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Nager CW. Updating Evidence for Treatment of Pelvic Organ Prolapse. JAMA 2023; 330:599-600. [PMID: 37581683 DOI: 10.1001/jama.2023.13733] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Charles W Nager
- Department of Ob/Gyn and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, UC San Diego Health, La Jolla, California
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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.
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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).
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Abstract
BACKGROUND Pelvic organ prolapse is a common problem in women. About 40% of women will experience prolapse in their lifetime, with the proportion expected to rise in line with an ageing population. Women experience a variety of troublesome symptoms as a consequence of prolapse, including a feeling of 'something coming down' into the vagina, pain, urinary symptoms, bowel symptoms and sexual difficulties. Treatment for prolapse includes surgery, pelvic floor muscle training (PFMT) and vaginal pessaries. Vaginal pessaries are passive mechanical devices designed to support the vagina and hold the prolapsed organs back in the anatomically correct position. The most commonly used pessaries are made from polyvinyl-chloride, polythene, silicone or latex. Pessaries are frequently used by clinicians with high numbers of clinicians offering a pessary as first-line treatment for prolapse. This is an update of a Cochrane Review first published in 2003 and last published in 2013. OBJECTIVES To assess the effects of pessaries (mechanical devices) for managing pelvic organ prolapse in women; and summarise the principal findings of relevant economic evaluations of this intervention. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 January 2020). We searched the reference lists of relevant articles and contacted the authors of included studies. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in at least one arm of the study. DATA COLLECTION AND ANALYSIS Two review authors independently assessed abstracts, extracted data, assessed risk of bias and carried out GRADE assessments with arbitration from a third review author if necessary. MAIN RESULTS We included four studies involving a total of 478 women with various stages of prolapse, all of which took place in high-income countries. In one trial, only six of the 113 recruited women consented to random assignment to an intervention and no data are available for those six women. We could not perform any meta-analysis because each of the trials addressed a different comparison. None of the trials reported data about perceived resolution of prolapse symptoms or about psychological outcome measures. All studies reported data about perceived improvement of prolapse symptoms. Generally, the trials were at high risk of performance bias, due to lack of blinding, and low risk of selection bias. We downgraded the certainty of evidence for imprecision resulting from the low numbers of women participating in the trials. Pessary versus no treatment: at 12 months' follow-up, we are uncertain about the effect of pessaries compared with no treatment on perceived improvement of prolapse symptoms (mean difference (MD) in questionnaire scores -0.03, 95% confidence interval (CI) -0.61 to 0.55; 27 women; 1 study; very low-certainty evidence), and cure or improvement of sexual problems (MD -0.29, 95% CI -1.67 to 1.09; 27 women; 1 study; very low-certainty evidence). In this comparison we did not find any evidence relating to prolapse-specific quality of life or to the number of women experiencing adverse events (abnormal vaginal bleeding or de novo voiding difficulty). Pessary versus pelvic floor muscle training (PFMT): at 12 months' follow-up, we are uncertain if there is a difference between pessaries and PFMT in terms of women's perceived improvement in prolapse symptoms (MD -9.60, 95% CI -22.53 to 3.33; 137 women; low-certainty evidence), prolapse-specific quality of life (MD -3.30, 95% CI -8.70 to 15.30; 1 study; 116 women; low-certainty evidence), or cure or improvement of sexual problems (MD -2.30, 95% -5.20 to 0.60; 1 study; 48 women; low-certainty evidence). Pessaries may result in a large increase in risk of adverse events compared with PFMT (RR 75.25, 95% CI 4.70 to 1205.45; 1 study; 97 women; low-certainty evidence). Adverse events included increased vaginal discharge, and/or increased urinary incontinence and/or erosion or irritation of the vaginal walls. Pessary plus PFMT versus PFMT alone: at 12 months' follow-up, pessary plus PFMT probably leads to more women perceiving improvement in their prolapse symptoms compared with PFMT alone (RR 2.15, 95% CI 1.58 to 2.94; 1 study; 260 women; moderate-certainty evidence). At 12 months' follow-up, pessary plus PFMT probably improves women's prolapse-specific quality of life compared with PFMT alone (median (interquartile range (IQR)) POPIQ score: pessary plus PFMT 0.3 (0 to 22.2); 132 women; PFMT only 8.9 (0 to 64.9); 128 women; P = 0.02; moderate-certainty evidence). Pessary plus PFMT may slightly increase the risk of abnormal vaginal bleeding compared with PFMT alone (RR 2.18, 95% CI 0.69 to 6.91; 1 study; 260 women; low-certainty evidence). The evidence is uncertain if pessary plus PFMT has any effect on the risk of de novo voiding difficulty compared with PFMT alone (RR 1.32, 95% CI 0.54 to 3.19; 1 study; 189 women; low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain if pessaries improve pelvic organ prolapse symptoms for women compared with no treatment or PFMT but pessaries in addition to PFMT probably improve women's pelvic organ prolapse symptoms and prolapse-specific quality of life. However, there may be an increased risk of adverse events with pessaries compared to PFMT. Future trials should recruit adequate numbers of women and measure clinically important outcomes such as prolapse specific quality of life and resolution of prolapse symptoms. The review found two relevant economic evaluations. Of these, one assessed the cost-effectiveness of pessary treatment, expectant management and surgical procedures, and the other compared pessary treatment to PFMT.
