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Zhong W, Zhang L, Zhong JQ, He XP, Liu HQ, Zhu WQ, Fang CF. Comparison of outcomes between preservation or division of the uterine round ligament in laparoscopic groin hernia repair in females: a meta-analysis and trial sequential analysis. Hernia 2024; 28:343-354. [PMID: 38165537 PMCID: PMC10997534 DOI: 10.1007/s10029-023-02917-6] [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: 07/27/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females. METHODS We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively. RESULTS Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI - 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI - 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI - 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable. CONCLUSION In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.
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Affiliation(s)
- W Zhong
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - L Zhang
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - J Q Zhong
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - X P He
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - H Q Liu
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - W Q Zhu
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - C F Fang
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China.
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Minaglia SM. Small Bowel Obstruction After Colpopexy-Case Report and Images of the Mechanism. Urogynecology (Phila) 2024; 30:457-460. [PMID: 37737744 DOI: 10.1097/spv.0000000000001407] [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] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Affiliation(s)
- Steven Michael Minaglia
- From the Queen's University Medical Group and John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
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Yang X, Feng T. A case report of vaginal delivery in the second trimester of severe uterine prolapse complicated with cervical incarceration. Medicine (Baltimore) 2024; 103:e37202. [PMID: 38363949 PMCID: PMC10869074 DOI: 10.1097/md.0000000000037202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Uterine prolapse is a rare complication of pregnancy, and there is still no consensus on the choice of delivery method. METHODS The patient's reproductive history included an abortion and eutocic delivery of a girl weighing 3200 g; the current pregnancy was the third pregnancy. Her cervical region was outside the vaginal opening and was red in color, with evident enlargement (6 × 4 cm) and a broken surface. The cervical area also showed white discharge. According to her Transvaginal ultrasonography revealed a fetus in the uterine cavity at approximately 19 weeks of gestation. Gynecological examination revealed prolapse of both the anterior and posterior vaginal walls. Evaluation of the pelvic organ prolapse-Q scores showed that the patient had uterine prolapse at stage IV. RESULTS Vaginal delivery was performed smoothly after oral administration mifepristone and misoprostol tablets for a few days, obtaining a dead female fetus in cephalic, 25 cm in length. The cervix of the pregnant woman did not prolapse during the delivery. CONCLUSION For pregnancy with uterine prolapse and cervical incarceration, transvaginal delivery is a potential treatment option. Maintenance of cervical retraction and oral mifepristone administration with misoprostol tablets is crucial during this delivery. This treatment can minimize the risk of cervical lacerations and uterine rupture, helping surgeons to complete the operation successfully.
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Affiliation(s)
- Xiaoyue Yang
- Department of Ministry of Medicine, Medical College of Wuhan University of Science and Technology, Wuhan, Hubei Province, China
| | - Tongfu Feng
- Department of Gynecology of Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei Province, China
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Fukai S, Maeda S, Chikazawa K, Rikiyama T. Strangulated bowel obstruction caused by vaginal perforation due to vaginal cancer in a patient with chronic uterine prolapse. BMJ Case Rep 2023; 16:e255815. [PMID: 38086574 PMCID: PMC10728924 DOI: 10.1136/bcr-2023-255815] [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] [Accepted: 11/28/2023] [Indexed: 12/18/2023] Open
Abstract
A woman in her 90s with chronic uterine prolapse presented with abdominal pain and a vaginal mass. The patient had generalised peritonitis and a strangulated bowel obstruction originating from a perforated posterior vagina. We performed partial intestinal resection and a total hysterectomy, including excision of the perforation of the vaginal site and the adnexa. The patient died on postoperative day 8 due to worsening systemic sepsis. The pathological diagnosis revealed an invasive carcinoma in the perforated area of the vagina. Obstetric factors are the most frequent cause of female genital tract perforation, and chronic uterine prolapse is associated with this condition; however, vaginal cancer has never been reported as a cause of perforation. Therefore, close collaboration in gynaecology should be considered to investigate whether vaginal perforation and uterine prolapse are related to cancer.
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Affiliation(s)
- Shota Fukai
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Shimpei Maeda
- Jichi Ika University Saitama Medical Center, Saitama, Japan
| | - Kenro Chikazawa
- Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama-shi, Japan
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Ferdinando Ruffolo A, Giordano C, Lambert B, Salvatore S, Lallemant M, Cosson M. A comparison between the vaginal patch plastron associated with the anterior sacrospinous fixation and the Uphold™ LITE vaginal support system for the treatment of advanced anterior vaginal wall prolapse. Eur J Obstet Gynecol Reprod Biol 2023; 291:162-167. [PMID: 37898047 DOI: 10.1016/j.ejogrb.2023.10.027] [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: 04/13/2023] [Revised: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE The aim of the present study was to compare efficacy and safety of the vaginal patch plastron (VPP) associated to the anterior sacrospinous fixation (SSLF-A) with a TVM procedure (Uphold™ LITE support-system) for the treatment of the advanced anterior vaginal wall prolapse. STUDY DESIGN Single-center retrospective study. Women with symptomatic anterior prolapse ≥ III stage according to the POP-quantification (POP-Q) system and submitted to the VPP associated with the SSLF-A or to the Uphold™ procedure were included. Primary outcome was to compare objective and subjective cystocele relapse and reoperation rate at 6- and 12-month follow-up. Secondary outcome was to describe peri- and postoperative complications. Pearson chi-square test and exact Fisher test were adopted for categorical variables, while intergroup Mann-Whitney U test and intragroup Wilcoxon Rank Sum Test for continuous variables; the statistical analysis was conducted at 95 % confidence level. RESULTS Fifty-five women in VPP-group and 118 women in Uphold-group were included. At 6-month follow-up, objective anterior relapse in VPP-group (3/55, 5.4 %) was like Uphold-group (5/118, 4.2 %; p = 0.71), as well as objective apical relapse (0/55, 0 % vs 3/118, 2.5 %; p = 0.55); no significant difference emerged in bulge symptoms (1/55, 1.8 % vs 5/118, 4.2 %; p = 0.67). At 12-month follow-up women were telephonically investigated; no significant difference emerged in bulge symptoms (1/55, 1.8 % vs 6/118, 5.1 %; p = 0.43). Reoperation rate for the composite outcome POP relapse, stress urinary incontinence (SUI) and remotion of the TVM resulted lower in the VPP group (1/55, 1.8 % vs 13/118, 11 %; p = 0.03). Post-operative buttock pain (32/55, 58.2 % vs 24/118, 20.3 %; p < 0.0001) and post-operative urinary retention (16/55, 29.1 % vs 6/118, 5.1 %; p < 0.0001) were higher in VPP-group, with a complete resolution between 2 and 3 weeks after treatment. CONCLUSION VPP associated with SSLF-A was as effective as Uphold™ LITE support-system for both anterior and central compartment prolapse treatment at 6- and 12-month follow-up. VPP-group presented a lower reoperation rate for the composite outcome prolapse relapse repair, SUI, and removal of the mesh.
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Affiliation(s)
| | - Celine Giordano
- Department of Obstetrics and Gynecology, McGill University, Montréal, QC, Canada
| | - Benjamin Lambert
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000 Lille, France
| | - Stefano Salvatore
- Unit of Gynecology and Obstetrics, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Marine Lallemant
- Department of Gynecology, University Hospital of Besançon, 25000 Besançon, France
| | - Michel Cosson
- Department of Gynecology, Jeanne de Flandre University Hospital, 59000 Lille, France
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Deshpande RR, Foy OB, Mandelbaum RS, Roman LD, Dancz CE, Wright JD, Matsuo K. Reconstructive Surgery at Hysterectomy for Patients With Uterine Prolapse and Gynecologic Malignancy. Obstet Gynecol 2023; 142:1487-1490. [PMID: 37847908 DOI: 10.1097/aog.0000000000005405] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/10/2023] [Indexed: 10/19/2023]
Abstract
In this cross-sectional study examining 211,708 patients with a diagnosis of uterine prolapse who underwent hysterectomy between 2016 and 2019 identified in the Healthcare Cost and Utilization Project's Nationwide Ambulatory Surgery Sample, co-diagnosis of gynecologic malignancy was reported in 2,398 (1.1%) patients, and they were less likely to receive reconstructive surgery at hysterectomy (odds ratio [OR] 0.90, 95% CI 0.84-0.96). This absence of reconstructive surgery was most pronounced among patients with complete uterine prolapse and gynecologic malignancy (OR 0.68, 95% CI 0.57-0.81). The association was also consistent in coexisting gynecologic premalignancy (n=3,357 [1.6%]). In conclusion, this national-level assessment suggests that patients with uterine prolapse and coexisting gynecologic malignancy or premalignancy may be less likely to receive reconstructive surgery for pelvic floor dysfunction at hysterectomy.
