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PubMed1994

Heavy lifting at work and risk of genital prolapse and herniated lumbar disc in assistant nurses.

Lifting of heavy burdens increases the intra-abdominal pressure, and may induce an increased risk of prolapse of the female internal genitals. While taking care of patients, the nursing staff in hospitals and nursing homes are exposed to heavy lifting. Scientifically uncontrolled causal observations among assistant nurses gave rise to the assumption of an increased risk. To test this hypothesis, a register study was carried out to investigate the risk of genital prolapse among assistant nurses compared with the female Danish population in general. For validation, the incidence of operation due to herniated lumbar disc was investigated. Two registers were used for the analyses, a pension fund register and the Danish National Registry of Hospitalized Patients. Some 28,619 assistant nurses, aged 20-69 years, and 1,652,533 controls of similar age were included. Operations due to genital prolapse and herniated lumbar disc were recorded during one year. The odds ratio (OR) with 95 per cent confidence intervals for the risk of operation due to genital prolapse was significantly increased among assistant nurses, OR = 1.6 (1.3-1.9), P < 0.0001. Correspondingly, the risk of operation for herniated lumbar disc was significantly increased for assistant nurses, OR = 1.6 (1.2-2.2), P < 0.01. We conclude that operations due to genital prolapse are more common among assistant nurses than among the overall female population. Based on this finding, we hypothesize that heavy lifting at work may be the underlying cause. This study confirmed the suggestion of previous epidemiological studies that herniated lumbar disc is associated with heavy lifting at work.

Adult↗
PubMed1995

Urethral prolapse: an often misdiagnosed cause of urogenital bleeding in girls.

Urethral prolapse is an uncommon disorder in girls, usually presenting as "vaginal" bleeding. This retrospective chart review focuses on the high rate of misdiagnosis of urethral prolapse and describes treatment modalities based on 24 patients seen at a major children's hospital during an 11-year span. Their mean age was 4.9 years. The initial diagnosis, made by the referring pediatrician or emergency physician, was correct in only five girls (21%). Twenty children presented with urogenital bleeding. Operative correction was employed as initial treatment in 16 girls, with one recurrence. The remaining eight children were treated nonoperatively. Of these, five showed no improvement and underwent surgical repair. Although most children eventually require resection of the prolapsed urethral mucosa, nonoperative treatment is appropriate for asymptomatic girls with a mild degree of urethral prolapse. Increased physician awareness of urethral prolapse is desirable to enhance early recognition and to avoid unnecessary examinations and parental concern.

Child↗
PubMed1997

Comparison of three perineal procedures for the treatment of rectal prolapse.

BACKGROUND: The optimal surgical procedure for the management of rectal prolapse is still under debate. Therefore, the aim of this study was to compare the short-term outcome of three perineal procedures in patients with rectal prolapse. METHODS: Between April 1989 and April 1995, all consecutive patients who had Delorme's procedure, perineal rectosigmoidectomy, or perineal rectosigmoidectomy with levatoroplasty for full-thickness rectal prolapse were clinically and physiologically assessed before and after surgery. A standard incontinence scoring system, based on the frequency and type of incontinence (0 = full continence, 20 = complete incontinence), was used to compare the results of each procedure. Additionally, morbidity and mortality and clinical and functional outcome were evaluated and compared. RESULTS: The study group of 61 patients who had perineal procedures for rectal prolapse included 55 women and 6 men, with a mean age of 75 years (range, 48 years to 101 years); 16 patients died of comorbid conditions between 3 months and 42 months after surgery. There were statistically significant differences among the groups relative to short-term recurrence rates, postoperative incontinence scores, mean resection length, coloanal anastomotic stricture, and leak. However, preoperative and postoperative anal manometry did not reveal statistically significant changes within or between the groups. CONCLUSIONS: Perineal rectosigmodectomy with levatoroplasty has the best short-term outcome for the treatment of rectal prolapse.

Aged↗
PubMed1999

Fallopian tube prolapse after hysterectomy.

