1
|
Abstract
This JAMA Patient Page describes the condition of uterine prolapse and its risk factors, symptoms, and treatment options.
Collapse
|
2
|
Greiling MS, Packeiser EM, Gerhauser I, Goericke-Pesch S. Uterine prolapse in a non-pregnant bitch. Reprod Domest Anim 2023; 58:1773-1776. [PMID: 37888850 DOI: 10.1111/rda.14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/14/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
A ten-year-old mixed breed bitch was presented for a tissue prolapse protruding from her vulva. Following detailed examination and stabilization, the ovaries and uterine horns were removed by laparotomy, whereas the prolapsed tissue identified as uterus including cervix was removed vaginally. Histology confirmed uterine prolapse, a rare condition in bitches usually found shortly after birth especially due to dystocia. In contrast, the present case was found in a nulliparous non-pregnant bitch. Diagnostic and therapeutic approaches, including microbiological and histological findings, are described and discussed critically.
Collapse
Affiliation(s)
- Marie Sophie Greiling
- Reproductive Unit - Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Eva-Maria Packeiser
- Reproductive Unit - Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Ingo Gerhauser
- Department of Pathology, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Sandra Goericke-Pesch
- Reproductive Unit - Clinic for Small Animals, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| |
Collapse
|
3
|
Jawade S, Gomase K. A case of a 55-year-old female with uterine prolapse grade IV: a rare clinical image. Pan Afr Med J 2023; 46:10. [PMID: 37928221 PMCID: PMC10620324 DOI: 10.11604/pamj.2023.46.10.41360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Switi Jawade
- Department of Obstetrics and Gynaecology Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe Wardha, Wardha, Maharashtra, India
| | - Kavita Gomase
- Department of Obstetrics and Gynaecology Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Higher Education and Research (DU) Sawangi Meghe Wardha, Wardha, Maharashtra, India
| |
Collapse
|
4
|
Norby N, Murchison AB, McLeish S, Ghahremani T, Whitham M, Magann EF. Uterine Prolapse in Pregnancy: A Review. Obstet Gynecol Surv 2023; 78:537-543. [PMID: 37976302 DOI: 10.1097/ogx.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Importance Although not a common occurrence, uterine prolapse during pregnancy can have significant effects for pregnancy outcomes and quality of life of maternal patients. Most data about management exist as case reports; a review of these cases provides some guidance about treatment options. Objectives This review examines current literature about uterine prolapse during pregnancy to assess current information about this condition, prevalence, diagnosis, management, and outcomes. Evidence Acquisition Electronic databases (PubMed and Embase) were searched using terms "uterine prolapse" AND "pregnancy" AND "etiology" OR "risk factors" OR "diagnosis" OR "therapy" OR "management" limited to the English language and between the years 1980 and October 31, 2022. Results Upon review of 475 articles, 48 relevant articles were included as well as 6 relevant articles found on additional literature review for a total of 54 articles. Of those articles, 62 individual cases of uterine prolapse in pregnancy were reviewed including pregnancy complications, mode of delivery, and outcomes. Prevalence was noted to be rare, but much more common in second and subsequent pregnancies. Most diagnoses were made based on symptomatic prolapse on examination. Management strategies included bed rest, pessary use, and surgery (typically during the early second trimester). Complications included preterm delivery, patient discomfort, urinary retention, and urinary tract infection. Delivery methods included both cesarean and vaginal deliveries. Conclusions Although a rare condition, uterine prolapse in pregnancy is readily diagnosed on examination. Reasonable conservative management strategies include observation, attempted reduction of prolapse, and pessary use; if these measures fail, surgical treatment is an option. Relevance Our review compiles literature and known cases of uterine prolapse during pregnancy and current evidence about prevalence, diagnosis, management, outcomes, and complications of uterine prolapse during pregnancy in order to inform our target audience in their clinical practice.
Collapse
Affiliation(s)
- Nicole Norby
- Resident, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Amanda B Murchison
- Associate Professor, Residency Director, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Shian McLeish
- Resident, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Taylor Ghahremani
- MFM Fellow, The University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megan Whitham
- Assistant Professor, Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Everett F Magann
- Professor MFM Fellowship Director, University of Arkansas for Medical Sciences, Little Rock, AR
| |
Collapse
|
5
|
Deshpande RR, Matsuzaki S, Cox KR, Foy OB, Mandelbaum RS, Ouzounian JG, Dancz CE, Matsuo K. Incidence, characteristics, and maternal outcomes of pregnancy with uterine prolapse. Am J Obstet Gynecol MFM 2023; 5:101020. [PMID: 37245607 DOI: 10.1016/j.ajogmf.2023.101020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Gravid uterine prolapse refers to abnormal descent of the uterus during pregnancy. It is a rare pregnancy complication and its clinical characteristics and obstetrical outcomes are not well understood. OBJECTIVE This study aimed to assess the national-level incidence, characteristics, and maternal outcomes of pregnancies complicated by gravid uterine prolapse. STUDY DESIGN This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 14,647,670 deliveries from January 2016 to December 2019. The exposure assignment was the diagnosis of uterine prolapse. The coprimary outcome measures were incidence rate, clinical and pregnancy characteristics, and delivery outcomes of patients with gravid uterine prolapse. The inverse probability of treatment weighting cohort was created to mitigate the difference in prepregnancy confounding factors, followed by adjusting for pregnancy and delivery factors. RESULTS The incidence of gravid uterine prolapse was 1 in 4209 deliveries (23.8 per 100,000). In a multivariable analysis, older age (≥40 years; adjusted odds ratio, 3.21; 95% confidence interval, 2.70-3.81); age from 35 to 39 years (adjusted odds ratio, 2.66; 95% confidence interval, 2.37-2.99); Black (adjusted odds ratio, 1.48; 95% confidence interval, 1.34-1.63), Asian (adjusted odds ratio, 1.45; 95% confidence interval, 1.28-1.64), and Native American (adjusted odds ratio, 2.17; 95% confidence interval, 1.63-2.88) race/ethnicity; tobacco use (adjusted odds ratio, 1.19; 95% confidence interval, 1.03-1.37); grand multiparity (adjusted odds ratio, 1.78; 95% confidence interval, 1.24-2.55); and history of pregnancy losses (adjusted odds ratio, 2.20; 95% confidence interval, 1.48-3.26) were the patient characteristics associated with increased risk of gravid uterine prolapse. Current pregnancy characteristics associated with gravid uterine prolapse included cervical insufficiency (adjusted odds ratio, 3.25; 95% confidence interval, 1.94-5.45), preterm labor (adjusted odds ratio, 1.53; 95% confidence interval, 1.18-1.97), preterm premature rupture of membranes (adjusted odds ratio, 1.40; 95% confidence interval, 1.01-1.94), and chorioamnionitis (adjusted odds ratio, 1.64; 95% confidence interval, 1.18-2.28). Delivery characteristics associated with gravid uterine prolapse included early-preterm delivery at <34 weeks' gestation (69.1 vs 32.0 per 1000; adjusted odds ratio, 1.86; 95% confidence interval, 1.34-2.59) and precipitate labor (35.2 vs 20.1; adjusted odds ratio, 1.73; 95% confidence interval, 1.22-2.44). Moreover, risks of postpartum hemorrhage (112.1 vs 44.4 per 1000; adjusted odds ratio, 2.70; 95% confidence interval, 2.20-3.32), uterine atony (32.0 vs 15.7; adjusted odds ratio, 2.10; 95% confidence interval, 1.46-3.03), uterine inversion (9.6 vs 0.3; adjusted odds ratio, 31.97; 95% confidence interval, 16.60-61.58), shock (3.2 vs 0.7; adjusted odds ratio, 4.18; 95% confidence interval, 1.41-12.40), blood product transfusion (22.4 vs 11.1; adjusted odds ratio, 2.06; 95% confidence interval, 1.34-3.18), and hysterectomy (7.5 vs 2.3; adjusted odds ratio, 3.02; 95% confidence interval, 1.40-6.51) were increased in the gravid uterine prolapse group compared with the nonprolapse group. Conversely, patients with gravid uterine prolapse were less likely to deliver via cesarean delivery compared with those without gravid uterine prolapse (200.6 vs 322.8 per 1000; adjusted odds ratio, 0.51; 95% confidence interval, 0.44-0.61). CONCLUSION This nationwide analysis suggests that pregnancy with gravid uterine prolapse is uncommon but associated with several high-risk pregnancy characteristics and adverse delivery outcomes.