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Affiliation(s)
- Rasika R Deshpande
- Division of Gynecologic Oncology, the Division of Reproductive Endocrinology & Infertility, and the Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, the Keck School of Medicine, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, New York
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Peinado Molina RA, Hernández Martínez A, Martínez Vázquez S, Martínez Galiano JM. Influence of pelvic floor disorders on quality of life in women. Front Public Health 2023; 11:1180907. [PMID: 37942254 PMCID: PMC10629477 DOI: 10.3389/fpubh.2023.1180907] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/02/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
Objective To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions. Methods An observational study was conducted with women in Spain between 2021 and 2022. Information was collected using a self-developed questionnaire on sociodemographic data, employment, history and health status, lifestyle and habits, obstetric history, and health problems. The SF-12 questionnaire was used to assess quality of life. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor problems, and includes the POPDI-6 subscales for prolapse, CRADI- 8 for colorectal symptoms, and UDI-6 for urinary symptoms. Crude (MD) and adjusted mean differences (aMD) were estimated with their respective 95% confidence intervals (CI). Results Thousand four hundred and forty six women participated in the study with a mean age of 44.27 (SD = 14.68). A statistical association was observed between all the pelvic floor disorders and QoL, overall and in all its dimensions (p <0.001), in the bivariable analysis. The lowest scores were observed in the emotional component. After adjusting for confounding factors, the pelvic floor disorders in general (aMD -0.21, 95% CI: -0.23 to -0.20), the impact of uterine prolapse symptoms (aMD -0.20, 95% CI: -0.27 to -0.12), the colorectal-anal symptoms (aMD -0.15, 95% CI: -0.22 to -0.09), and urinary symptoms (aMD -0.07, 95% CI: -0.13 to -0.03) was negatively associated on the score on the SF-12 questionnaire (p <0.05). Conclusions Women who have a pelvic floor dysfunction, symptoms of pelvic organ prolapse, colorectal-anal symptoms, or urinary symptoms, have a worse perceived quality of life in all dimensions. Prolapse symptoms have the biggest impact, and the emotional component of QoL is the most affected sub-domains.
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Affiliation(s)
| | - Antonio Hernández Martínez
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Nursing, University of Castilla la Mancha, Ciudad Real, Spain
| | | | - Juan Miguel Martínez Galiano
- Department of Nursing, University of Jaén, Jaén, Spain
- Epidemiology and Public Health CIBER (CIBERESP), Madrid, Spain
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Zhou Z, Tong C, Tian L, Zhang X, Li Y, Xiao Y, Yan L. Retrospective study of preservation and transection of the round ligament of uterus during laparoscopic transabdominal preperitoneal inguinal hernia repair in adult women. Hernia 2023; 27:1195-1202. [PMID: 36949269 PMCID: PMC10533639 DOI: 10.1007/s10029-023-02765-4] [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: 12/12/2022] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The processing of the round ligament of uterus in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia in women has contended. This study aimed to explore whether there is any difference in the surgical outcome and postoperative complications between the two processing modalities, preservation, and transection of the round ligament of uterus, in adult female inguinal hernia patients undergoing TAPP. METHODS Retrospective analysis of 84 female patients (117 sides) who underwent TAPP in XXX Hospital from July 2013 to August 2022. Patient characteristics and technical details of the surgical procedure were collected and divided into two groups according to whether the round ligament of uterus was severed intraoperatively or not. There were 52 cases (77 sides) in the group with preservation of the round ligament of uterus and 32 cases (40 sides) in the group with transection of the round ligament of uterus, comparing the general condition, surgical condition, and the occurrence of postoperative related complications between the 2 groups. RESULTS The operative time for unilateral primary inguinal hernia was (129.2 ± 35.1) and (89.5 ± 42.6) minutes in the preservation and transection groups, respectively. There were no statistical differences between the two groups in terms of age, length of hospital stay, ASA, BMI, history of lower abdominal surgery, type and side of hernia, intraoperative bleeding, and time to surgery for primary bilateral hernia (P > 0.05). In addition, there was likewise no statistical difference in the occurrence of postoperative Clavien-Dindo classification, VAS, seroma, mesh infection, labia majora edema, chronic pain or abnormal sensation in the inguinal region, and hernia recurrence in the two groups as well (P > 0.05). CONCLUSION There is no evidence that the transection of the round ligament of the uterus during TAPP has an impact on postoperative complications in patients. However, given the important role of the uterine round ligament in the surgical management of patients with uterine prolapse and the high incidence of uterine prolapse in older women, hernia surgeons should also be aware of the need to protect the round ligament of uterus in older women.
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Affiliation(s)
- Z Zhou
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
- Yan'an University, Yan'an, China
| | - C Tong
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - L Tian
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - X Zhang
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Y Li
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Y Xiao
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - L Yan
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an, 710068, China.
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Komon W, Saraluck A, Viseshsindh W, Chinthakanan O. The Surgical Management of Large Bladder Calculi and Irreducible Uterine Prolapse: A Case Report and Review of Literature. Urol Int 2023; 107:835-838. [PMID: 37487475 DOI: 10.1159/000531523] [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: 03/13/2023] [Accepted: 06/06/2023] [Indexed: 07/26/2023]
Abstract
Bladder calculi are rare in women. We report a case of bladder calculi complicating irreducible uterovaginal prolapse. It provides diagnostic and operative challenges to the management team. A 77-year-old woman presented with irreducible complete uterovaginal prolapse. Bladder stones were appreciated on examination and confirmed with imaging. The patient was managed surgically with transabdominal hysterectomy with bilateral uterosacral colpopexy followed by cystolithotomy. The patient's postoperative course was uncomplicated, and she had an uneventful recovery at her 3-month postoperative visit without a recurrence of prolapse and gained good continence. The presence of bladder calculi should be considered in the setting of irreducible pelvic organ prolapse. The abdominal approach of cystolithotomy with a concomitant hysterectomy and vaginal apical suspension is safe and effective.
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Affiliation(s)
- Wanchat Komon
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Apisith Saraluck
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Wit Viseshsindh
- Department of Surgery, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
| | - Orawee Chinthakanan
- Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
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Jansen SM, Pellino K, Zhou Q, Brown HW, Heisler CA. Fecal Incontinence and the Risk of Urinary Tract Infection in Patients Presenting for Urogynecological Consultation. Urogynecology (Phila) 2023; 29:641-645. [PMID: 37348087 PMCID: PMC10873920 DOI: 10.1097/spv.0000000000001328] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
IMPORTANCE Urinary tract infection (UTI) is common in urogynecology patients. Patients with fecal incontinence (FI) often attribute their UTIs to FI, but this association has not been evaluated. OBJECTIVES The objectives of this study were to compare the prevalence of UTI in urogynecology patients with and without FI and to characterize factors associated with UTI and recurrent UTI. STUDY DESIGN This retrospective cohort study included all new adult patients who presented to an academic female pelvic medicine and reconstructive surgery practice with FI from January 2014 through December 2017. Patients were age-matched to new adult patients with stage <2 pelvic organ prolapse without FI. All urine culture results from 1 year before and 1 year after the first visit were identified. Logistic regression identified factors associated with UTI. RESULTS Among 399 patients, 106 (27%) had a culture-confirmed UTI in the year before or after their first urogynecology visit; the prevalence of UTI was 23% (45/198) in patients with FI and 30% (61/201) in those without FI (P = 0.09). The rate of recurrent UTI was 11.5% overall and did not differ among those with and without FI. In multivariate models, variables that were statistically significantly associated with UTI included age, diabetes mellitus, anterior vaginal wall prolapse, and sexual activity. Fecal incontinence was not associated with any or recurrent UTI. CONCLUSIONS The prevalence of UTI and recurrent UTI was similar in urogynecology patients with and without FI. Variables that were associated with UTI risk included older age, sexual activity, diabetes mellitus, and anterior vaginal wall prolapse.