BACKGROUND: Fallopian tube prolapse is reported to most commonly occur after vaginal hysterectomy. Both diagnosis and management have varied, resulting in differing efficacies of treatment. METHODS: We reviewed the presentation, diagnosis, management, and outcomes of 18 cases of tubal prolapse in 17 women. RESULTS: Most cases (65%) occurred after abdominal hysterectomy. The post-hysterectomy course was complicated by cuff cellulitis in three women, an infected cuff hematoma in one, and post-extubation pulmonary edema in one; four were observed for elevated temperature only. At presentation, 44% complained of dyspareunia, 39% vaginal bleeding, 33% vaginal discharge, 28% abdominal pain, and 28% were asymptomatic. Seven women had vaginal excision (one requiring an additional abdominal procedure), three had laparotomy with salpingectomy, and seven (41%) had spontaneous disappearance of prolapsed fallopian tube without treatment. CONCLUSIONS: In our series, tubal prolapse most commonly occurred after abdominal hysterectomy. Moreover, women with tubal prolapse may be asymptomatic, and observation alone may lead to resolution.

Abdominal Pain↗
PubMed2005

Surgery for pelvic organ prolapse: current status and future perspectives.

PURPOSE OF REVIEW: The aim of this article is to highlight the latest developments and future perspectives of the surgical treatment of pelvic organ prolapse. RECENT FINDINGS: The review of the relevant literature was performed through a complex search strategy including both free text and medical subject heading (MeSH) protocols. The search was limited to records written in English, concerning humans, and published in 2004. In addition, the Cochrane Database of Systematic Reviews was browsed for records regarding surgical treatment of pelvic organ prolapse. The selected papers were ranked according to the grade of evidence provided. Eight hundred and fifteen records were selected from a Medline search. We reviewed the abstracts of the records and selected 61 papers concerning the topic of the review. There was only one meta-analysis and four randomized clinical trials. All the other chosen studies were retrospective. The quality of the evidence found was poor. The evidence supported the use of mesh in anterior vaginal wall prolapse surgery and the indications both for abdominal sacrocolpopexy in case of vaginal vault prolapse and posterior colporrhaphy in case of rectocele. However, the data regarding lower urinary tract, bowel, sexual functions, generic quality of life issues, and long-term outcome were insufficient. SUMMARY: Well designed, adequately powered, multicenter prospective randomized studies should be planned, including appropriate standardizations of methodology of pelvic organ prolapse staging (such as POP-Q system) and indications for treatment. Moreover, validated questionnaires should be used to assess the impact of surgery on functional and quality of life issues at adequate follow-up.

Female↗
PubMed2004

Factors associated with pelvic floor dysfunction with emphasis on urinary and fecal incontinence and genital prolapse: an epidemiological study.

OBJECTIVE: To describe a general population of women with regard to factors associated with urinary and fecal incontinence and genital prolapse symptoms. METHODS: A questionnaire about medical background, urinary and fecal incontinence and genital prolapse symptoms was mailed to 100040-year-old and 100060-year-old Swedish women. Associations were described by odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Sixty-seven percent answered the questionnaire. Multivariate analysis showed urinary incontinence to be associated with anal sphincter rupture [OR 4.4 (95% CI 1.0-18.8)], pelvic heaviness [3.8 (2.1-7.0)], body mass index (BMI) >or=30 kg/m2[3.7 (2.0-6.7)], multiparity [1.8 (1.0-3.4)], varicose veins surgery [1.9 (1.2-3.2)] and age [1.9 (1.2-3.2)]. Univariate analyses revealed statistically significant associations between urinary incontinence and incontinence for flatus [4.8 (3.0-7.8)], for liquid stool [5.0 (2.9-8.6)] and for solid stool [5.9 (2.4-14.2)]. Chronic bronchitis [5.7 (1.7-18.9)] was strongly associated with urinary incontinence but was only reported by the older age group. Prolapse symptoms were strongly associated with both urinary and fecal incontinence. Prolapse symptoms as opposed to urinary and fecal incontinence seemed to be associated more with injuries at delivery than with chronic pelvic floor strain. CONCLUSIONS: Women with urinary incontinence are also likely to suffer from fecal incontinence and prolapse and vice versa. Other associated factors for pelvic floor dysfunction were overweight, and especially obesity, chronic bronchitis, vaginal delivery and multiparity, age, heredity and diseases suggestive of collagen disorders. A multidisciplinary management of women with pelvic floor symptoms is suggested and possible prevention is discussed.

Abdomen↗
PubMed2004

Operation for pelvic organ prolapse: a follow-up study.