Collapse
Affiliation(s)
- Rasika R Deshpande
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo)
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan (Dr Matsuzaki)
| | - Kaily R Cox
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo)
| | - Olivia B Foy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo); Keck School of Medicine, University of Southern California, Los Angeles, CA (Ms Foy)
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo); Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Mandelbaum)
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Ouzounian)
| | - Christina E Dancz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Dancz)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Drs Deshpande and Cox, Ms Foy, and Drs Mandelbaum and Matsuo); Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (Dr Matsuo).
| |
Collapse
|
6
|
Singh A, Sankhe A. Cervical prolapse in pregnancy. Pan Afr Med J 2022; 42:253. [PMID: 36338556 PMCID: PMC9617489 DOI: 10.11604/pamj.2022.42.253.35247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Aarshika Singh
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
- Corresponding author: Aarshika Singh, Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India.
| | - Ashirwad Sankhe
- Department of General Surgery, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
| |
Collapse
|
7
|
Olafsdottir T, Thorleifsson G, Sulem P, Stefansson OA, Medek H, Olafsson K, Ingthorsson O, Gudmundsson V, Jonsdottir I, Halldorsson GH, Kristjansson RP, Frigge ML, Stefansdottir L, Sigurdsson JK, Oddsson A, Sigurdsson A, Eggertsson HP, Melsted P, Halldorsson BV, Lund SH, Styrkarsdottir U, Steinthorsdottir V, Gudmundsson J, Holm H, Tragante V, Asselbergs FW, Thorsteinsdottir U, Gudbjartsson DF, Jonsdottir K, Rafnar T, Stefansson K. Genome-wide association identifies seven loci for pelvic organ prolapse in Iceland and the UK Biobank. Commun Biol 2020; 3:129. [PMID: 32184442 PMCID: PMC7078216 DOI: 10.1038/s42003-020-0857-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/25/2020] [Indexed: 12/17/2022] Open
Abstract
Pelvic organ prolapse (POP) is a downward descent of one or more of the pelvic organs, resulting in a protrusion of the vaginal wall and/or uterus. We performed a genome-wide association study of POP using data from Iceland and the UK Biobank, a total of 15,010 cases with hospital-based diagnosis code and 340,734 female controls, and found eight sequence variants at seven loci associating with POP (P < 5 × 10-8); seven common (minor allele frequency >5%) and one with minor allele frequency of 4.87%. Some of the variants associating with POP also associated with traits of similar pathophysiology. Of these, rs3820282, which may alter the estrogen-based regulation of WNT4, also associates with leiomyoma of uterus, gestational duration and endometriosis. Rs3791675 at EFEMP1, a gene involved in connective tissue homeostasis, also associates with hernias and carpal tunnel syndrome. Our results highlight the role of connective tissue metabolism and estrogen exposure in the etiology of POP.
Collapse
Affiliation(s)
| | | | - Patrick Sulem
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
| | | | - Helga Medek
- Department of Obstetrics and Gynecology, Landspitali University Hospital, 101, Reykjavik, Iceland
| | - Karl Olafsson
- Department of Obstetrics and Gynecology, Landspitali University Hospital, 101, Reykjavik, Iceland
| | - Orri Ingthorsson
- Department of Obstetrics and Gynecology, Akureyri Hospital, 600, Akureyri, Iceland
| | - Valur Gudmundsson
- Department of Obstetrics and Gynecology, Akureyri Hospital, 600, Akureyri, Iceland
| | - Ingileif Jonsdottir
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, 101, Reykjavik, Iceland
- Department of Immunology, Landspitali University Hospital, 101, Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | - Pall Melsted
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, 101, Reykjavik, Iceland
| | - Bjarni V Halldorsson
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
- School of Science and Engineering, Reykjavik University, 101, Reykjavik, Iceland
| | - Sigrun H Lund
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
| | | | | | | | - Hilma Holm
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
| | - Vinicius Tragante
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Unnur Thorsteinsdottir
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, 101, Reykjavik, Iceland
| | - Daniel F Gudbjartsson
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
- School of Engineering and Natural Sciences, University of Iceland, 101, Reykjavik, Iceland
| | - Kristin Jonsdottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, 101, Reykjavik, Iceland
| | - Thorunn Rafnar
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE Genetics/Amgen, Sturlugata 8, 101, Reykjavik, Iceland.
- Faculty of Medicine, School of Health Sciences, University of Iceland, 101, Reykjavik, Iceland.
| |
Collapse
|
8
|
Schulten SFM, Detollenaere RJ, Stekelenburg J, IntHout J, Kluivers KB, van Eijndhoven HWF. Sacrospinous hysteropexy versus vaginal hysterectomy with uterosacral ligament suspension in women with uterine prolapse stage 2 or higher: observational follow-up of a multicentre randomised trial. BMJ 2019; 366:l5149. [PMID: 31506252 PMCID: PMC6734519 DOI: 10.1136/bmj.l5149] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and success of uterus preserving sacrospinous hysteropexy as an alternative to vaginal hysterectomy with uterosacral ligament suspension in the surgical treatment of uterine prolapse five years after surgery. DESIGN Observational follow-up of SAVE U (sacrospinous fixation versus vaginal hysterectomy in treatment of uterine prolapse ≥2) randomised controlled trial. SETTING Four non-university teaching hospitals, the Netherlands. PARTICIPANTS 204 of 208 healthy women in the initial trial (2009-12) with uterine prolapse stage 2 or higher requiring surgery and no history of pelvic floor surgery who had been randomised to sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension. The women were followed annually for five years after surgery. This extended trial reports the results at five years. MAIN OUTCOME MEASURES Prespecified primary outcome evaluated at five year follow-up was recurrent prolapse of the uterus or vaginal vault (apical compartment) stage 2 or higher evaluated by pelvic organ prolapse quantification system in combination with bothersome bulge symptoms or repeat surgery for recurrent apical prolapse. Secondary outcomes were overall anatomical failure (recurrent prolapse stage 2 or higher in apical, anterior, or posterior compartment), composite outcome of success (defined as no prolapse beyond the hymen, no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse), functional outcome, quality of life, repeat surgery, and sexual functioning. RESULTS At five years, surgical failure of the apical compartment with bothersome bulge symptoms or repeat surgery occurred in one woman (1%) after sacrospinous hysteropexy compared with eight women (7.8%) after vaginal hysterectomy with uterosacral ligament suspension (difference-6.7%, 95% confidence interval -12.8% to-0.7%). A statistically significant difference was found in composite outcome of success between sacrospinous hysteropexy and vaginal hysterectomy (89/102 (87%) v 77/102 (76%). The other secondary outcomes did not differ. Time-to-event analysis at five years showed no differences between the interventions. CONCLUSIONS At five year follow-up significantly less anatomical recurrences of the apical compartment with bothersome bulge symptoms or repeat surgery were found after sacrospinous hysteropexy compared with vaginal hysterectomy with uterosacral ligament suspension. After hysteropexy a higher proportion of women had a composite outcome of success. Time-to-event analysis showed no differences in outcomes between the procedures. TRIAL REGISTRATION trialregister.nl NTR1866.
