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PubMedDate not supplied

[Radiculographic symptoms of changes in the adjacent intervertebral disks in the course of lumbar disk prolapse].

From a group of 400 radiculographic examinations the authors selected 34 cases operated upon for disc prolapse. These patients had additional signs of prolapse of the neighbouring intervertebral discs. The analysis showed that the latter signs were present mostly in the discs situated above the level of disc prolapse. In only two cases these changes were found in the disc situated below the level of prolapse. The sign of bulging-in dural sac in radiculography may be an impression of bulging disc and, much less frequently, it can be caused by a slight prolapse of the disc. Demonstration of these changes in contrast-medium investigations of the vertebral canal should be taken into account during the planned operation. The importance of disturbances of spinal biomechanics in the development of multilevel discopathy is stressed.

Humans↗
PubMed1994

[Intra-sphenoidal prolapse of the internal carotid artery. Computed tomography of 300 sinuses].

OBJECTIVES: Endonasal sphenoidotomy is a high risk operation: fatal complications due to direct lesion to the internal carotid artery have been reported. We conducted a prospective analysis of carotid prolapse within the sphenoid cavity in order to draw attention to this dangerous anatomic variant. METHODS: Tomodensitometry of the sinuses was performed in 150 patients (mean age 35 years; range 20-70) with inflammatory nasal symptoms of less than one year duration (mean 5.2 months). Cases with benign or malignant tumours, polyposis or a past history of sinus trauma were excluded. Transversal sections were analyzed by one radiologist and one ear-nose-throat specialist. The diagnosis of carotid prolapse was defined as an intrasphenoid protrusion of the artery at least as long as one-third of its circumference. Results of the analysis were expressed as percent for 300 sinuses. RESULTS: Prolapse of the internal carotid was found in 20.3% of the sinuses (n = 61). In all cases a thin (> 1 mm) bony structure surrounded the artery. No prolapse was observed into the posterior ethmoid cells. CONCLUSIONS: Intrasphenoid prolapse of the internal carotid artery is a major risk factor in nasal and sinus surgery. The high incidence (1 out of 5 sinuses) indicates the need for routine preoperative imagery to reduce surgical risk.

Adult↗
PubMed2005

Robotic-assisted pelvic organ prolapse surgery.

BACKGROUND: This study describes technical aspect and short-term results of pelvic organ prolapse surgery using the da Vinci robotic system. METHODS: During a 1-year period, 18 consecutive patients with pelvic organ prolapse were operated on using the da-Vinci system. Clinical data were prospectively collected and analyzed. RESULTS: All but one procedure was successfully completed robotically (95%). Performed procedures were colpohysteropexy (n = 12), mesh rectopexy (n = 2), or sutured rectopexy combined with sigmoid resection (n = 4). Average setup time was 21 min and significantly decreased with experience. Mean operative time was 172 min (range, 45-280). There were no mortality and no specific morbidity due to the robotic approach. Mean hospital stay was 7 days. At 6 months, all patients were free of pelvic organ prolapse and stated that they were satisfied with anatomical and functional results. CONCLUSION: Our experience indicates that using the da-Vinci robotic system is feasible, safe, and effective for the treatment of pelvic organ prolapse.

Adult↗
PubMed1994

Clinical features of urinary incontinence and urogenital prolapse in a black inner-city population.

OBJECTIVE: Our purpose was to describe the clinical features and urodynamic findings of a black female inner-city population with urinary incontinence and uterovaginal prolapse. STUDY DESIGN: A retrospective review of the urogynecoloy records of 159 black female patients was performed. RESULTS: Genital prolapse was common. A cystocele was identified in 116 patients, a rectocele in 88 patients, and uterine or vaginal vault prolapse in 41 patients. Subtracted multichannel cystometry revealed detrusor overactivity in 58 patients, genuine stress incontinence in 44 patients, and mixed incontinence in 30 patients. Sixteen patients had normal urodynamic studies. The presence of a cystocele and the physical sign of stress incontinence at initial examination were found equally in patients with genuine stress incontinence, detrusor instability, and mixed incontinence at cystometry. There was no correlation between other commonly associated clinical factors (such as age, parity, and obesity) and the urodynamic diagnosis. CONCLUSIONS: Many of the factors commonly assumed to predispose women to the development of incontinence and prolapse may not apply to the black inner-city population. Urodynamic testing to establish the correct diagnosis is required, because the correlation between symptoms, physical examination, and urodynamic findings is relatively poor in this population.

