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 973 records · Page 54Linked to original sources
PubMed2005

Abdominal sacrocolpopexy for vault prolapse without burial of mesh: a case series.

OBJECTIVES: To audit the clinical outcome of abdominal vault suspension (sacrocolpopexy, hysteropexy or cervicopexy) using non-absorbable mesh, without burial by closure of the peritoneum. DESIGN: A case series. SETTING: Urogynaecology units of four hospitals. POPULATION: One hundred and twenty-eight women having open or laparoscopic sacrocolpopexy (121), hysteropexy (6) or cervicopexy (1) using non-absorbable mesh for vault prolapse. METHODS: Patients had suspension of the vault, uterus or cervix from the sacral promontory using a monofilament polypropylene mesh. The pelvic peritoneum was not closed over the mesh. Patients were followed up every six months. MAIN OUTCOME MEASURES: Incidence of bowel complications as a consequence of the mesh; cure rate of prolapse and incidence of other post-operative complications; rate of re-operation for prolapse or incontinence. RESULT: After a median follow up of 19 months (1.5-62), there were no bowel complications as a result of non-burial of mesh. Three patients had asymptomatic vaginal mesh erosion, which required minor surgical intervention. Ninety percent of patients had good resolution of their prolapse symptoms while 10% of patients required further surgery. CONCLUSION: Leaving the mesh uncovered by the pelvic peritoneum was not associated with complications. It appears safe to perform vault suspension without closing the peritoneum.

Adult↗
PubMed2005

Peri-operative physiotherapy improves outcomes for women undergoing incontinence and or prolapse surgery: results of a randomised controlled trial.

BACKGROUND: Urinary incontinence and pelvic organ prolapse are common complaints in women. Physiotherapy and surgery to correct these conditions are often seen as mutually exclusive. No study has yet investigated their synergistic potential. AIM: This study aimed to investigate the role of peri-operative physiotherapy in women undergoing corrective surgery for pelvic organ prolapse and/or incontinence. METHODS: In this randomised controlled trial, 30 women underwent preoperative physiotherapy and 30 others had no physiotherapy prior to their incontinence and or prolapse surgeries. Comparison was performed on the basis of the following tests: paper towel test, urinary symptom specific health and quality of life questionnaire, frequency/volume chart and pelvic floor muscle manometry. Women were followed up for 3 months. RESULTS: Both groups showed improvement in urinary continence. Significant group differences were noted in the quality of life questionnaire (P= 0.004), urinary symptoms (P= 0.017) and maximum pelvic floor muscle squeeze on manometry (P= 0.022). Diurnal frequency analysis indicates that there is a significant difference in favour of the treatment group (P= 0.024). CONCLUSION: Routine pre and post operative physiotherapy interventions improve physical outcomes and quality of life in women undergoing corrective surgery for urinary incontinence and or pelvic organ prolapse.

Adult↗
PubMed1982

Mitral valve prolapse and pre-excitation.

Two out of 118 patients with mitral valve prolapse were found to have pre-excitation. The presence of mitral valve prolapse in one patient with Lown-Ganong-Levine syndrome and the persistence of prolapse in the presence and absence of pre-excitation in another patient with intermittent type B Wolff-Parkinson-White syndrome suggest that mitral valve prolapse in pre-excitation syndrome may not be secondary to the abnormal activation pattern of the left ventricle, which has been suggested as a possible mechanism by some investigators.

Adolescent↗
PubMed1981

Manometric evaluation of rectal prolapse and faecal incontinence.

Sixty-three patients with complete rectal prolapse and/or faecal incontinence have undergone anal manometry and the results have been compared with an equal number of age- and sex-matched controls. Maximal basal pressure (MBP) and maximum squeeze pressure (MSP) were measured before and at four months and a year after treatment. The anal pressures of normal subjects are presented. Patients with rectal prolapse alone had normal anal pressures, whereas patients with incontinence with or without prolapse had significantly lower basal and squeeze pressures than controls. Successful surgical treatment of prolapse or incontinence did not produce significant change in anal canal pressures, whereas the combination of pelvic floor exercises and a continence aid was associated with a significant rise in MSP.