Collapse
Affiliation(s)
- Sascha F M Schulten
- Department of Obstetrics and Gynaecology, Isala Clinics, PO Box 10400, 8000 GK Zwolle, Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Renée J Detollenaere
- Department of Obstetrics and Gynaecology, Isala Clinics, PO Box 10400, 8000 GK Zwolle, Netherlands
| | - Jelle Stekelenburg
- Department of Obstetrics and Gynaecology, Medical Centre Leeuwarden, Leeuwarden, Netherlands
- Department of Health sciences, University Medical Center Groningen, Global health, Groningen, Netherlands
| | - Joanna IntHout
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Hugo W F van Eijndhoven
- Department of Obstetrics and Gynaecology, Isala Clinics, PO Box 10400, 8000 GK Zwolle, Netherlands
| |
Collapse
|
9
|
Donon L. [Clinical and paraclinical examination in genital prolapses]. Rev Prat 2019; 69:381-384. [PMID: 31626486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The clinical evaluation of a prolapse has several components: a precise interrogation, a careful clinical examination, the evaluation of its maintenance on the quality of life. It must take into account the urinary, genital and anorectal spheres. From this clinical evaluation will depend the choice and interpretation of paraclinical investigations that may be requested. But the complementary examinations must never replace the interrogation and the clinical examination. Only symptomatic genital prolapses should be treated.
Collapse
|
10
|
Abstract
Yapıcıoğlu Yıldızdaş H, Ece Ü, Bilen Yurdakul G, Kolağasıgil E. Spontaneously resolved uterine prolapse in a neonate with spina bifida. Turk J Pediatr 2019; 61: 979-981. Neonatal uterine prolapse is rare and mostly due to spina bifida. It is probably due to abnormal innervation of levator ani and subsequent atrophy of the muscle in patients with spina bifida. Here we report a newborn patient with uterine prolapse after meningomyelocele operation. Foley catheter was used to manage uterine prolapse, however rectal prolapse occurred and catheter was pulled out. She was followed in an outpatient clinic without any management. She is now seven months old and had no uterine prolapse since the age of two months.
Collapse
Affiliation(s)
| | - Ümit Ece
- Department of Newborn Intensive Care Unit, Private Adana Algomed Hospital, Adana, Turkey
| | | | - Eda Kolağasıgil
- Department of Gynecology and Obstetric Clinic, Private Adana Algomed Hospital, Adana, Turkey
| |
Collapse
|
11
|
Christopher A. The Deleterious Effects of a Vaginal Pessary in a Patient with a History of Radiation Therapy to the Posterior Vaginal Wall. Am Surg 2017; 83:e224-e225. [PMID: 28738918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
12
|
Giri A, Hartmann KE, Aldrich MC, Ward RM, Wu JM, Park AJ, Graff M, Qi L, Nassir R, Wallace RB, O'Sullivan MJ, North KE, Velez Edwards DR, Edwards TL. Admixture mapping of pelvic organ prolapse in African Americans from the Women's Health Initiative Hormone Therapy trial. PLoS One 2017; 12:e0178839. [PMID: 28582460 PMCID: PMC5459562 DOI: 10.1371/journal.pone.0178839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/19/2017] [Indexed: 12/27/2022] Open
Abstract
Evidence suggests European American (EA) women have two- to five-fold increased odds of having pelvic organ prolapse (POP) when compared with African American (AA) women. However, the role of genetic ancestry in relation to POP risk is not clear. Here we evaluate the association between genetic ancestry and POP in AA women from the Women’s Health Initiative Hormone Therapy trial. Women with grade 1 or higher classification, and grade 2 or higher classification for uterine prolapse, cystocele or rectocele at baseline or during follow-up were considered to have any POP (N = 805) and moderate/severe POP (N = 156), respectively. Women with at least two pelvic exams with no indication for POP served as controls (N = 344). We performed case-only, and case-control admixture-mapping analyses using multiple logistic regression while adjusting for age, BMI, parity and global ancestry. We evaluated the association between global ancestry and POP using multiple logistic regression. European ancestry at the individual level was not associated with POP risk. Case-only and case-control local ancestry analyses identified two ancestry-specific loci that may be associated with POP. One locus (Chromosome 15q26.2) achieved empirically-estimated statistical significance and was associated with decreased POP odds (considering grade ≥2 POP) with each unit increase in European ancestry (OR: 0.35; 95% CI: 0.30, 0.57; p-value = 1.48x10-5). This region includes RGMA, a potent regulator of the BMP family of genes. The second locus (Chromosome 1q42.1-q42.3) was associated with increased POP odds with each unit increase in European ancestry (Odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28, 2.22; p-value = 1.93x10-4). Although this region did not reach statistical significance after considering multiple comparisons, it includes potentially relevant genes including TBCE, and ACTA1. Unique non-overlapping European and African ancestry-specific susceptibility loci may be associated with increased POP risk.
Collapse
Affiliation(s)
- Ayush Giri
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Melinda C. Aldrich
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Renee M. Ward
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Jennifer M. Wu
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Amy J. Park
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, District of Columbia, United States of America
| | - Mariaelisa Graff
- Department of Epidemiology, Gillings School of Global Public health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Lihong Qi
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, Davis, Davis, California, United States of America
| | - Rami Nassir
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, California, United States of America
- Department of Internal Medicine, University of California, Davis, Davis, California, United States of America
| | - Robert B. Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Mary J. O'Sullivan
- Department of Obstetrics and Gynecology, Miller School of Medicine, Miami, Florida, United States of America
| | - Kari E. North
- Department of Epidemiology, Gillings School of Global Public health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Todd L. Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- * E-mail:
| |
Collapse
|
13
|
Newton BW, Harmanli O. Perplexing presentation of uterine prolapse and a prolapsed pedunculated leiomyoma. Am J Obstet Gynecol 2016; 215:799.e1-799.e2. [PMID: 27567565 DOI: 10.1016/j.ajog.2016.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/10/2016] [Accepted: 08/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Bradley W Newton
- Departments of Obstetrics and Gynecology, Tufts University School of Medicine, Baystate Medical Center, Springfield, MA
| | - Oz Harmanli
- Departments of Obstetrics and Gynecology, Tufts University School of Medicine, Baystate Medical Center, Springfield, MA.
