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PubMed2004

Surgery for occult rectal prolapse.

OBJECTIVE: An 'occult' rectal prolapse may be diagnosed during investigation of altered bowel habit. It has been suggested that the outcome of surgery for these patients may be associated with results that are inferior to those achieved in patients with overt rectal prolapse. This study compares the results of surgery for 'occult' and overt rectal prolapse in terms of mortality, morbidity and change in bowel habit. PATIENTS AND METHODS: A retrospective review was undertaken of consecutive patients undergoing surgery for rectal prolapse during the decade 1988-98. Resection rectopexy was the treatment of choice except in patients with faecal incontinence who underwent sutured rectopexy. Those patients who were unfit for an abdominal operation were offered a perineal procedure. Outcome measures were mortality, morbidity, prolapse recurrence, constipation and faecal incontinence. Data were retrieved from case note review, clinical assessment, telephone consultation or postal questionnaire. RESULTS: Rectal prolapse surgery was undertaken in 69 patients with an overt prolapse and 74 patients with an 'occult' prolapse. Patients in the 'occult' prolapse group were significantly younger than those with overt prolapse (P = 0.0002). There were significantly more perineal procedures in the overt prolapse group compared with the 'occult' prolapse group (54% vs 5%, P = 0.0001). There were no deaths within 28 days of surgery. Major surgical complications occurred in 5 patients (3.5%). Seven patients (10%) experienced recurrent prolapse. Rectal prolapse surgery reduced the incidence of St. Mark's grade 4 faecal incontinence from 38% to 19% in the overt prolapse group (P = 0.023) and from 49% to 22% in the 'occult' prolapse group (P < 0.001). Following surgery the incidence of constipation increased in the 'occult' group from 39% to 50% but decreased in the overt prolapse group from 42% to 35%. CONCLUSIONS: Surgery for an 'occult' rectal prolapse is unlikely to benefit patients whose principle symptom is constipation. Approximately half of those patients whose 'occult' rectal prolapse is associated with faecal incontinence will have their bowel habit improved by prolapse surgery.

Adolescent↗
PubMed2004

Pelvic symptoms in women with pelvic organ prolapse.

OBJECTIVE: To assess symptoms of bladder, bowel, and sexual function in women with pelvic organ prolapse and to compare symptoms by different degrees of prolapse. METHODS: This retrospective study used data from 352 women with prolapse or urinary incontinence. The pelvic organ prolapse quantification measurements, as well as responses to 3 self-administered questionnaires assessing urinary, bowel, and sexual function were used. For each individual, pelvic organ prolapse quantification measures of prolapse were obtained in centimeters in relation to the hymen for 3 compartments: anterior vagina, vaginal apex or cervix, and posterior vagina. Data were analyzed by comparing the frequency of symptoms to centimeter measures of the most advanced prolapse (regardless of site) and the other compartments of prolapse. RESULTS: Of the 330 patients available for analysis, 2.4% had stage I, 46.1% had stage II, 48.2% had stage III, and 3.3% had stage IV prolapse. The average age was 58.8 years (+/- 12.1), with a median parity of 3. Forty-eight percent were postmenopausal and taking estrogen, 27% were postmenopausal and not taking estrogen, and 25% were premenopausal. Patients who had stress incontinence symptoms had less advanced prolapse (median 5 cm less prolapse in the apical compartment) than patients without stress incontinence. Women who required manual assistance to urinate had more advanced prolapse (median 3.5 cm more prolapse in the most advanced compartment) than those who did not. Patients with urinary urgency and urge incontinence also had less advanced prolapse, although the differences were smaller than for stress incontinence (median 3 cm difference or less). There were no clinically significant differences in any compartment for symptoms related to sexual or bowel function. CONCLUSION: Women with more advanced prolapse were less likely to have stress incontinence and more likely to manually reduce prolapse to void; however, prolapse severity was not associated with sexual or bowel symptoms. LEVEL OF EVIDENCE: II-2.

Coitus↗
PubMed1990

Value of acceleration flows and regurgitant jet direction by color Doppler flow mapping in the evaluation of mitral valve prolapse.

