Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Prolapse”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 883 records · Page 49Linked to original sources
PubMed1994

Repair of vaginal vault prolapse by suspension of the vagina to iliococcygeus (prespinous) fascia.

OBJECTIVES: We reviewed our experience with the use of iliococcygeus fascia for repair of vaginal vault prolapse. STUDY DESIGN: A retrospective chart review identified 110 patients who had repair of vaginal vault prolapse by suspension of the vagina to iliococcygeus fascia from March 1981 to April 1991. All patients were followed for a minimum of 3 years. RESULTS: Thirty-seven (33.6%) patients had uterine prolapse with enterocele. Posthysterectomy enterocele was present in 73 (66.4%) patients. All had a complex pelvic floor defect including cystocele or rectocele. Mean age was 54.5 +/- 14.6 years and mean parity was 4.1 +/- 3.2 births. Forty-two (38%) were grand multiparous patients. Five were nulliparous. Length of the procedure was 163.2 +/- 11.4 minutes. Estimated blood loss was 358.2 +/- 253.6 ml. Postoperative urinary catheterization was required for 6.1 +/- 4.1 days. Duration of hospital stay was 5.5 +/- 2.0 days. Three patients had hemorrhage > 750 ml and two required transfusion. One bowel injury and one bladder injury occurred. Forty-one patients had postoperative complications. The patients have been followed up for a minimum of 3 years, and four have had recurrent defects. All recurrent defects involved the anterior vaginal wall. CONCLUSIONS: Suspension of the vagina to the iliococcygeus fascia for repair of vaginal vault prolapse provides excellent long-term results. Critical to the success of vaginal vault suspension are adequate dissection and repair of all fascial defects. Adequate repair of the perineal body also plays a pivotal role. The anterior vaginal wall remains susceptible to recurrence.

Adult↗
PubMed1980

A new concept for the management of rectal prolapse.

The various modified fixation procedures used for rectal prolapse take into account the pathophysiologic concept of complete prolapse of the rectum as a sliding hernia of the pouch of Douglas. The possibility of intussusception by reinforcement of the wall of the extensively mobilized rectum was successfully prevented by a new technique. The use of this simple technique in another form of prolapse, namely, prolapse of the terminal colostomy, convinced us to its usefulness.

Humans↗
PubMed1984

Divided loop colostomy that does not prolapse.

A loop colostomy in infants and children is usually temporary, made through a small abdominal incision, and frequently prolapses its distal limb within months of its construction. Once this prolapse occurs, its permanent reduction is hardly ever achieved. On the other hand, the colostomy that is made at the time of a major laparotomy and the colostomy whose limbs are brought out through separate abdominal wall openings, rarely prolapse. The advantage of the loop colostomy over the latter two types is that it is easier to make and easier to close. Within the last 3 years, 13 infants and children received a form of loop colostomy that way easy to construct, easy to close, and did not prolapse between these two procedures. The loop colostomy (right transverse in all instances) was brought out through a small right upper quadrant transverse rectus cutting incision, and after the fascia was closed on either side of the colon loop, the latter was divided with the distal stoma tunnelled under the skin about 2.5 cm to the left and sutured to a second skin opening with interrupted 4-0 Dexon sutures. The proximal stoma was sutured to the original skin incision in a similar fashion. Function of this modified loop colostomy was no different, and neither the stomal therapist nor the parents had any trouble caring for this double type of colostomy opening. The closure was not any more difficult. Both stomas were mobilized through one longer than usual transverse incision, trimmed off, and the usual end-to-end colostomy anastomosis was made either extraperitoneal or intraperitoneal.

Adolescent↗
PubMed1990

Rectal prolapse: 17-year experience with the posterior repair and suspension.