| |
Collapse
|
14
|
Glazener C, Constable L, Hemming C, Breeman S, Elders A, Cooper K, Freeman R, Smith ARB, Hagen S, McDonald A, McPherson G, Montgomery I, Kilonzo M, Boyers D, Goulao B, Norrie J. Two parallel, pragmatic, UK multicentre, randomised controlled trials comparing surgical options for upper compartment (vault or uterine) pelvic organ prolapse (the VUE Study): study protocol for a randomised controlled trial. Trials 2016; 17:441. [PMID: 27609058 PMCID: PMC5016955 DOI: 10.1186/s13063-016-1576-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One in three women who have a prolapse operation will go on to have another operation, though not necessarily in the same compartment. Surgery can result in greater impairment of quality of life than the original prolapse itself (such as the development of new-onset urinary incontinence, or prolapse at a different site). Anterior and posterior prolapse surgery is most common (90 % of operations), but around 43 % of women also have a uterine (34 %) or vault (9 %) procedure at the same time. There is not enough evidence from randomised controlled trials (RCTs) to guide management of vault or uterine prolapse. The Vault or Uterine prolapse surgery Evaluation (VUE) study aims to assess the surgical management of upper compartment pelvic organ prolapse (POP) in terms of clinical effectiveness, cost-effectiveness and adverse events. METHODS/DESIGN VUE is two parallel, pragmatic, UK multicentre, RCTs (Uterine Trial and Vault Trial). Eligible for inclusion are women with vault or uterine prolapse: requiring a surgical procedure, suitable for randomisation and willing to be randomised. Randomisation will be computer-allocated separately for each trial, minimised on: requiring concomitant anterior and/or posterior POP surgery or not, concomitant incontinence surgery or not, age (under 60 years or 60 years and older) and surgeon. Participants will be randomly assigned, with equal probability to intervention or control arms in either the Uterine Trial or the Vault Trial. Uterine Trial participants will receive either a vaginal hysterectomy or a uterine preservation procedure. Vault Trial participants will receive either a vaginal sacrospinous fixation or an abdominal sacrocolpopexy. Participants will be followed up by postal questionnaires (6 months post surgery and 12 months post randomisation) and also reviewed in clinic 12 months post surgery. The primary outcome is the participant-reported Pelvic Organ Prolapse Symptom Score (POP-SS) at 12 months post randomisation. DISCUSSION Demonstrating the efficacy of vault and uterine prolapse surgeries is relevant not only to patients and clinicians but also to health care providers, both in the UK and globally. TRIAL REGISTRATION Current controlled trials ISRCTN86784244 (assigned 19 October 2012), and the first subject was randomly assigned on 1 May 2013.
Collapse
Affiliation(s)
- Cathryn Glazener
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Lynda Constable
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Christine Hemming
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Suzanne Breeman
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kevin Cooper
- Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Robert Freeman
- Department of Obstetrics and Gynaecology, Plymouth Hospital NHS Trust, Plymouth, UK
| | | | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Gladys McPherson
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | | | - Mary Kilonzo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Beatriz Goulao
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| |
Collapse
|
15
|
Ishchenko AI, Aleksandrov LS, Ishchenko AA, Hudoley EP. [Method of Surgical Management of Genital Prolapse with Cervical Elongation]. Vestn Ross Akad Med Nauk 2016; 71:413-9. [PMID: 29298001 DOI: 10.15690/vramn727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objectives According to different authors, the percentage of genital prolapse among gynaecological diseases that require surgical correction reaches 28−38,9%. Pelvic muscle wasting is a special kind of pelvic prolapse, often leading to cervical elongation and hypertrophy. Contemporary methods of treatment for this condition have the high rate of relapse― 8,9−22%, thus urging to improve the existing techniques. Purpose This research was to estimate the effectiveness of novel modification of Manchester operation in comparison with classic Manchester operation in the management of pelvic prolapse with cervical elongation. Methods We enrolled 83 patients with pelvic prolapse and cervical elongation and divided them into two groups. In GroupI (n=47) we used the novel surgical method, supplementing original Manchester procedure with cervical stump fixation and other improvements. In GroupII we used original Manchester procedure. We compared laboratory measures as well as surgery duration, blood loss, incidence of complications, and duration of post-operational hospital stay. Patients were followed-up for 2years to estimate long-term effectiveness of surgical intervention. Statistical analysis was performed in SPSS 17.0. Results Surgery duration in GroupII was significantly longer (47,8±26,2 vs 57,5±35,1 minutes, p<0.05). There were no significant differences in lab tests, post-operational hospital stay (5,2±0,9 vs 7,3±1,2) and incidence of post-operational complications (3 vs 4 cases). Over the 2 years of follow-up we registered 1 case of relapse in Group I and 3 cases of relapse in Group II, thus estimating the effectiveness of surgery as 97,9 vs 91,7%, a non-significant difference. We noticed that all relapsed women had signs of systemic dysplasia of connective tissue. Conclusion Suggested modification of Manchester operation improves duration of surgical intervention itself, while providing a comparable level of effectiveness.
Collapse
|
16
|
Badi SS, Foarfă MC, Rîcă N, Grosu F, Stănescu C. Etiopathogenic, therapeutic and histopathological aspects upon the anterior vaginal wall prolapse. Rom J Morphol Embryol 2015; 56:765-770. [PMID: 26429170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The pelvine organ prolapse (POP) is a condition affecting million of women, with a major impact upon the social and professional life of the patients. According to various studies, it affects approximately 40% of the women aged over 50 years. About 10% of women with POP require a surgical procedure for POP or urinary incontinence. Our study comprised a number of 14 patients, aged between 55 and 70 years, hospitalized and treated in the Clinic of Urology within the Emergency County Hospital of Craiova, Romania, between 2011 and 2013, for second-degree cystocele. Of these, 11 (78.57%) patients had more than two natural deliveries, 10 suffered more than three abortions, and eight (57.14%) women suffered from obesity. The increase of abdominal pressure, induced by chronic coughing, constipation or hard physical work, was identified in more patients. Thus, six (42.8%) patients presented chronic bronchitis, four (28.57%) patients were smokers, eight (57.14%) patients presented chronic constipation, and 10 (71.42%) patients stated that they had performed hard physical work. The presence of effort urinary incontinence, associated to the cystocele, was found in eight (57.14%) cases. The surgical intervention consisted in the performance of a direct cystopexia with a synthetic tent, placed in a transobturatory way, in a "tension free" manner (Perigee System). The post-operatory evolution was a good one; the results after six months showed that 12 (85.71%) women were cured, two (14.29%) cases of cystocele relapsed, while in two patients there maintained the effort urinary incontinence. The histopathological examination of the anterior vaginal wall fragments, harvested during the surgical intervention, showed the presence of a chronic inflammatory infiltrate in the lamina propria of the uterine mucosa, which may cause the post-operatory relapses. We consider that the reduction of the inflammatory process through the administration of anti-inflammatory drugs could reduce the POP onset and progress.
Collapse
Affiliation(s)
- Sabin Sorin Badi
- Department of Histology, "Victor Papilian" Faculty of Medicine, "Lucian Blaga" University of Sibiu, Romania;
| | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Sarah Gray
- GP Specialist, CornwallTamar Valley Health, Callington, Cornwall, UK
| |
Collapse
|
18
|
Bigliardi E, Di Ianni F, Parmigiani E, Cantoni AM, Bresciani C. Complete uterine prolapse without uterine mucosal eversion in a queen. J Small Anim Pract 2014; 55:235-7. [PMID: 24697408 DOI: 10.1111/jsap.12190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2013] [Indexed: 11/30/2022]
Abstract
A five-year-old female cat weighing 3 kg was presented by the owner after noticing a large pink, bilobed mass protruding through the vulva during labour. The cat was in good condition, with appropriate lactation, and the newborn kittens were nursing normally. The uterus was not reverted or invaginated at examination, and there was rupture of the mesovarium, mesometrium and uterine-vaginal connection around the cervix. Manual reduction of the prolapsed uterus was not possible because of torn ligaments. A coeliotomy was performed to remove the ovaries, and the apex of the uterine horns was passed by the vaginal route. The remaining part of the mesometrium was disconnected, and the prolapsed uterus was removed. The queen and kittens were discharged from the hospital on the second day after surgery. An unusual feature of this case is that the prolapse was complete, without eversion of any part of the uterus through a vaginal tear.
