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At least 577 records · Page 32Linked to original sources
PubMed1997

Inflammatory valvular prolapse produced by acute rheumatic carditis: echocardiographic analysis of 66 cases of acute rheumatic carditis.

Sixty-six cases of rheumatic fever (RF) associated with acute rheumatic carditis (ARC) diagnosed on the basis of the revised Jones criteria (1982) were studied retrospectively (Group I) and prospectively (Group II). Echocardiography in Group I revealed anterior mitral valve prolapse (AMVP) in 28/55 cases (51%), posterior mitral valve prolapse (PMVP) in four (7%), combined anterior and posterior mitral valve prolapse (BMVP) in five (9%), aortic valve prolapse (AVP) in eight (15%), and in Group II, AMVP in nine (82%), BMVP in one (9%), AVP in six (55%). Among the prolapsed valves 40% of the mitral valves in Group I and 64% in Group II were redundant with irregular focal thickenings. In the follow-up examination, three cases without AMVP in the early stage of ARC developed AMVP later; on the other hand, AMVP was found in the early stage and disappeared later in another three. These findings suggest that overall, ARC is an important etiology of MVP and AVP in China.

Adolescent↗
PubMed2000

Urinary incontinence and pelvic organ prolapse in women with Marfan or Ehlers Danlos syndrome.

OBJECTIVE: This study was undertaken to determine the prevalence of urinary incontinence and pelvic organ prolapse in a cohort of women with either Marfan syndrome or Ehlers-Danlos syndrome. STUDY DESIGN: Female patients with either Marfan syndrome or Ehlers-Danlos syndrome were identified through a medical records search at two urban hospitals. Each patient's medical record was reviewed, and the history of pelvic organ prolapse and urinary incontinence was obtained through telephone interview. RESULTS: Twelve women with Marfan syndrome were identified. Among these women 5 (42%) reported a history of urinary incontinence and 4 (33%) reported a history of pelvic organ prolapse. Eight women with Ehlers-Danlos syndrome were identified. Among these women 4 (50%) reported a history of urinary incontinence and 6 (75%) reported a history of pelvic organ prolapse. CONCLUSIONS: Women with Marfan or Ehlers-Danlos syndrome have high rates of urinary incontinence and pelvic organ prolapse. This finding supports the hypothesized etiologic role of connective tissue disorders as a factor in the pathogenesis of these conditions.

Adult↗
PubMed2002

Management of the urethral outlet in patients with severe prolapse.

PURPOSE OF REVIEW: Numbers of women seeking consultation for pelvic floor disorders, a large portion of which will involve pelvic organ prolapse (POP) and lower urinary tract dysfunction, are expected to reach epidemic proportions within the next decade. A full understanding of the complex impact of pelvic organ prolapse on lower urinary tract function is crucial to successful management. RECENT FINDINGS: Recent data lend support to the concept that women with POP, but no associated urethral dysfunction, may be best served by a surgical repair that carefully avoids dissection in the periurethral area. Conversely, preoperative evaluation will often reveal bladder outlet obstruction concomitant with 'hidden', 'potential', or 'occult' stress urinary incontinence when the prolapse is reduced. Many of these women will not have incontinence symptoms in daily life. Paradoxically, the mechanical bladder outlet obstruction may induce detrusor instability with subsequent obstructed/overactive bladder symptom complexes not dissimilar to those of men with prostatic bladder outlet obstruction. Anatomic research shows that the vessels and nerves supplying the urethra are particulary vulnerable to surgical techniques used in pelvic organ prolapse repair. SUMMARY: This mix of obstructed, overactive bladder with hidden stress incontinence increases with degree of POP, and all women with severe prolapse will fair best if evaluated for all three conditions prior to surgical repair.

Collagen↗
PubMed2006

Spontaneous reduction of bladder base prolapse with gradual filling: a video-urodynamic observation.