Adult↗
PubMed1996

Pathology of the rectal wall in solitary rectal ulcer syndrome and complete rectal prolapse.

BACKGROUND: The aetiology and pathology of rectal prolapse and solitary rectal ulcer are poorly understood. AIMS: To examine the full thickness rectal wall in these two conditions. METHODS: The pathological abnormalities in the surgically resected rectal wall were studied from nine patients with solitary rectal ulcer syndrome, 11 complete rectal prolapse, and nine cancer controls. Routine haematoxylin and eosin and Van Gieson staining for collagen were performed. RESULTS: The rectal wall from solitary rectal ulcer syndrome specimens was thickened compared with complete rectal prolapse and controls. The major difference was in the muscularis propria (2.2 v 1.1 v 1.2 mm, medians, p < 0.005) and particularly the inner circular muscular layer, and to a lesser extent the submucosal and outer longitudinal muscular layers. Some solitary rectal ulcer syndrome specimens showed unique features such as decussation of the two muscular layers (four of nine), nodular induration of inner circular layer (four of nine) and grouping of outer longitudinal layer into bundles (three of nine); these were not seen in complete rectal prolapse or control specimens. CONCLUSIONS: These features, which resemble the features of high pressure sphincter tissue, may be of aetiological importance, and suggest a different pathogenesis for these two disorders. Excess collagen was seen in both disorders, was more severe in solitary rectal ulcer syndrome specimens, and probably reflects a response to repeated trauma.

Adult↗
PubMed1984

Significance of pulmonary valve prolapse. A cross sectional echocardiographic study.

Many patients with congenital heart disease now undergo cardiac surgery based solely on clinical and echocardiographic findings, but those with intracardiac shunts still frequently require cardiac catheterisation because there is no reliable non-invasive method of measuring the pulmonary artery pressure. Blinded to the haemodynamic results two independent observers retrospectively studied the cross sectional echocardiograms of 59 patients with uncomplicated ventricular septal defect to assess whether diastolic backward bowing of the pulmonary valve leaflets towards the right ventricular outflow tract (pulmonary valve prolapse) was associated with pulmonary hypertension. There was considerable interobserver variation in the diagnosis of pulmonary valve prolapse, but concordance was achieved in 27 cases. Mean pulmonary artery systolic and mean and diastolic pressures and the ratios of aortic to pulmonary artery mean pressures were all significantly higher for the group with pulmonary valve prolapse diagnosed by both observers than for the group without, thus showing an association between pulmonary valve prolapse and pulmonary hypertension. Further studies are warranted to determine the usefulness of this cross sectional echocardiographic sign in routine clinical practice.

Aorta↗
PubMedDate not supplied

Dynamic MR imaging of pelvic organ prolapse: spectrum of abnormalities.

Pelvic organ prolapse is a relatively common condition in women that can have a significant impact on quality of life. Pelvic organ prolapse typically demonstrates multiple abnormalities and may involve the urethra, bladder, vaginal vault, rectum, and small bowel. Patients may present with pain, pressure, urinary and fecal incontinence, constipation, urinary retention, and defecatory dysfunction. Diagnosis is made primarily on the basis of findings at physical pelvic examination. Imaging is useful in patients in whom findings at physical examination are equivocal. Fluoroscopy, ultrasonography, and magnetic resonance (MR) imaging can be useful in evaluating pelvic organ prolapse. Advantages of MR imaging include lack of ionizing radiation, depiction of the soft tissues of the pelvic floor, and multiplanar imaging capability. Dynamic imaging is usually necessary to demonstrate pelvic organ prolapse, which may be obvious only when abdominal pressure is increased. Treatment is more likely to be successful if a survey of the entire pelvis is performed prior to therapy. Therapy is usually undertaken only in symptomatic patients. In all patients, imaging findings must be interpreted in conjunction with physical examination findings and the patient's symptoms.

Female↗
PubMed1998

Colposacropexy with Gore-tex mesh in marked vaginal and uterovaginal prolapse.