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Affiliation(s)
- Carol Bugge
- School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Elisabeth J Adams
- Department of Urodynamics, Liverpool Women's Hospital, Liverpool, UK
| | - Deepa Gopinath
- Department of Obstetrics and Gynaecology, Cairns Hospital, Cairns, Australia
| | - Fiona Stewart
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Melanie Dembinsky
- School of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Pauline Sobiesuo
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rohna Kearney
- The Warrell Unit, Department of Gynaecology, St Mary's Hospital, Manchester University Foundation NHS Trust, Manchester, UK
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Lu D, Liu F, Ning X, Zhang H, Huang Y. Anterior vaginal wall protrusion in pregnancy: a case report. J Int Med Res 2020; 48:300060519899524. [PMID: 31975632 PMCID: PMC7113705 DOI: 10.1177/0300060519899524] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Vaginal prolapse rarely complicates pregnancy. We experienced a 36-year-old, gravida 3, para 1 woman who presented at 37 weeks’ gestation with gestational diabetes mellitus and a large anterior vaginal prolapse that could not be reduced manually or by bed rest. After obtaining consent, a cesarean section was successfully performed, and a live neonate delivered. The prolapsed anterior vagina recovered spontaneously following the cesarean operation. A vaginal prolapse in pregnancy is rare. Elective or emergency cesarean section is a possible treatment option when the prolapse cannot be reduced manually or by bed rest. Our case highlights the importance of routine obstetric examinations for early detection of a vaginal wall prolapse.
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Affiliation(s)
- Dajiang Lu
- Department of Obstetrics, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
- Dajiang Lu, Department of Obstetrics, the People’s Hospital of Qiannan, 9 Wenfeng Road, Duyun, 558000 Guizhou, P.R. China.
| | - Fang Liu
- Department of Obstetrics, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
| | - Xue Ning
- Department of Gynecology, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
| | - Hua Zhang
- Department of Obstetrics, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
| | - Yan Huang
- Department of Gynecology, the People’s Hospital of Qiannan, Duyun, Guizhou, P.R. China
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Walter JE. A comparison of the use of mesh to native tissue in the management of vaginal vault prolapse. Best Pract Res Clin Obstet Gynaecol 2018; 54:73-88. [PMID: 30580956 DOI: 10.1016/j.bpobgyn.2018.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 11/08/2018] [Accepted: 11/12/2018] [Indexed: 01/04/2023]
Abstract
Vaginal vault prolapse afflicts millions of women and evokes significant psychosocial and pelvic floor dysfunction. The risk factors and modalities of conservative management are discussed in this study. There remains controversy in the optimal surgical management. This review serves to study the clinical conundrum of the decision-making process to utilize the mesh and the approach. In-depth evaluation of mesh-related postsurgical complications as compared to those associated with the native tissue is explored.
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Affiliation(s)
- Jens-Erik Walter
- McGill University, Fellowship in Female Pelvic Medicine & Reconstructive Surgery, D05.2541, 1001 Decarie Boulevard Montreal, QC, H4A 3J1, Canada.
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Li J. [Second national census and treatment of uterine prolapse and urinary fistula]. Zhonghua Yi Shi Za Zhi 2018; 48:287-294. [PMID: 30646667 DOI: 10.3760/cma.j.issn.0255-7053.2018.05.005] [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: 06/09/2023]
Abstract
From 1977 to 1982, under the unified deployment of the Ministry of Health, census and treatment of uterine prolapse and urinary fistula were generally carried out in various places. Compared with the first census, the organizational collaboration is more effective, professional, and play a greater role. After that, surgical treatment can be applied to a wider range, and tens of thousands of critically patients can be treated and recovered.
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Affiliation(s)
- J Li
- Basic Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
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Chang YJ, Chen WC, Chiang JH, Su YC, Tsai KS, Man KM, Tsai MY, Chen YH, Chen HY. Traditional Chinese medicine decreases the obstructive uropathy risk in uterovaginal prolapse: A nationwide population-based study. Medicine (Baltimore) 2018; 97:e12369. [PMID: 30235697 PMCID: PMC6160251 DOI: 10.1097/md.0000000000012369] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Traditional Chinese medicine (TCM) is a popular treatment for voiding dysfunction in Eastern countries. However, no previous studies have investigated the effects of TCM on preventing obstructive uropathy in uterovaginal prolapse women. We conducted a large-scale nationwide population-based cohort study to investigate the relationship between TCM and obstructive uropathy in uterovaginal prolapse women. This is a retrospective cohort study with the Taiwan National Health Insurance Research Database (NHIRD). The study population was newly diagnosed uterovaginal prolapse patients between 1997 and 2010 year. Among patients, 762 uterovaginal prolapse patients in this cohort. Significant adjusted HRs of urine retention or hydronephrosis in Cox proportional hazard models were uterovaginal prolapse (hazard ratio [HR]: 1.74, 95% confidence intervals [CI]: 1.43-2.14), age 40 to 64 years (1.51, 1.01-2.27), ≥60 years (3.52, 2.32-5.34), DM (1.52, 1.23-1.89), hypertension (1.38, 1.13-1.7), constipation (1.35, 1.05-1.75), urinary tract calculi (1.54, 1.06-2.23), and TCM users (0.34, 0.28-0.41). The Kaplan-Meier analysis showed a higher incidence rate of urine retention or hydronephrosis in the uterovaginal prolapse cohort compared with that of the without uterovaginal prolapse cohort. The results of this nationwide population-based study support a relationship between TCM and a reduced risk of obstructive uropathy in uterovaginal prolapse women.