Using a posterior repair and rectal suspension procedure for those patients who need surgical treatment of rectal prolapse, we have treated 46 patients over a period of 17 years at Children's Mercy Hospital in Kansas City, MO. One patient with caudal dysgenesis died of multiple congenital anomalies following two unsuccessful attempts at posterior repair and suspension. Four patients developed a recurrence afterwards, which was found to be due to sigmoid intussusception and, presumably, had played a major part in their original prolapse. Two of these required resection, one from the transanal approach and one from the transabdominal approach. One resolved spontaneously and another is as yet unresolved. Three patients had minor mucosal prolapse that was transient and two patients had extrusion of silk sutures but continued to have a very satisfactory result. Overall, 42 patients had satisfactory resolution of their rectal prolapse. Three of the four patients who had unsatisfactory results had associated anomalies that contributed to their poor outcome.

Child↗
PubMed1995

Posterior plication of the rectum for rectal prolapse in children.

Fourteen patients with rectal prolapse (age range, 1 to 12 years) underwent posterior plication of the rectum for rectal prolapse. The procedure consisted of (1) natal cleft incision, (2) midline separation of the levator muscle, (3) dissection of two thirds of the circumference of the rectum, (4) plication of the posterior wall of the rectum using U-shaped mattress sutures, and (5) fixation of the sutures of the rectal wall to the coccyx. There has been no recurrence of prolapse in any of the patients. The authors' experience suggests that an elongated rectum is responsible for prolapse. This simple but definitive technique is recommended.

Child↗
PubMed1995

Short-term results and long-term patients' appraisal of abdominal colposacropexy for treatment of genital and vaginal vault prolapse.

OBJECTIVE: To evaluate short-term results and long-term patients' satisfaction of abdominal colposacropexy performed for massive genital prolapse in our institute during a 14-year period. STUDY DESIGN: A retrospective analysis was performed of 101 consecutive women who underwent abdominal colposacropexy. The procedure consisted of retroperitoneal interposition of a Mersilene mesh between a prolapsed vaginal vault or uterus and the anterior surface of the sacrum. A questionnaire was used to evaluate patients' satisfaction after surgery. RESULTS: In the short-term there was an acceptable rate of complications of surgery, comparable with that reported in the literature. Prolapse-related complaints evaluated by questionnaire were markedly diminished after surgery. Pain and functional complaints were only partly improved in a subgroup of patients. Only 32% of the patients responded that they were fully cured after operation. CONCLUSIONS: Abdominal colposacropexy shows a particularly favorable result on prolapse-related complaints. Functional complaints and pain are not substantially relieved by this procedure. The complication rate of surgery is acceptable.

Adult↗
PubMed1993

Urethral prolapse in children.

We report our experience with 23 girls with urethral prolapse. Vaginal bleeding was the most common complaint, and predisposing factors (cough, trauma, and constipation) were found in 10 children. Although reported almost exclusively in black girls, 14 of the 23 patients were white. Three basic techniques were used for therapy: conservative management, ligation over a Foley catheter, and total excision of the prolapse. Ligation over a Foley catheter had a high incidence of complications (partial recurrence, infection, postoperative pain) and is no longer used. The best results were obtained by complete excision of the urethral prolapse. We propose that treatment should be based on the etiopathogenesis of the prolapse and the clinical condition of the child; patients with a single and acute episode of increased abdominal pressure, such as trauma, and those at high risk for general anesthesia are managed by conservative therapy. All others, and patients who fail medical treatment, undergo surgical excision.

Child, Preschool↗
PubMed1992

Assessment of cardiac adrenergic supply in mitral valve prolapse using m-[123I]iodobenzylguanidine scintigraphy.

