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PubMed1994

[Biomechanics of traction for treatment of lumber disc prolapse].

The intervertebral distance in 31 prolapsed discs under traction increased on the average by 1.34 mm, but in normal discs 0.87 mm. Of 47 prolapsed discs without traction, 29 had negative intradisc pressure, 10 zero, and 8 positive. The total average value of the pressure before traction was -1.3 kPa. Under lumber traction, the pressure decreased in 30 discs, unchanged in 8, and increased in 9, with the average value being -3.2 kPa. The intradisc pressure in 7 normal discs was contrary to the pressure in the prolapsed disc. The difference between the two groups was highly significant (P < 0.01). The pressure unchanged when the intervertebral distance of prolapsed disc unchanged under traction, but the pressure decreased as the distance increased in most cases under traction.

Adolescent↗
PubMed1996

Laparoscopic Approach for Severe Pelvic Vault Prolapse

Laparoscopic repair of grade 1 to 4 pelvic vault prolapse was performed in 103 patients. All women filled in quality of life questionnaires, and had standing vault examination, transperineal ultrasound examination, and cough stress test. Laparoscopic Burch, paravaginal repair, central pubovesical repair, culdoplasty, sacral colpopexy, and posterior vaginal repair were performed after the type and extent of the prolapse were determined. The majority of the procedures were done as day surgery. Almost all women were able to void spontaneously. At 6 weeks all patients had repeat questionnaires, vault examination, transperineal ultrasound, and cough stress test. No recurrences of vault prolapse or of genuine stress incontinence (GSI) were found at that time. Eighty-nine women were reexamined at 1 one year with the questionnaires, ultrasound vault examination, cough stress, and urodynamics. Of the 89 with GSI, 83 (93%) were objectively dry. Five (6%) of the 89 had recurrent vault prolapse. The laparoscopic cure rate of GSI is comparable with that of open repairs.

Journal Article↗
PubMed1988

Comparison of auscultation with two-dimensional and Doppler echocardiography in patients with suspected mitral valve prolapse.

Auscultation was compared to two-dimensional echocardiography (2D echo) and Doppler ultrasonography in 140 consecutive patients referred for evaluation for suspected mitral valve prolapse (MVP) to asses the precision of the two diagnostic methods. Ninety patients (64%) had midsystolic clicks, of which 42 (47%) had MVP by echocardiography; 6 patients (4%) had MVP by 2D echo but no click on examination. In 15 (17%) of the 90 patients, a click was heard only in the standing or squatting positions and 2D echo did not detect prolapse in the supine position in 10 (67%) of the 15. With auscultation as the reference standard for MVP, 2D echo has a sensitivity of 47% and a specificity of 89%. Of the 140 patients, 51 (36%) had systolic murmurs; Doppler detected mitral and/or tricuspid regurgitation in 26 (50%). In 23 (16%) patients, there was Doppler evidence of mitral or tricuspid regurgitation even though systolic murmurs were not heard. Auscultation shows a 53% sensitivity and 73% specificity for systolic murmurs, using Doppler ultrasonography as the reference standard. Of 48 patients with MVP by 2D echo, 15 (13%) had associated mitral regurgitation by Doppler. The results indicate that 2D echo and Doppler ultrasonography should be interpreted in concert with auscultation for the diagnosis of mitral valve prolapse and for therapeutic decision making.

Adult↗
PubMed2005

Recurrence rates after abdominal surgery for complete rectal prolapse: a multicenter pooled analysis of 643 individual patient data.