OBJECTIVE: Long-term results of surgery for pelvic organ prolapse in terms of objective and subjective cure rates, postoperative complications and side-effects were studied retrospectively. METHODS: Two hundred and sixty-nine women underwent surgery between 1986 and 1988 and were invited to a follow-up visit in 1998-99. One hundred and twenty-eight (47%) women attended the follow-up. In the time between surgery and follow-up, 67 (25%) women had died. The medical records were reviewed for women not attending follow-up (n = 131), revealing a higher age and a more severe prolapse in the lost to follow-up group. RESULTS: The subjective cure rate, with cure of all symptoms of pelvic organ prolapse, was 46% (n = 59). The objective cure rate, with satisfactory anatomic outcome, was 56% (n = 72). If perfect results had been attained in the women who did not undergo follow-up examination, the subjective and objective cure rates would be 73% and 79%, respectively. Previous prolapse surgery, a traumatic delivery, urinary incontinence and a prolapse stage III or more seemed to be risk factors for an adverse outcome. CONCLUSIONS: In evaluating the cure rate of pelvic floor surgery not only the anatomic outcome should be studied but also the outcome in terms of side-effects and/or symptoms as resolved, persistent or new onset. An unsatisfactory anatomic outcome was not necessarily associated with symptoms. The modest cure rate after surgery may be due to the aggravation with time of pelvic floor disorder, this confounding the results of surgery.

Adult↗
PubMed2005

Surgery for pelvic organ prolapse in women of 80 years of age and older.

BACKGROUND: To investigate the long-term results of women over 80 years of age following surgery for pelvic organ prolapse. Design. Retrospective, descriptive study. METHODS: We reviewed all records of women of 80 years and older operated for pelvic organ prolapse; all patients alive were contacted through a postal questionnaire. RESULTS: A total of 2058 operations for pelvic organ prolapse were performed in the study period. One hundred and twenty-eight patients were 80 years and older with the mean age of 83 years (range 80-92 years). In three cases, serious complications occurred, and one of them died shortly after the operation. Follow-up was done with a postal questionnaire. Eighty-eight percent of patients who were alive at the time of data analysis returned the questionnaire. The mean duration of follow-up was 28 months (range 1-80 months). There were no patients who reported a relapse of prolapse. Urinary incontinence, urge, stress, or mixed incontinence, was present in almost half of the cases. The time to full recovery after the operation was experienced to be less than 3 months for 48%. General satisfaction with the procedure was high with 88% being (very) satisfied. CONCLUSION: The operative correction of a pelvic organ prolapse in a group of women 80 years and older is a successful operation, with an acceptable morbidity and a high satisfaction of the patients.

Aged↗
PubMed1980

Concealed rectal prolapse.

In a series of 97 patients with rectal prolapse 36 were unaware that the prolapse was occurring. Failure to recognize the prolapse may cause delay in diagnosis and inappropriate treatment. In most instances the prolapse was considered to be primary and responded well to surgical repair; however, in a few patients the prolapse seemed to follow prolonged straining, and in these surgical repair is not so successful.

Adolescent↗
PubMed1992

Mitral valve billowing and prolapse--an overview.

Three decades after it was demonstrated that nonejection systolic clicks and late systolic murmurs have a mitral valve origin and that a specific syndrome is associated with the primary degenerative mitral lesion, numerous questions remain unanswered. A principal cause of confusion is the use of the term 'prolapse', which essentially implies a pathological state, in many patients with minimal evidence of a mitral valve anomaly. It should be recognised that no specific feature, whether evaluated by high standard echocardiography or indeed by careful morphological and histological examination, can be defined which distinguishes a normal variant from a pathological valve. There is a gradation from the normal billowing during ventricular systole of mitral leaflet bodies to marked billowing. With advanced billowing or floppy leaflets, failure of leaflet edge apposition supervenes (true prolapse). This is functionally abnormal and allows mitral regurgitation. Prolapse in turn may progress to a flail leaflet and hence gross regurgitation. Relatively rare complications of this degenerative mitral valve anomaly include systemic emboli, infective endocarditis, arrhythmias and, arguably, autonomic nervous system abnormalities. An attempt is made to clarify the management of some symptoms and other aspects of mitral prolapse-including rheumatic anterior leaflet prolapse (without billowing) which remains prevalent in South Africa and Third World countries.

Arrhythmias, Cardiac↗
PubMed2000

Surgical management of genital prolapse: is chain cystourethrography useful for evaluating anatomical corrections and urinary symptoms after surgery?