Presynaptic as well as postsynaptic adrenergic regulation abnormalities are reported in symptomatic patients with mitral valve prolapse. This study was undertaken to evaluate presynaptic sympathetic supply by m-[123I]iodobenzylguanidine scintigraphy in 17 preselected patients with mitral valve prolapse and symptoms suggestive of hyperadrenergic dysautonomia as compared to normal scintigraphic findings. Mitral valve prolapse was echocardiographically proven within the left parasternal long axis view. Percentual activity of m-[123I]iodobenzylguanidine in 33 sectors of all oblique slices along the short axis was calculated relative to the maximal uptake, set at 100%. In general, no significant differences of mean values of sectoral quantitative uptake of m-[123I]iodobenzylguanidine were detectable between patients and the control group. Only in two sectors of the basal anterolateral region P values < 0.01 were present. Thus, using m-[123I]iodobenzylguanidine scintigraphy as marker of cardiac adrenergic supply, no evidence of altered presynaptic hyperadrenergic supply was present in patients with mitral valve prolapse. These findings suggest postsynaptic regulation abnormalities to be preponderant in this condition.

3-Iodobenzylguanidine↗
PubMed1995

P-wave signal-averaged electrocardiogram in patients with idiopathic mitral valve prolapse syndrome and supraventricular arrhythmias.

The aim of the study was to assess whether the P-wave triggered signal-averaged ECG (SAECG) used in patients with idiopathic mitral valve prolapse syndrome could predict the risk of the development of supraventricular arrhythmias. Fifty patients with idiopathic mitral valve prolapse syndrome (15 men, 35 women, mean age: 37 +/- 9 years) were prospectively studied. P-wave triggered SAECG was recorded with a commercially available system (HIPEC-200HA Aerotel). The following parameters were calculated: the root-mean-square voltage for the terminal 10, 20, 30 ms of filtered P-wave (RMS10,20,30) and time duration of filtered P-wave (PWD). Nine patients with mitral valve prolapse syndrome (18%) revealed the occurrence of supraventricular arrhythmias on Holter monitoring whereas of the remaining 41 (82%), no clinically relevant supraventricular arrhythmias were detected. We found PWD values to be significantly longer in patients with supraventricular arrhythmias when compared with those without arrhythmias: 119.8 +/- 6.9 ms vs. 111.7 +/- 12.1 ms, respectively, P < 0.02. We conclude that P-wave triggered SAECG could be a useful technique for detecting patients with idiopathic mitral valve prolapse syndrome at risk of paroxysmal supraventricular arrhythmias.

Adult↗
PubMed1991

Noncardiac chest pain in adolescents and children with mitral valve prolapse.

Chest pain in adolescents and children is usually not of cardiac origin. Of cardiac conditions commonly linked to chest pain in childhood, mitral valve prolapse (MVP) is the most prevalent, but this association has recently been questioned. In light of recent reports of gastroesophageal sources of chest pain in adults with MVP, we performed a comprehensive gastroesophageal evaluation of 17 preadolescents and adolescents with mitral valve prolapse who had chest pain as their presenting symptom. Evaluation consisted of esophageal manometry, Bernstein test, esophageal pH probe, and/or esophagogastroscopy. Fourteen of the 17 patients had at least one abnormal finding. Five patients had esophagitis, five had gastritis, one had high-amplitude esophageal contractions, one had abnormal esophageal manometry with positive Bernstein test, one had esophageal reflux and positive Bernstein test, and one had abnormal manometry with esophageal reflux. The 13 patients with esophagitis, gastritis, reflux, or positive Bernstein test were treated with antacid, with resolution of chest pain in 12 patients. Two of these patients underwent follow-up endoscopy with documentation of improvement. The patient with high-amplitude esophageal contractions was treated with dicyclomine, which resulted in resolution of chest pain. The observation that the chest pain was not related to mitral valve prolapse is important in clinical practice and raises further questions as to whether mitral valve prolapse causes chest pain.

Adolescent↗
PubMed2005

The expression and function of the endothelin system in contractile properties of vaginal myofibroblasts of women with uterovaginal prolapse.