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Affiliation(s)
| | - Katherine Pellino
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee
| | - Qianqian Zhou
- University of Wisconsin School of Medicine and Public Health
| | - Heidi W. Brown
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christine A. Heisler
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Crowder CA, Sayegh N, Guaderrama NM, Jeney SES, Buono K, Yao J, Whitcomb EL. Rectocele: Correlation Between Defecography and Physical Examination. Urogynecology (Phila) 2023; 29:617-624. [PMID: 36701286 DOI: 10.1097/spv.0000000000001330] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE There is a lack of consensus regarding the clinical applicability of fluoroscopic defecography in evaluation of pelvic organ prolapse. OBJECTIVES The aim was to evaluate the association between rectocele on defecography and posterior vaginal wall prolapse (PVWP) on physical examination. The secondary objective was to describe radiologic and clinical predictors of surgical intervention and outcomes. STUDY DESIGN This was a retrospective review of patients enrolled in a large health maintenance organization who underwent defecography and were examined by a urogynecologist within 12 months. The electronic medical record was reviewed for demographic and clinical variables, including pelvic organ prolapse and defecatory symptoms, physical examination, and surgical intervention through 12 months after initial urogynecologic examination or 12 months after surgery if applicable. RESULTS One hundred eighty-six patients met inclusion criteria. Of those, 168 (90.3%) had a rectocele on defecography and 31 (16.6%) had PVWP at or beyond the hymen. Rectocele size on defecography was poorly correlated with PVWP stage (spearman ρ = 0.18). Forty patients underwent surgical intervention. Symptoms of splinting, digitation, and stool trapping were associated with surgical intervention (odds ratio, 4.24; 95% confidence interval, 1.59-11.34; P < 0.01) as was advanced PVWP stage ( P < 0.01), while rectocele presence and size on defecography were not. Large rectocele size on defecography was correlated with persistent postoperative defecatory symptoms ( P = 0.02). CONCLUSIONS We demonstrated a poor correlation between rectocele size on defecography and PVWP stage. Defecatory symptoms (splinting, digitation, stool trapping) and higher PVWP stage were associated with surgical intervention, while rectocele on defecography was not.
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Affiliation(s)
- Carly A Crowder
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, UC Irvine
| | | | | | - Sarah E S Jeney
- Division of Urogynecology, University of New Mexico, Department of Obstetrics and Gynecology, Albuquerque, NM
| | | | - Janis Yao
- Clinical Informatics and Research Databases, Southern California Permanente Medical Group, Pasadena CA
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Thanasa A, Thanasa E, Paraoulakis I, Kamaretsos E, Ziogas A, Kontogeorgis G, Grapsidi V, Gerokostas EE, Mylona E, Thanasas I. Total uterine prolapse: a rare cause of chronic obstructive uropathy associated with renal dysfunction (a case report). Pan Afr Med J 2023; 44:57. [PMID: 37128617 PMCID: PMC10148173 DOI: 10.11604/pamj.2023.44.57.38550] [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: 12/16/2022] [Accepted: 01/17/2023] [Indexed: 02/03/2023] Open
Abstract
Pelvic organ prolapse is rarely associated with severe bilateral ureteral hydronephrosis and renal dysfunction. The etiopathogenetic mechanism has not been fully elucidated. Contemporary imaging methods of the urinary tract play a decisive role in assessing the morphological function of the kidneys. In cases of moderate and severe pelvic organ prolapse, surgery appears to be the main choice of treatment. Our case concerns a post-menopausal patient with three vaginal deliveries in her obstetric history and with a history of bilateral hydronephrosis and impaired renal function who was referred to the outpatient clinic for a gynecological examination due to complete uterine prolapse. Bilateral hydroureteronephrosis due to prolapse was assessed as the main cause of renal dysfunction. A surgical intervention was decided to the pelvic floor and a vaginal hysterectomy was performed with simultaneous correction of the cystocele and rectocele. The postoperative course was uneventful. Three months later, re-examination of the urinary tract showed complete remediation of kidney morphology and function. The present case report emphasizes the significant degree of bilateral hydroureteronephrosis and deterioration of renal function rarely seen in patients with complete uterine prolapse. At the same time, it is pointed out that the exclusion of renal dysfunction related to complete uterine prolapse should be the main concern of the modern gynecologist even for complex cases with coexisting etiological factors for renal disease, in order to avoid permanent renal parenchymal damage and ensure the best health and quality of life of these patients.
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Affiliation(s)
- Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology of General Hospital in Trikala, Trikala, Greece
| | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology of General Hospital in Trikala, Trikala, Greece
| | - Apostolos Ziogas
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa, Greece
| | | | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology of General Hospital in Trikala, Trikala, Greece
| | | | - Elisavet Mylona
- Department of Radiology of General Hospital in Trikala, Trikala, Greece
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology of General Hospital in Trikala, Trikala, Greece
- Corresponding author: Ioannis Thanasas, Department of Obstetrics and Gynecology of General Hospital in Trikala, Trikala, Greece.
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Mou T, Cadish LA, Gray EL, Bretschneider CE. Cost-Effectiveness of Prophylactic Retropubic Sling at the time of Vaginal Prolapse Surgery. Am J Obstet Gynecol 2022; 227:471.e1-471.e7. [PMID: 35644248 DOI: 10.1016/j.ajog.2022.05.044] [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: 03/10/2022] [Revised: 05/07/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prophylactic midurethral sling (MUS) at the time of prolapse repair significantly reduces risk of de novo stress urinary incontinence (SUI), but it is associated with some small but significant morbidities. Since there has not been a standardized approach to MUS utilization, decision analysis provides a method to evaluate the cost and effectiveness associated with varying MUS strategies in addressing risk of de novo SUI. OBJECTIVES We aimed to compare the cost-effectiveness of the three MUS utilization strategies in treating de novo SUI one year following vaginal prolapse repair. The three approaches are: 1) staged strategy: prolapse repair without prophylactic MUS, 2) universal sling: prolapse repair with prophylactic MUS, and 3) selective sling: prolapse repair with prophylactic MUS only in patients with a positive prolapse-reduced cough stress test (CST). STUDY DESIGN We created a decision analysis model to compare staged strategy, universal sling, and selective sling. We modeled probabilities of de novo SUI, patients choosing subsequent MUS surgery for de novo SUI, and outcomes related to MUS. De novo SUI rates were determined for each strategy from published data. Likelihood of patients with de novo SUI choosing MUS surgery as their first-line treatment was also determined from the literature, and this scenario was only applied to patients without prophylactic MUS at their index prolapse repair. Finally, outcomes related to MUS including recurrent or persistent SUI, voiding dysfunction requiring sling lysis, mesh exposure requiring excision, and de novo overactive bladder requiring medications were all derived from publicly available data. All MUS was assumed to be retropubic. The costs for each procedure were obtained from the 2020 Centers for Medicare & Medicaid Services Physician Fee Schedule or previous literature converted to 2020 US dollars with the Consumer Price Index. The primary outcome was modeled as the incremental cost effectiveness ratio (ICER). We performed multiple one-way sensitivity analyses to assess model robustness. RESULTS The lowest cost strategy was the staged strategy which costs $1,051.70 per patient, followed by $1,093.75 for selective sling and $1,125.54 for universal sling. The selective sling approach, however, had the highest health utility value; therefore, universal sling was dominated by selective sling as it is both less costly and more effective. When compared to the staged strategy, selective sling was cost-effective with ICER of $2,664/QALY, meeting the predetermined threshold. In multiple 1-way sensitivity analyses, the variable with the largest effect was the percentage of patients electing to undergo subsequent MUS surgery for de novo SUI after index surgery. Only when this proportion exceeded 62% did universal sling become the cost-effective option as selective sling surpassed the predetermined ICER threshold and became dominated. CONCLUSION Selective sling was the preferred and cost-effective strategy in treating de novo SUI one year following vaginal prolapse repair. Surgeons should counsel their patients preoperatively regarding the possibility of de novo SUI after prolapse repair as well as the benefits and risks of prophylactic MUS.