To clarify the role of color Doppler echocardiography in the evaluation of mitral valve prolapse, we studied 49 consecutive patients in whom the sites of mitral valve prolapse were confirmed at the time of operation. The study group consisted of 22 patients with anterior leaflet prolapse, 24 patients with posterior leaflet prolapse, and three patients with multiple scallop prolapse (one patient with both anterior leaflet and middle scallop prolapse, and two patients with both medial and lateral scallop prolapse). Two-dimensional echocardiographic diagnosis of anterior leaflet prolapse was correct in all patients. The diagnosis of posterior leaflet prolapse by two-dimensional echocardiography, however, was mistaken as anterior leaflet prolapse in 16 (13 patients with medial scallop prolapse and three patients with lateral scallop prolapse) of the 24 patients according to current diagnostic criteria for mitral valve prolapse. Eight patients with middle scallop prolapse were diagnosed correctly by two-dimensional echocardiography. Acceleration flows in the left ventricle were observed by color Doppler echocardiography in all 49 patients. The sites of acceleration flows detected by color Doppler echocardiography coincided with those of prolapse confirmed in all at the time of operation. There was a significant correlation between the maximum area of acceleration flow signals and severity of mitral regurgitation estimated by angiography. In the 13 patients with medial scallop prolapse and the three patients with lateral scallop prolapse, a regurgitant jet originated from a bulged portion of the posterior leaflet and was directed toward the opposite left atrial cavity to the bulged portion by short-axis images of color Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1999

True incidence of vaginal vault prolapse. Thirteen years of experience.

OBJECTIVE: To assess the true incidence of vaginal vault prolapse after hysterectomy. STUDY DESIGN: The records of 2,670 patients who had undergone hysterectomy between 1983 and 1987 were reviewed. From this population, 448 patients were selected for follow-up study. The mean follow-up phase was 11 years (range, 9-13). Patients were divided into two groups according to the presence or the absence of genital prolapse at hysterectomy. Pelvic examination was performed in order to identify the presence of vault prolapse. Pelvic support was assessed using Baden and Walker's "halfway description." RESULTS: Five of the 2,670 patients who had undergone hysterectomy at our institution returned on their own initiative for surgical correction of vault prolapse. Using the modalities in the literature, the incidence of vault prolapse was 0.4%. Instead, on pelvic examination, the incidence of vault prolapse was 4.4% (20 patients in a group of 448). Fourteen of the 20 with vault prolapse had previously undergone vaginal hysterectomy for genital prolapse: six had had abdominal hysterectomy for benign disease, excluding genital prolapse. Therefore, the incidence of vaginal vault prolapse was 11.6% (14/120 patients) when hysterectomy had been performed for genital prolapse and 1.8% (6/328) when hysterectomy had been performed for other benign diseases. In the latter group (328 patients), all the cases of vault prolapse developed after abdominal hysterectomy: the incidence was 2% (6/308 patients); no case (0/20 patients) of vault prolapse developed after vaginal hysterectomy that had been performed on patients without genital prolapse. The primary risk factor for vaginal vault prolapse in this study, was obesity. Obese subjects were significantly more susceptible to developing the condition when compared to nonobese (P < .001). CONCLUSION: Our data show that there is a low incidence of vaginal vault prolapse when hysterectomy is performed in the absence of defects in pelvic support. A comparison of our method and those described in the literature to determine the incidence of vaginal vault prolapse showed that this event is often underevaluated if long-term follow-up after hysterectomy is not carried out.

Adult↗
PubMed1999

Prevalence and clinical outcome of mitral-valve prolapse.

BACKGROUND: Mitral-valve prolapse has been described as a common disease with frequent complications. To determine the prevalence of mitral-valve prolapse in the general population, as diagnosed with the use of current two-dimensional echocardiographic criteria, we examined the echocardiograms of 1845 women and 1646 men (mean [+/-SD] age, 54.7+/-10.0 years) who participated in the fifth examination of the offspring cohort of the Framingham Heart Study. METHODS: Classic mitral-valve prolapse was defined as superior displacement of the mitral leaflets of more than 2 mm during systole and as a maximal leaflet thickness of at least 5 mm during diastasis, and nonclassic prolapse was defined as displacement of more than 2 mm, with a maximal thickness of less than 5 mm. RESULTS: A total of 84 subjects (2.4 percent) had mitral-valve prolapse: 47 (1.3 percent) had classic prolapse, and 37 (1.1 percent) had nonclassic prolapse. Their age and sex distributions were similar to those of the subjects without prolapse. None of the subjects with prolapse had a history of heart failure, one (1.2 percent) had atrial fibrillation, one (1.2 percent) had cerebrovascular disease, and three (3.6 percent) had syncope, as compared with unadjusted prevalences of these findings in the subjects without prolapse of 0.7, 1.7, 1.5, and 3.0 percent, respectively. The frequencies of chest pain, dyspnea, and electrocardiographic abnormalities were similar among subjects with prolapse and those without prolapse. The subjects with prolapse were leaner (P<0.001) and had a greater degree of mitral regurgitation than those without prolapse, but on average the regurgitation was classified as trace or mild. CONCLUSIONS: In a community based sample of the population, the prevalence of mitral-valve prolapse was lower than previously reported. The prevalence of adverse sequelae commonly associated with mitral-valve prolapse in studies of patients referred for that diagnosis was also low.