Collapse
|
19
|
Kerkhof MH, Scholten I. Nausea, vomiting, malaise, frequent urination--Dx? J Fam Pract 2014; 63:592-599. [PMID: 25343157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Manon H Kerkhof
- Department of Obstetrics and Gynecology, VU University Medical Centre, Amsterdam, The Netherlands.
| | | |
Collapse
|
20
|
Saha DK, Hasan KM, Rahman SM, Majumder SK, Zahid MK, Chakraborty AK, Bari MS. Neonatal uterine prolapse - a case report. Mymensingh Med J 2014; 23:401-405. [PMID: 24858176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Uterine prolapse is commonly seen in the geriatric age group. Congenital vaginouterine prolapse is a rare condition occurring in neonates and is usually associated with spinal cord malformations in about 85% of cases. Several modalities of treatment have been described for neonatal uterine prolapse. Conservative treatment in the form of simple digital reposition, use of pessary or other self-retaining device is usually sufficient to treat this condition, which is self-limiting and regressive. Here we report our first case of neonatal uterine prolapse, managed successfully with simple digital reposition.
Collapse
Affiliation(s)
- D K Saha
- Dr Dipankar Kumar Saha, Registrar, Pediatric Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh
| | | | | | | | | | | | | |
Collapse
|
21
|
Smith TM, Luo J, Hsu Y, Ashton-Miller J, Delancey JO. A novel technique to measure in vivo uterine suspensory ligament stiffness. Am J Obstet Gynecol 2013; 209:484.e1-7. [PMID: 23747493 DOI: 10.1016/j.ajog.2013.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 05/06/2013] [Accepted: 06/03/2013] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this study was to describe a new computer-controlled research apparatus for measuring in vivo uterine ligament force-displacement behavior and stiffness and to present pilot data for women with and without prolapse. STUDY DESIGN Seventeen women with varying uterine support underwent testing in the operating room (OR) after anesthetic induction. A tripod-mounted computer-controlled linear servoactuator was used to quantify force-displacement behavior of the cervix and supporting ligaments. The servoactuator applied a caudally directed force to a tenaculum at 4 mm/sec velocity until the traction force reached 17.8 N (4 lbs). Cervix location on Pelvic Organ Prolapse Quantification system (POP-Q) in the clinic, in the OR, at rest, and with minimal force (<1.1 N); maximum force (17.8 N) was recorded. Ligament "stiffness" between minimum and maximum force was calculated. RESULTS The mean ± SD subject age was 54.5 ± 12.7 years; parity was 2.9 ± 1.1; body mass index was 29.0 ± 4.3 kg/m(2), and POP-Q point C was -3.1 ± 3.9 cm. POP-Q point C was correlated most strongly with cervix location at maximum force (r = +0.68; P = .003) and at rest (r = +0.62; P = .009). Associations between cervix location at minimum force (r = +0.46; P = .059) and ligament stiffness (r = -0.44; P = .079) were not statistically significant. Cervix location in the OR with minimal traction lay below the lowest point found on POP-Q for 13 women. CONCLUSION POP-Q point C was correlated strongly with cervix location at rest and at maximum traction force; however, only 19% of the variation in POP-Q point C location was explained by ligament stiffness. The cervix location in the OR at minimal traction lay below POP-Q point C value in three-fourths of the women.
Collapse
Affiliation(s)
- Tovia Martirosian Smith
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | | | | | | | | |
Collapse
|
22
|
Abstract
Pelvic floor disorders present very differently with regard to symptoms and manifestation. Both diagnostic and treatment options require specific experience and an interdisciplinary approach. Diagnostic work-up is primarily based on medical history, physical examination and procto-rectoscopy. Furthermore, endosonography and perineal sonography have also gained importance. In almost all cases following these basic examinations conservative therapy options should be considered. As the interdisciplinary concept is very important, for careful diagnosis of pelvic floor disorders it became crucial to find an adequate form of treatment. Every decision for surgical therapy should not only focus on the results of previous examinations but should also consider the individual situation of each patient. In pelvic floor disorders a large variety of symptoms are confronted with a vast number of different and often highly specific procedures. The decisions on who to treat and how to treat are not only based on individual patient requests and desires but also on the experience and preference of the surgeon.
Collapse
Affiliation(s)
- T H Schiedeck
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland,
| |
Collapse
|
23
|
Sallami S, Ben Rhouma S, Gammoudi A, Cherif MK, Horchani A. Urethral prolapse misdiagnosed as vaginal tumor in an elderly woman. Tunis Med 2013; 91:160-161. [PMID: 23526281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
24
|
Zelis M, Mercelina-Roumans P, Meesters B. [A woman with a remarkable prolapse]. Ned Tijdschr Geneeskd 2013; 157:A5004. [PMID: 23328010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 59-year-old woman (para 3) felt something protruding from the vagina after a violent cough, followed by an extreme abdominal pain. A spontaneous small bowel evisceration through a vaginal herniation was diagnosed.
Collapse
Affiliation(s)
- Maartje Zelis
- Atrium Medisch Centrum Parkstad, Afd. Obstetrie en Gynaecologie, Heerlen, the Netherlands.
| | | | | |
Collapse
|
25
|
Dane C, Rustemoglu Y, Kiray M, Ozkuvanci U, Tatar Z, Dane B. Vaginal leiomyoma in pregnancy presenting as a prolapsed vaginal mass. Hong Kong Med J 2012; 18:533-535. [PMID: 23223657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Vaginal leiomyomas are rare benign solid tumours of the vagina. They can cause mechanical dystocia, which is a common problem in obstetrics leading to serious maternal and perinatal complications. Here we describe a patient with a vaginal leiomyoma diagnosed during the mid-trimester that could have caused dystocia. This 22-year-old woman presented with a vaginal mass and leaking vaginal fluid during pregnancy. On examination, a prolapsed, pedunculated mass, measuring 5 × 3 × 4 cm was detected in the anterior vaginal wall. Via a midline incision, the mass was easily enucleated and removed. Transvaginal surgical enucleation of the vaginal leiomyoma is usually curative and recommended as the initial treatment of choice to prevent for dystocia. Such treatment is indicated when the tumour is a potential obstacle to normal labour.
Collapse
Affiliation(s)
- Cem Dane
- Department of Gynecology and Obstetrics, Haseki Training and Research Hospital, Istanbul, Turkey.
| | | | | | | | | | | |
Collapse
|
26
|
Zhu L, Lang JH. [Some key points of treatment for pelvic organ prolapses]. Zhonghua Fu Chan Ke Za Zhi 2011; 46:561-563. [PMID: 22169510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
27
|
Serradilla LN, Gómez-Ríos MA, Nicolás C, Ramón y Cajal L. Embolization before surgery of a large pedunculated submucosal myoma prolapsed into the vagina. Acta Obstet Gynecol Scand 2011; 90:554-5. [PMID: 21332453 DOI: 10.1111/j.1600-0412.2011.01108.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
Owczarek M, Krzyszkowska I, Sikora W. [Incarcerated gravid uterus--case report]. Ginekol Pol 2010; 81:944-946. [PMID: 21395087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
A case of an incarcerated, retroflexed gravid uterus in a 29-year-old patient with a right ovarian cyst in the 14th week of her second pregnancy was presented. In 1999, at the age of 18, the patient had undergone enucleation of a dermoid cyst of the left ovary by laparotomy and a segment of the right ovary had been collected. After conservative treatment trial, the patient was qualified for a surgical procedure. Right ovarian cyst enucleation was performed. Left ovary adhesions with epiploic appendices of sigmoid colon were released and the uterus was reached from retroflexion. The patient, with saved pregnancy was discharged from the hospital in the state of good health on the sixth day after the surgery.