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Affiliation(s)
- Yin-Jen Chang
- Departments of Chinese Medicine, Urology, Medical Research, Obstetrics and Gynecology, and Anesthesiology
| | - Wen-Chi Chen
- Departments of Chinese Medicine, Urology, Medical Research, Obstetrics and Gynecology, and Anesthesiology
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University
| | - Yuan-Chih Su
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University
| | - Kao-Sung Tsai
- Departments of Chinese Medicine, Urology, Medical Research, Obstetrics and Gynecology, and Anesthesiology
- Department of Applied Cosmetology, Hungkuang University
| | - Kee-Ming Man
- Departments of Chinese Medicine, Urology, Medical Research, Obstetrics and Gynecology, and Anesthesiology
| | - Ming-Yen Tsai
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Yung-Hsiang Chen
- Departments of Chinese Medicine, Urology, Medical Research, Obstetrics and Gynecology, and Anesthesiology
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Huey-Yi Chen
- Departments of Chinese Medicine, Urology, Medical Research, Obstetrics and Gynecology, and Anesthesiology
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture
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Jelovsek JE, Barber MD, Brubaker L, Norton P, Gantz M, Richter HE, Weidner A, Menefee S, Schaffer J, Pugh N, Meikle S. Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial. JAMA 2018; 319:1554-1565. [PMID: 29677302 PMCID: PMC5933329 DOI: 10.1001/jama.2018.2827] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) are commonly performed pelvic organ prolapse procedures despite a lack of long-term efficacy data. OBJECTIVE To compare outcomes in women randomized to (1) ULS or SSLF and (2) usual care or perioperative behavioral therapy and pelvic floor muscle training (BPMT) for vaginal apical prolapse. DESIGN, SETTING, AND PARTICIPANTS This 2 × 2 factorial randomized clinical trial was conducted at 9 US medical centers. Eligible participants who completed the Operations and Pelvic Muscle Training in the Management of Apical Support Loss Trial enrolled between January 2008 and March 2011 and were followed up 5 years after their index surgery from April 2011 through June 2016. INTERVENTIONS Two randomizations: (1) BPMT (n = 186) or usual care (n = 188) and (2) surgical intervention (ULS: n = 188 or SSLF: n = 186). MAIN OUTCOMES AND MEASURES The primary surgical outcome was time to surgical failure. Surgical failure was defined as (1) apical descent greater than one-third of total vaginal length or anterior or posterior vaginal wall beyond the hymen or retreatment for prolapse (anatomic failure), or (2) bothersome bulge symptoms. The primary behavioral outcomes were time to anatomic failure and Pelvic Organ Prolapse Distress Inventory scores (range, 0-300). RESULTS The original study randomized 374 patients, of whom 309 were eligible for this extended trial. For this study, 285 enrolled (mean age, 57.2 years), of whom 244 (86%) completed the extended trial. By year 5, the estimated surgical failure rate was 61.5% in the ULS group and 70.3% in the SSLF group (adjusted difference, -8.8% [95% CI, -24.2 to 6.6]). The estimated anatomic failure rate was 45.6% in the BPMT group and 47.2% in the usual care group (adjusted difference, -1.6% [95% CI, -21.2 to 17.9]). Improvements in Pelvic Organ Prolapse Distress Inventory scores were -59.4 in the BPMT group and -61.8 in the usual care group (adjusted mean difference, 2.4 [95% CI, -13.7 to 18.4]). CONCLUSIONS AND RELEVANCE Among women who had undergone vaginal surgery for apical pelvic organ vaginal prolapse, there was no significant difference between ULS and SSLF in rates of surgical failure and no significant difference between perioperative behavioral muscle training and usual care on rates of anatomic success and symptom scores at 5 years. Compared with outcomes at 2 years, rates of surgical failure increased during the follow-up period, although prolapse symptom scores remained improved. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01166373.
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Affiliation(s)
- J. Eric Jelovsek
- Obstetrics/Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Matthew D. Barber
- Obstetrics/Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - Linda Brubaker
- Departments of Obstetrics and Gynecology and Urology, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
- Associate Editor, JAMA
| | - Peggy Norton
- Department of Obstetrics and Gynecology, University of Utah, Medical Center, Salt Lake City
| | - Marie Gantz
- RTI International, Research Triangle Park, North Carolina
| | - Holly E. Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Alison Weidner
- Department of Obstetrics and Gynecology, Duke University, Medical Center, Durham, North Carolina
| | - Shawn Menefee
- Department of Obstetrics and Gynecology, Southern California Kaiser Permanente, San Diego
| | - Joseph Schaffer
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Norma Pugh
- RTI International, Research Triangle Park, North Carolina
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Affiliation(s)
- Osei K Kankam
- Elderly Medical Unit, Queen Mary's Hospital Sidcup, NHS Trust, Frognal Avenue, Sidcup, Kent DA14 6LT, UK.