Adult↗
PubMed2001

Correlation of symptoms with location and severity of pelvic organ prolapse.

OBJECTIVE: The purpose of this study was to compare the symptoms that are related to pelvic floor dysfunction with the location and severity of the coexisting prolapse. STUDY DESIGN: Two hundred thirty-seven consecutive patients with symptomatic pelvic organ prolapse came to Johns Hopkins Medicine during a 24-month period beginning in July 1998 and completed a symptom-specific Likert scale questionnaire that included standardized questions that were compiled from commonly used validated instruments. All questionnaires were completed by the patients before they were seen by a physician. Further evaluation included a standardized physical examination that included the International Continence Society's system for grading uterovaginal prolapse. Symptoms were categorized according to both severity and associated anatomic compartment. Symptoms that were related to urinary and anal incontinence and voiding, defecatory, sexual, and pelvic floor dysfunction were analyzed with respect to location and severity of pelvic organ prolapse with the use of the nonparametric correlation coefficient, Kendall's tau-b. RESULTS: The mean age of the women was 57.2 years (range, 23-93 years); 109 of the women (46%) had undergone hysterectomy. Overall, stage II was the most common pelvic organ prolapse (51%) that was encountered. In 77 patients (33%), anterior compartment pelvic organ prolapse predominated; 46 patients (19%) demonstrated posterior compartment prolapse, whereas 26 patients (11%) had apical prolapse. In 88 patients (37%), no single location was more severe than another. Voiding dysfunction that was characterized by urinary hesitancy, prolonged or intermittent flow, and a need to change position was associated with the increasing severity of anterior and apical pelvic organ prolapse. Pelvic pressure and discomfort along with visualization of prolapse were strongly associated with worsening stages of pelvic organ prolapse in all compartments. Defecatory dysfunction characterized by incomplete evacuation and digital manipulation was associated with worsening posterior compartment pelvic organ prolapse. Impairment of sexual relations and duration of abstinence were strongly associated with worsening pelvic organ prolapse. An inverse correlation was observed between increasing severity of pelvic organ prolapse and urinary incontinence and enuresis. CONCLUSION: Women with pelvic organ prolapse experience symptoms that do not necessarily correlate with compartment-specific defects. Increasing severity of pelvic organ prolapse is weakly to moderately associated with several specific symptoms that are related to urinary incontinence and voiding, defecatory, and sexual dysfunction.

Adult↗
PubMed2004

Pelvic organ prolapse in older women: prevalence and risk factors.

OBJECTIVE: We sought to estimate the prevalence of pelvic organ prolapse in older women using the Pelvic Organ Prolapse Quantification examination and to identify factors associated with prolapse. METHODS: Women with a uterus enrolled at one site of the Women's Health Initiative Hormone Replacement Therapy randomized clinical trial were eligible for this ancillary cross-sectional study. Subjects underwent a Pelvic Organ Prolapse Quantification examination during a maximal Valsalva maneuver and in addition completed a questionnaire. Logistic regression was used to identify independent risk factors for each of 2 definitions of prolapse: 1) Pelvic Organ Prolapse Quantification stage II or greater and 2) the leading edge of prolapse measured at the hymen or below. RESULTS: In 270 participants, age (mean +/- SD) was 68.3 +/- 5.6 years, body mass index was 30.4 +/- 6.2 kg/m(2), and vaginal parity (median [range]) was 3 (0-12). The proportions of Pelvic Organ Prolapse Quantification stages (95% confidence intervals [CIs]) were stage 0, 2.3% (95% CI 0.8-4.8%); stage I, 33.0% (95% CI 27.4-39.0%); stage II, 62.9% (95% CI 56.8-68.7%); and stage III, 1.9% (95% CI 0.6-4.3%). In 25.2% (95% CI 20.1-30.8%), the leading edge of prolapse was at the hymen or below. Hormone therapy was not associated with prolapse (P =.9). On multivariable analysis, less education (odds ratio [OR] 2.16, 95% CI 1.10-4.24) and higher vaginal parity (OR 1.61, 95% CI 1.03-2.50) were associated with prolapse when defined as stage II or greater. For prolapse defined by the leading edge at or below the hymen, older age had a decreased risk (OR 0.50, 95% CI 0.27-0.92) and less education, and larger babies had an increased risk (OR 2.38, 95% CI 1.31-4.32 and OR 1.97, 95% CI 1.07-3.64, respectively). CONCLUSION: Some degree of prolapse is nearly ubiquitous in older women, which should be considered in the development of clinically relevant definitions of prolapse. Risk factors for prolapse differed depending on the definition of prolapse used.