Adult↗
PubMed1998

A new operation for genitourinary prolapse.

PURPOSE: A new method to support female prolapsed pelvic organs is presented, which involves use of nonabsorbable mesh cut in a hammock shape. The approach is transvaginal and the novelties are the way in which the mesh is anchored and its considerable size. MATERIALS AND METHODS: The mesh is anchored transversally between the 2 arcus tendineus of the endopelvic fascia and in the anteroposterior direction between the bladder and uterine necks. The anteroposterior dimension of the mesh must completely cover the cystocele. From January 1996 to June 1997 this technique was used in 44 patients ranging in age from 43 to 86 years. The patients presented with various degrees of incontinence and combinations of cystocele, uterine or vaginal vault prolapse, rectocele and/or enterocele. Cystocele and incontinence were classified according to the SEAPI QMM scales and the other anatomical defects according to the Beecham classification. Preoperative analysis of all patients included cystography, video urodynamics, and pelvic and abdominal echography. RESULTS: All patients affected by some degree of incontinence were cured. Patients with prolapse without incontinence were completely satisfied with the operation. Uterine prolapse was third degree in 6 of 20 patients and it partially recurred in 3. Cystography in all patients demonstrated excellent repair of the descensus. Sexual life and menses did not change, and no pelvic fibrosis or hydroureteronephrosis occurred. Followup ranges from 9 to 23 months (median 13.9). CONCLUSIONS: This technique has broad application and is simple to perform. Longer followup will prove its merits definitively.

Adult↗
PubMed1999

Female pelvic organ prolapse: diagnostic contribution of dynamic cystoproctography and comparison with physical examination.

OBJECTIVE: The aim of this study was to assess the contribution of dynamic cystoproctography to the evaluation of female pelvic organ prolapse and to compare this contribution with that of physical examination. MATERIALS AND METHODS: The presence or absence of rectocele, enterocele, sigmoidocele, and cystocele on physical examination and on cystoproctography was retrospectively analyzed in 170 consecutive patients. For each of these diagnostic methods, organ prolapse was graded as small, moderate, or large on the basis of specific, defined measurements. RESULTS: A rectocele was detected by proctography in 155 patients (91%); 119 (77%) of these rectoceles were also found on physical examination. Barium trapping at proctography was related to rectocele size. Proctography showed an enterocele in 47 patients (28%); 24 (51%) of these enteroceles were also found on physical examination. Physical examination also found 44 enteroceles that could not be corroborated radiologically. At proctography, the enteroceles were relatively large, extending an average of 7.3 cm below the vaginal apex. Eight patients had sigmoidoceles, none of which were found on physical examination. A cystocele was shown by cystoproctography in 159 patients (94%); 132 (83%) of these cystoceles were also found on physical examination. CONCLUSION: The correlation between finding prolapsed pelvic organs on dynamic cystoproctography and finding them on physical examination varies. Most radiographically detected rectoceles and cystoceles are found on physical examination, whereas the correlation for enteroceles and sigmoidoceles is poor. Dynamic cystoproctography provides direct visualization and quantification of female pelvic organ prolapse, information that usually can only be inferred by physical examination.

Adult↗
PubMedDate not supplied

[Post-partum urogenital and perineal prolapse].