OBJECTIVE: To report video-urodynamic observations on the effect of gradual bladder filling on the degree of bladder base prolapse while erect, as the effect of bladder fullness on the degree of bladder base descent in patients with a cystocele has rarely been addressed. PATIENTS AND METHODS: Thirty-six consecutive patients with complaints of a protruding vaginal mass due to bladder prolapse underwent video-urodynamic studies, comprised of filling and voiding cystometry with contrast material, while standing. RESULTS: During filling cystometry, in 16 of 36 patients (44%) the prolapse gradually and spontaneously reduced with increasing bladder volumes, so that at cystometric capacity the bladder base was completely reduced. Straining at cystometric capacity did not affect the bladder base position and, during voiding cystometry, the bladder base remained completely reduced. In the remaining 20 patients there was only partial reduction of the cystocele during bladder filling, i.e. the cystocele was reduced by half or less. Seven of the 16 patients with a full reduction of cystocele had concurrent uterine prolapse, compared with 15 of 20 (80%) who had only partial or no spontaneous reduction; the difference was statistically significant (P = 0.02). CONCLUSION: These video-urodynamic results suggest that when erect the degree of bladder base descent is volume-dependent, and that concomitant uterine prolapse might hinder spontaneous reduction of the cystocele.

Aged↗
PubMed1993

Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem.

The existence of combined rectal and vaginal prolapse is more common than the literature would suggest. This paper outlines a further development in the operative management which has been applied to 24 patients with this problem. All had had a hysterectomy and most had had in addition one or more vaginal repairs. The common mode of presentation was one of pelvic pain (19 patients), sometimes severe, crippling and intractable and some form of protrusion (14 patients), difficult or unsatisfied defaecation and rectal incontinence (9 patients). The vaginal prolapse which always involved the vault and usually involved the lower vagina was usually found to be incomplete and the rectal prolapse complete (but occult). The operative procedure essentially consists of a Wells type rectopexy which has a new modification in which the sling is extended to anchor the vaginal vault after correction of the enterocele by the abdominal approach. A vaginal repair is subsequently performed at the same operation where anterior or posterior vaginal prolapse persists. Important points in the procedure are the avoidance of sepsis (the vaginal vault is not opened during the procedure) and protection of the ureters by careful assessment of the lateral margins of the vaginal vault which is illuminated by transvaginal vault endoscopy. At this early stage operative morbidity has been minimal, relief of the pelvic symptoms has been most encouraging, but the length of follow-up is short (range 6-30 months, average 15.6) and long-term evaluation will be necessary as with all surgery for prolapse.

Adult↗
PubMed1987

Postinflammatory mitral and aortic valve prolapse: a clinical and pathological study.

In this study we reevaluated whether the sole cause of mitral valve prolapse (MVP) and aortic valve prolapse (AVP) is myxomatous degeneration. Forty-two surgical cases of prolapsed valves with mitral and/or aortic regurgitation were reviewed (AVP in nine, MVP in 27, and combined AVP and MVP [CVP] in six). On microscopic examination, myxomatous degeneration was observed in 20 patients, including six with AVP, 13 with MVP, and one with CVP. In the other 22 patients, including three with AVP, 14 with MVP, and five with CVP, microscopic examination revealed fibrosis with vascularization and scattered infiltration of inflammatory round cells caused by postinflammatory changes with or without chronic inflammation. We coined the term "postinflammatory valve prolapse" (PIVP) to describe these valves. Both postinflammatory and myxomatous degeneration were observed in seven patients with floppy mitral valves attributable to PIVP. Rupture of chordae tendineae was present in six patients with myxomatous mitral valve and three with PIVP. Seven patients with PIVP had a history of rheumatic fever. The results suggest that valvular prolapse is produced not only by myxomatous degeneration but also by postinflammatory changes, including those caused by rheumatic fever.

Adult↗
PubMed1990

[Secondary prolapse of heart valves].