OBJECTIVE: The endothelin-1 system regulates (myo)fibroblast contraction in wound healing. Our aim was to determine endothelin-1 system expression and function in contractile properties of vaginal myofibroblasts of women with uterovaginal prolapse. STUDY DESIGN: Cultures of alpha-smooth muscle actin-positive myofibroblasts that were established at the time of repair surgery for prolapse (n = 30; mean age, 56 +/- 14 years) were analyzed and compared for their expression of the endothelin-1 system and contractile properties to myofibroblasts from primiparous women. RESULTS: Myofibroblasts expressed the complete endothelin system but did not secrete endothelin-1. Endothelin-1 binding was mediated exclusively by the endothelin B-receptor. In 3-dimensional collagen gels, spontaneous contraction of myofibroblasts from estrogen-treated women with prolapse was statistically significantly lower than from young primiparous women. Exogenous addition of endothelin-1 decreased the spontaneous contraction of myofibroblasts. CONCLUSION: Genital myofibroblasts of women with uterovaginal prolapse are poorly contractile, and endothelin-1 further decreases vaginal myofibroblast contraction, which is opposite to observations in skin myofibroblasts.

Actins↗
PubMed2005

Incidence and predictors of prolonged urinary retention after TVT with and without concurrent prolapse surgery.

OBJECTIVES: The purpose of this study was to describe the time to adequate voiding, incidence of urinary retention, and predictors of voiding efficiency and urinary retention after tension-free vaginal tape (TVT) with and without concurrent prolapse surgery. STUDY DESIGN: Medical records of patients who underwent TVT between August 1999 and July 2003 were reviewed. Urinary retention was defined as the need for urethrolysis, urethral dilation, or postoperative catheterization for >6 weeks. Linear and logistic regression models were used to determine predictors of time to adequate voiding and urinary retention. RESULTS: Two hundred sixty-seven patients were available for analysis; 66% had concurrent prolapse repair, 4% had concurrent laparoscopically assisted vaginal hysterectomy (LAVH), and 30% had an isolated TVT. TVT with and without concurrent prolapse repair or LAVH were statistically similar with respect to median days to voiding (8 vs 5) and the rate of urinary retention (11.2% vs 11.3%). Overall, 4.9% underwent urethrolysis, 1.9% received urethral dilation, and 4.1% required prolonged catheterization. Increasing age, decreasing BMI, and postoperative urinary tract infection were independent predictors of time to adequate voiding. Previous history of incontinence surgery was the only independent predictor of urinary retention (Adjusted odds ratio [AOR] 2.96, 95%CI [1.17-7.06]). CONCLUSION: Concurrent prolapse surgery does not appear to significantly alter postoperative voiding efficiency or increase the risk of prolonged urinary retention compared with TVT alone.

Adult↗
PubMed2005

Factors which influence the short-term success of pessary management of pelvic organ prolapse.

OBJECTIVE: The purpose of this study was to identify patient criteria which may affect the outcome of a pessary trial. STUDY DESIGN: Records of 407 patients presenting with symptomatic pelvic organ prolapse who had a trial of pessary management were reviewed. Success was defined both by the initial fitting as well as by whether the patient was using the pessary at the 3-week follow-up visit. Outcomes were compared using chi-square test, 2-sample Student t test, or the Wilcoxon rank sum test, as appropriate. Statistical analysis was carried out at a significance of .05. RESULTS: One hundred sixty-eight patients (41%) were successfully fitted and continuing to use a pessary at the time of the 3-week follow-up visit. The likelihood of a successful pessary trial was significantly lower in subjects with a past history of hysterectomy (P<.001) or known reconstructive surgery for prolapse (P=.010). There was no association between the stage of prolapse and pessary trial outcome. There was no significance found in the relationship between the predominant location of support loss and the pessary trial outcome at the 3-week follow-up visit. CONCLUSION: The type and severity of pelvic organ prolapse do not influence the likelihood of a successful pessary fitting, and should not be used as a basis on which to select patients for pessary management.

Adult↗
PubMed2005

Local anesthesia with sedation for transvaginal correction of advanced genital prolapse.