BACKGROUND: It is well known that vaginal birth, even under apparently normal circumstances, involves a significant mechanical straining of the various muscular connective structures which make up the pelvic floor and that an unusual strain of the perineal plates can cause morphologic-functional alterations which are not entirely reversible. The integrity of structures which make up the "pelvic floor" and the "endopelvic fascia" is the fundamental element to maintaining a normal anatomic position of the pelvic organs in the various functional conditions. Consequently prolapse of female pelvic organs can be linked back to the functional limitations of perineal plates (muscular support fascia system) and/or of the ligaments of the sub-peritoneal endopelvic connective tissue (ligament suspension system). METHODS: After birth 537 mothers underwent a urological and gynecological examinations as follows: collection of clinical data regarding pregnancy development and birth; medical history regarding the number of day- and night-time urinations, urinary volume, possible encouraging factors and pre-urinary sensations; objective urological and gynecological examination (pubo-coccygeal test, highlighting of possible agonistic and antagonistic muscular synergies, stress test, evaluation and staging of vaginal prolapse according to Baden and Walker; instrumental evaluation in cases of post-partum urinary incontinence. Simple regression analyses were carried out where prolapse of various vaginal segments were proportionately related to the various risk factors. RESULTS: Maternal age at birth, parity, weight before pregnancy and at term, weight increase, duration of second stage of labour, development and characteristics of the birth, perineal condition and neonatal weight were all variables considered risk factors while prolapse in each vaginal segment, PC-test, involuntary reflex execution of opposite command and uterine retroversion were all "response variables" whose dependence on various risk factors was studied. Analysis of the associations between the various pairs of variables showed a correlation, both positive and negative, whether the population considered was that of all mothers or that of primiparae. CONCLUSIONS: In the light of the results of this study, it can be said that there are two important pathogenetic factors: the tissue factors and the iatrogenic factor. Elevated maternal age and multiparity underline the role of the tissue factor in the pathogenesis of obstetric perineal damage. With regard to the iatrogenic factor it is interesting to note a higher concentration of symptomatic women cases where labour had been induced or birth had been achieved through instrumental delivery.

Analysis of Variance↗
PubMed1991

[Rectal cysts and rectal functional disorders after surgical treatment for genital prolapse].

From 1966 to 1984, 417 female patients were operated for genital prolapse in the department of surgical gynecology of the Salpêtrière Hospital (Pr Blondon's department). The results of the surgical treatment were studied in the posterior perineum from an anatomical (rectocele) and functional point of view (indiced rectal disorders). This study allows drawing several conclusions: when the context leads to deciding to operate the prolapse through an abdominal approach, it is desirable, in order to reduce the risk of postoperative rectocele, to systematically insert a posterior prosthetic band, which will be tethered as low as possible on the posterior aspect of the vaginal (after a sufficiently low extensive rectovaginal cleaving). The Orr-Loygue rectopexy must remain indicated for rectal prolapse, even more so as it is associated with incontinence. Since this procedure often causes constipation of even more complex exoneration disorders, it must be reserved for prolapse associated to a large rectocele (type IV) or an invalidating dyschezia.

Constipation↗
PubMed1982

[Observations on prolapse of the aortic cusps].

The patterns of valve motion were analyzed in 14 patients with combined aortic and mitral valve prolapse by two-dimensional echocardiography. Four patients have also tricuspid valve prolapse. In one we could find evidence of a myxomatous pulmonic valve with prolapse of the posterior cusp. By two-dimensional echocardiography all patients had redundant aortic leaflets bulging into left ventricular outflow tract during diastole. M-mode examination of the aorta was normal in five patients; eccentricity of the diastolic aortic valve echo was found in two patients; seven showed multiple echoes from the valve leaflets, with diastolic fluttering. The aortic valve was visualized in the left ventricular outflow tract during diastole in one patient. The size of the aortic root was normal in all. Six patients had transient ischemic cerebral attacks and no evidence of extracranial or intracranial vascular disease by angiography. As polyvalvular prolapse as demonstrated by echo suggest a myxomatous degeneration of the valves, we hypothesize that there may be a causal relationship between TIA and this type of pathological process.

Adolescent↗
PubMed1996

[Markers of connective tissue dysplasia in patients with idiopathic atrioventricular valve prolapse and anomalously sited chordae tendineae].

Phenotype was investigated in 86 patients with idiopathic prolapses of atrioventricular valves and in 21 patients with displaced chordae. 10 and 4 markers of connective tissue dysplasia were distinguished for patients with the prolapses and anomalous chordae, respectively. For patients with dysplasia of connective tissue of the heart a modified version of phenotypical length is proposed: norm-anomalous chordae--prolapse of the 1st degree--prolapse of the 2nd degree. For patients with 3 and more markers echo-CG registration is advisable to reject mitral and/or tricuspid valves.