This study focusses on abdominal sacral colpopexy which appears to provide the most anatomically correct restoration and secure and durable support for advanced vaginal or uterovaginal prolapse. 21 patients underwent colposacropexy or hysterocolposacropexy using Gore-tex mesh. All patients referred symptoms of vaginal heaviness and urinary dysfunctions. Five presented with complete vaginal vault prolapse, 7 with third-degree anterior colpoceles and 9 with uterovaginal prolapse. Hydronephrosis was present in 4. Five patients had previously undergone total hysterectomy, and underwent only sacropexy; 9 underwent standard total abdominal hysterectomy before sacropexy; 7 underwent hysterocolposacropexy, preserving the uterus. In colposacropexy anchorage was designed to provide a large vagina-mesh contact area thus reducing the risk of suspension failure. Hysterocolposacropexy was performed using 3 stitches to anchor the synthetic mesh to the vagina and the uterine isthmus. Postoperative follow-up times range from 12 to 68 months. Overall results for 19/21 patients were satisfactory. In all 21 patients the descensus was markedly reduced. Hydronephrosis was completely resolved. Slight incontinence persisted in 3, but protection was not required. Slight dysuria persisted in 2. First-degree cystoceles recurred only in 3 patients who underwent hysterocolposacropexy. Sacropexy with synthetic mesh seems to be the most valid support of uterovaginal prolapse as the physiological vaginal axis is restored and vaginal function is preserved. Our success rate and the overall satisfaction expressed by 19/21 patients have encouraged us to continue in this surgical approach.

Adult↗
PubMed2001

Extracorporal resection of the rectum in the treatment of complete rectal prolapse using a circular stapling device.

UNLABELLED: BACKGROUND AND PATIENTS: The technique of the extracorporal resection of the rectum using a circular stapler in the treatment of complete rectal prolapse is described on the basis of 31 successfully applied operations at the Surgical Unit in Düsseldorf-Gerresheim. RESULTS: The easy-to-perform operation does not require general anaesthesia, the incidence of peri-operative complications (5/31) and lethality (1/31) is acceptable and post-operative recovery is fast due to less physiologic insult as compared to transabdominal procedures. The recurrence rates (0/22) stand the comparison with transabdominal procedures. The operation can be re-performed in the case of a recurrent prolapse. CONCLUSIONS: Our good results show that the perineal rectosigmoidostomy using a circular stapler is a safe and efficient means of controlling rectal prolapse. Many advantages in comparison with transabdominal procedures make it an attractive option for many patients suffering from rectal prolapse.

Digestive System Surgical Procedures↗
PubMed2005

Uterus-sparing vaginal surgery of genitourinary prolapse employing biocompatible material.

OBJECTIVE: The study presents an original uterus sparing technique for transvaginal repair of total genitourinary prolapse. The technique employs a synthetic mesh of mixed polypropylene and 910 polyglactin fibers. METHODS: The prosthesis creates a support for the cystocele, the cervix and the enterocele. It has four anchoring sites: two at the rear in the sacrospinous ligaments and two at the front in the arcus tendineous of the levator ani muscle. Between February 2001 and December 2004, 24 patients (mean age 66.9 years), presenting symptoms of uterine prolapse, cystocele and enterocele (POP-Q stage III-IV Aa associated to II-III-IV C), were treated with our procedure. Pre- and postoperative parameters were evaluated statistically. RESULTS: No patient had any serious complications. The mean follow-up was 31.1 months (range 6-52). 19 patients (79.1%) have shown excellent results and have been completely cured. In 5 other cases (20.8%), the cystocele was completely cured and there was a significant improvement in the hysterocele and the enterocele. One patient required surgical treatment for postoperative stress incontinence. Statistical analysis of data regarding the pre- and postoperative prolapse stage demonstrated a high degree of objective cure rates (p < 0.0001). CONCLUSIONS: While hysterectomy remains the habitual treatment for severe uterine prolapse, our technique provides a promising alternative solution. It is also significant that there were no complications of erosion or infection associated with the prosthesis.

Aged↗
PubMed2005

Pelvic organ prolapse complicating third trimester pregnancy. A case report.