Aged↗
PubMed2005

The relationship of vaginal prolapse severity to symptoms and quality of life.

OBJECTIVE: To assess the relationship and location of vaginal prolapse severity to symptoms and quality of life. DESIGN: A prospective observational study. SETTING: Urogynaecology Unit, Imperial College, St Mary's Hospital, London. POPULATION: Women with and without symptoms of vaginal prolapse. METHODS: All women completed a validated Prolapse Quality of Life (P-QOL) questionnaire. This included a urinary, bowel and sexual symptom questionnaire. All women were examined using the Pelvic Organ Prolapse Quantification system (POP-Q). POP-Q scores in those with and without prolapse symptoms were compared. Urinary and bowel symptoms and sexual function were compared and related to prolapse severity and location. MAIN OUTCOME MEASURES: POP-Q scores, P-QOL scores, urinary and bowel symptoms and sexual function. RESULTS: Three hundred and fifty-five women were recruited-233 symptomatic and 122 asymptomatic of prolapse. The median P-QOL domain scores ranged between 42-100 in symptomatic women and 0-25 in those who were asymptomatic. The stage of prolapse was significantly higher in those symptomatic of prolapse (P < 0.001) except for perineal body (PB) measurement. Urinary symptoms were not correlated with uterovaginal prolapse severity whereas bowel symptoms were strongly associated with posterior vaginal wall prolapse. Cervical descent was found to have a relationship with sexual dysfunction symptoms. CONCLUSIONS: Women who present with symptoms specific to pelvic organ prolapse demonstrate greater degrees of pelvic relaxation than women who present without symptoms. Prolapse severity and quality of life scores are significantly different in those women symptomatic of prolapse. There was a stronger relationship between posterior prolapse and bowel symptoms than anterior prolapse and urinary symptoms. Sexual dysfunction was related to cervical descent.

Adolescent↗
PubMed1982

Idiopathic mitral valve prolapse-analysis by real-time two-dimensional echocardiography.

Mitral valve prolapse is diagnosed in real-time two-dimensional echocardiograms when there are discrepancies in the coaptation zone of the anterior mitral leaflet and the posterior mitral leaflet. Out of the 100 cases of mitral valve prolapse diagnosed in this way, 65 had prolapsed anterior mitral leaflets, 28 prolapsed posterior mitral leaflets and 7 prolapses of both the anterior and posterior mitral leaflets. In addition to the cases with mitral valve prolapse 23 cases of ruptured chordae tendineae of the mitral valve, including 15 cases which had undergone surgery, were investigated. The frequent site of mitral valve prolapse was the posteromedial commissure in the anterior leaflet and the posteromedial and anterolateral commissures in the posterior leaflet. These sites coincide with those where rupture of the chordae tendineae of the mitral valve was apt to occur. An investigation of the relation between age and mitral valve prolapse showed that the number of cases of prolapsed anterior leaflet did not increase with age, but there was an age-related increase in the number of cases of prolapsed posterior leaflets. It was also found that the degree of the prolapse progressed with age. Many of the cases of ruptured chordae tendineae of the mitral valve were in their forties or fifties, and there appeared to be some relation between the progress of the prolapse and age. Mitral regurgitant murmurs were recorded on phonocardiograms, and the severer the degree, the wider the range of the prolapse. Mitral regurgitation was more likely to occur in cases of prolapsed posterior leaflets than in those with prolapsed anterior leaflets, even if the degree and the range of the prolapse were mild.