Abnormalities, Multiple↗
PubMed1988

The cause of rectal prolapse in children.

Fifty-four pediatric patients with rectal prolapse (RP) were identified by review of medical records from 1977 to 1987. Rectal prolapse was attributed to chronic constipation (15 patients), acute diarrheal disease (11 patients), cystic fibrosis (CF) (six patients), and neurologic/anatomic abnormalities (13 patients). In nine patients, no underlying cause was identified. The patients with CF did not differ from the other groups in terms of age at time of onset of prolapse, growth measurements, or number of episodes of prolapse. All patients with CF had a history of abnormalities or presented with signs and symptoms consistent with this diagnosis; none had a history of constipation. Although physicians can be reassured that CF is not a likely diagnosis in patients with RP and acute diarrheal disease or a clear history of constipation, a sweat test is indicated in all such cases as well as in those in which there is no apparent underlying cause. A sweat test is not usually indicated in patients with RP in association with underlying anatomic abnormalities.

Child↗
PubMed1979

Exercise and anxiety neurosis: comparison of patients with and without mitral valve prolapse.

It has been hypothesized that mitral valve prolapse may account for a substantial number of patients who have symptoms of chronic anxiety neurosis. In a previous investigation, this hypothesis was confirmed in eight of 21 patients who had anxiety neurosis. In the present investigation, we reevaluated the hypothesis that persons with anxiety neurosis have impaired exercise ability by exercising 20 of the anxiety neurotics according to a standard treadmill exercise protocol. Compared with the control group, the anxiety neurotics required less exercise to achieve an equivalent heart rate and therefore their estimated maximum oxygen consumption was less, thus confirming the hypothesis. However, this difference was due entirely to the anxiety neurotics with mitral valve prolapse, and those without prolapse did not differ significantly from the controls. This suggests that impaired exercise tolerance in anxiety neurotics may be attributable to a subgroup of these patients with mitral valve prolapse.

Adult↗
PubMed2000

Glomerular prolapse as precursor of one type of segmental sclerosing lesions.

A distinctive segmental glomerular abnormality is confined to the region of the tubular opening. The hypothesis was that this followed prolapse of the tuft into the tubule. Analysis was made of 39 renal biopsy specimens with acute postinfective glomerulonephritis, later material from ten cases, four specimens from three women with pre-eclampsia, and 21 control specimens, with morphometry of glomeruli and immunohistological examination for immunoproteins and monocytes/macrophages. Prolapse was found in 14 specimens with acute postinfective glomerulonephritis, associated in eight with adhesion to Bowman's capsule and local alterations in the tuft, which together constitute early tip changes. Another three had early tip changes only and eight others had thin adhesions between the tuft and capsule next to the tubular opening. Later material confirmed this order of development and showed another late change, with sclerosed and hyaline material in the tuft and adhesion at the tubular origin. Findings in pre-eclampsia were comparable. Glomeruli were significantly larger in acute postinfective glomerulonephritis than in controls and were shown by others to be larger in pre-eclampsia than in normal pregnancy. Immunohistology showed IgM and a few foamy monocytes/macrophages in early tip changes but not in prolapsed loops. Glomerular prolapse appears to be a temporary consequence of acute enlargement of the tuft, probably causes mechanical damage to epithelial cells, and is a precursor of permanent structural changes near the tubular origin. This gives a unifying hypothesis to explain how these changes can be seen in acute postinfective glomerulonephritis, pre-eclampsia, and many other human and experimental renal disorders.

Acute Disease↗
PubMedDate not supplied

Uterine prolapse associated with bladder exstrophy: surgical management and subsequent pregnancy.