PURPOSE: This study was designed to determine what impact surgical technique, means of access, and method of rectopexy have on recurrence rates following abdominal surgery for full-thickness rectal prolapse. METHODS: Consecutive individual patient data on age, gender, surgical technique (mobilization-only, mobilization-resection-pexy, or mobilization-pexy), means of access (open or laparoscopic), rectopexy method (suture or mesh), follow-up length, and recurrences were collected from 15 centers performing abdominal surgery for full-thickness rectal prolapse between 1979 and 2001. Recurrence was defined as the presence of full-thickness rectal prolapse after abdominal surgery. Chi-squared test and Cox proportional hazards regression analysis were used to assess statistical heterogeneity. Recurrence-free curves were generated and compared using the Kaplan-Meier method and log-rank test, respectively. RESULTS: Abdominal surgery consisted of mobilization-only (n = 46), mobilization-resection-pexy (n = 130), or mobilization-pexy (n = 467). There were 643 patients. After excluding center 8, there was homogeneity on recurrence rates among the centers with recurrences (n = 8) for age (hazards ratio, 0.6; 95 percent confidence interval, 0.2-1.7; P = 0.405), gender (hazards ratio, 0.6; 95 percent confidence interval, 0.1-2.3; P = 0.519), and center (hazards ratio, 0.3; 95 percent confidence interval, 0.1-1.5; P = 0.142). However, there was heterogeneity between centers with (n = 8) and without recurrences (n = 6) for gender (P = 0.0003), surgical technique (P < 0.0001), means of access (P = 0.01), and rectopexy method (P < 0.0001). The median length of follow-up of individual centers varied from 4 to 127 months (P < 0.0001). There were 38 recurrences at a median follow-up of 43 (range, 1-235) months. The pooled one-, five-, and ten-year recurrence rates were 1.06, 6.61, and 28.9 percent, respectively. Age, gender, surgical technique, means of access, and rectopexy method had no impact on recurrence rates. CONCLUSIONS: Although this study is likely underpowered, the impact of mobilization-only on recurrence rates was similar to that of other surgical techniques.

Adolescent↗
PubMed1988

Prolapse of atrioventricular valve leaflets in the setting of double orifice.

Prolapse of the valve leaflets is reported in 2 cases in the setting of double orifice atrioventricular valve. Diagnosis in the first case, an asymptomatic 8-year-old female, was achieved by echocardiography and consisted in prolapsing leaflets of a double orifice ("bridge type") mitral valve. The second patient, a 24-year-old male, died suddenly. Postmortem examination revealed prolapsing atrioventricular valves, with double orifice ("holy type") of the septal leaflet of the tricuspid valve. There was disruption of the penetrating atrioventricular bundle into multiple fragments with fasciculo-ventricular by-pass fibers.

Adult↗
PubMed2005

Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases.

OBJECTIVE: To evaluate the surgical outcome, complications and benefits of laparoscopic double promonto-fixation for patients with pelvic prolapse. METHODS: Women with genito-urinary prolapse underwent a transperitoneal placement of a 100% polyester mesh on the anterior vaginal wall and a posterior mesh on the levator ani muscle. Both of these were anchored to the sacral promontory. A TVT was placed simultaneously in patients who had concurrent stress urinary incontinence. RESULTS: A total of 363 patients were operated upon between 1996 and 2002. Their mean age was 63 (range 35-78), average follow-up was 14.6 months, the mean operating time was 97 minutes. There were 8 conversions due to anesthetic or surgical difficulties. Follow up was done by a postal questionnaire and physical examination at 6 months and then yearly. 96% were satisfied with the results of their operation and no patients complained of sexual dysfunction. There was a 4% recurrence rate of prolapse, 3 vaginal erosions, 2 urinary retentions that required TVT section, 1 bowel incarcerations, 1 spondylitis and 2 mesh infection. CONCLUSIONS: Laparoscopic promonto-fixation is feasible and highly effective technique that offers good long-term results with complication rates similar to open surgery, with the added benefits of minimally invasive surgery.

Adult↗
PubMed1984

Identification of the increased frequency of cardiovascular abnormalities associated with mitral valve prolapse by two-dimensional echocardiography.