Adolescent↗
PubMed1982

Does mitral valve prolapse cause nonspecific symptoms?

I studied the prevalence and symptoms of idiopathic mitral valve prolapse by auscultation in 972 consecutive patients in an adult general medical population. Forty-five patients (4.6%) had idiopathic mitral valve prolapse defined by a nonejection click with or without a late systolic murmur. The prevalence was not significantly different in men and women. The mean age (49.9 yr) and age distribution of patients with prolapse were similar to those of patients without prolapse (47.7 yr). The prevalence of dizziness (4.1% vs. 1.5%), fatigue (4.4% vs. 2.6%), and palpitations (4.4% vs. 1.3%), was not significantly greater in patients with or without prolapse. Atypical chest pain (13% vs. 4.3%) and chronic anxiety (8.8% vs. 2.9%) were more frequent (less than 0.05) in the patients with prolapse than in those without prolapse. Of the patients with prolapse, 29 were healthy without clinically identifiable diseases while 16 had medical diseases. In the group without prolapse, 184 patients were healthy and 707 had other diseases. When patients with isolated prolapse without other associated diseases were compared to healthy patients without prolapse, the prevalence of atypical chest pain (17.4% vs. 17.2%) and chronic anxiety (7.1% vs. 10.3%) were not significantly different. When patients with prolapse and other diseases were compared to patients without prolapse and other diseases, the prevalence of atypical chest pain (6.2% vs. 1.1%) and chronic anxiety (6.2% vs. 1.7%) was again not significantly different. Thirty-two patients without prolapse were suspected but not confirmed of having disease and were not included in this analysis. The results would have been unaltered by their inclusion in the diseased group without prolapse.

Age Factors↗
PubMed2006

Responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women undergoing vaginal surgery and pessary treatment for pelvic organ prolapse.

OBJECTIVE: This study was undertaken to evaluate the responsiveness of the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) in women with pelvic organ prolapse undergoing surgical and nonsurgical management. STUDY DESIGN: The responsiveness of the prolapse, urinary and colorectal scales of the PFDI and PFIQ were assessed in 2 independent populations: (1) 42 women with stage II or greater prolapse enrolled in an ongoing multicenter randomized trial comparing 2 different pessaries (Pessary group) and (2) 64 women with stage III or greater prolapse who underwent vaginal reconstructive surgery (Surgery group). All subjects completed the PFDI and PFIQ at baseline and again either 3 months (Pessary group) or 6 months (Surgery group) after initiation of treatment. Responsiveness was assessed with standardized response mean (SRM), effect size (ES), and the paired t test. RESULTS: In the Pessary group, there was a significant improvement in the prolapse and urinary scales of the PFDI, with each demonstrating moderate responsiveness (prolapse: SRM 0.69, ES 0.68; urinary: SRM 0.57, ES: 0.50, P < .001 for each). The colorectal scale of the PFDI and each of the 3 scales of the PFIQ demonstrated no significant change in scores with pessary use. In the Surgery group, there was a significant improvement in the prolapse, urinary, and colorectal scales of both the PFDI and PFIQ (P < .01 for each). The prolapse and urinary scales of the PFDI demonstrated excellent responsiveness with SRM and ES 1.20 or greater for the prolapse scale and equal to1.05 for the urinary scales. The colorectal scale of the PFDI and the urinary and prolapse scales of the PFIQ demonstrated moderate responsiveness (SRM 0.61-0.70 and ES 0.56-0.60) after surgery. Subjects who had a recurrence of their prolapse develop after surgery (6%) had significantly less improvement in the prolapse scale of the PFDI than those who did not. After controlling for preoperative prolapse stage and baseline quality of life scores, subjects in the Surgery group had significantly greater improvement in each of the scales of the PFDI and the prolapse and urinary scales of the PFIQ than did the Pessary group (P < .05 for each). CONCLUSION: The PFDI and PFIQ are responsive to change in women undergoing surgical and nonsurgical treatment for pelvic organ prolapse. The PFDI is more responsive than the PFIQ.

Aged↗
PubMed2006

Frequency and severity of plaque prolapse within Cypher and Taxus stents as determined by sequential intravascular ultrasound analysis.