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Abstract
Laser therapy has a therapeutic role in various medical conditions and most recently has gained interest as a non-hormonal treatment for genitourinary syndrome of menopause (GSM) and as a non-invasive option for stress urinary incontinence (SUI). Several therapies are available to alleviate GSM symptoms, including hormonal and non-hormonal products. Both microablative fractional CO2 laser and the non-ablative vaginal Er:YAG laser (VEL) induce morphological changes in the vaginal tissues, and data from non-randomized clinical trials suggest that laser therapy can alleviate vaginal dryness and dyspareunia. VEL has been reported to improve SUI as well as vaginal prolapse. Although large randomized trials have not been reported, the evidence suggests that VEL can be offered as a safe and efficacious alternative to hormone replacement therapy (HRT) for GSM, as well as a first-line treatment for mild to moderate SUI, before surgical procedures are resorted to. Randomized studies are needed to compare laser treatments with other therapies, as well as to assess the duration of the therapeutic effects and the safety of repeated applications. Research is presently evaluating both an automated robotic probe for VEL treatments and an intraurethral probe for the treatment of severe and type III SUI.
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Affiliation(s)
- Marco Gambacciani
- Department of Obstetrics and Gynaecology, Pisa University Hospital, Pisa, Italy.
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Li J. [The first national general investigation and treatment of uterine prolapse: 1959-1966]. Zhonghua Yi Shi Za Zhi 2016; 46:289-296. [PMID: 28104003 DOI: 10.3760/cma.j.issn.0255-7053.2016.05.007] [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: 06/06/2023]
Abstract
The first national general investigationon uterine prolapse is an important measure of strengthening the protection of working women. Under the guidance of the Ministry of Health, local governments are extensively carried out all rescuing works, including the adjustment of labor time by organizing traditional and western medicine practitioners to carry on the comprehensive survey and concentrated treatment, with certain effects. Across the full application of traditional Chinese medical therapies with its recipes and medicines, traditional Chinese medical practitioners were actively involved in rescuing. Restricted by the medical conditions with non-popular surgical treatment, medical practitioners continuously explored the surgical treatment suitable for rural areas, offering valuable experiences for the future treatment.
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Affiliation(s)
- J Li
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, 510405, China
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Bulchandani S, Toozs-Hobson P, Verghese T, Latthe P. Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications? Post Reprod Health 2015; 21:141-145. [PMID: 26537626 DOI: 10.1177/2053369115614704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use. STUDY DESIGN We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz). RESULTS Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge. CONCLUSION Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse.
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Affiliation(s)
| | | | - Tina Verghese
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham UK
| | - Pallavi Latthe
- Birmingham Women's NHS Foundation Trust, Birmingham, UK School of Clinical and Experimental Medicine, University of Birmingham, Birmingham UK
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Füeßl HS. [Pelvic floor training helps in prolapse symptoms]. MMW Fortschr Med 2015; 157:35. [PMID: 26289878 DOI: 10.1007/s15006-015-3411-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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14
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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.
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Affiliation(s)
- Sabin Sorin Badi
- Department of Histology, "Victor Papilian" Faculty of Medicine, "Lucian Blaga" University of Sibiu, Romania;
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Affiliation(s)
- Sarah Gray
- GP Specialist, CornwallTamar Valley Health, Callington, Cornwall, UK
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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.
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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.
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Affiliation(s)
- D K Saha
- Dr Dipankar Kumar Saha, Registrar, Pediatric Surgery, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh
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Good MM, Korbly N, Kassis NC, Richardson ML, Book NM, Yip S, Saguan D, Gross C, Evans J, Harvie HS, Sung V. Prolapse-related knowledge and attitudes toward the uterus in women with pelvic organ prolapse symptoms. Am J Obstet Gynecol 2013; 209:481.e1-6. [PMID: 23748108 DOI: 10.1016/j.ajog.2013.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [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: 01/08/2013] [Revised: 04/26/2013] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study was to describe the basic knowledge about prolapse and attitudes regarding the uterus in women seeking care for prolapse symptoms. STUDY DESIGN This was a cross-sectional study of English-speaking women presenting with prolapse symptoms. Patients completed a self-administered questionnaire that included 5 prolapse-related knowledge items and 6 benefit-of-uterus attitude items; higher scores indicated greater knowledge or more positive perception of the uterus. The data were analyzed using descriptive statistics and multiple linear regression. RESULTS A total of 213 women were included. The overall mean knowledge score was 2.2 ± 1.1 (range, 0-5); 44% of the items were answered correctly. Participants correctly responded that surgery (79.8%), pessary (55.4%), and pelvic muscle exercises (34.3%) were prolapse treatment options. Prior evaluation by a female pelvic medicine and reconstructive surgery specialist (beta = 0.57, P = .001) and higher education (beta = 0.3, P = .07) was associated with a higher mean knowledge score. For attitude items, the overall mean score was 15.1 (4.7; range, 6-30). A total of 47.4% disagreed with the statement that the uterus is important for sex. The majority disagreed with the statement that the uterus is important for a sense of self (60.1%); that hysterectomy would make me feel less feminine (63.9%); and that hysterectomy would make me feel less whole (66.7%). Previous consultation with a female pelvic medicine and reconstructive surgery specialist was associated with a higher mean benefit of uterus score (beta = 1.82, P = .01). CONCLUSION Prolapse-related knowledge is low in women seeking care for prolapse symptoms. The majority do not believe the uterus is important for body image or sexuality and do not believe that hysterectomy will negatively affect their sex lives.