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Affiliation(s)
- Tsung Mou
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Lauren A Cadish
- Section of Urogynecology, Department of Obstetrics and Gynecology, Providence Saint John's Health Center, Santa Monica, CA
| | - Elizabeth L Gray
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - C Emi Bretschneider
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Lee DH, Joo JK, Suh DS, Shin BS, Hwang SY, Kim KH. Successful treatment of locally advanced bulky cervical cancer complicated by irreducible complete uterine prolapse: A case report. Medicine (Baltimore) 2022; 101:e28664. [PMID: 35060561 PMCID: PMC8772643 DOI: 10.1097/md.0000000000028664] [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] [Received: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Cervical cancer complicated by irreducible complete uterine prolapse in elderly patients is extremely rare. No standard treatment has been established for these conditions. PATIENT CONCERNS A 74-year-old woman with a 30-year history of pelvic organ prolapse presented with irreducible complete uterine prolapse and a large exophytic mass involving the cervix and vaginal wall. DIAGNOSIS Biopsy of the mass was performed at the referring institution and showed invasive verrucous-type squamous cell carcinoma. INTERVENTIONS A prolapsed uterus with a tumor mass could not be manually reduced. After completion of concurrent chemoradiotherapy, the tumor mass in the prolapsed uterus decreased and could be reduced manually. Subsequently, the patient underwent hysterectomy and intra-abdominal uterosacral ligament suspension. OUTCOMES At 19 months of postoperative follow-up, the patient remained disease-free and had no evidence of vault prolapse. LESSONS This study has important clinical implications and may provide a therapeutic strategy to address unmet medical needs in combination with locally advanced cervical cancer complicated by irreducible complete uterine prolapse. These conditions were successfully treated using a multidisciplinary approach of chemoradiotherapy followed by radical hysterectomy and uterosacral ligament suspension.
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Affiliation(s)
- Dong Hyung Lee
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Dong Soo Suh
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Byung Sup Shin
- Department of Obstetrics and Gynecology, Hanmaeum Changwon Hospital, Changwon, Republic of Korea
| | - Seo Yoon Hwang
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ki Hyung Kim
- Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
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Skręt A, Trawińska J, Bielatowicz J, Książek M, Niewęgłowska-Guzik B, Radkowski A, Kargol J, Magierło JS, Barnaś E, Gawlik B. Synchronous occurrence of HPV-associated cervical squamous cell carcinoma (FIGO IIA) in prolapsed uterus and adenocarcinoma of the anal canal cT1N0M0: Case report. Medicine (Baltimore) 2021; 100:e28004. [PMID: 34918650 PMCID: PMC8677995 DOI: 10.1097/md.0000000000028004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 10/05/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Guidelines of rare synchronous tumours treatment are often unavailable due to lack of wide prospective studies. Additionally, their management is not just a simple sum of coexisting tumours management and has to regard many circumstances like symptoms, age, comorbidities, advancement. PATIENT CONCERNS Herein, we report a case of an 81-year-old woman who presented with bleeding from the prolapsed uterus. DIAGNOSES Based on physical examination, that is, speculum examination, bimanual, and per rectum, followed by rectoscopy and histopathology, the diagnosis of cervical squamous cell carcinoma FIGO IIA2 in prolapsed uterus with anal canal adenocarcinoma cT1N0M0 was made. INTERVENTIONS Dominating complaint of bleeding from prolapsed cervix was managed with radical vaginal hysterectomy in conjunction with wide colpectomy preceded by laparoscopic pelvic and paraaortic lymphadenectomy. Due to the lack of consent for removal of the anus, only radiotherapy was applied instead. OUTCOMES The patient underwent magnetic resonance image follow-up. No recurrence was found at 18 months. LESSONS Imaging is useful method of synchronous cancers diagnostics. These cancers may vary in aetiology and stage. Cervical cancer may be co-existing with another anogenital cancer. Therapy of synchronous cancers should be individualized taking into account patient's consent, age, physical condition, and comorbidities.
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Affiliation(s)
- Andrzej Skręt
- Department of Obstetrics and Gynecology with Oncological Gynecology, Health Care Center, Krakowska 91, Dębica, Poland
| | - Joanna Trawińska
- Department of Obstetrics and Gynecology, Frederic Chopin Provincial Clinical Hospital No. 1, Fryderyka Szopena 2, Rzeszow, Rzeszow, Poland
| | - Joanna Bielatowicz
- Department of Obstetrics and Gynecology with Oncological Gynecology, Health Care Center, Krakowska 91, Dębica, Poland
| | - Mariusz Książek
- Clinical Department of Histopathology, St Hedwig the Queen Clinical Provincial Hospital No. 2 in Rzeszow, Lwowska 60, Rzeszow, Poland
| | | | - Andrzej Radkowski
- Radiotherapy Unit with the Department of Radiotherapy, St Luke Provincial Hospital, Lwowska 178a, Tarnow, Poland
| | - Jaromir Kargol
- Department of Radiology and Diagnostic Imaging, Clinical Hospital No1 in Rzeszow, Rzeszow, Poland
| | - Joanna Skręt- Magierło
- Institute of Medical Sciences, Medical College of Rzeszow University, Rejtana 16c, Rzeszow, Poland
| | - Edyta Barnaś
- Institute of Health Sciences, Medical College of Rzeszow University, Rejtana 16c, Rzeszow, Poland
| | - Bogusław Gawlik
- Department of Obstetrics and Gynecology with Oncological Gynecology, Health Care Center, Krakowska 91, Dębica, Poland
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Kisby CK, Kelley SR, Linder BJ. Management of advanced prolapse including a bowel obstruction: expanding the role of transvaginal surgery. Int Urogynecol J 2021; 33:153-155. [PMID: 34851440 DOI: 10.1007/s00192-021-05027-y] [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: 08/27/2021] [Accepted: 10/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We reviewed a case of concomitant advanced pelvic organ prolapse and partial small bowel obstruction managed via transvaginal small bowel resection and native tissue prolapse repair. METHODS The patient is an 82-year-old woman with a history of a radical cystectomy and ileal conduit 2 years prior for bladder cancer that was transferred from an outside hospital for incarcerated prolapse including a small bowel obstruction with transition point inside the prolapse. She had previously unsuccessfully tried several pessaries for her prolapse. She was widowed and not sexually active. After conservative management of her bowel obstruction was unsuccessful, she was taken to the operating room for transvaginal prolapse repair. Intraoperatively, we encountered an isolated area of indurated bowel adherent to the prolapse. Colorectal surgery performed a transvaginal small bowel resection with stapled anastomosis, and a modified LeFort colpocleisis was performed to address her prolapse. Her postoperative course was uncomplicated, and at 6 months, she reported normal bowel function and had no evidence of prolapse recurrence. CONCLUSION We present a case of incidental bowel pathology during vaginal prolapse surgery, requiring a small bowel resection. This case demonstrates the feasibility of this procedure when working with a multi-disciplinary team and localized bowel pathology.