Two-dimensional echocardiography (2-D echo) was performed in 86 consecutive patients with mitral valve prolapse (MVP) and in 25 normal subjects. In normal subjects, mitral leaflet thickness was 3.5 +/- 0.8 mm (mean +/- standard deviation) and the mitral leaflet thickness to aortic wall thickness ratio was 1.0 +/- 0.2. Patients with MVP were separated into 2 groups: those with normal mitral thickness (less than or equal to mean + 2 SD observed in normal subjects, i.e., less than or equal to 5.1 mm) and normal mitral thickness to aortic wall thickness ratio (less than or equal to mean + 2 SD observed in normal subjects, i.e., less than or equal to 1.4) (group I) and others in whom these values were increased (group II). In group I, mitral thickness was 3.6 +/- 0.6 mm and mitral thickness to aortic wall thickness ratio was 1.1 +/- 0.1, and in group II, mitral thickness was 8.8 +/- 1.2 mm and mitral thickness to aortic wall thickness ratio was 2.2 +/- 0.5. The only significant cardiovascular abnormalities in group I were mitral regurgitation in 2 patients and tricuspid valve prolapse in 1 patient. In group II, 7 patients had clinically significant mitral regurgitation, 8 had aortic root abnormalities, 4 had tricuspid valve prolapse and 6 had Marfan's syndrome. Cardiovascular abnormalities were present in 60% (18 of 30) of patients in group II and in 6% (3 of 56) of patients in group I (p less than 0.001). Two-dimensional echo enabled the identification of a subset of patients with MVP who had thickened mitral leaflets. These patients had an increased incidence of cardiovascular abnormalities.

Adult↗
PubMed2006

[Efficacy and safety of Pelvicol in the vaginal treatment of prolapse].

OBJECTIVES: To evaluate the efficacy and safety of a porcine biomaterial (Pelvicol) in the transvaginal surgical treatment of urogenital prolapse. MATERIAL AND METHOD: Prospective study from June 2001 to February 2004 based on 132 patients with a mean age of 67.6 +/- 9.89 years presenting major urogenital prolapse: 132 cystoceles and 84 rectoceles with 100% and 63.4% of grade 2 or 3, respectively. Patients were evaluated by questionnaire and clinical examination at 1 month, 6 months, 12 months and 24 months after the operation. Two hundred and sixteen Pelvicol implants were inserted via a vaginal approach: 132 anterior implants and 84 posterior implants. RESULTS: The mean follow-up was 21 months [range: 6-24]. No intraoperative complication was observed. The postoperative complication rate was 11.3% (15/132) including 1 prosthetic exposure with a favourable outcome. After 6 months, 1 recurrence of cystoceles and 1 recurrence of rectoceles were found in 132 patients. Out of the 117 patients followed up for 12 months, 6 presented with grade 2 cystoceles and 1 grade 2 rectoceles. After 24 months, out of the 107 patients evaluated, 18 cystoceles and 9 rectoceles of grade 2 or 3 were found. Globally, 83.1% of patients did not present with grade 2 or 3 recurrences after 24 months. Safety was considered to be good with 10% of moderate pelvic pain and 6% of de novo dyspareunia at 12 months. The overall satisfaction rate was 94%. CONCLUSION: These preliminary results demonstrate an efficacy of 83.1% at 24 months and the good safety of Pelvicol in the transvaginal surgical treatment of urogenital prolapse.

Aged↗
PubMed1988

[Van der Hoeve's syndrome with Ebstein's anomaly, and prolapse of the mitral and aortic valves: a case report].

A hitherto unrecognized case of van der Hoeve's syndrome complicated by Ebstein's anomaly, and prolapse of the mitral and aortic valves was reported. A 46-year-old woman presented with blue sclera, osteogenesis imperfecta and a hearing loss, which are typical symptoms of this syndrome. The electrocardiogram showed a type B WPW syndrome. The phonocardiogram showed a loud and widely split first heart sound, an accentuated protodiastolic extrasound, a decrescendo regurgitant systolic murmur, and a presystolic murmur. The x descent of the jugular phlebogram was obliterated by a markedly increased c wave. Based on M-mode and two-dimensional echocardiograms, 1) the interventricular septal motion was paradoxical and the closure of the tricuspid valve was delayed, 2) the septal tricuspid leaflet was displaced toward the apex from its normal annular insertion on the apical four-chamber view, 3) the three leaflets of the tricuspid valve were abnormally elongated, 4) the anterior mitral leaflet and the non-coronary cusp of the aortic valve were elongated and prolapsed. Doppler echocardiography detected severe tricuspid and mild mitral regurgitations. We suggest that the development of Ebstein's anomaly is possibly related to that of osteogenesis imperfecta genetically and that not only Ebstein's anomaly but a connective tissue disorder contributes to the elongated and prolapsed leaflets.