Secondary valve prolapse emerges in a variety of heart diseases: coronary heart disease, dilated and hypertrophic cardiomyopathies, acquired valvular heart disease, infectious endocarditis, pulmonary hypertension, etc. Valve prolapse results from dilation of valvular fibrous rings, dysfunction of papillary muscles, mitral lesions in valvulitides. Secondary valve prolapse in dilatation of valvular opening entails manifest disorders of systemic and intracardiac hemodynamics except for cases of aortic root dilatation. In decreased valvular opening secondary valve prolapse is not associated with considerable shifts in hemodynamics. Secondary valve prolapse suggests primary structural and functional defects in the heart rather than promotes the development of circulatory insufficiency.

Adult↗
PubMed1989

[The pathology of mitral valve prolapse in dogs].

The authors present investigations of the prolapse of the mitral valves in dogs. In 18 cases there were dogs with a prolapse, in 6 dogs there was a prolapse of the tricuspid valves, and in 3 cases a prolapse of both valves was observed. In all cases prolapse occurred together with endocardiosis of the valves or as a consequence of it.

Animals↗
PubMed1983

[Aortic valve prolapse].

The aortic valve prolapse which can be diagnosed by echocardiography is usually found in patients with the floppy valve syndrome. The clinical symptoms are identical with those of the mitral valve prolapse. The frequency of aortic valve prolapse in 67 cases of mitral valve prolapse was 8.9%, the frequency of aortic insufficiency 5.9%. A main etiological factor of aortic valve prolapse is a myxomatous degeneration of valvular tissue which can affect one or more cardiac valves.

Aortic Valve↗
PubMed1993

[Uterine fixation to the promontory and the Orr-Loygue operation in associated genital and rectal prolapse].

The association of genital prolapse and rectal prolapse is rare. The authors report six cases of simultaneous mixed prolapse treated surgically via an abdominal approach. The latter technique enables the treatment of genital prolapse by uterine fixation to the promontory and rectal prolapse by rectopexy using the Orr-Loygue technique. Chronic constipation and obstetric trauma are constantly found among etiological factors. Four of our patients had urinary stress incontinence. There were no preoperative complications. One patient reported worsening of her constipation. Mean follow-up is only 20 months (2 months to 3 years), but no recurrences have occurred. Review of the literature and of series with more than fifteen years follow-up shows that the Orr-Loygue operation is reliable with a low complication rate and only rare recurrences.

Aged↗
PubMed1998

Pelvic prolapse: diagnosing and treating cystoceles, rectoceles, and enteroceles.

The current generation of women is maintaining a healthier and more active lifestyle into an older age. Treatable conditions such as stress urinary incontinence and pelvic prolapse detract from this active lifestyle. In many cases, an improved quality of life can be maintained by treating pelvic prolapse conditions with relatively minor surgical procedures. Optimal treatment requires a knowledge of pelvic floor anatomy, an understanding of the various pelvic floor defects, and experience in selecting the appropriate procedure. The unequivocal diagnosis of pelvic prolapse conditions can only be made on physical examination. Each section of the vagina -- anterior, posterior, lateral, and apex -- must be inspected and evaluated separately to define the true nature and degree of prolapse. The examination should be performed with a moderate amount of urine in the bladder, and the patient must strain forcefully during the procedure. In some cases, this requires that the patient stand or sit upright during part of the examination to allow all areas of prolapse to become manifest. When the proper procedures are performed, excellent long-term results can be anticipated. The successful treatment of cystoceles requires an evaluation for both lateral and central defects, as inadequate treatment of either defect will lead to recurrences. The treatment of rectoceles is more controversial: Most clinicians would repair symptomatic rectoceles, but many choose not to treat asymptomatic rectoceles because there is little documented benefit to justify the risk of postoperative dyspareunia. Small asymptomatic enteroceles may be treated with a pessary; however, large symptomatic enteroceles usually require surgery.

Female↗
PubMed1999

Development of postoperative urinary stress incontinence in clinically continent patients undergoing prophylactic Kelly plication during genitourinary prolapse repair.