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Affiliation(s)
- Cassandra K Kisby
- Department of Obstetrics/Gynecology, Duke University Medical Center, 201 Trent Dr., Baker House 203, Durham, NC, 27710, USA.
| | - Scott R Kelley
- Division of Colorectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Brian J Linder
- Department of Urology, Mayo Clinic, Rochester, MN, USA
- Department of Obstetrics/Gynecology, Mayo Clinic, Rochester, MN, USA
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17
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Wu M, Wang X, Lin X, Fu Y, Chen H, Guan X, Huang W, Chen Y, Zhang L, Jing C, Wei J, Tian J, Zhang X. Cut-offs for defining uterine prolapse using transperineal ultrasound in Chinese women: prospective multicenter study. Ultrasound Obstet Gynecol 2021; 58:127-132. [PMID: 33094536 DOI: 10.1002/uog.23524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/05/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Transperineal ultrasound is a simple and highly repeatable method that has been used increasingly in the quantification of pelvic organ prolapse, but abnormal uterine descent on ultrasound in Chinese women is still poorly defined. We aimed to determine the optimal cut-off to define abnormal uterine descent on transperineal ultrasound in Chinese women. METHODS This prospective multicenter study recruited women who were examined in tertiary-level gynecological centers, due to symptoms of lower urinary tract and/or pelvic floor dysfunction, between February 2017 and September 2018. All recruited women underwent a standardized interview, pelvic organ prolapse quantification (POP-Q) examination, and four-dimensional transperineal ultrasound examination. On ultrasound, uterine descent was measured relative to the posteroinferior margin of the symphysis pubis during maximum Valsalva maneuver. The optimal cut-off value for definition of abnormal uterine descent was selected as the value with the highest Youden index and the diagnostic performance of this cut-off for the prediction of prolapse symptoms and POP-Q stage was assessed and compared by means of the area under the receiver-operating-characteristics curve (AUC). RESULTS In total, 538 Chinese women, with a mean age of 39.4 (range, 18-81) years, were enrolled into the study. Both uterine descent on transperineal ultrasound (P < 0.001) and POP-Q stage (P < 0.001) were associated strongly with presence of prolapse symptoms. Uterine descent on ultrasound was associated significantly with POP-Q stage for apical compartment prolapse (P < 0.001). The optimal cut-off value for the definition of abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver in the prediction of prolapse symptoms was 4.79 mm above the symphysis pubis (AUC, 0.75 (95% CI, 0.71-0.78)), while the optimal cut-off values in the prediction of prolapse of POP-Q Stage ≥ 1 and POP-Q Stage ≥ 2 were 6.63 mm above the symphysis pubis (AUC, 0.83 (95% CI, 0.80-0.86)) and 8.42 mm below the symphysis pubis (AUC, 0.85 (95% CI, 0.82-0.88)), respectively. CONCLUSIONS The optimal cut-off value to define abnormal uterine descent on transperineal ultrasound during maximum Valsalva maneuver for the prediction of prolapse symptoms in this population of Chinese women was 4.79 mm above the symphysis pubis, close to that for predicting apical compartment prolapse of POP-Q Stage ≥ 1 (6.63 mm above the symphysis pubis). These are somewhat different from values described previously in mainly Caucasian populations. Ethnic differences should be taken into account in the evaluation of pelvic organ prolapse using transperineal ultrasound. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Wu
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - X Wang
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - X Lin
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Y Fu
- Department of Ultrasound, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, China
| | - H Chen
- Department of Ultrasound, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China
| | - X Guan
- Ultrasound Diagnosis Center, Shaanxi Provincial People's Hospital, The Third Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - W Huang
- Department of Ultrasound, The First People's Hospital of Foshan, Foshan, Guangdong Province, China
| | - Y Chen
- Department of Medical Ultrasound, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China
| | - L Zhang
- Department of Ultrasound Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - C Jing
- Department of Ultrasound, Dalian Maternal and Child Health Care Hospital, Dalian, Liaoning Province, China
| | - J Wei
- Department of Ultrasound, Jiujiang City Maternal and Child Health Care Hospital, Jiujiang, Jiangxi Province, China
| | - J Tian
- Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - X Zhang
- Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Ting NS, Lee HC, Ke JY, Li PC, Ding DC. Total uterine prolapse complicated with vesicovaginal fistula: A case report. Medicine (Baltimore) 2021; 100:e26386. [PMID: 34128901 PMCID: PMC8213252 DOI: 10.1097/md.0000000000026386] [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] [Received: 04/19/2021] [Accepted: 06/02/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Vesicovaginal fistula (VVF) most commonly occurs due to iatrogenic injury during surgery or obstructed labor. We report a rare case of a patient with severe pelvic organ prolapse who developed VVF even though pessary had not been used. PATIENT CONCERNS A 63-year-old postmenopausal woman, para 3 (all spontaneous vaginal deliveries), complained of vaginal bulging sensation and involuntary urinary leakage for 3 years. DIAGNOSIS Stage IV uterine prolapse with VVF. INTERVENTIONS She underwent transvaginal VVF repair combined with total vaginal hysterectomy and sacrospinous ligament fixation. The postoperative course was uncomplicated. OUTCOMES The patient remained free of complications during the 1-year follow-up. LESSONS This case illustrates the point that patients with pelvic organ prolapse (POP) should be treated promptly and careful follow-up should be conducted. Clinicians should be aware of the symptoms of VVF to ensure its early diagnosis and treatment.
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Affiliation(s)
- Ning-Shiuan Ting
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Hsiang-Chen Lee
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | | | - Pei-Chen Li
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Aydın S, Gorchiyeva İ, Tanoglu FB. Total colpocleisis technique in huge neglected ulcerated uterovaginal prolapse. Int Urogynecol J 2020; 31:2169-2171. [PMID: 32556845 DOI: 10.1007/s00192-020-04288-3] [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: 02/05/2020] [Accepted: 03/16/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We present a video describing the technical considerations for performing a total colpocleisis in the management of significant, neglected, ulcerated, and symptomatic complete uterovaginal prolapse. METHODS A 79-year-old debilitated woman presented with a large, ulcerated pelvic bulge. A previous attempt at pessary treatment failed because of a disproportion of the pessary with the prolapse size. She had a history of liver insufficiency and hypertension. Obliterative colpocleisis surgery was selected because the healing of a large ulcerated vagina was not likely within a short timeframe. Sharp dissection with scissors and de-epithelialisation of the remaining non-eroded vaginal mucosa with the friction of a sharp-edged surgical knife were performed. Closely located purse strings were used to obliterate potential spaces. Two mirror image triangles in the anterior and posterior vaginal walls were removed. After the formation of a new perineal body, the diamond-shaped vaginal incision was closed vertically to narrow introitus. RESULTS The patient was discharged on the first postoperative day and an uncomplicated postoperative course ensued. At the 4-week follow-up, there was no evidence of infection, recurrent prolapse, de novo stress incontinence, or voiding with difficulty. CONCLUSIONS Total colpocleisis is an excellent surgical option in women with multiple, large cervicovaginal ulcers and multiple comorbidities with no desire for penetrative vaginal function.
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Affiliation(s)
- Serdar Aydın
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, İstanbul, Turkey.
| | - İrana Gorchiyeva
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, İstanbul, Turkey
| | - Fatma Basak Tanoglu
- Department of Obstetrics and Gynecology, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih, İstanbul, Turkey
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20
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Hiremath AC, K S S. Cystolitholapaxy and laparoscopic sacrocolpopexy in a case of multiple urinary bladder calculi & vault prolapse. Eur J Obstet Gynecol Reprod Biol 2019; 243:12-15. [PMID: 31629924 DOI: 10.1016/j.ejogrb.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/03/2019] [Revised: 09/04/2019] [Accepted: 10/05/2019] [Indexed: 11/19/2022]
Abstract
Vesical calculi are more common in men than women. The prevalence in women is less than 2%. Multiple vesical calculi in chronic cases of utero vaginal prolapse or vault prolapse is rare. Urinary stasis, urethral kinking along with chronic infection are the probable predisposing factors for stone formation [2]. We report a case of 65 year old female, with mass per vagina since 10 years, who developed acute urinary retention due to impaction of vesical calculus at the external urethra meatus. Subsequently in a span of 12 h she passed 3 more vesical calculi. KUB X-ray failed to show any calculi but Computed Tomography(CT) Kidney Ureter Bladder (KUB) showed 2 vesical calculi. After cystolitholapaxy she underwent laparoscopic sacrocolpopexy for vault prolapse. In cases of chronic uterovaginal prolapse or vault prolapse X-Ray KUB should not miss the prolapsed part of the cystocele as calculi are present in the most redundant part. Chances of missing radiolucent uric acid calculi is high. In such cases CT KUB is essential.