Abnormalities, Multiple↗
PubMed1987

[Prolapse of the tricuspid valve].

Of 113 patients who were investigated by echocardiography with regard to mitral prolapse, simultaneous tricuspidal prolapse was detected in 13.3% (15 patients), isolated tricuspidal prolapse (TP) was detected in one patient. Incomplete right bundle branch (RBB) was detected in 11 TP patients, complete RBB in one that might be associated with the involvement in the degenerative process of the proximal part of the right bundle branch in the zone adjoining the tricuspid valve. The characteristic feature of MP and TP was the presence of two systolic clicks.

Adolescent↗
PubMed1986

[Echocardiographic monitoring of Marfan's syndrome. Triple valvular prolapse and calcified permeable foramen ovale].

A patient with typical Marfan's syndrome was monitored by echocardiography, which detected (in 1978) a prolapse of the mitral valve complicated by severe cardiac insufficiency, necessitating valve replacement. Seven years later an aneurysm of the ascending aorta (60 mm) was detected which caused prolapse of the aortic valve with valvular insufficiency, combined with prolapse of the tricuspid valve and a calcified foramen ovale the permeability of which was verified by peripheral injection of contrast medium. Echocardiography, notably two-dimensional, is an excellent examination for regular and atraumatic monitoring of Marfan's syndrome and detection of cardiovascular complications.

Adult↗
PubMed1996

Vaginal prolapse: management with nonsurgical techniques.

Obvious genital prolapse should not be ignored. Undoubtedly, it will progress, lead to worsening symptoms and alterations in pelvic function, and become more difficult to treat. Conservative management approaches include pelvic floor (Kegel) exercises for mild prolapse and use of vaginal pessaries to mechanically support prolapsed tissues. Comprehensive evaluation of bladder and urethral function should be done before any surgical repair is undertaken. Reconstructive surgery provides definitive therapy if all anatomic defects are addressed and the necessary lifestyle changes (eg, avoidance of exertional activities) are instituted.

Female↗
PubMed1997

[Prolapse surgery through the vagina with the help of Endo Stitch. Technical note and preliminary study].

OBJECTIVE: Vaginal cure of genitourinary prolapses is a reliable technique. We propose a technical simplification: the use of the laparoscopic suturing instrument Endo Stitch. Bladder neck suspension can be performed in this way without supra-pubic incision. Sacrospinous suspension is sometimes difficult with a risk of sciatic nerve, pudendal artery or rectum trauma. This is also performed more easily using Endo Stitch. SUBJECTS AND METHODS: Twenty patients with genitourinary prolapse were treated by one surgeon using the Endo Stitch. The patients were followed for 6 to 18 months. RESULTS: No per- or postoperative complications attributable to the use of Endo Stitch were encountered. With two recurrent genital prolapses and one persistent urinary stress incontinence, anatomic and functional results seem to be similar to reference series, but must be confirmed with more follow-up.

Adult↗
PubMed2005

Surgical management of rectal prolapse.