The concomitant phenomenon of a third trimester pregnancy with a significant degree of pelvic organ prolapse is extremely rare. We report on a patient with pelvic organ prolapse complicating third trimester pregnancy treated by concomitant cesarean hysterectomy and abdominal sacrocolpopexy. A 30-year-old woman, gravida 6, parity 5, was admitted to the hospital with uterine contractions in week 35 of gestation. Pelvic examination in the dorsal lithotomy position revealed a stage 3 pelvic organ prolapse. A cesarean hysterectomy was performed. After hysterectomy, the vaginal cuff was suspended to the periosteum overlying the sacral promontory. Cesarean hysterectomy might be a therapeutic option for women who have completed their families and are suffering from severe pelvic organ prolapse complicating third trimester pregnancy, particularly in developing countries where access to health care is limited.

Adult↗
PubMed1978

Prolapse of the mitral valve: clinical, hemodynamic, angiographic and echocardiographic correlations.

Among 1,519 patients undergoing diagnostic cardiac catheterization over a 2-year period, angiographically unequivocal mitral valve prolapse was identified in 79 cases (5.2%). Mitral valve prolapse was clinically unsuspected in 30 of these 79 patients. Echocardiographic studies were available in 44 cases, but only 55% of the patients with prolapse of the mitral valve documented by angiography had positive echocardiographic findings. One third of the patients had associated coronary artery disease, aortic valve disease or atrial septal defects. 14 patients (18%) had moderate or severe mitral regurgitation. There was a wide spectrum of hemodynamic and ventriculographic abnormalities that could not entirely be explained by the degree of prolapse, by the severity of mitral regurgitation or by the presence of associated diseases.

Adolescent↗
PubMed1988

Prevalence of mitral valve prolapse in chronic lymphocytic thyroiditis and nongoitrous hypothyroidism.

An increased prevalence of mitral valve prolapse has been found in Graves' disease and a common autoimmune etiology has been suggested for both disorders. We investigated the prevalence of mitral valve prolapse in 87 patients with autoimmune chronic lymphocytic thyroiditis, 50 patients with nongoitrous hypothyroidism and 111 healthy control subjects. Mitral valve prolapse was found in 16.09% of patients with chronic lymphocytic thyroiditis compared to 6 and 5.4% in nongoitrous hypothyroidism and normal controls, respectively. The result is statistically significant, p less than 0.02, and confirms that the prevalence of mitral valve prolapse is significantly increased in patients with autoimmune disorders of the thyroid gland, when compared to normals and nonautoimmune conditions.

Adult↗
PubMed1996

Ehlers-Danlos syndrome: relationship between joint hypermobility, urinary incontinence, and pelvic floor prolapse.

OBJECTIVE: To compare the incidence of joint hypermobility and prolapse in incontinent and continent women with Ehlers-Danlos syndrome (EDS). METHODS: Forty-six patients with EDS were evaluated by history and physical examination. The degree of joint mobility of shoulder, elbow, wrist, hip, knee, and ankle was evaluated by orthopedic surgeons and physical therapists. Joint range of motion measurements were obtained using an orthopedic goniometer. RESULTS: The two EDS groups, incontinent (n = 28) and continent (n = 18) women, had a statistically similar mean age, weight, and parity (p = NS). In the EDS population overall joint hypermobility averaged 34.3%. Individuals with EDS type 3 had significantly more joint hypermobility than those with type 1 and 2 EDS. However, logistic regression analysis demonstrated no significant relationship between prolapse and joint hypermobility. Wrist dorsiflexion (p < 0.05) and palmar flexion (p = 0.05) were the only variables related to incontinence. CONCLUSION: It has previously been reported that hypermobility was correlated with pelvic floor prolapse. Of 18 joint measures per patient, hypermobility of both wrist dorsiflexion and palmar flexion was associated with symptoms of incontinence. We were unable to document an association between joint hypermobility and prolapse in the EDS population.

Ehlers-Danlos Syndrome↗
PubMed1981

Platelets, thromboembolism and mitral valve prolapse.