OBJECTIVE: The purpose of this study was to evaluate local anesthesia with sedation for vaginal surgery for advanced genital prolapse. STUDY DESIGN: Five sacrospinous ligament suspensions and 12 vaginal paravaginal defect repairs performed under local anesthesia in 2004 were identified. Medical records and patient satisfaction questionnaire were reviewed. Patient demographics, degree of prolapse, duration of surgery, hospital stay, and responses to an anesthesia satisfaction questionnaires were recorded. RESULTS: All repairs incorporated placement of dermal allograft. Concomitant procedures included: 6 tension-free vaginal tape (TVTs), 12 posterior and 4 enterocele repairs. Mean patient age was 66.1 years. All patients had prolapse of apex or anterior wall > or = grade 3. Mean OR time was 132 minutes. Average hospital stay was 1.2 days. No patient was converted to general anesthesia. All 17 patients were "very satisfied" with their surgical experience. CONCLUSION: Local anesthesia with sedation can be successfully employed for most vaginal reconstructive surgeries with advanced genital prolapse. Patients report a high level of satisfaction.

Aged↗
PubMed2006

Levator plate angle in women with pelvic organ prolapse compared to women with normal support using dynamic MR imaging.

OBJECTIVE: The purpose of this study was to determine whether the levator plate is (1) horizontal in women with normal support, (2) different between women with and without prolapse, (3) related to levator hiatus and perineal body descent. STUDY DESIGN: Cohorts of cases with prolapse at least 1 cm below the hymen and normal controls with all points 1 cm or more above the hymen were prospectively enrolled in a study of pelvic organ support to be of similar age, race, and parity. Subjects underwent supine midsagittal dynamic magnetic resonance imaging (MRI) during Valsalva. Levator plate angle (LPA) was measured relative to a horizontal reference line. Levator hiatus length (LH) and perineal body location (PB) were also measured. Student t tests and Pearson correlation coefficients (r) were performed. RESULTS: Sixty-eight controls and 74 cases were analyzed. During Valsalva, controls had a mean LPA of 44.3 degrees . Cases, compared to controls, had 9.1 degrees (21%) more caudally directed LPA (53.4 degrees vs 44.3 degrees , P < .01), 15% larger LH length (7.8 cm vs 6.8 cm, P < .01), and 24% more caudal PB location (6.8 cm vs 5.5 cm, P < .01). Increases in LPA were correlated with increased LH length (r = 0.42, P < .0001) and PB location (r =.51, P < .0001). CONCLUSION: The measured levator plate angle in women with normal support is 44.3 degrees . During Valsalva, women with prolapse have a modest (9.1 degrees) though statistically greater levator plate angle compared to controls. This larger angle showed moderate correlation with larger levator hiatus length and greater displacement of the perineal body in women with prolapse compared to controls.

Abdominal Muscles↗
PubMed2006

Can we screen for pelvic organ prolapse without a physical examination in epidemiologic studies?

OBJECTIVE: Large population-based epidemiologic studies of pelvic organ prolapse are rare. One barrier is the need for physical examination in order to confirm disease status. The objectives of this study were to develop a simple screening question for pelvic organ prolapse (POP) and to evaluate its test characteristics in high and low prevalence populations. STUDY DESIGN: Data from 100 women enrolled in the validation study of the Pelvic Floor Distress Inventory (PFDI) were used to identify the question or questions that most accurately identified women with advanced pelvic organ prolapse. After identifying an accurate and reliable screening question from this original group, its test characteristics were evaluated prospectively in 2 additional distinct populations: a group of 120 women presenting to a tertiary care urogynecology clinic (High prior probability of POP) and 448 women presenting to a nurse practitioner for annual gynecologic examination (Low prior probability of POP). Subjects in these 2 groups each completed the screening question and underwent a POPQ examination by a blinded examiner. RESULTS: A single question was identified from the original study population that most accurately and reliably identified those women with POP "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" An affirmative answer to this question was 96% sensitive (95%CI 92-100) and 79% specific (95%CI 77-92) for prolapse beyond the hymen. The 1-week test-retest reliability was good (kappa .84). The prevalence of POP in this group was 29%. No other single question or group of questions had better test characteristics. When prospectively evaluated in the second High probability population (prevalence 39%), similar test characteristics were noted: sensitivity 85% (95%CI 71-93), specificity 86% (95%CI 75-92). However, when evaluated in the Low prior probability group (POP prevalence 3.8%) the specificity improved to 99% (95%CI 98-99), while the sensitivity decreased dramatically to 35% (95%CI 15-61). CONCLUSION: Screening for POP without a physical examination is subject to spectrum bias. Spectrum bias occurs when a diagnostic test performs differently in different groups of patients. In groups with a high prior probability of POP, a simple screening question can accurately screen for advanced POP without a physical exam. However, in groups with a low prior probability of POP such as might be seen in a population-based epidemiologic study, this question has poor sensitivity.