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Affiliation(s)
- Meadow M Good
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
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Abstract
Pelvic organ prolapse is a common pelvic floor disorder in postmenopausal women. The literature is quite poor concerning the management of prolapse during pregnancy in young women. We report the case of a 39-year-old multiparous woman referred for the treatment of an exteriorized uterine prolapse at 13 weeks of gestation. The management of cervical prolapse depends on its stage, its evolution and on gestational age. It combines local antiseptics, rest and manual reintegration or reduction of the prolapsus using a pessary to prevent ulceration of the cervix. In case of stage IV (POP-Q) uterine prolapse, vaginal delivery may be compromised. No recommendation is actually available about route of delivery in case of exteriorized uterine prolapse. It should be clearly discussed regarding the potential risk of cesarean section for dystocia. Surgical repair of the prolapse will be discussed after childbirth according to functional impairment and women's desire for pregnancy.
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Affiliation(s)
- A-C Pizzoferrato
- Service de gynécologie obstétrique et médecine de la reproduction, centre hospitalier intercommunal de Poissy/Saint-Germain-en-Laye, Poissy, France.
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Abstract
BACKGROUND Pelvic organ prolapse is common, with some degree of prolapse seen in up to 50% of parous women in a clinic setting, although many are asymptomatic. The use of pessaries (a passive mechanical device designed to support the vagina) to treat prolapse is very common, and up to 77% of clinicians use pessaries for the first line management of prolapse. A number of symptoms may be associated with prolapse and treatments include surgery, pessaries and conservative therapies. A variety of pessaries are described which aim to alleviate the symptoms of prolapse and avert or delay the need for surgery. OBJECTIVES To determine the effectiveness of pessaries (mechanical devices) for pelvic organ prolapse. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register of trials (searched 13 March 2012), which includes searches of CENTRAL, MEDLINE, PREMEDLINE and handsearching of conference proceedings, and handsearched the abstracts of two relevant conferences held in 2011. We also searched the reference lists of relevant articles. SELECTION CRITERIA Randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in one arm of the study. DATA COLLECTION AND ANALYSIS Abstracts were assessed independently by two authors with arbitration from a third if necessary. Data extraction was completed independently for included studies by two review authors. MAIN RESULTS To date there is only one published randomised controlled trial assessing the use of pessaries in the treatment of pelvic organ prolapse. AUTHORS' CONCLUSIONS The review authors identified one randomised controlled trial comparing ring and Gellhorn pessaries. The results of the trial showed that both pessaries were effective for the approximately 60% of women who completed the study with no significant differences identified between the two types of pessary. However, methodological flaws were noted in the trial, as elaborated under risk of bias assessment. There is no consensus on the use of different types of device, the indications nor the pattern of replacement and follow-up care. There is an urgent need for randomised studies to address the use of pessaries in comparison with no treatment, surgery and conservative measures.
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Affiliation(s)
- Carol Bugge
- School of Nursing, Midwifery and Health, University of Stirling, Stirling,
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Yang JF, Han JS, Zhu FL, Wang YT, Yao Y, Qiao J. [Clinical study on silicone pessary in the treatment of pelvic organ prolapse]. Zhonghua Fu Chan Ke Za Zhi 2012; 47:487-491. [PMID: 23141156] [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
OBJECTIVE To evaluate the therapeutic effect and influence factors of silicone pessary in treatment of pelvic organ prolapse (POP). METHODS From October 2005 to October 2010, 132 with symptomatic POP managed by pessary were enrolled in this retrospective study. Validated prolapse quality of life questionnaire (pelvic floor distress inventory short form 20, PFDI-20), pelvic floor impact questionnaire short form 7 (PFIQ-7) and the patients' satisfaction degree were used to evaluate the therapeutic effect. Clinical characteristic of the patients with successful using for more than 6 months (successful fitting group), giving up within 6 months (giving up group), unsuccessful fitting (unsuccessful fitting group) were compared. Factors influencing satisfaction degree and causing discontinuation were investigated. RESULTS One hundred and six among 132 (106/132, 80.3%) patients were in successful fitting group, 26 (26/132, 19.7%) patients were in the unsuccessful fitting group. In the successful fitting group, 86.8% (92/106) patients were followed up, the median follow-up time was 12.5 months. And 78.3% (72/92) patients continued to use pessary with the wearing time ranged 3 - 69 months; 21.7% (20/92) patients discontinued with the wearing time ranged 1 - 38 month, 14 patients (14/20) gave up in the initial 6 months. The median scores of PFDI-20 and PFIQ-7 questionnaires before pessary use were 50.0 and 47.6, which decreased to 8.9 and 0.0 after pessary use (P < 0.05). And 87.1% (61/70) patients were satisfied. There was no significantly difference among 3 groups on clinical characteristics, such as age, body mass index (BMI), pelvic surgery and so on (P > 0.05). The main factor influencing satisfaction degree and causing discontinuation was difficulties in placing and removing. CONCLUSIONS Silicone pessary is effective for patients with POP. It could relieve discomfort symptoms and improve quality of life. The main factor influencing pessary use is difficulties in placing and removing. Thus, More suggestions are needed for patients in the initial 6 months.