We used intravascular ultrasound to evaluate the incidence, characteristics, and clinical sequel of plaque prolapse within drug-eluting stents. The influence of stent design on plaque prolapse has not been studied. Drug-eluting stents were serially expanded, first at 14 atm and then at 20 atm, with intravascular ultrasound imaging after each inflation. The stent, lumen, and maximum plaque prolapse areas were measured. The residual lumen area and percentage of plaque prolapse burden (maximum plaque prolapse area/stent area) were calculated. Plaque prolapse was divided into grades 1 (<5%), 2 (5% to 10%), and 3 (10% to 20%). Eighty patients (83 lesions, 41 Cypher and 42 Taxus Express stents) were studied. The incidence of plaque prolapse was 41% (17 of 41 lesions) with the Cypher stents versus 24% (10 of 41 lesions) with the Taxus stents after 14 atm (p = 0.096) and 35% (14 of 40) in Cypher stents versus 17.8% (5 of 28) in Taxus stents after 20 atm (p = 0.17). However, the maximum plaque prolapse area was never >20% of the stent area. The frequency and amount of plaque prolapse neither increased nor decreased at higher (20 atm) inflation pressures. Lesions with prolapse were longer (p = 0.004), with a larger external elastic membrane area and greater plaque burden (each p <0.0001) and a larger remodeling index (p = 0.013). Conversely, nonprolapsed plaques had a higher incidence of superficial calcium (p = 0.001). Creatinine kinase-MB elevation was higher with plaque prolapse, and the magnitude of creatinine kinase-MB elevation correlated with the extent of plaque prolapse (r = 0.664, p = 0.002). Multiple logistic regression analysis indicated that a longer lesion length (p = 0.012), and smaller minimal luminal area (p = 0.031) had higher risks of plaque prolapse. In conclusion, plaque prolapse was frequently observed in Cypher and Taxus stents. However, sequential intravascular ultrasound imaging showed that the frequency and amount of plaque prolapse were neither increased nor decreased by additional higher pressure inflations.

Aged↗
PubMed2005

Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations.

PURPOSE: Rectal prolapse is a known postoperative problem in children with anorectal malformations. The aims of this study were to determine the incidence of significant rectal prolapse (>5 mm), to objectively quantify its predisposing factors, and to offer recommendations as to its prevention and surgical treatment. METHODS: The authors reviewed their series of 1619 patients with anorectal malformations; 1169 underwent primary posterior sagittal anorectoplasty (PSARP) at their institution between 1980 and 2002, and complete records were available for 833. The series was analyzed for incidence of prolapse, type of anorectal malformation, status of the sacrum, muscle quality, associated vertebral and spinal anomalies, and postoperative constipation. A specific technique for prolapse repair was used. RESULTS: Of 833 patients, 45 developed significant rectal prolapse (3.8%). The mean age at the time of PSARP was 0.73 years (range, 0.19-5 years). The average time to recognition of prolapse following PSARP was 13.1 months. Of these 45 patients, 32 required surgical repair and of those, 3 required a second surgical repair. The incidence of prolapse varied by complexity of anorectal defect: cloaca (6.2%), rectobladder neck fistula (6.8%), rectourethral fistula (5.4%), rectovestibular fistula (1.2%), rectal atresia (0%), and rectoperineal fistula (0%). There was a significantly increased incidence of prolapse in patients with a low muscle quality score and in patients with vertebral anomalies (20% vs 3.2%). The presence of a tethered cord and an abnormal sacral ratio did not correlate with an increased incidence of prolapse. Twenty-two patients developed prolapse following colostomy closure, and of these, 12 (55%) suffered from constipation. CONCLUSIONS: The overall incidence of significant rectal prolapse following PSARP is low. Prevention of prolapse with the PSARP technique may be because of key technical steps. Patients with higher anorectal malformations, poorer muscle quality, and vertebral anomalies had a greater risk of developing postoperative rectal prolapse. The presence of tethered cord and quality of the sacrum were not predictive of postoperative prolapse. Constipation seems to be a factor in the development of prolapse.

Anal Canal↗
PubMed2000

Recurrent rectal prolapse: what is the next good option?