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Affiliation(s)
| | - Shivakumar K S
- Sri Sathya Sai Institue of Higher Medical Sciences, Bengaluru, 560066, India
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González Palanca SJ, González Veiga EJ, Palmeiro Fernández G, Domínguez Salgado JC, Mariño Méndez H, Varela Ponte C. Long-term results of genital prolapse surgery with polypropylene mesh. Actas Urol Esp 2019; 43:254-261. [PMID: 30955903 DOI: 10.1016/j.acuro.2018.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/25/2018] [Revised: 11/20/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND OBJECTIVE The risk of intervention due to urogenital prolapse in a woman's life is 11.1%. Recurrences after classic surgery reach up to 38%. With the aim of improving these results, transvaginal mesh kits are used. The purpose of the study is to describe the results of efficacy and long-term safety of vaginal prolapse surgery with polypropylene mesh, assess subjective symptoms before and after surgery and the level of satisfaction. PATIENTS AND METHODS A descriptive, retrospective study of 58 women with symptomatic genital prolapses operated with polypropylene mesh between September / 2011-November / 2016. Mean age: 66.53 years, 98.27% menopausal women, 77.59% overweight/obesity, 29.31% with previous gynaecological surgery and 55.17% with combined prolapse. 46 Elevate anterior and 12 posterior were inserted. The mean follow-up period was 34.02 months. The PFDI questionnaire was used pre and post-surgery, as well as the satisfaction questionnaire. RESULTS Healing rate of 91.38%. Recurrences were associated with a higher BMI and with background of recurrence of previous surgery. Mean length of stay: 2.5 days. 70.69% did not need analgesia at discharge. Clavien-Dindo complications: 1 type I (urinary retention), 5 type II (urinary tract infection) and 1 type IIIa (erosion). De novo stress urinary incontinence occurred in 3.44%, while de novo dyspareunia 14.28%. 89.36% patients improved subjective symptoms, and 95.92% were satisfied. CONCLUSION This surgery achieves high healing rates, with few complications, improvement of subjective symptoms and high level of satisfaction of the patients.
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Affiliation(s)
- S J González Palanca
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España.
| | - E J González Veiga
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - G Palmeiro Fernández
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - J C Domínguez Salgado
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - H Mariño Méndez
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
| | - C Varela Ponte
- Servicio de Ginecología y Obstetricia, Hospital Comarcal Valdeorras, O Barco, Ourense, España
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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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23
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Bahler L, Douma CE, Peterson GM, van Dorp WT, Verburgh CA. [Acute kidney failure due to uterine prolapse]. Ned Tijdschr Geneeskd 2018; 162:D2586. [PMID: 30040279] [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: 06/08/2023]
Abstract
BACKGROUND Kidney failure due to uterine prolapse is rare, nonetheless, early recognition and treatment of this form of postrenal kidney failure are essential in order to prevent serious complications. CASE DESCRIPTION In this article we describe a 73-year-old woman and a 63-year-old-woman with severe kidney failure due to a uterine prolapse. Both patients were initially treated with a nephrostomy catheter to ensure the passage of urine from the kidneys, after which the uterus was repositioned using a vaginal ring. CONCLUSION Renal failure due to uterine prolapse can be easily diagnosed by physical examination. If uterine prolapse is diagnosed in a patient with renal failure, it is essential to quickly ensure the passage of urine in order to secure the function of the kidney.
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Affiliation(s)
- Lonneke Bahler
- Spaarne Gasthuis, afd. Inwendige Geneeskunde, Haarlem Zuid
- Contact: L. Bahler
| | | | | | - Wim T van Dorp
- Spaarne Gasthuis, afd. Inwendige Geneeskunde, Haarlem Zuid
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Verma ML, Tripathi V, Singh U, Rahman Z. Salvage from cervical dystocia in third degree uterovaginal prolapse: Duhrssen's incision. BMJ Case Rep 2018; 2018:bcr-2017-223821. [PMID: 29444799 PMCID: PMC5847846 DOI: 10.1136/bcr-2017-223821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Accepted: 01/19/2018] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 28-year-old woman second gravida with a full-term pregnancy who presented to us in active phase of labour with third degree uterovaginal prolapse complicated by entrapment of fetal head by dystocia of cervix and fetal distress. Patient was immediately shifted to the operation theatre and prompt delivery was conducted by giving Duhrssen's incision on the highly vascular, oedematous prolapsed cervix. The outcome was an alive and healthy male baby. Duhrssen's incision was stitched with minimal blood loss. Postnatal management included antibiotics and daily intravaginal packing. Patient was discharged along with the baby in satisfactory condition.
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Affiliation(s)
- Manju Lata Verma
- Department of Obstetrics and Gynaecology, King Georges Medical University Lucknow, Lucknow, India
| | - Vartika Tripathi
- Department of Obstetrics and Gynaecology, King Georges Medical University Lucknow, Lucknow, India
| | - Uma Singh
- Department of Obstetrics and Gynaecology, King Georges Medical University Lucknow, Lucknow, India
| | - Zakia Rahman
- Department of Obstetrics and Gynaecology, King Georges Medical University Lucknow, Lucknow, India
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Novák O, Vašek P, Gärtner M, Krhut J. A rare complication of long-term vaginal prolapse. Ceska Gynekol 2018; 83:271-275. [PMID: 30441957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Description of rare complication of long-term uterine prolaps. Desing: Case report. SETTING Department of Obstetric and Gynecology, University Hospital Ostrava. CASE REPORT A seventy-years-old pacient with longterm complete uterine prolaps underwent vaginal hysterectomy with colpoclesis at department of Obstetric and Gynecology of university hospital Ostrava in August 2017. The surgery was planned more than year ago, when patient had no symptoms. But due to patient's injury, it was postponed and the condition was already complicated by urine incontinency. The surgery was complicated by bladder lesion, because it was suggested as a pelvis tumor. Correction of cystolithiasis was planned at a second time, when suprapubic cystoli-thotomy was performed after 16 days. Temporary urinary derivation was ensured by bilateral nephrostomy, epicystostomy and urinal catetrization for low residual bladder capacity after surgery. CONCLUSION Bladder stones are a rare complication of otherwise relatively frequent complete urogenital prolaps in women. Major causes include micturition disorder and chronic urinary tract infection which is caused by vaginal and uterus descensus.
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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.
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27
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Leanza V, Ciotta L, Vecchio R, Zanghì G, Maiorana A, Leanza G. Hydronephrosis and utero-vaginal prolapse in postmenopausal women: management and treatment. G Chir 2016; 36:251-6. [PMID: 26888700 DOI: 10.11138/gchir/2015.36.6.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Pelvic organ prolapse is a multifactorial disease. Aim was to evaluate the effect of the whole surgical correction of pelvic floor on hydronephrosis due to severe prolapse. PATIENTS AND METHODS A retrospective case study on 250 patients presenting with severe uterovaginal prolapse was carried out. RESULTS Hydronephrosis was found in 32/234 (13.7 %). All patients underwent hysterectomy, vaginal apex axial suspension, posterior and anterior repair, vaginally. Prepubic TICT (Tension free Incontinence Cystocoele Treatment) was done in 38 cases (3 with hydronephrosis). Of the 32/234 (13.7 %) patients with hydronephrosis, 18/32 (56.25%) had complete resolution of hydronephrosis after treatment, 14/32 (43.75%) had a reduction of calico-pyelic dilatation, among them 8 patients had a second degree and 6 a first degree of hydronephrosis. CONCLUSIONS Vaginal-hysterectomy, axial apex suspension, anterior and posterior repair resulted in either complete resolution or improvement of hydronephrosis. Prepubic TICT did not interfere on mechanical obstruction and maintained postoperative continence in the event of occult Stress Urinary Incontinence (SUI).