Collapse
Affiliation(s)
- Małgorzata Owczarek
- Oddział Ginekologiczno-Potozniczy Radomskiego Szpitala Specjalistycznego im. dr Tytusa Chałubińskiego w Radomiu.
| | | | | |
Collapse
|
29
|
Kruger JA, Heap SW, Murphy BA, Dietz HP. How best to measure the levator hiatus: evidence for the non-Euclidean nature of the 'plane of minimal dimensions'. Ultrasound Obstet Gynecol 2010; 36:755-758. [PMID: 20645397 DOI: 10.1002/uog.7750] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/13/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To clarify whether the 'plane of minimal dimensions' of the levator hiatus on three-dimensional (3D) ultrasound accurately represents the minimal anatomical transverse hiatal dimension during a Valsalva maneuver. METHODS In this retrospective study of 3D transperineal ultrasound and magnetic resonance (MR) imaging, datasets from 19 female participants were used to measure the transverse diameter of the levator hiatus using the plane of minimal dimensions on maximum Valsalva maneuver. The term 'apparent minimal transverse diameter' (aMTD) was used to define the transverse diameter measured using axial ultrasound and comparable axial or coronal MR images. Coronal MR images, using the plane of the vagina as a reference, were also obtained on maximum Valsalva. The transverse diameter measured between the caudal margin of the pubococcygeus/puborectalis on the MR coronal image is denoted by the term 'true minimal transverse diameter' (tMTD). Statistical comparisons between the aMTD and tMTD were made using Student's t-test. RESULTS No significant difference was demonstrated between the aMTD as measured by ultrasonography and MRI. However, there were significant differences found between the aMTD measured by both ultrasound and MRI and the tMTD measured on coronal MR images (both P < 0.01), with mean ( ± SD) values of 4.36 ± 0.85, 4.13 ± 1.09 and 3.23 ± 0.49 cm, respectively. CONCLUSION This study highlights the complexity and 3D nature of the levator hiatus and pelvic floor muscles. Investigators have previously assumed that the plane of minimal dimensions of the hiatus can be measured in a flat plane, however, the 3D nature of the hiatus means that the true levator hiatus occupies a warped (non-Euclidean) plane. Hiatal measurements on Valsalva may be subject to systematic error if performed in a single section, i.e. using a flat (Euclidean) plane.
Collapse
Affiliation(s)
- J A Kruger
- Auckland Bioengineering Institute, Auckland, New Zealand.
| | | | | | | |
Collapse
|
30
|
Mucowski SJ, Jurnalov C, Phelps JY. Use of vaginal mesh in the face of recent FDA warnings and litigation. Am J Obstet Gynecol 2010; 203:103.e1-4. [PMID: 20227672 DOI: 10.1016/j.ajog.2010.01.060] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 10/08/2009] [Accepted: 01/20/2010] [Indexed: 11/15/2022]
Abstract
Choosing to use mesh in vaginal reconstructive surgery for pelvic organ prolapse or stress urinary incontinence is perplexing in the face of recent US Food and Drug Administration (FDA) warnings. In October 2008, the FDA alerted practitioners to complications associated with transvaginal placement of surgical mesh. Litigation is another concern. A Google search of "transvaginal mesh" results in numerous hits for plaintiff attorneys seeking patients with complications related to use of mesh. In light of a recent decision by the US Supreme Court and strategies by manufactures of medical devices to escape liability, it is imperative that gynecologic surgeons using transvaginal mesh document proper informed consent in the medical records. The purpose of this commentary is not to deter gynecologic surgeons from using transvaginal mesh when appropriate, but to provide an overview of current medical-legal controversies and stress the importance of documenting informed consent.
Collapse
Affiliation(s)
- Sara J Mucowski
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, TX 77555-0587, USA
| | | | | |
Collapse
|
31
|
Abstract
Disorders of the pelvic floor are common sources of morbidity, decreased quality of life, and are unfortunately increasing in incidence. Owing to their complex and often coexistent nature, a comprehensive, multidisciplinary strategy of testing and care is required. Many nonoperative and operative approaches for management of the symptoms of pelvic floor disorders are available. This article reviews the evaluation and management for these difficult disorders.
Collapse
|
32
|
Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J 2009; 21:5-26. [PMID: 19937315 DOI: 10.1007/s00192-009-0976-9] [Citation(s) in RCA: 1392] [Impact Index Per Article: 92.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 07/27/2009] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Next to existing terminology of the lower urinary tract, due to its increasing complexity, the terminology for pelvic floor dysfunction in women may be better updated by a female-specific approach and clinically based consensus report. METHODS This report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by many external referees. Appropriate core clinical categories and a subclassification were developed to give an alphanumeric coding to each definition. An extensive process of 15 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A terminology report for female pelvic floor dysfunction, encompassing over 250 separate definitions, has been developed. It is clinically based with the six most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific imaging (ultrasound, radiology, and MRI) has been a major addition while appropriate figures have been included to supplement and help clarify the text. Ongoing review is not only anticipated but will be required to keep the document updated and as widely acceptable as possible. CONCLUSIONS A consensus-based terminology report for female pelvic floor dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
Collapse
Affiliation(s)
- Bernard T Haylen
- St Vincent's Clinic, Suite 904, 438 Victoria Street, Darlinghurst, Sydney, 2010, NSW, Australia.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Rouzi AA, Sahly NN, Shobkshi AS, Abduljabbar HS. Manchester repair. An alternative to hysterectomy. Saudi Med J 2009; 30:1473-1475. [PMID: 19882064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Local data regarding Manchester repair are not available in the current literature. We report a retrospective case series of 7 women who presented with uterine prolapse, and underwent Manchester repair from January 1997 to May 2008 at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. All of these women were multiparous (para 31) and wanted to avoid hysterectomy, and become pregnant. The duration of the procedure was 119 16 minutes. No operative complications were observed. The mean duration of follow up was 52 years. All of the women were satisfied with the procedure. Two (28.6%) patients subsequently became pregnant and had a successful vaginal delivery. Manchester repair is a valid alternative to hysterectomy for women with a second degree uterine prolapse who want to preserve their fertility.
Collapse
Affiliation(s)
- Abdulrahim A Rouzi
- Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
| | | | | | | |
Collapse
|
34
|
Affiliation(s)
- B Adams
- Belfast City Hospital and Royal Jubilee Maternity Service, Belfast, UK.
| | | |
Collapse
|
35
|
Affiliation(s)
- M Quinn
- Department of Obstetrics and Gynaecology, Hope Hospital, Salford, UK.
| | | |
Collapse
|
36
|
Marchese K. Improving evidence-based practice: use of the POP-Q system for the assessment of pelvic organ prolapse. Urol Nurs 2009; 29:216-223. [PMID: 19718936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The focus of improving health care outcomes today relies on utilizing evidence-based practice. Pelvic organ prolapse affects women of all ages and negatively impacts their quality of life. Evidence-based tools for consistent assessment of prolapses have been developed, validated, and used by many clinicians. Use of these tools needs to become standard of practice for all clinicians who work in the women's health arena. The Brink scale and the POP-Q assessment tool can assist clinicians, direct quality care, and provide evidence-based practice.