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Affiliation(s)
- Jun-fang Yang
- Department of Obstetrics and Gynecology, Third Hospital Peking University, Beijing 100191, China
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22
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23
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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]
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24
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Taksande AM, Vilhekar KY, Batra P, Jain M. Neonatal genital prolapse. J Indian Med Assoc 2011; 109:502-503. [PMID: 22315847] [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: 05/31/2023]
Abstract
Neonatal genital prolapse is a rare condition, usually associated with congenital spinal defects and is often resistant to simple reduction. A case of complete uterine prolapse which was noted shortly after birth in a female baby with a meningocele at the lumbar region with rectal prolapse is reported. The vagina and uterus was restored to their normal position but came out immediately after reduction.
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Affiliation(s)
- Amar M Taksande
- Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Wardha 442102
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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]
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Muller N. Continence coach: Closing care gaps across the globe. Ostomy Wound Manage 2011; 57:14. [PMID: 21322277] [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: 05/30/2023]
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Maito JM, Quam ZA, Craig E, Danner KA, Rogers RG. Predictors of Successful Pessary Fitting and Continued Use in a Nurse-Midwifery Pessary Clinic. J Midwifery Womens Health 2010; 51:78-84. [PMID: 16504903 DOI: 10.1016/j.jmwh.2005.09.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [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: 11/29/2022]
Abstract
Women with incontinence and/or pelvic organ prolapse presenting to an urogynecology service were offered referral to a dedicated midwifery pessary clinic. Charts of these women were reviewed for demographic information, physical examination, pelvic floor disorders, and details of pessary-fitting sessions. Successful fitting was defined as a comfortable fit and retention of the pessary with valsalva and voiding. Continuation was defined as a successfully fit patient who returned at least once after the initial fitting with the pessary still in use. Spearman's correlations identified variables associated with successful fitting and continuation of use. Logistic regression identified variables that predicted continued use. Eighty-six percent of women were successfully fit, and 89% continued pessary use for a mean of 6 months. Predictors of unsuccessful fitting included a history of a prior prolapse procedure or hysterectomy (P < or = .001). Severe posterior prolapse was associated with pessary discontinuation after adjustment for patient's age (P < .04). Success rates for treatment of stress urinary incontinence, pelvic organ prolapse, or both were not significantly different (success rates of 94%, 89%, and 81%, respectively; P = .50). Predictors of unsuccessful pessary fitting include history of a prior prolapse procedure and hysterectomy. Severe posterior prolapse was the single predictor of pessary discontinuation.
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Affiliation(s)
- Jennifer M Maito
- University of New Mexico School of Medicine, Albuquerque, NM 87131-0001, USA
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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.
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Affiliation(s)
- Bernard T Haylen
- St Vincent's Clinic, Suite 904, 438 Victoria Street, Darlinghurst, Sydney, 2010, NSW, Australia.
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Hamada H, Zazi A. [Post-trauma uterine prolaps in infant. A case report]. ACTA ACUST UNITED AC 2009; 38:689-92. [PMID: 19846260 DOI: 10.1016/j.jgyn.2009.03.016] [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] [Received: 12/19/2008] [Accepted: 03/12/2009] [Indexed: 11/18/2022]
Abstract
We report on one case of genital prolaps that happened after an astride fell in a girl aged 7-year-old. The manual reducing of the cervix followed by putting a blown Foley catheter n(o) 8 intravaginally for 1 week has allowed good results. Post-trauma uterine prolaps in infant is a rare condition supposed to be due to connective tissue weakness. Conservative treatment should be as possible applied at this age.
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Affiliation(s)
- H Hamada
- Service de gynécologie-obstétrique, hôpital El Idrissi, Kénitra, Maroc. halima
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Cheong P, Harland E, Nauta M, Yoong W. Egg on my face: an unusual way of reducing prolapse.J Obstet Gynaecol 2005; 25(2): 222 – 223. J OBSTET GYNAECOL 2009; 26:87. [PMID: 16390731 DOI: 10.1080/01443610500420012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- A Jain
- Department of Obstetrics and Gynaecology, Singleton Hospital, Swansea, UK
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Affiliation(s)
- V Nallendran
- Tameside General Hospital, Ashton-under-Lyne, UK.
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Pelvic floor weakness. New options for support. Mayo Clin Health Lett 2009; 27:4-5. [PMID: 19718784] [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: 05/28/2023]
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Fox WB. Physical therapy for pelvic floor dysfunction. Med Health R I 2009; 92:10-11. [PMID: 19248419] [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
This article has summarized the assessment of a woman with pelvic floor muscle dysfunction or pain complaints and has briefly described the interventions used to treat women with these concerns. The American Physical Therapy Association explains: "As a woman in today's world, you enjoy a life of many choices. The choices we make will determine the way we use our body through the decades. A physical therapist will be there for you as you progress through all stages of your life."
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Kiilholma P, Nieminen K. [Gynaecological prolapses]. Duodecim 2009; 125:199-206. [PMID: 19341034] [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
Prolapses of the pelvic floor are common in women after childbirth. After hysterectomy, prolapse surgery is the second most common gynaecological surgery. Knowledge of pelvic anatomy and prolapses is essential for choosing a correct form of treatment and achieving a successful therapy. Follow-up is sufficient for prolapses that are asymptomatic or present minor symptoms. Rehabilitation of pelvic floor muscles may be helpful in the prevention of prolapses. The use of pessaries comes into question mainly in patients, to whom a surgical treatment is not applicable. Vaginal procedures are the primary ones for pelvic reconstructive surgery.
