Is laparoscopic high McCall colpopexy effective in treating uterine prolapse with uterine preservation?
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After correction of partial uterine prolapse in a Holstein cow, a 6-cm-long twig was found deep in the affected uterine horn. The twig was removed, and calcium-dextrose and penicillin G were administered. Recovery was unremarkable. Other reports of uterine foreign bodies in cows are scarce and do not describe uterine foreign bodies associated with uterine prolapse or invagination.
Uterine and vaginal collagen content and plasma oestradiol concentration were measured in traditional, male-line and prolapsed male-line turkeys to investigate the higher incidence of uterine prolapse in the male-line strain. The effect of exogenous oestradiol on vaginal collagen and plasma oestradiol was also tested in the traditional and male-line strains. Vaginal collagen was significantly lower in the male-line compared to the traditional-line, while it was lowest in prolapsed male-line turkeys. Plasma oestradiol concentration was higher in the traditional-line than the male-line. No difference in plasma oestradiol concentration was found between prolapsed and non-prolapsed male-line turkeys. Administration of oestradiol for 7 days significantly raised plasma oestradiol concentration but had no effect on vaginal collagen. Decreased vaginal collagen content was associated with uterine prolapse and may predispose the male-line strain to uterine prolapse. There was no evidence from these results to support an involvement of oestradiol in uterine prolapse in male-line turkeys.
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Neonatal uterine prolapse has been rarely described in the literature. Most cases have an underlying cause, usually spinal cord malformations. Conservative treatment has been advocated for this condition in the neonates. We would like to present the late presentation of a child with complete uterine prolapse which was treated with classical uterine ventrisuspension.
OBJECTIVE: Vaginal hysterectomy remains the accepted surgical treatment for women with uterine prolapse. The Manchester repair is favored in women wishing uterine preservation. Vaginal hysterectomy alone fails to address the pathologic cause of the uterine prolapse. The Manchester repair has a high failure rate and may cause difficulty sampling the cervix and uterus in the future. The laparoscopic suture hysteropexy offers physiologic repair of uterine prolapse. METHOD: At the laparoscopic suture hysteropexy, the pouch of Douglas is closed and the uterosacral ligaments are plicated and reattached to the cervix. RESULTS: Forty-three women with symptomatic uterine prolapse were prospectively evaluated and underwent laparoscopic suture hysteropexy with a mean follow-up of 12 +/- 7 months (range 6-32). The mean operating time for the laparoscopic suture hysteropexy alone was 42 +/- 15 minutes (range 22-121), and the mean blood loss was less than 50 mL. On review, 35 women (81%) had no symptoms of prolapse and 34 (79%) had no objective evidence of uterine prolapse. Two women subsequently completed term pregnancies and were without prolapse. Both underwent elective cesarean delivery. CONCLUSION: The laparoscopic suture hysteropexy is effective and safe in the management of symptomatic uterine prolapse. The result is physiologically correct, without disfiguring the cervix. This may be an appropriate procedure for women with uterine prolapse wishing uterine preservation.
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A 5-year-old cheetah suffered a complete prolapse of the left uterine horn after the birth of her second litter. Two attempts to reduce the prolapse transvaginally failed. The animal was hospitalized 13 days after the prolapse first occurred, and an ovariohysterectomy was performed to resolve the prolapse. The prolapsed uterine horn had been mutilated: its tip, together with the ipsilateral ovary was absent. Laparotomy revealed no sign of recent or past hemorrhage or adhesions, or any signs of the left ovarian artery or left ovarian vein in the remnants of the left mesovarium. A large vein crossed the uterine body from the left uterine horn to join the right uterine vein, presumably serving as the only route of venous drainage for the prolapsed uterine horn. A possible cause for the prolapse is excessive mobility of the uterus due to prior rupture of its mesial support. The animal died 24 days after surgery due to chronic renal failure, as a result of severe renal amyloidosis.