Collapse
|
37
|
Lewicky-Gaupp C, Margulies RU, Larson K, Fenner DE, Morgan DM, DeLancey JOL. Self-perceived natural history of pelvic organ prolapse described by women presenting for treatment. Int Urogynecol J 2009; 20:927-31. [PMID: 19390760 DOI: 10.1007/s00192-009-0890-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/31/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to describe the self-perceived natural history of pelvic organ prolapse (POP) in women seeking care. METHODS Women presenting to a university-based urogynecology clinic for POP (n = 107) completed a questionnaire including questions about how and when their prolapse was discovered. A urogynecologic examination including the pelvic organ prolapse quantification (POP-Q) was also performed. RESULTS Forty-eight percent of these women sought medical attention "immediately" after discovering a bulge. The median time to seek care was 4 months (range from 1 month to 45 years). Twenty-six percent associated their prolapse with a specific event (e.g., moving furniture or pushing a car). POP was self-discovered by 76% (81/107) of women. Self-discovered prolapses were larger than those diagnosed by physicians (Ba +1.3 vs 0.1 cm, P = .03, respectively). CONCLUSIONS Women seek medical advice within months of discovering their prolapse. Self-discovery is associated with higher stage prolapse than prolapse diagnosed by health care providers.
Collapse
Affiliation(s)
- Christina Lewicky-Gaupp
- Pelvic Floor Research Group, Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Henn EW, van Rensburg JA, Cronje HS. Management of anterior vaginal prolapse in South Africa: national survey. S Afr Med J 2009; 99:229-230. [PMID: 19588773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
|
39
|
|
40
|
Aniuliene R. Tension-free vaginal tape versus tension-free vaginal tape obturator (inside-outside) in the surgical treatment of female stress urinary incontinence. Medicina (Kaunas) 2009; 45:639-643. [PMID: 19773623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED The objective of this study was to compare TVT (tension-free vaginal tape) and TVT-O (tension-free vaginal tape obturator from inside to outside) procedures for the female surgical treatment of stress urinary incontinence: results, complications, and effectiveness after 1 year. MATERIAL AND METHODS A prospective randomized study was carried out. The patients were followed up for 12 months. A total of 114 patients were operated on using TVT procedure and 150 patients - TVT-O procedure. There was no significant difference in age, body mass index, parity, menopausal status, and prolapse (no patients had cystocele greater than stage II) comparing both groups. RESULTS The mean time in surgery was significantly shorter in the TVT-O group (19+/-5.6 min) as compared with the TVT group (27+/-7.1 min). No differences in the effectiveness of both procedures were found: TVT - 94.6% and TVT-O - 94.6% after one year, respectively. Hospital stay was significantly shorter in the TVT-O group (1.5+/-0.5 days) than in the TVT group (4.0+/-1.6 days). Significantly fewer complications were observed in the TVT-O group. CONCLUSION TVT and TVT-O operations are equally effective for the surgical treatment of female stress urinary incontinence. TVT-O group had shorter time in surgery and showed a lower rate of complications.
Collapse
Affiliation(s)
- Rosita Aniuliene
- Department of Obstetrics and Gynecology, Kaunas University of Medicine, Eiveniu 2, Kaunas 50009, Lithuania.
| |
Collapse
|
41
|
Hampton BS. Pelvic organ prolapse. Med Health R I 2009; 92:5-9. [PMID: 19248418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pelvic organ prolapse can encompass a range of disorders, from asymptomatic, altered anatomy to complete eversion of the vagina and may present with associated urinary, defecatory, and sexual dysfunction. Patient symptoms are important to elicit, because many patients with prolapse are asymptomatic. Ascertaining patient treatment goals is necessary when discussing options for management, and patients can choose from conservative, noninvasive treatment and prevention to surgical reconstruction. As comparable data for prolapse operations are poor, surgical route is determined based on the type and severity of prolapse, surgeon preference, and desired outcome.
Collapse
|
42
|
Haverkorn R, Lemack GE. Editorial comment on: Medium-term anatomic and function results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol 2008; 55:1467-8. [PMID: 19111381 DOI: 10.1016/j.eururo.2008.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
43
|
Naspro R. Editorial comment on: Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol 2008; 55:1468. [PMID: 19111384 DOI: 10.1016/j.eururo.2008.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
44
|
Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, Coremans G, Deprest J. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol 2008; 55:1459-67. [PMID: 19111382 DOI: 10.1016/j.eururo.2008.12.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 12/09/2008] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited prospective data on the anatomic and functional outcome after laparoscopic sacrocolpopexy (LSC) are available in the literature. OBJECTIVE To describe the medium-term anatomic and functional outcome of LSC. DESIGN, SETTING, AND PARTICIPANTS Prospective consecutive series of 132 women with vaginal vault prolapse undergoing LSC between 2001 and 2006, which was after our learning curve. Patients with urodynamically proven stress incontinence (SI) underwent a concomitant tension-free vaginal tape (TVT) procedure. INTERVENTION Patients underwent LSC with a polypropylene implant. MEASUREMENTS Principal outcome measures were anatomic cure (stage 1 or lower) assessed by the Pelvic Organ Prolapse Quantification (POPQ) system and subjective cure and impact on quality of life measured by a standardised interview and, since its introduction in 2004, by a prolapse-specific quality-of-life questionnaire (P-QOL). RESULTS AND LIMITATIONS At a mean follow-up of 12.5 mo, the anatomic cure rate for the apex was 98%. Anatomic failures elsewhere were mainly at the posterior compartment (18%). Subjective prolapse cure rate was 91.7%, and no patients required reoperation for recurrent prolapse. Symptoms of preoperative SI, urge incontinence, or constipation were cured in 43%, 46%, and 42% of patients, respectively. The rate of de novo SI was 7.3%. De novo constipation developed in 5% and de novo dyspareunia developed in 19%. Patients' quality of life improved significantly. Erosions occurred in 4.5%, all within 1 yr. A limitation of the study is that the quality-of-life assessment score became available halfway through the study, limiting the number of preoperative observations (n=36). CONCLUSIONS We demonstrated that LSC results in good anatomic outcome and subjective cure of prolapse symptoms at medium term. The posterior compartment was most vulnerable for recurrence.
Collapse
Affiliation(s)
- Filip Claerhout
- Pelvic Floor Unit, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Park AJ, Paraiso MFR. Surgical management of uterine prolapse. Minerva Ginecol 2008; 60:493-507. [PMID: 18981977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The surgical management of uterine prolapse requires an apical suspension procedure, with or without uterine removal. Options in the surgical treatment of uterine prolapse encompass the open, laparoscopic, or vaginal approaches. Vaginal apical suspension procedures include the uterosacral vaginal vault suspension, sacrospinous ligament fixation, iliococcygeus fascia suspension, and the McCall or Mayo culdoplasty. The abdominal sacral colpopexy may be performed via laparotomy or laparoscopy. Uterine preservation techniques include the Manchester procedure, sacrospinous hysteropexy, laparoscopic sacral hysteropexy and laparoscopic uterosacral vault suspension. Most of the data for subjective and objective outcomes for these prolapse procedures are from uncontrolled retrospective case series. Currently there is no definitive gold standard procedure to favor a particular route in the treatment of uterine prolapse. Thus, the optimal procedure to treat uterine prolapse depends on the specific defects that are present, as well as considerations such as the patient's age, comorbidities, activity level, desire for future fertility, history of prior prolapse surgery in other compartments, patient preference, as well as the skill and comfort level of the surgeon with the particular surgery.