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Borah BJ, Laughlin-Tommaso SK, Myers ER, Yao X, Stewart EA. Association Between Patient Characteristics and Treatment Procedure Among Patients With Uterine Leiomyomas. Obstet Gynecol 2016; 127:67-77. [PMID: 26646122 PMCID: PMC4689646 DOI: 10.1097/aog.0000000000001160] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyze the association between patient characteristics and the probability of undergoing any uterine-sparing procedure (endometrial ablation, myomectomy, and uterine artery embolization) compared with hysterectomy as the first uterine leiomyoma (index) procedure and the probability of undergoing a specific uterine-sparing procedure. METHODS We conducted a retrospective analysis using a commercial insurance claims database containing more than 13 million enrollees annually. Based on the index procedure performed 2004-2009, women were classified into one of the four procedure cohorts. Eligible women were aged 25-54 years on the index date, continuously insured through 1-year baseline and 1-year follow-up, and had a baseline uterine leiomyoma diagnosis. Logistic regression was used to assess the association between patient characteristics and leiomyoma procedure. RESULTS The study sample comprised 96,852 patients (endometrial ablation=12,169; myomectomy=7,039; uterine artery embolization=3,835; and hysterectomy=73,809). Patient characteristics associated with undergoing any uterine-sparing procedure compared with hysterectomy included health maintenance organization health plan enrollment, Northeast region residence, the highest income and education quintiles based on zip code, an age-race interaction, and baseline diagnoses including menstrual disorders, pelvic pain, anemia, endometriosis, genital prolapse, and infertility. Among those who had a uterine-sparing procedure, characteristics associated with undergoing uterine artery embolization or endometrial ablation compared with myomectomy included increasing age, being from the Midwest relative to the Northeast, and certain baseline conditions including menstrual disorder, pelvic pain, endometriosis, and infertility. CONCLUSION Both clinical and nonclinical factors were associated with the receipt of alternatives to hysterectomy for uterine leiomyomas in commercially insured women.
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Affiliation(s)
- Bijan J. Borah
- Associate Professor of Health Services Research, Mayo Clinic College of Medicine, Senior Associate Consultant, Department of Health Sciences Research, and Department of Obstetrics & Gynecology (Joint Appointment), Mayo Clinic Rochester, MN
| | - Shannon K. Laughlin-Tommaso
- Assistant Professor of Obstetrics-Gynecology, Mayo Clinic College of Medicine & Consultant, Department of Surgery and Department of Obstetrics & Gynecology, Mayo Clinic Rochester, MN
| | - Evan R. Myers
- Professor of Obstetrics and Gynecology, Duke University School of Medicine & Chief of the Division of Clinical and Epidemiologic Research, Department of Obstetrics & Gynecology, Durham, NC
| | - Xiaoxi Yao
- Research Fellow, Center for Science of Health Care Delivery, Mayo Clinic Rochester, MN
| | - Elizabeth A. Stewart
- Professor of Obstetrics-Gynecology, Mayo Clinic College of Medicine & Consultant, Department of Obstetrics & Gynecology, Rochester, MN
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29
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Abstract
Although uterine prolapse and carcinoma of the uterine cervix are not rare events, their association is very uncommon. The treatment of cervical cancer has been protocolled, but the management of uterovaginal prolapse associated with carcinoma of the cervix is not standardised and therapy strategies vary considerably among authors. Our case reports a 74-year-old patient, admitted to the emergency department with an ulcerated prolapsed uterus. Biopsy of the cervical lesion confirmed a squamous-cell carcinoma. The patient underwent vaginal hysterectomy plus open bilateral iliopelvic lymphadenectomy complemented with radiotherapy with quimiosensibilisation. With this aggressive treatment approach, there was progression of the disease. The authors believe that this case typiaddition to the few published reports.
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Affiliation(s)
- Catarina Pardal
- Gynecology and Obstetrics Department, Hospital de Braga, Braga, Portugal
| | - Catia Correia
- Gynecology and Obstetrics Department, Hospital de Braga, Braga, Portugal
| | - Paula Serrano
- Gynecology and Obstetrics Department, Hospital de Braga, Braga, Portugal
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30
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Affiliation(s)
- Sarah Gray
- GP Specialist, CornwallTamar Valley Health, Callington, Cornwall, UK
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31
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Yang X, Tan C, An F, Sun X, Wang J. [Perspective study of urodynamic factors with pre- and post-operation overactive bladder symptoms for anterior vaginal prolapse]. Zhonghua Fu Chan Ke Za Zhi 2014; 49:829-833. [PMID: 25603907] [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: 06/04/2023]
Abstract
OBJECTIVE To identify pre-operative demographic and urodynamic (UD) parameters related to overactive bladder (OAB) symptoms of pre-operation and persistence of after pelvic organ prolapse (POP) repair. METHODS From Jan 1, 2010 to Oct 31, 2012, this perspective study examined demographic and UD data of 175 patients undergoing POP surgery. Pre- and post- operative urinary distress inventory 6 (UDI- 6) scores for frequency and urge urinary incontinence (UUI) were analyzed, and correlations between scores and pre-operative UD data were also analyzed. RESULTS (1)Surgery resulted in a improvement of frequency (71.0% , 71/100) and UUI (69.2% , 63/91) at 12-24 months follow-up. (2)Pre-operative UD parameters: first desire of bladder <100 ml, 6.3% (11/175); detrusor overactivity, 14.9% (26/175); post-void residual ≥50 ml, 11.4% (20/175); maximal flow rate (Qmax), (16±7) ml/s. (3)Comparison of pre- operative UD datas between patients with OAB symptoms and without, with OAB symptoms group had more patients of type III stress urinary incontinence [5% (5/91) versus 0 (0/84), P = 0.022]. (4)Qmax was higher in improvement in UUI group than that in persistent UUI after POP repair [(17±7) ml/s versus (13±5) ml/s, P < 0.01]. CONCLUSIONS POP repair significantly reduces OAB symptoms; however, there had not exact predictor for symptoms of persistent frequency, UUI after POP repair. Persistent UUI symptom may be related to Qmax of pre-operative UD.
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Affiliation(s)
- Xin Yang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
| | - Cheng Tan
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Fang An
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Xiuli Sun
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
| | - Jianliu Wang
- Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
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32
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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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33
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Khandwala S, Williams C, Reeves W, Dai J, Jayachandran C. Role of vaginal mesh hysteropexy for the management of advanced uterovaginal prolapse. J Reprod Med 2014; 59:371-378. [PMID: 25098027] [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: 06/03/2023]
Abstract
OBJECTIVE To determine the role of vaginal mesh hysteropexy in the management of advanced genital organ prolapse as assessed by subjective and objective parameters. STUDY DESIGN Retrospective case series of 77 women followed for at least 1 year after vaginal mesh hysteropexy performed for stage III or greater uterovaginal prolapse. The primary outcome was Pelvic Organ Prolapse Quantification (POP- Q) stage < II and no subjective bothersome bulge and no further interventions for prolapse. Secondary outcomes assessed were complications such as intraoperative bleeding, injuries, and postoperative complications such as mesh exposure, mesh retraction, dyspareunia, urinary incontinence, and voiding dysfunction. RESULTS Mean follow-up was 13.7 +/- 4.1 months. Our composite success score was 85.7%. The anatomic (POP-Q) success score was 90.9%. Most failures (all but 1) were stage II with cervix as leading edge. Incidence of de novo dyspareunia was 3.7% and vaginal mesh erosion was 6.5%. Most patients 68/77 (88.3%) were discharged home voiding normally. CONCLUSION Vaginal mesh hysteropexy offers good success; however, comparative studies are required to validate its true role.