The present study was undertaken to evaluate the efficacy of Kelly plication in preventing postoperative urinary stress incontinence in clinically continent patients undergoing surgery for genitourinary prolapse. Thirty clinically continent patients with grade-3 genitourinary prolapse were found to have a positive stress test with repositioning of the prolapse during preoperative urodynamic evaluation. In addition to the genitourinary prolapse repair, these patients underwent a Kelly plication as a preventive measure against possible development of postoperative urinary stress incontinence. Postoperative follow-up included a detailed urogynecologic questionnaire, pelvic examination, urine culture, Q-tip cotton swab test, and a full urodynamic evaluation. The mean duration of follow-up was 25.5 +/- 14.1 months. Fifteen (50%) patients developed subjective and objective postoperative stress incontinence. Eleven (37%) patients developed objective postoperative stress incontinence (proven by urodynamic evaluation) with no subjective complaints of stress incontinence. Prophylactic Kelly plication as performed by the method described does not appear to be effective in preventing postoperative urinary stress incontinence in clinically continent patients who undergo surgery for genitourinary prolapse.

Evaluation Studies as Topic↗
PubMed1981

Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse.

The clinical, anorectal manometric and electrophysiological findings in 24 patients with faecal incontinence, 10 of whom also had rectal prolapse, and in 8 patients with rectal prolapse without incontinence, are reported. Single fibre electromyographic studies and anal reflex latencies were abnormal, indicating damage to the innervation of the pelvic floor musculature, in all the patients with faecal incontinence, with or without rectal prolapse. These studies were normal in 7 of the 8 patients in whom rectal prolapse occurred without incontinence. These investigations imply that denervation of the sphincter musculature can be recognized by electrophysiological tests in most patients with primary faecal incontinence and that the pathogenesis of rectal prolapse differed in the two groups of patients.

Action Potentials↗
PubMed1984

Abnormalities of colonic function in patients with rectal prolapse and faecal incontinence.

We have investigated changes in colonic motility and anorectal function in 6 continent patients with a rectal prolapse; in 10 incontinent patients with rectal prolapse and in 16 patients with idiopathic faecal incontinence compared with 26 age and sex match controls. A history of incontinence, irrespective of a prolapse, was associated with significantly lower anal squeeze pressures (P less than 0.05), a deficient anorectal angle (P less than 0.05), failure to retain a balloon containing more than 250 cm3 of air in the rectum (P less than 0.01) and increased sigmoid motility (P less than 0.02) compared with controls. By contrast patients with rectal prolapse and no incontinence had normal anal pressures, a normal anorectal angle and normal sigmoid motility, but transit was delayed. These results indicate that abnormal sigmoid motility is commonly associated with faecal incontinence and that slow transit constipation is frequent in patients with rectal prolapse who are continent.

Adult↗
PubMed2003

Pelvic connective tissue resilience decreases with vaginal delivery, menopause and uterine prolapse.

BACKGROUND: The late onset of pelvic visceral prolapse and incontinence after childbirth injury could be explained by menopause-associated connective tissue weakening. Uterosacral ligament resilience (UsR) was assessed to determine whether it influenced uterine or pelvic floor mobility, or varied with age, vaginal delivery, menopause or histological variations in the ligament. METHODS: UsR was measured by tensiometry in ligaments from 85 hysterectomy specimens, and was correlated with the presence of symptomatic uterocervical prolapse, prehysterectomy uterine and anorectal mobility, patient age, history of vaginal delivery and menopause. Forty-five of these ligaments were examined for ligament thickness, muscle to collagen ratio, and oestrogen and progesterone receptor density. The results were correlated with UsR. RESULTS: UsR was significantly reduced (P = 0.02) in symptomatic uterovaginal prolapse, but there was no correlation with either uterocervical or anorectal descent in women without symptomatic prolapse. There was a significant decrease in UsR with vaginal delivery (P = 0.003), menopause (P = 0.009) and older age (P = 0.005). The uterosacral ligament was significantly thinner and contained fewer oestrogen and progesterone receptors after menopause, but this did not affect UsR. CONCLUSION: Where pelvic floor muscles are weakened, decreases in pelvic connective tissue resilience related to the menopause may facilitate progression to symptomatic pelvic visceral prolapse.

