed myxomatous degeneration in all twenty-one specimens, cysts in eight, and fibrosis in ten. In addition, we examined 368 autopsy specimens from people who had been between twenty-five and eighty-five years old at the time of death. In many of the subjects who had died in the sixth decade of life or later, we found that the orientation of the inner fiber bundles of the anulus fibrosus was reversed, so that they bulged inward. The reversal appeared to be the result of myxomatous degeneration of the middle fibers of the anulus, atrophy of the nucleus, and narrowing of the disc space. These histological findings suggest explanations for the predominance of protrusions of the nucleus pulposus in patients who are less than sixty years old and of prolapse of the anulus fibrosus in the few patients who are more than sixty years old who have herniation of an intervertebral disc.

Adolescent↗