Collapse
Affiliation(s)
- A J Park
- Section of Female Pelvic Medicine and Reconstructive Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
| | | |
Collapse
|
46
|
Epstein LB, Graham CA, Heit MH. Impact of sacral colpopexy on in vivo vaginal biomechanical properties. Am J Obstet Gynecol 2008; 199:664.e1-6. [PMID: 18986642 DOI: 10.1016/j.ajog.2008.07.056] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2008] [Revised: 05/19/2008] [Accepted: 07/28/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine if sacral colpopexy has an impact on in vivo vaginal biomechanical properties. STUDY DESIGN Thirty-five participants who underwent sacral colpopexy were enrolled in this prospective clinical trial. In vivo vaginal biomechanical properties, including elasticity, viscoelasticity, and vaginal stiffness index, as well as symptom severity questionnaires (pelvic floor distress inventory-short form) and Pelvic Organ Prolapse Quantification (POP-Q) examination, were performed preoperatively and 6 weeks postoperatively. RESULTS Thirty-two participants completed the study. Six weeks after sacral colpopexy participants demonstrated a decrease in prolapse related symptoms (POPDI-6 score, 39.8 vs 9.0, P < .00001) and 97% demonstrated anatomical cure of their prolapse. At 6 weeks follow-up participants demonstrated an increase in elasticity (2.26 vs 3.43, P < .00001), viscoelasticity (1.55 vs 4.08, P < .000001), and vaginal stiffness index (108.65 vs 164.50, P < .01). CONCLUSION These findings suggest that sacral colpopexy increases in vivo vaginal biomechanical properties, as well as decreasing anatomical and symptom-related severity of pelvic organ prolapse.
Collapse
Affiliation(s)
- Lee B Epstein
- Louisville Pelvic Floor Research Group, Louisville, KY, USA
| | | | | |
Collapse
|
47
|
Gutman RE, Ford DE, Quiroz LH, Shippey SH, Handa VL. Is there a pelvic organ prolapse threshold that predicts pelvic floor symptoms? Am J Obstet Gynecol 2008; 199:683.e1-7. [PMID: 18828990 DOI: 10.1016/j.ajog.2008.07.028] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/19/2008] [Accepted: 07/11/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to determine the minimum threshold level at which maximum anatomic prolapse predicts bothersome pelvic floor symptoms. STUDY DESIGN We performed a cross-sectional study of women older than 40 years undergoing gynecologic and urogynecologic examinations using Pelvic Organ Prolapse Quantification (POP-Q) examinations to assess support and Pelvic Floor Distress Inventory questionnaires to assess symptoms. Across the spectrum of prolapse severity, we calculated receiver operating characteristic (ROC) curves and areas under the curves (AUCs) for each symptom. RESULTS Of 296 participants, age was 56.3 +/- 11.2 years, and 233 (79%) were white. POP-Q stage was 0 in 39 (13%), 1 in 136 (46%), 2 in 89 (30%), and 3 in 33 (11%). ROC analysis for each symptom revealed an AUC of 0.89 for bulging/protrusion; 0.81 for splinting to void; 0.55-0.62 for other prolapse and urinary symptoms; and 0.48-0.56 for bowel symptoms. Using a threshold of 0.5 cm distal to the hymen, the sensitivity (69%) and specificity (97%) were high for protrusion symptoms but poor for most other symptoms considered. CONCLUSION Vaginal descensus 0.5 cm distal to the hymen accurately predicts bulging/protrusion symptoms; however, we could not identify a threshold of prolapse severity that predicted other pelvic floor symptoms.
Collapse
Affiliation(s)
- Robert E Gutman
- Departments of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | |
Collapse
|
48
|
Margulies RU, Lewicky-Gaupp C, Fenner DE, McGuire EJ, Clemens JQ, Delancey JOL. Complications requiring reoperation following vaginal mesh kit procedures for prolapse. Am J Obstet Gynecol 2008; 199:678.e1-4. [PMID: 18845282 DOI: 10.1016/j.ajog.2008.07.049] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 05/09/2008] [Accepted: 07/21/2008] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objective of the study was to the characterize the symptoms and management of vaginal mesh-related complications requiring operative intervention. STUDY DESIGN This was a case series of patients undergoing excision of vaginal graft material. Only women who had vaginal mesh placement for the correction of pelvic organ prolapse (POP) were included. We describe the symptoms, complications, and management of women treated surgically for vaginal mesh-related complications. RESULTS Thirteen referred women underwent surgery for vaginal mesh-related complications. All meshes were Apogee and/or Perigee. Ten had symptomatic mesh exposures, 1 had an exposure with pelvic abscess, and 2 had pain syndromes without mesh exposure. Patients also had rectovaginal fistula, vesicovaginal fistula, recurrent POP, and persistent discharge. Five women had prior surgery for this problem. All patients underwent transvaginal mesh excision and other indicated procedures at our institution, and 6 women required a second surgery at our institution, with a median of 2 surgeries per patient. CONCLUSION Vaginal mesh placement for POP can be associated with pain, exposure, and fistula formation, requiring multiple operative interventions.
Collapse
Affiliation(s)
- Rebecca U Margulies
- Pelvic Floor Research Group and the Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | | | | | | | | |
Collapse
|
49
|
Ridgeway B, Walters MD, Paraiso MFR, Barber MD, McAchran SE, Goldman HB, Jelovsek JE. Early experience with mesh excision for adverse outcomes after transvaginal mesh placement using prolapse kits. Am J Obstet Gynecol 2008; 199:703.e1-7. [PMID: 18845292 DOI: 10.1016/j.ajog.2008.07.055] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 05/13/2008] [Accepted: 07/21/2008] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the complications, treatments, and outcomes in patients choosing to undergo removal of mesh previously placed with a mesh procedural kit. STUDY DESIGN This was a retrospective review of all patients who underwent surgical removal of transvaginal mesh for mesh-related complications during a 3-year period at Cleveland Clinic. At last follow-up, patients reported degree of pain, level of improvement, sexual activity, and continued symptoms. RESULTS Nineteen patients underwent removal of mesh during the study period. Indications for removal included chronic pain (6/19), dyspareunia (6/19), recurrent pelvic organ prolapse (8/19), mesh erosion (12/19), and vesicovaginal fistula (3/19), with most patients (16/19) citing more than 1 reason. There were few complications related to the mesh removal. Most patients reported significant relief of symptoms. CONCLUSION Mesh removal can be technically difficult but appears to be safe with few complications and high relief of symptoms, although some symptoms can persist.
Collapse
Affiliation(s)
- Beri Ridgeway
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | | |
Collapse
|
50
|
Olszycki M, Majos A, Grzelak P, Makowski M, Wilamowska A, Stefańczyk L, Pertyński T. [Dynamic sequences of MR in evaluation of anatomy and function of pelvic floor by perimenopausal women]. Ginekol Pol 2008; 79:687-691. [PMID: 19058523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
UNLABELLED Pelvic organ prolapse is one of the most common disorders and it concerns over 50% of women over the age of fifty who gave birth. BACKGROUND The purpose of this study was to establish a clinically useful protocol of MR investigation in the assessment of pelvic organs position changes during rest and in time of Velsalva test OBJECTIVE The material includes 17 postmenopausal women (48- 59-years-old) who were examined due of lumbosacralis discopathy in MR division of USK 1 in Lodz since 2007. The examination was extended to pelvic organs imaging with the help of Velsalva test. RESULTS Having compared static and dynamic images of investigated group and results of reference lines measurements, we have found normal pelvic organ position comparing to the H line in case of 10 women, in case of 5 women there was just a small displacement--up to 2 cm under the H line--and in case of 2 other women 2 cm above the H line. We have also found substantial increase of P line length (over 25% during tenesmus) in women with pelvic floor disorders. CONCLUSION Dynamic MR imaging proves extremely useful in evaluation of pelvic organs position changes during rest and in time of Velsalva test.
Collapse
Affiliation(s)
- Marek Olszycki
- Zakład Radiologii-Diagnostyki Obrazowej Uniwersytetu Medycznego w Lodzi, 90-153 Lódź, ul. Kopcińskiego 22.
| | | | | | | | | | | | | |
Collapse
|