OBJECTIVE: To evaluate the relationship between chain cystourethrography and surgery for genital prolapse and urinary symptoms. METHODS: A retrospective study of women with genital prolapse was conducted from January 1991 through December 1997. To assess the preoperative and postoperative anatomical situations objectively, chain cystourethrography was performed. RESULTS: Fifty-seven patients underwent surgical repairs for genital prolapse. All of them recovered from the genital prolapse both subjectively and objectively after surgery. Chain cystourethrography is useful for evaluating postoperative anatomical corrections. However, 6 patients (12%) suffered from a recurrent feeling of genital prolapse, and 14 patients (28%) had urinary symptoms postoperatively. CONCLUSIONS: Our treatment showed good anatomical corrections based on chain cystourethrography, and there were no prognostic differences among the surgical procedures. However, anatomical correction does not always mean improvement of urinary symptoms. Further studies are needed to clarify what factors contribute to the prognosis in such cases.

Adult↗
PubMed2004

Transvaginal repair of anterior and posterior compartment prolapse with Atrium polypropylene mesh.

OBJECTIVE: To determine the efficacy and safety of a new technique using Atrium polypropylene mesh (Atrium, Hudson, New Hampshire, USA) as an overlay graft for repair of large or recurrent anterior and posterior compartment prolapse. DESIGN: A retrospective review of women who had vaginal prolapse surgery with Atrium mesh reinforcement. SETTING: Tertiary referral urogynaecology unit in Australia. POPULATION: Forty-seven women where mesh was placed under the bladder base with lateral extensions onto the pelvic sidewall, 33 women where a Y-shaped mesh was placed from the sacrospinous ligaments to the perineal body and 17 women who had mesh placement in both compartments. METHODS: Women were assessed by site-specific vaginal examination pre-operatively and post-operatively at six weeks, six months and two years. MAIN OUTCOME MEASURES: All complications. Rate of recurrent prolapse assessed by the Baden-Walker halfway classification system. RESULTS: Mean follow up was 29 months (range 6 to 52). Four of 64 women with anterior mesh placement (6%) developed a grade 2 asymptomatic cystocele. Five women (5%) required further surgery for recurrent prolapse at a non-mesh site. Erosion occurred in nine women (9%). Three healed after intravaginal oestrogen cream, five after excision of exposed mesh and vaginal closure and one woman also had surgical closure of a rectovaginal fistula. The risk of mesh erosion decreased over the study period. Urinary, coital and bowel symptoms were significantly improved following surgery. CONCLUSIONS: This technique shows promise in correcting pelvic organ prolapse. Vaginal mesh erosion is the most common complication and is related to surgical experience.

Adult↗
PubMed2005

Functional and anatomical outcome of anterior and posterior vaginal prolapse repair with prolene mesh.

OBJECTIVE: To evaluate the effects of prolene mesh on urinary, bowel and sexual function in prolapse surgery. DESIGN: Prospective observational study on consecutive women. SETTING: Two referral uorgynaecological units in Italy. POPULATION: Women requiring prolapse repair for anterior or posterior vaginal prolapse. METHODS: All women were assessed for urinary, bowel, prolapse symptoms and dyspareunia pre- and post-operatively. Urodynamics was performed in selected cases. Surgery consisted of an anterior or posterior repair plus a prolene mesh. Follow up was after 1, 6 and 12 months. The ANOVA test was used for statistical analysis. MAIN OUTCOME MEASURES: Vaginal anatomical restoration, urinary, bowel and sexual function. RESULTS: We recruited 63 women (mean age 63 years) with a mean follow up of 17 months. Anatomically, the success rate was 94%. Thirty-two women had an anterior repair. Among this group, the sexual activity rate did not alter but dyspareunia increased by 20%. Urge and stress incontinence did not change post-operatively but urgency improved in 10% and 13% had vaginal erosion of the mesh. Thirty-one women had a posterior repair. Among this group, sexual activity decreased by 12% and dyspareunia increased in 63%. Constipation improved in 15% and anal incontinence in 4%, and 6.5% of women had vaginal erosion of the mesh and one required mesh removal for pelvic abscess. CONCLUSIONS: Although this study shows good anatomical results with the use of prolene mesh for prolapse repair, there was a high rate of morbidity. We believe that the use of prolene mesh should be abandoned.

Aged↗
PubMed2005

Tissue Fixation System posterior sling for repair of uterine/vault prolapse -- a preliminary report.