BACKGROUND: The problem of complete rectal prolapse is formidable, with no clear predominant treatment of choice. Surgical management is aimed at restoring physiology by correcting the prolapse and improving continence and constipation with acceptable mortality and recurrence rates. Abdominal procedures are ideal for young fit patients, whereas perineal procedures are reserved for older frail patients with significant comorbidity. Laparoscopic procedures with their advantages of early recovery, less pain, and possibly lower morbidity are recently added options. Regardless of the therapy chosen, matching the surgical selection to the patient is essential. OBJECTIVE: To review the present status of the surgical treatment of rectal prolapse. DATA SOURCES: Literature review using MEDLINE. All articles reporting on rectopexy were included. STUDY SELECTION: Articles reporting on prospective and retrospective comparisons were included. Case reports were excluded, as were studies comparing data with historical controls. DATA EXTRACTION: The results were tabulated to show outcomes of different studies and were compared. Studies that did not report some of the outcomes were noted as "not stated." DATA SYNTHESIS: Abdominal operations offer not only lower recurrence but also greater chance for functional improvements. Suture and mesh rectopexy produce equivalent results. However, the polyvinyl alcohol (Ivalon) sponge rectopexy is associated with an increased risk of infectious complications and has largely been abandoned. The advantage of adding a resection to the rectopexy seems to be related to less constipation. Laparoscopic rectopexy has similar results to open rectopexy but has all of the advantages related to laparoscopy. Perineal procedures are better suited to frail elderly patients with extensive comorbidity. CONCLUSIONS: Abdominal procedures are generally better for young fit patients; the results of all abdominal procedures are comparable. Suture and mesh rectopexy are still popular with many surgeons-the choice depends on the surgeon's experience and preference. Similarly, the procedure may be done through a laparoscope or by laparotomy. Perineal procedures are preferable for patients who are not fit for abdominal procedures, such as elderly frail patients with significant comorbidities. The decision between perineal rectosigmoidectomy and Delorme procedures will depend on the surgeon's preference, although the perineal rectosigmoidectomy has better outcomes.

Age Factors↗
PubMed1996

Levator ani muscle in women with genitourinary prolapse: indirect assessment by muscle histopathology.

The objective of this study was to assess the state of innervation in levator ani muscle sites using muscle histopathology. Asymptomatic women and patients with genitourinary prolapse were included. Histopathologic analysis allows indirect assessment of a muscle's innervation. Therefore, levator ani muscle was collected in a standardized fashion during abdominal surgery and frozen in the operating room using isopentane slush cooled by liquid nitrogen. Serial sections of levator ani muscle in cross-section were studied with standard histochemical and immunohistochemical techniques. The staining patterns from these histochemical techniques allowed quantitative determination of the ratios of fiber types I, IIA, and IIB and their fiber diameters. Objective assessment of fiber type grouping was performed. The distribution of both fiber type percentage and diameter were non-parametric. Therefore, the Mann-Whitney U-test was used to analyze the data for statistical differences between the means for these variables. There was no statistical difference in levator ani muscle fiber type percentage and diameter in patients with prolapse and/or urinary incontinence when compared to asymptomatic women. Levator ani muscles have a higher proportion of slow fibers (66%) than found in other human female muscle (48%). There was no evidence for denervation/reinnervation in any of the biopsy specimens. In this study, levator ani muscle biopsies from incontinent and/or prolapse patients were neither denervated nor reinnervated.

Adult↗
PubMed1990

Two siblings with Tel Hashomer camptodactyly and mitral valve prolapse.

A brother and sister with Tel Hashomer camptodactyly and mitral valve prolapse are described. Mitral valve prolapse is heterogenous, but appears to occur more frequently in individuals with connective tissue disorders. The presence of mitral valve prolapse as a component manifestation of Tel Hashomer camptodactyly suggests that abnormal connective tissue is a pleiotropic effect of the mutant allele.

Abnormalities, Multiple↗
PubMed1976

Bilhariziasis and prolapse of the rectum.

Twenty-six cases with complete prolapse of the rectum were investigated. In 8 of these, bilharziasis of the rectum and colon was found to be the cause of the prolapse. The role of bilharziasis in the pathogenesis of this condition is discussed. The age and sex incidence of bilharzial prolapse differs from that of cases without bilharziasis.

Adult↗
PubMed1985

Treatment of rectal prolapse by sphincteric support using silastic rods.

The use of silastic perianal rings to control rectal prolapse in the elderly has been reviewed. Forty-one patients were treated over a 6 year period by a total of 52 operations. Their mean age was 80 years and there was no operative mortality. Prolapse was adequately controlled in 71 per cent of patients, and a further three patients had no recurrence despite failure and removal of the ring. The results of this procedure are inferior to those obtained by abdominal operations for rectal prolapse, but deserve serious consideration in those elderly patients who may be unfit for laparotomy.

Aged↗