The prevalence of obstructive uropathy linked to uterine prolapse ranges between 4% and 80%, depending on the series, probably due to the varying degree of severity of the prolapses under consideration. Renal failure or anuria is an unusual complication. Several etiopathogenic theories regarding obstructive uropathy secondary to prolapse have been put forward: ureteral compression by the uterine vessels, severe urethral angulation, ureteral compression against levator ani muscles and the elongation and narrowing of the distal ureter. The major radiological exploration used in studying the urinary tract of these patients is intravenous urography in bipedestation. Emergency treatment for obstructive anuria resulting from a uterine prolapse consists of manually replacement of the prolapse. Surgery is considered to be the definitive ideal treatment, although in the case of surgical or anaesthetic high risk patients, inserting a permanent pessary may constitute a satisfactory solution. We present a case of obstructive anuria resulting from uterine prolapse, which was successfully treated with the insertion of a ring pessary.
OBJECTIVE: To determine if there is an association between the degree of thoracic kyphosis and the prevalence of advanced uterine prolapse in women. METHODS: A retrospective case-control study compared the degree of thoracic kyphosis among white women with advanced uterine prolapse with that of matched controls. Medical records were reviewed for 412 consecutive women who underwent either abdominal or vaginal hysterectomy. The cases were those with uterine prolapse to or beyond the level of the introitus, and women with no evidence of prolapse served as controls. Spinal curvature was measured preoperatively for each patient using a lateral chest x-ray and the Ferguson method. Forty-eight cases were matched to 48 controls for age, weight, menopausal status, and hormonal status. Results were stratified to analyze the effect of parity on the relationship between uterine prolapse and thoracic kyphosis. RESULTS: The degree of thoracic kyphosis was higher in patients with uterine prolapse than in controls (mean paired difference = 4.9 degrees, 95% confidence interval [CI] 3.1-6.7; P < .001). Patients with uterine prolapse had a mean spinal curvature of 13.0 degrees (95% CI 11.5-14.5), whereas controls had one of 8.1 degrees (95% CI 6.9-9.4). A higher degree of thoracic kyphosis was associated with an incremental higher occurrence of uterine prolapse (odds ratio 1.35, 95% CI 1.11-1.65; P < .01). CONCLUSION: Thoracic kyphosis appears to be associated with uterine prolapse.
The content and quality of type I collagen in the parametrium of women with and without uterine prolapse was evaluated. Forty-four consecutive patients were selected and divided into two groups: A, 21 women without uterine prolapse, and B, 23 with uterine prolapse. Patients in group A had uterine leiomyoma and were submitted to abdominal hysterectomy; in those from group B, vaginal hysterectomy was performed for correction of the uterine prolapse. During surgery, fragments of the parametrium were removed and processed for immunohistochemical analysis using polyclonal antibodies for type I collagen. A system of computerized digital imaging analysis was used for the quantification of collagen fibers. There was no difference between collagen content in patients either with or without prolapse, nor between pre- and postmenopausal women with prolapse. A modification of the quality of the collagen fiber was observed, it being longer and more compact in the group without uterine prolapse. In contrast, in the group with prolapse, the fibers were shorter and thinner and areas with large spaces between fibers were found at several points of the parametrium. The conclusion was that patients with uterine prolapse have the same type I collagen content as those without, but the quality of the fiber is modified. The hormonal status also did not affect collagen content.
Uterine prolapse resulting in hydronephrosis was uncommon. We report two cases of complete uterine prolapse and bilateral moderate hydronephrosis. Case 1, she was admitted due to fever with pyuria. Uterine prolapse was noted by incidental finding. Urine culture showed Escherichia coli. She received total vaginal hysterectomy, which corrected the obstruction and bladder dysfunction. Case 2, she had a history of liver cirrhosis and was denied further operation due to bleeding tendency. Renal echo and intravenous pyelography showed bilateral moderate hydronephrosis with hydroureter in the two cases. Normal renal function was found in the two cases. We suggest early diagnosis and management are necessary in order to prevent renal failure and urinary tract infection.