Cerebral and retinal ischemic events have been described in mitral valve prolapse. To determine whether platelets play a part in the pathogenesis of thromboembolism we studied 29 patients with mitral valve prolapse, including nine (group I) with thromboembolism (cerebral, retinal and deep venous), eight (group II) with transient visual obscurations and 12 (group III) with neither thromboembolism nor visual complaints, compared with 18 control patients and 38 normal subjects. Patients in groups I and II had increased platelet coagulant activities concerned with the initiation and early stages of intrinsic coagulation, and group I patients had an increased proportion of circulating platelet aggregates and platelets relatively insensitive top epinephrine in aggregation and secretion. The incidence of platelet coagulation hyperactivity in patients with mitral valve prolapse was 76% (100% in group I, 75% in group II, 58% in group III), compared with 6% in control patients. These results suggest that platelets play a role in the purported association of thromboembolism and mitral valve prolapse.

Adult↗
PubMed1983

Mitral valve prolapse in short-term experimental coronary occlusion: a possible mechanism of ischemic mitral regurgitation.

Experimental coronary occlusions were carried out in 12 closed-chest dogs to investigate the functional anatomic characteristics of the mitral valve complex during acute myocardial ischemia. Two-dimensional echocardiography was used to assess left ventricular function, the mitral valve complex, and left atrial size. Presence of mitral regurgitation was assessed by left ventricular contrast echocardiography. Thirty-seven coronary occlusions of up to 10 min in duration were carried out in proximal or distal locations in the left anterior descending and the left circumflex coronary arteries. Mitral regurgitation, which was mild in severity as judged by a small rise in pulmonary artery wedge pressures, was observed in 15 of 37 brief coronary occlusion experiments. Mitral valve prolapse was noted in all 15 experiments, as well as in four additional studies in which mitral regurgitation was not seen. The development of experimental mitral valve prolapse was explained by measurements that demonstrated a relative displacement of the papillary muscle tips toward the mitral orifice. We conclude that mitral valve prolapse is a common sequela of short-term coronary occlusion and is often associated with mild mitral regurgitation. Relative displacement of ischemic papillary muscles toward the mitral orifice appears to be a likely mechanism of acute ischemic mitral valve prolapse.

Animals↗
PubMed1985

Spontaneous mitral valve prolapse in a breeding colony of rhesus monkeys.

Mitral valve prolapse was observed in 26 of 92 animals in a harem breeding colony of rhesus monkeys (Macaca mulatta). The affected animals had a systolic murmur best auscultated over the mitral region with the animal in a sitting position. Mid-to-late systolic clicks were also heard. Phonocardiographic examination also demonstrated systolic murmurs and clicks in six of 16 animals. Twenty-three of the animals were studied by M mode and/or two-dimensional echocardiography. The diagnosis was confirmed in 12 animals that had a murmur during the examination. Electrocardiograms revealed T wave abnormalities in five animals and left or right ventricular hypertrophy in five. Four adult animals that died during the course of the study were confirmed at necropsy as having prolapse of the posterior and/or anterior mitral valve leaflets into the atrium. Analysis of the breeding records suggested that mitral valve prolapse was a dominant genetic trait with an approximate birth incidence of 16% to 20% in the colony. The existence of mitral valve prolapse in a nonhuman primate species provides a unique opportunity to study the disease in an experimental animal.

Animals↗
PubMedDate not supplied

Cerebral ischemic events in patients with mitral valve prolapse.

All patients 20 years old or older referred for echocardiographic examination and found to have mitral valve prolapse during the period January 1975 through December 1979 were included in the study. Of the 1,138 patients, two-thirds were women and one-third were men. Their average age was 48.4 years. Forty patients (3.5%) had histories of prior focal cerebrovascular ischemic events. In 26 of the 40 patients, no responsible mechanism other than mitra valve prolapse was identified, and in 4, the ischemic event occurred during an episode of bacterial endocarditis, a known complication of mitral valve prolapse. In 10 of the 26 patients, there was clinical information to suggest an embolic mechanism for the ischemic. A conservative estimate of the prevalence rate for cerebral infarction in this group of patients is four times greater than the rate expected in a normal population. This difference is likely due to the contribution of mitral valve prolapse in the pathogenesis of cerebral infarction.

Adult↗