PURPOSE: The aim of this study was to assess the clinical and functional outcome of surgery for recurrent rectal prolapse and compare it with the outcome of patients who underwent primary operation for rectal prolapse. METHODS: All patients who underwent surgery for rectal prolapse were evaluated for age, gender, procedure, anorectal manometry and electromyography findings, and morbidity. The results for patients who underwent surgery for recurrent rectal prolapse were compared with a group of patients matched for age, gender, surgeon, and procedure who underwent primary operations for rectal prolapse. RESULTS: A total of 115 patients underwent surgery for rectal prolapse. Twenty-seven patients, 10 initially operated on at this institution and 17 operated on elsewhere, underwent surgery for recurrent rectal prolapse. These 27 patients were compared with 27 patients with primary rectal prolapse operated on in our department. In the recurrent rectal prolapse group, prior surgery included rectopexy in 7 patients, Delorme's procedure in 7 patients, perineal rectosigmoidectomy in 7 patients, anal encirclement procedure in 4 patients, and resection rectopexy in 2 patients. Operations performed for recurrence were perineal rectosigmoidectomy in 14 patients, resection rectopexy in 8 patients, rectopexy in 2 patients, pelvic floor repair in 2 patients, and Delorme's procedure in 1 patient. There were no statistically significant differences between the groups in preoperative incontinence score (recurrent rectal prolapse, 13.6 +/- 7.8 vs. rectal prolapse, 12.7 +/- 7.2; range, 0-20) or manometric or electromyography findings, and there were no significant differences in mortality (0 vs. 3.7 percent), mean hospital stay (5.4 +/- 2.5 vs. 6.9 +/- 2.8 days), anastomotic complications (anastomotic stricture (0 vs. 7.4 percent), anastomotic leak (3.7 vs. 3.7 percent) and wound infection (3.7 vs. 0 percent), postoperative incontinence score (2.8 +/- 4.8 vs. 1.5 +/- 2.7), or recurrence rate (14.8 vs. 11.1 percent) between the two groups at a mean follow-up of 23.9 (range, 6-68) and 22 (range, 5-55) months, respectively. The overall success rate for recurrent rectal prolapse was 85.2 percent. CONCLUSION: The outcome of surgery for rectal prolapse is similar in cases of primary or recurrent prolapse. The same surgical options are valid in both scenarios.

Adult↗
PubMed2004

Gastric prolapse through a gastrostomy tract.

BACKGROUND/PURPOSE: Few reports have documented the incidence or the characteristics of children with gastric prolapse through a gastrostomy tract. The purpose of this report was to determine the incidence of gastric prolapse through a gastrostomy tract and to identify the salient features associated with gastric prolapse. METHODS: This was a retrospective review of 1,042 children from The Children's Hospital, Denver, CO who had a gastrostomy constructed for enteral access between 1992 and 2002. The charts of children who had gastric prolapse through the gastrostomy tract were scrutinized to obtain a profile of the children who had prolapse, and 14 parameters were analyzed for correlation with the incidence of this complication. RESULTS: Thirteen children had gastric prolapse through the gastrostomy tract for an incidence of gastric prolapse of 1.2%; 5 children had recurrent gastric prolapse through a gastrostomy tract for an incidence of recurrent gastric prolapse of 0.5%. Gastric prolapse occurred more often in children with ventilator dependence (31%), poor nutrition (54%), and neurologic disorders (58%). Gastrostomy devices with both ends fixed and rigid were associated with gastric prolapse (2.7%) more often than devices with only 1 end fixed and rigid (0.6%). Laparoscopic gastrostomy was associated with gastric prolapse and recurrent gastric prolapse more often than other gastrostomy construction techniques. CONCLUSIONS: Children with poor nutrition, ventilator dependence, a neurologic disorder, a gastrostomy device with both ends fixed and rigid, and/or a laparoscopic gastrostomy, were prone to gastric prolapse.

Catheterization↗
PubMed1999

Use of the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons in perimenopausal women.