Congenital bladder exstrophy affects 1 in 125,000 to 250,000 females. Consisting of absence of the anterior abdominal wall with exposure of the ureteral orifices, failure of pubic symphysis fusion, and deficient anterior pelvic diaphragm musculature, bladder exstrophy is frequently associated with genital prolapse. Pregnancy may be complicated by recurrent urinary tract infections, preterm labor, mild procidentia, and malpresentation. Due to the rarity of the condition, there is a corresponding scarcity of obstetric literature regarding management during pregnancy. We report the case of a young woman with surgically repaired bladder exstrophy who developed genital prolapse. The uterus was suspended using a sacral colpopexy utilizing a Gore-Tex graft. Subsequently, the patient became pregnant and delivered a healthy male infant at 35 weeks' gestation via cesarean section (without recurrence of the genital prolapse postpartum). Sacral colpopexy to correct genital prolapse associated with bladder exstrophy may preserve fertility in young patients.

Adolescent↗
PubMedDate not supplied

Aortic root dilatation and mitral valve prolapse in the fragile X syndrome.

Forty patients with fragile X [fra(X)] or Martin-Bell syndrome, confirmed by chromosome analysis, underwent full cardiac evaluation including physical examination, chest film, electrocardiography (ECG), and M-mode and 2-dimensional echocardiography. Thirty-four males and six females were studied. Although all patients were asymptomatic, seven males were found to have mild aortic root dilatation. All seven also had evidence of mitral valve prolapse. Twenty-two (55%) of the study patients had mitral valve prolapse with either a click or murmur heard on physical examination and confirmation by M-mode echocardiography. The frequency of mitral valve prolapse was the same in males and females, but 80% of males older than 18 years had mitral valve prolapse. These findings support the hypothesis of a connective tissue dysplasia in the fra(X) syndrome.

Adolescent↗
PubMed2003

Prevalence of mitral valve prolapse in Stickler syndrome.

The prevalence of mitral valve prolapse in Stickler syndrome has been reported to be much higher than in the general population. As a result, it has been recommended that all patients with Stickler syndrome undergo routine echocardiography and have antibiotic prophylaxis prior to surgery. The purpose of this study was to evaluate the prevalence of mitral valve prolapse in a large cohort of UK patients with Stickler syndrome in whom the clinical diagnosis has been confirmed by molecular genetic analysis. Probands and pedigrees were identified from the Vitreoretinal Service database according to previously published criteria. Ophthalmic, skeletal, audiometric, and orofacial features were assessed. Affected individuals underwent a full cardiological examination including auscultation and two-dimensional echocardiography. Mutation analysis of the COL2A1 and COL11A1 genes was carried out. Seventy-eight patients from 25 pedigrees were studied. Mutation analysis confirmed the clinical diagnosis in every pedigree. No patient was found to have clinical evidence of cardiovascular disease and no patient had significant mitral or other valvular prolapse on echocardiography. These data from a large cohort of UK patients with proven Stickler syndrome do not suggest an increased incidence of mitral valve prolapse over and above that found in the general population. Routine echocardiography screening and use of preoperative antibiotics are unnecessary and should be reserved for those individual cases where there is clear clinical indication.

Cohort Studies↗
PubMed1980

Clinical and manometric evaluation of rectal prolapse and incontinence.

The clinical presentation and manometric findings in 46 patients with rectal prolapse and/or incontinence are reported. Basal and maximal squeeze pressures in the anal canal of patients with prolapse alone did not differ from the pressures in age and sex-matched controls whereas anal pressures in both groups of patients with incontinence were significantly lower than in controls. Physiotherapy and faradism had no therapeutic value in rectal prolapse but gave improvement in 30 per cent of patients with incontinence. Rectopexy gave satisfactory results in all the patients with prolapse and improved incontinence in 70 per cent. Post-anal repair cured 87 per cent of patients with idiopathic anorectal incontinence or with persistent incontinence after rectopexy. No form of treatment was associated with any significant elevation of anal pressures.

Adolescent↗
PubMed1980

The occult rectal prolapse syndrome.

Occult rectal prolapse is a condition of young adults which causes problems in diagnosis. Symptoms consist of tenesmus and the passage of blood and mucus associated with constipation and straining at stool. The rectal prolapse often remains unrecognized for a long time because demonstration of the prolapse is difficult. There are characteristic changes in the rectum on clinical examination and these should alert the clinician to the diagnosis. Treatment of the prolapse relieves the symptoms.

Adolescent↗