Adult↗
PubMed1981

Cross-sectional echocardiographic visualization of abnormal systolic motion of the left ventricle in mitral valve prolapse.

In 11 of 34 patients with typical mitral valve prolapse on the M-mode echocardiogram, cross-sectional echocardiography in the apical four-chamber view revealed a characteristic abnormality not previously described. In mid- to late-systole the ventricular septum contracted vigorously, forming a bend or sharp convexity toward the left ventricle, while motion of the posterolateral basal left ventricle was diminished and delayed. This finding was not encountered in 35 other patients with innocent systolic murmurs, or in 15 patients with mitral regurgitation of etiologies other than mitral valve prolapse. This abnormal pattern of left ventricular contraction on cross-sectional echocardiography occurred with equal frequency in patients with holosystolic and late-systolic prolapse; it was seen more frequently in patients with severe prolapse than in those with mild to moderate prolapse.

Adult↗
PubMed1997

Internal rectal intussusception seldom develops into total rectal prolapse.

PURPOSE: This study was designed to analyze how often internal rectal intussusception develops into total rectal prolapse. METHODS: Repeated investigations with defecography were performed in 312 patients because of persisting symptoms. In 79 patients who had a rectal intussusception at the first defecography, results of the second defecography and the patients' records were studied. RESULTS: A total of 38 patients had not undergone any surgical treatment of rectal intussusception or rectal prolapse between the first and second defecographies. One of these patients had a rectal prolapse at the second defecography, and another developed a clinical prolapse after the second defecography. CONCLUSIONS: The present study demonstrates that the risk of developing a rectal prolapse in patients with rectal intussusception is small. This risk should, therefore, not be used as an indication for surgery.

Administration, Oral↗
PubMed1999

Functional results of operative treatment of rectal prolapse over an 11-year period: emphasis on transabdominal approach.

PURPOSE: A variety of surgical procedures have been developed to treat rectal prolapse, but there is still no consensus on the operation of choice. The aim of this study was to evaluate the functional results of operative treatment of rectal prolapse during an 11-year period in our department. METHODS: All patients treated for complete rectal prolapse during an 11-year period, from 1985 to 1995, in a single university hospital were included. Of the 123 patients, 22 were men, and the mean age was 59 (range, 15-88) years. The medical records of all patients were reviewed retrospectively, and a questionnaire on bowel symptoms before and after surgery was sent to all 95 living patients. RESULTS: The majority of the procedures (91 percent) were performed by abdominal approach, and the most frequently used open technique was posterior rectopexy with mesh (78 percent). Of the incontinent patients, 35 (63 percent), all those less than 40 years of age and 64 percent of those 40 years or older, were continent postoperatively (P = 0.0001) after a median follow-up of five (range, 1-72) months. According to the questionnaire, after a median follow-up of 85 (range, 16-144) months, only 38 percent of the incontinent patients in the mesh or suture group, 78 percent of patients less than 40 years of age (n = 18), and 52 percent of those 40 years or older (n = 47) claimed to be continent postoperatively. The proportion of patients with constipation was greater after the operation than preoperatively (P = 0.02) and more patients used medication for constipation after than before the operation (P = 0.0001). The overall complication rate was 15 percent, and the mortality rate was 1 percent (1/123). In the mesh or suture group there were 6 (6 percent) recurrent complete prolapses and 11 (12 percent) mucous prolapses. CONCLUSION: Posterior rectopexy with mesh gave good results in our hands. Older age and longer follow-up seem to have a negative effect on the functional outcome of the operation and on the recurrence rate.

Abdomen↗