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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.
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Carcio H. Detour around surgery: tuck and tone to treat pelvic organ prolapse. Adv Nurse Pract 2008; 16:61-66. [PMID: 19178020] [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: 05/27/2023]
Affiliation(s)
- Helen Carcio
- Health and Continence Institute, Deerfield, Mass., USA
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Abstract
This article outlines a simplified approach to diagnosis and treatment of women with urinary incontinence or pelvic organ prolapse that can be used by primary care physicians to identify patients with these conditions and initiate treatment for basic problems.
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Affiliation(s)
- Husam Abed
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 4th Floor, Ambulatory Care Center, 2211 Lomas Blvd. NE, Albuquerque, NM 87106, USA
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Shkol'nikov ME, Mazo EB, Krivoborodov GG, Dobrokhotova IE, Kaĭfadzhan MM, Fandeeva LV, Nurullin RF, Zhdanova MS. [Trospium chloride in combined treatment of females with genital prolapse and overactive urinary bladder]. Urologiia 2008:16-19. [PMID: 19069489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The trial of efficacy of trospium chloride (TC) in a dose of 45 mg/day in females with overactive bladder (OAB) symptoms preserved after genital prolapse (GP) surgical correction included 28 females (age 55-82, mean age 68.07 +/- 12 years). GP was corrected by means of vaginal hysterectomy and anterior colporraphy. Treatment results were assessed 3 months after surgery basing on urine diary. Overall TC efficacy reached 82%. Symptoms attenuated in patients with and without detrusor overactivity: voiding frequency reduced by 31 and 24%, imperative voidings reduced by 26 and 8%, mean urine volume rose by 28 and 19%, respectively. Side effects were mild. TC demonstrated good efficacy in OAB patients, it noticeably improved quality of life.
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Starczewski A, Brodowska A, Brodowski J. [Epidemiology and treatment for urinary incontinence and pelvic organ prolapse in women]. Pol Merkur Lekarski 2008; 25:74-76. [PMID: 18839620] [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: 05/26/2023]
Abstract
Urinary incontinence (UI) is defined as uncontrolled urine leakage through an urethra. At present, the following types of UI can be specified: stress incontinence (SI), urge incontinence (UI), mixed incontinence (MI), overflow incontinence (OI) in which the bladder becomes too full because it cannot be fully emptied, and functional incontinence (FI). Incontinence is one of the most common chronic diseases in women and is found in 17-60% of the whole population. In most patients, SI is combined with pelvic organ prolapse. The basic risk factors mentioned as contributing to these two conditions are obstetrical past and gynaecological history and atrophic changes in the urogenital area. There are also a number of diseases related to the increase in intra-abdominal pressure, such as obesity chronic constipation and diseases associated with persistent cough. Other factors leading to pelvic organ prolapse include hard physical work, some professional sports, connective tissue disorders, neuropathy and disturbed innervation of the pelvic floor. To deal with stress incontinence (SI), conservative and surgical treatment is employed. In the first degree intensity, it is mainly physiotherapy, electrical stimulation of the pelvic floor muscles, lifestyle modification and reduction of body mass. When the SI symptoms are more severe, surgical treatment is usually preferred. From among many methods, these presently used are Burch and sling operations. On the other hand, surgical treatment for pelvic organ prolapse involves colpoperineoplasty with the use of polypropylene mesh (Prolift), colporrhaphy by double TOT approach method, median colporrhaphy, Cooper's ligament or sacrospinous ligament colpopexy, and attachment of the uterus to the sacrum. The results of surgical treatment depend on co-occurrence of risk factors, the surgical method chosen, the lapse of time from the surgery and the type of the applied biomedical material.
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Affiliation(s)
- Andrzej Starczewski
- Department of Reproduction and Gynecology, Pomeranian Medical University of Szczecin, Poland
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Herbruck LF. Stress urinary incontinence: an overview of diagnosis and treatment options. Urol Nurs 2008; 28:186-199. [PMID: 18605512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Giving birth is known to create risk for various degrees of urinary incontinence (UI) at any time after the birth. Environmental and genetic factors predispose many women to pelvic floor disorders. When a woman determines she is incontinent and has approached her provider, she will need an accurate, proper diagnosis and then consider a selected course of treatment. It is imperative that she is informed of all choices so she can choose the treatment with which she is most comfortable, fits her lifestyle, and will improve her quality of life.
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Floyd MSJ, Casey RG, Bredin HC. Procidentia: a reversible cause of hydronephrosis in an 80-year-old woman. Int Urogynecol J 2008; 19:1179-81. [PMID: 18330482 DOI: 10.1007/s00192-008-0587-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 02/02/2008] [Indexed: 11/25/2022]
Affiliation(s)
- M St J Floyd
- Department of Urology, University College Hospital, Newcastle, Galway, Ireland.