AIMS: To assess the posterior Tissue Fixation System (TFS) sling for repair of uterine/vault prolapse. PATIENTS AND METHODS: The TFS comprises of two small polypropylene soft tissue anchors connected to an adjustable polypropylene tape. The posterior TFS sling works much like a McCall procedure. The anchors are inserted just lateral to the uterosacral ligaments. Tightening the sling elevates the prolapsed uterus/vaginal vault. The study group comprised 67 patients who were assessed with a 24-h urinary diary, structured questionnaire, transperineal ultrasound, urodynamics, cough stress test, and 24-h pad test, pre and postoperatively. RESULTS: Sixty-seven patients, mean age 65 years (35-87), mean weight 71 kg (38-117 kg), mean 1.6 previous pelvic operations, underwent posterior sling (level 1) repair for uterine/vault prolapse (fourth degree: n = 2; third degree: n = 17; second degree: n = 20; symptomatic first degree: n = 28). Level 2 (n = 18) and level 3 repairs (n = 18) were also performed as required. One patient was lost to the study. At mean 9 months' review (3-15 months), the prolapse repair had been successful in all but one patient. There were however, 14 de novo herniations postoperatively (20%), cystocoele 12, enterocoele 1, rectocoele 1. Operating time for the sling only was 5-10 min, and mean hospital stay was 1.5 days. Minimal analgesia was required. CONCLUSIONS: The preliminary results indicate that the TFS posterior sling appears to work well in patients with uterine/vault prolapse. Longer term follow up and studies by other surgeons are required to fully evaluate this procedure.

Adult↗
PubMed1994

Patent foramen ovale in young stroke patients with mitral valve prolapse.

Because mitral valve prolapse and patent foramen ovale are supposed to promote stroke in young patients, we assessed the frequency of patent foramen ovale in 18 patients younger than 45 years with stroke and mitral valve prolapse diagnosed on echocardiography at the time of stroke, who were admitted to 2 university hospitals. Eleven patients were called back to hospital for contrast transthoracic and/or transesophageal echocardiography, 3 to 7 years after their initial stroke. A patient foramen ovale was found in 9 patients (50%). In 4 re-assessed patients no mitral valve prolapse was found using our present criteria. Six patients with mitral valve prolapse had a patent foramen ovale (43%). Our results suggest that mitral valve prolapse is commonly associated with patent foramen ovale in young stroke patients.

Adolescent↗
PubMed1990

Survival and fertility after uterine prolapse in dairy cows.

Sixty-eight cases of uterine prolapase in pastured dairy cows were treated in 2 consecutive spring calving seasons in East Gippsland, Victoria. Fifty cows survived (73.5%). Of 43 cows available for followup, 36 (84%) conceived in the mating period following the prolapse, taking 10 d longer to conceive than herd mates that calved on the same day. Three of the 36 cows (8%) that conceived, aborted, this occurring in the middle trimester of pregnancy. No prolapses occurred at the following calving but one case had suffered uterine prolapse 2 years previously. The conclusions drawn from these observations are that cows with uterine prolapse have a good chance of surviving if treated, that treatment is cost-effective, that uterine prolapse is unlikely to reoccur and treated cows have a good chance of conceiving. The veterinarians involved in this investigation were reasonably accurate in their ability to predict long term survival but not as good in predicting ability to conceive again.

Age Factors↗
PubMed1990

Visceral prolapse after castration in the horse: a review of 18 cases.

During a 10 year period, 18 horses were treated surgically because of visceral prolapse after castration. Surgery was successful in six cases of omental prolapse and in eight out of 12 cases of intestinal prolapse. To minimise the risk of visceral prolapse, the authors prefer half-closed castration, with proper ligation of the parietal vaginal tunic, to open castration. If adequate treatment is started promptly, prognosis in cases of visceral prolapse is favourable.

Animals↗
PubMed1983

Independence of mitral valve prolapse and neurosis.

An association has been claimed between mitral valve prolapse and the neuroses, especially the anxiety states, panic disorders, and agoraphobia. In this study 103 patients with echocardiographically confirmed mitral valve prolapse were tested with the Eysenck Personality Inventory for neuroticism and with the General Health Questionnaire for the presence of neurotic symptoms. The scores for neuroticism and neurotic symptoms were not significantly different from those of patients with other cardiac diseases or from those of patients presenting in primary care. In addition 50 patients with agoraphobia were screened by echocardiography for mitral valve prolapse, but no cases were detected. It appears that some of the earlier evidence for an association between mitral valve prolapse and neurosis may have been based on groups which were incorrectly diagnosed. It is concluded that mitral valve prolapse and neurosis are independent conditions.

Adult↗