OBJECTIVES: This study was undertaken to apply the standardized Pelvic Organ Prolapse staging system to perimenopausal women to obtain normative data and to determine any effects of risk factors for incontinence and prolapse on Pelvic Organ Prolapse staging system scores. STUDY DESIGN: Two hundred forty-one women aged 45 to 55 years who were seen for perimenopausal care were evaluated in the dorsal lithotomy position for pelvic prolapse at enrollment and again at 12 months. Prolapse was scored according to the Pelvic Organ Prolapse staging system, as approved by the International Continence Society. All subjects completed questionnaires to obtain demographic data, reproductive history, and gynecologic history. Data were evaluated with the Mann-Whitney rank sum test and with 1-way analysis of variance on ranks. RESULTS: The subjects had a mean parity of 2.2 and a mean weight of 72.4 kg. Hysterectomy had been performed in 28% of the women. Urinary incontinence was reported by 66% of the women at enrollment. Mean prolapse scores that described the position of the cervix, the position of the posterior fornix, and the total vaginal length were significantly changed by the 1-year follow-up, with scores reflecting increased prolapse. The mean score at point Ba, which represents the proximal portion of the anterior vaginal wall, was significantly lower, consistent with decreased prolapse at this site. History of smoking, prior hysterectomy, weight, parity, and incontinence at enrollment did not significantly correlate with any of the 9 measured prolapse points. CONCLUSIONS: Normative data for the Pelvic Organ Prolapse staging system of the International Continence Society, American Urogynecologic Society, and Society of Gynecologic Surgeons were measured in a group of perimenopausal women. Apparent increases in prolapse at points C, D, and tvl may reflect changes in vaginal size rather an increase in uterine or vaginal vault prolapse. This variability may confound the use of the Pelvic Organ Prolapse staging system in longitudinal studies involving perimenopausal women.

Female↗
PubMed2001

Occult stress urinary incontinence and the effect of vaginal vault prolapse on abdominal leak point pressures.

OBJECTIVES: To compare the difference in abdominal leak point pressures (ALPPs) between patients with large cystoceles and severe vaginal vault prolapse and to assess the frequency of occult stress urinary incontinence (SUI) in these groups. METHODS: A total of 24 adult female patients with pelvic prolapse underwent prospective fluorourodynamic testing to determine the change in ALPP with and without reduction of the pelvic prolapse. Twelve patients had grade III-IV vaginal vault prolapse and 12 had large cystoceles without vault prolapse. ALPP testing was performed with the prolapse unreduced and then reduced using gauze packing and a vaginal speculum. RESULTS: In patients with vault prolapse, the frequency of occult SUI was 50% (6 of 12) and the mean decrease in ALPP was 59 cm H(2)O after prolapse reduction. In the patients with cystocele, all patients had overt SUI, and the mean change in ALPP was 11 cm H(2)O after prolapse reduction. A component of intrinsic sphincter deficiency was identified in 9 (75%) of 12 women with vault prolapse after reduction, and 8 (66%) of 12 women with no vault prolapse had a component of intrinsic sphincter deficiency before reduction, with an additional 2 (17%) of 12 patients after reduction. CONCLUSIONS: There is a high incidence of occult SUI in patients with vault prolapse and the ALPP after reduction is decreased to a much greater degree in patients with vaginal vault prolapse than in patients with cystocele alone. By reducing the pelvic prolapse during urodynamic testing, an accurate ALPP can be obtained, allowing the appropriate incontinence procedure to be performed.

Female↗
PubMed2005

Pelvic organ prolapse.

Pelvic organ prolapse, including anterior and posterior vaginal prolapse, uterine prolapse, and enterocele, is a common group of clinical conditions affecting millions of American women. This article, designed for the practicing clinician, highlights the clinical importance of prolapse, its pathophysiology, and approaches to diagnosis and therapy. Prolapse encompasses a range of disorders, from asymptomatic altered vaginal anatomy to complete vaginal eversion associated with severe urinary, defecatory, and sexual dysfunction. The pathophysiology of prolapse is multifactorial and may operate under a "multiple-hit" process in which genetically susceptible women are exposed to life events that ultimately result in the development of clinically important prolapse. The evaluation of women with prolapse requires a comprehensive approach, with attention to function in all pelvic compartments based on a detailed patient history, physical examination, and limited testing. Although prolapse is associated with many symptoms, few are specific for prolapse; it is often challenging for the clinician to determine which symptoms are attributable to the prolapse itself and will therefore improve or resolve once the prolapse is treated. When treatment is warranted based on specific symptoms, prolapse management choices fall into 2 broad categories: nonsurgical, which includes pelvic floor muscle training and pessary use; and surgical, which can be reconstructive (eg, sacral colpopexy) or obliterative (eg, colpocleisis). Concomitant symptoms require additional management. Virtually all women with prolapse can be treated and their symptoms improved, even if not completely resolved.

Comorbidity↗