Adult↗
PubMed2006

The correlation of urethral mobility and point Aa of the pelvic organ prolapse quantification system before and after surgery.

OBJECTIVE: The purpose of the study was to determine the effects of pelvic floor surgery on Q-tip angle and point Aa of the pelvic organ prolapse quantification system. STUDY DESIGN: A clinical database was used for this retrospective review of Q-tip and prolapse measurements before and after pelvic floor surgery. Subanalyses of isolated bladder neck and prolapse surgeries were also performed. Correlations between Q-tip and point Aa were assessed with Pearson and Spearman coefficients and the Z statistic. RESULTS: Correlations between Q-tip and point Aa for all 350 women were not significantly different before and after the operation (r = 0.45 vs 0.49; P = .50). Subanalysis of the bladder neck-only group demonstrated similarly fair correlations (r = 0.26 vs 0.31; P = .71; n = 94). The prolapse-only group demonstrated better overall correlation without significant differences before and after the operation (r = 0.78 vs 0.51; P = .10; n = 26). CONCLUSION: Point Aa does not reflect bladder neck mobility accurately as measured by the Q-tip angle after surgical restoration of the pelvic anatomy.

Aged↗
PubMed2004

Gynecologic use of robotically assisted laparoscopy: Sacrocolpopexy for the treatment of high-grade vaginal vault prolapse.

Transabdominal sacrocolpopexy is an excellent treatment option for patients with high-grade vaginal vault prolapse, with long-term success rates ranging from 93% to 99%. However, it is associated with increased morbidity compared with vaginal repairs. In this article, we describe a novel minimally invasive technique of vaginal vault prolapse repair and present our initial experience. The surgical technique involves placement of 4 laparoscopic ports, 3 for the surgical robot and 1 for the assistant. A prolene mesh is then attached to the sacral promontory and to the vaginal apex using nonabsorbable expanded polytetrafluoroethylene sutures. At the end of the case, the mesh material is covered by the peritoneum. A total of 20 patients underwent a robot-assisted laparoscopic sacrocolpopexy at our institution in the past 18 months for severe symptomatic vaginal vault prolapse; 8 of the 20 (40%) underwent a concomitant anti-incontinence procedure. Mean follow-up was 5.1 (range, 1-12) months and mean age was 66 (range, 47-82) years. The mean total operative time was 3.2 (range, 2.25-4.75) hours. Of these patients, 1 was converted to an open procedure secondary to unfavorable anatomy. All but 1 patient, who left on postoperative day 2, were discharged from the hospital after an overnight stay. Complications were limited to mild port-site infections in 2 patients, which resolved with oral antibiotic therapy. Recurrent grade 3 rectocele developed in 1 patient, but there was no evidence of cystocele or enterocele. Significant incontinence (>1 pad/day) was present in 2 patients. All 18 patients reported being satisfied with the outcome of their surgery and all 10 would recommend it to a friend. This novel technique for vaginal vault prolapse repair combines the advantages of open sacrocolpopexy with the decreased morbidity and improved cosmesis of laparoscopic surgery. It is associated with decreased hospital stay, low complication and conversion rates, and high rates of patient satisfaction. Although our early experience is encouraging, long-term data are needed to confirm these findings and establish longevity of the repair.

Aged↗