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Serum samples were obtained from 26 beef cows with uterine prolapse and from 15 with minor dystocia (controls). The serum of animals with uterine prolapse had significantly lower calcium concentration (mean +/- S.D. = 8,22 +/- 0,69 mg/dL, P</=0,01), higher phosphorus concentration (mean +/- S.D. = 4,78 +/- 1,75 mg/dL, P</=0,05) and lower calcium to phosphorus ratios (mean +/- S.D. = 1,99 +/- 0,88, P</=0,01) than for the control animals (means +/- S.D. = 8,91 +/- 0,75 mg/dL, 3,54 +/- 1,41 mg/dL and 2,99 +/- 1,41 respectively). Mild hypocalcemia (6,9 mg/dL-7,9 mg/dL) was present in 11 (42,3%) of the cows with prolapse as compared to only one (6,7%) of the controls. Hypophosphatemia was present in 11 (42,3%) of the animals with prolapse and in ten (66,7%) of the controls. Eighteen (69,2%) of the animals with prolapse were alert and ambulatory when treated and 15 (57,7%) were known to have required help to deliver the calf. Of the cattle group with uterine prolapse, 14 (53,8%) were two years old, six (23,1%) were three years old, and six (23,1%) were four years of age or older. It was concluded that mild hypocalcemia and some degree of dystocia were associated with the uterine prolapses. The phosphorus results were equivocal but the high incidence of hypophosphatemia may reflect a phosphorus deficient diet.
Blood samples were collected from 53 dairy cows with uterine prolapse and from 53 cows with normal parturition (no uterine prolapse) matched by dairy as controls for various management programs among dairies. Cows with uterine prolapse had significantly lower total serum calcium content than did controls (P less than 0.01). Mean (+/- SEM) serum calcium content (mg/dl) for affected cows and controls were 6.08 (+/- 0.25) and 6.96 (+/- 0.20), respectively. Severe hypocalcemia (less than 4 mg/dl) was found in 10 (19%) of the affected cows, compared with 1 (1.8%) of the controls. Fifteen (28%) of the affected cows had moderate hypocalcemia (4.1 to 6.0 mg/dl), compared with 14 (26%) of the controls; 19 (36%) of the affected cows were mildly hypocalcemic (6.1 to 7.9 mg/dl), compared with 25 (47%) of the controls. Nine (17%) of the affected cows and 13 (25%) of the controls were within the normal range of calcium content (greater than 8 mg/dl). Nine of the affected cows were first-calf cows. The serum of these animals did not have significantly lower calcium concentrations, compared with controls matched by parity. Serum calcium values (mg/dl) for 9 first-calf cows and the 9 matched controls were 7.24 (+/- 0.42) and 7.00 (+/- 0.39), respectively. It was concluded that hypocalcemia was associated with uterine prolapse in multiparous dairy cows and, along with other factors, is involved as an etiologic factor for this puerperal condition.
A urethrocystohysterography (UCHG) and a prolapse scoring system (PSS) have been used to assess the types of uterine prolapse and postoperative outcomes since 1979. UCHG was useful in identifying the type of uterine prolapse and in selecting operative procedure. UCHG was done by injecting contrast medium into the bladder and uterine cavity and inserting a metallic bead chain into the urethra. A lateral pelvic X-ray was then taken at rest and during straining. The length of the uterus (UL), distance from the pelvic outlet (PO) to the bladder base (BB), distance from PO to the uterine fundus (UF), and distance from the ischial spine (IS) to UF were measured on the UCHG. We found that there were three types of uterine prolapse on the UCHG findings, type 1: cervical elongation without descent of uterine fundus and cystocele, type 2: uterine prolapse with moderate descent of uterine fundus and cystocele, and type 3: giant vaginal eversion including completely prolapsed uterus, marked cystocele, enterocele and rectocele. The operative time of vaginal hysterectomy with anterior and posterior colporthaphy (VH with AP repair) correlated well with UL and PO-UF distance on UCHG, and blood loss. Operating time was significantly shorter and amount of blood loss was significantly smaller in cases of Machester operation (cervical amputation, fixation of cardinal ligament stumps to the anterior wall of the remaining cervix and AP repair) than in those of VH with AP repair.(ABSTRACT TRUNCATED AT 250 WORDS)
The own method of uterine prolapse treatment with the use of beeswax pessary is presented. The described method is applied in cases where general health conditions do not allow to perform the surgery. The study revealed that the beeswax is a good material to make a vaginal pessary. It's great plasticity allows individual modelling in compliance with anatomical conditions of treated patient. That provides the proper stability of uterine position. The risk of possible urinary stress incontinence due to uterine reposition is also diminished.