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Powers K, Grigorescu B, Lazarou G, Greston WM, Weber T. Neglected pessary causing a rectovaginal fistula: a case report. J Reprod Med 2008; 53:235-237. [PMID: 18441734] [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: 05/26/2023]
Abstract
BACKGROUND Pessaries, properly maintained, have been shown to be safe for long-term care of symptomatic vaginal prolapse. Complications from neglected pessaries include impaction, erosion and fistula formation. Vesicovaginal fistulas have been described, but literature reports of rectovaginal fistulas are scarce. CASE A 70-year-old woman, referred for pessary management, was found to have an impacted pessary that could not be removed due to pain. Examination under anesthesia revealed a Gellhorn pessary in the lumen of the rectum. It was removed transanally, leaving a large rectovaginal fistula. The patient was scheduled for reparative surgery in conjunction with colorectal surgery, but she cancelled the day before. CONCLUSION For patients with a rectovaginal fistula resulting from an impacted vaginal pessary, a 2-stage procedure is required. The first stage, done under anesthesia, includes removal of the pessary and an examination to assess the size and location of the fistula. The second stage is operative management of the rectovaginal fistula, preceded by adequate bowel preparation. The clinician must stress proper pessary maintenance in order to avoid the serious consequences of a neglected pessary.
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Affiliation(s)
- Kenneth Powers
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York 10467, USA.
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Abstract
PURPOSE OF REVIEW To summarize recent evidence suggesting a genetic basis for the development of urogenital prolapse and stress urinary incontinence. RECENT FINDINGS Epidemiological evidence suggests that some women have a genetic predisposition to the development of urogenital prolapse and stress incontinence. Abnormal expression of various structural proteins is thought to be the molecular genetic mechanism for the development of these conditions. A group of families with an autosomal dominant pattern of transmission of urogenital prolapse with high penetrance has been identified. No similar cohort of families with familial stress incontinence currently exists, although candidate genes have been identified that appear to predispose women to urogenital prolapse and stress incontinence. Additionally, animal models of urogenital prolapse have been developed that closely parallel the development of prolapse in humans. SUMMARY A growing body of evidence suggests a genetic basis for the development of urogenital prolapse and stress incontinence. Candidate genes have been identified that may result in alteration of the normal metabolism of various structural proteins which may ultimately predispose some women to both urogenital prolapse and stress incontinence. Further research into the genetic basis of these conditions may provide a comprehensive understanding of the biological basis of these disorders.
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Affiliation(s)
- Christian Twiss
- Department of Urology, University of California, Los Angeles, California , USA.
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Reimer D, Sztankay A, Steppan I, Abfalter E, Lunzer H, Marth C, Zeimet AG. Cervical cancer associated with genital prolapse--a brief review of the literature and long-term results of successful treatment with radiochemotherapy and surgery in a very frail patient. EUR J GYNAECOL ONCOL 2008; 29:272-275. [PMID: 18592794] [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: 05/26/2023]
Abstract
BACKGROUND A case of cervical cancer associated with irreducible procidentia successfully treated with external beam radiation and extracorporeal HDR-AL with concomitant chemotherapy followed by obliterative vaginal surgery is reported for the first time. CASE A 73-year-old woman presented in frail condition suffering from a huge, irreducible uterovaginal procidentia combined with a squamous cell carcinoma of the cervix in FIGO Stage IIa. Successful treatment consisted of sequential application of combined radiotherapy with concurrent cisplatin chemotherapy followed by total vaginal hysterectomy and partial colpectomy with colpocleisis according to the Labhardt method. The five-year follow-up documents the excellent long-term results with regard to cervical cancer and pelvic floor stability. CONCLUSION Especially in patients ineligible for extended surgery, radiochemotherapy followed by an obliterative surgical approach is feasible without aberrant wound healing and constitutes a suitable and efficient option for treating carcinomas of the cervix associated with irreducible genital prolapse.
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Affiliation(s)
- D Reimer
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Austria
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Komolafe JO, Adeyemi AS, Odejide TO, Adedokun KA, Oyebamiji EO, Akindele RA. Common vulcanized rubber devices adapted as pessaries for pelvic prolapse treatment in resource-poor settings. Int J Gynaecol Obstet 2007; 100:279-80. [PMID: 18001737 DOI: 10.1016/j.ijgo.2007.08.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 08/23/2007] [Accepted: 08/27/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Johnson O Komolafe
- Department of Obstetrics and Gynecology, LAUTECH Teaching Hospital, Osogbo, Nigeria.
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Affiliation(s)
- Anjum Doshani
- Urogynaecology Department, Women's, Perinatal and Sexual Health Directorate, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW
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Abstract
Pelvic floor disorders are known to increase with age. With the number of elderly women more than doubling in the coming decades, gynecologists will need to be skilled in the assessment and treatment of these conditions. Conservative forms of therapy such as pessaries can often be successfully employed. These devices are well suited for elderly patients as they are noninvasive with minimal risk, provide immediate relief of symptoms, and are cost-effective compared with surgery. Although there are some downsides in using pessaries in clinical practice, many of these pitfalls can be appropriately addressed with education and training of clinician and patients.
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Affiliation(s)
- Elisa Rodriguez Trowbridge
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan 48109-0276, USA.
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Klutke CG. Female pelvic prolapse. Mo Med 2007; 104:430-434. [PMID: 18018531] [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: 05/25/2023]
Abstract
This article gives the practicing physician a summary of normal female pelvic and vaginal support structures and the etiology of pelvic prolapse. The most recent grading system for pelvic prolapse is reviewed. Changes on the various organ systems in the pelvis follow and concentrate on urinary incontinence, dyspareunia and bowel dysfunction. A review of the various non-surgical and surgical corrective procedures and a summary of the literature conclude the presentation.
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Affiliation(s)
- Carl G Klutke
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, USA.
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