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Kurt S, Guler T, Canda MT, Demirtas Ö, Tasyurt A. Treatment of uterine prolapse with bilateral hydronephrosis in a young nulliparous woman; a new minimally invasive extraperitoneal technique. Eur Rev Med Pharmacol Sci 2014; 18:1657-1660. [PMID: 24943978] [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: 06/03/2023]
Abstract
A 37-year-old nulligravid woman presented with a 2-year history of uterine prolapse along with mixed incontinence. Gynecological examination confirmed third degree cystocele and uterine prolapse. Renal ultrasonography showed enlarged kidneys and marked dilation of the bilateral pelvicalyceal system. She was hospitalized and a ring pessary was inserted after bladder catheterization. Her preoperative evaluation was performed and the patient was operated one month after her first admission. Anterior colporrhaphy along with Kurt Extraperitoneal Ligamentopexy was performed without any complication. A control visit on second postoperative month revealed recovery of incontinence symptoms and no prolapse was observed. To our knowledge this is the first reported treatment of a case with bilateral hydronephrosis due to uterine prolapse that were corrected and overcame with a novel minimally invasive extraperitoneal approach by fixation of bilateral round ligaments to the rectus fascia sheet.
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Affiliation(s)
- S Kurt
- Department of Obstetrics and Gynecology, Tepecik Teaching and Research Hospital, Izmir, Turkey.
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35
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Gomes CM, Rovner ES, Banner MP, Ramchandani P, Wein AJ. Simultaneous Upper and Lower Urinary Tract Obstruction Associated with Severe Genital Prolapse: Diagnosis and Evaluation with Magnetic Resonance Imaging. Int Urogynecol J 2014; 12:144-6. [PMID: 11374515 DOI: 10.1007/s001920170082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 11/30/2022]
Abstract
Genital prolapse causing both urethral and ureteral obstruction is an infrequent occurrence, especially in the absence of uterine prolapse. We report on a patient with massive genital prolapse causing both urethral and ureteral obstruction in whom magnetic resonance imaging demonstrated the level of obstructive uropathy and, after surgical repair of the prolapse, confirmed restoration of the normal pelvic and upper urinary tract anatomy.
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Affiliation(s)
- C M Gomes
- University of Pennsylvania Health System, Philadelphia, USA
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36
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Nechiporenko AN, Nechiporenko NA. [Dynamic magnetic resonance imaging of the pelvis in the differential diagnosis of types of urinary incontinence in women]. Urologiia 2013:35-37. [PMID: 23662492] [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: 06/02/2023]
Abstract
The technique was developed, and the results of static and dynamic magnetic resonance imaging of the pelvis in 52 women with clinically diagnosed descent or prolapse of internal genital organs are presented. Episodes ofinvoluntary urination during physical exertion were recorded in 42 women. The developed MRI method allows to fix not only the degree of prolapse of pelvic organs with an increase in intra-abdominal pressure (Valsalva maneuver, cough), but an involuntary opening of the urethra and its filling by contents of the bladder at the height of increased intra-abdominal pressure and the immediate closure of the urethra at the decrease of intra-abdominal pressure--leading features of stress urinary incontinence.
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37
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Milani ALF, Vollebregt A, Roovers JPWR, Withagen MIJ. [The use of mesh in vaginal prolapse]. Ned Tijdschr Geneeskd 2013; 157:A6324. [PMID: 23899707] [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: 06/02/2023]
Abstract
More than 13,000 vaginal prolapse operations are performed in the Netherlands each year. Native tissue repair is associated with a re-operation risk of 20-30%. Randomized trials demonstrate that mesh reinforced repairs are anatomically and functionally more effective in the short and medium term. Sexual functioning is comparable after mesh or native tissue repair; there is no difference in dyspareunia. It is not clear whether, in the long term, mesh decreases the risk of recurrence without increasing the risk of complications. 'Exposure' is the most frequently reported complication (4-19%), but treatment is usually not difficult. Pain caused by 'shrinkage' of the mesh is rare, but can be serious and is difficult to treat. The frequency of this complication is not well known. Until long-term results are known, mesh should only be considered in case of recurrent prolapse. Mesh surgery should be performed after informed consent and by surgeons with proven experience only.
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Affiliation(s)
- A L Fred Milani
- Reinier de Graaf Groep, afd. Obstetrie en Gynaecologie, Delft/Voorburg, the Netherlands.
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38
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Dietz HP, Beer-Gabel M. Ultrasound in the investigation of posterior compartment vaginal prolapse and obstructed defecation. Ultrasound Obstet Gynecol 2012; 40:14-27. [PMID: 22045564 DOI: 10.1002/uog.10131] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2011] [Indexed: 05/31/2023]
Abstract
Recent developments in diagnostic imaging have made gynecologists, colorectal surgeons and gastroenterologists realize as never before that they share a common interest in anorectal and pelvic floor dysfunction. While we often may be using different words to describe the same phenomenon (e.g. anismus/vaginismus) or attributing different meanings to the same words (e.g. rectocele), we look after patients with problems that transcend the borders of our respective specialties. Like no other diagnostic modality, imaging helps us understand each other and provides new insights into conditions we all need to learn to investigate better in order to improve clinical management. In this review we attempt to show what modern ultrasound imaging can contribute to the diagnostic work-up of patients with posterior vaginal wall prolapse, obstructed defecation and rectal intussusception/prolapse. In summary, it is evident that translabial/perineal ultrasound can serve as a first-line diagnostic tool in women with such complaints, replacing defecation proctography and MR proctography in a large proportion of female patients. This is advantageous for the women themselves because ultrasound is much better tolerated, as well as for healthcare systems since sonographic imaging is much less expensive. However, there is a substantial need for education, which currently remains unmet.
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Affiliation(s)
- H P Dietz
- Department of Obstetrics and Gynecology, Sydney Medical School Nepean, University of Sydney, Penrith, Australia.
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39
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Nechiporenko AN, Nechiporenko NA. [Condition of the urinary tract and the kidneys in females with prolapse and descent of the internal genitalia]. Urologiia 2012:14-19. [PMID: 23074926] [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: 06/01/2023]
Abstract
Excretory urography (EU), retrograde cystography (RC), static and dynamic pelvic MRT, renoradiography (RRG) were performed in 82 females with descent and prolapse of the internal genitalia. The above examination identified four degrees of the urinary bladder descent. The latter descent of the third and fourth degree caused ureteral obstruction in 48.1 and 87.1% cases, respectively, renal dysfunction in 81.5 and 100% cases, respectively. Static and dynamic pelvic MRT proved to be the most informative methods of examination of the urinary bladder and urethra in females with prolapse and descent of the internal genitalia.
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40
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Acharya S, Uprety DK. Carcinoma of vagina in utero-vaginal prolapse: a rare presentation. JNMA J Nepal Med Assoc 2012; 52:82-84. [PMID: 23478736] [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
Primary vaginal carcinoma in uterovaginal prolapse is a rare entity. We report a case of an 84-years-old lady, who presented with long standing vaginal ulcer in association with third degree uterovaginal prolapse. Incisional biopsy was taken from the ulcer. Histopathological examination showed a large cell keratinizing squamous cell carcinoma.
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Affiliation(s)
- S Acharya
- Department of Obstetrics and Gynaecology, College of Medical Sciences(CMS), Bharatpur, Chitwan
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Seisen T, Rouprêt M. [Treatment of vaginal prolapse and urinary stress incontinence]. Prog Urol 2012; 22:H1-3. [PMID: 22445520 DOI: 10.1016/s1166-7087(12)70023-4] [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: 11/18/2022]
Affiliation(s)
- T Seisen
- Service d'Urologie de l'Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Université Paris VI, Faculté de médecine Pierre et Marie Curie, France, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Li XW, Wang JL, Wei LH, Feng GJ, Liu YL. [Analysis of anorectal manometry in 40 women with posterior vaginal prolapse]. Zhonghua Fu Chan Ke Za Zhi 2011; 46:574-577. [PMID: 22169513] [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
OBJECTIVE To study abnormal defecation in patients with posterior vaginal prolapse combined with anorectal manometry. METHODS From Jan. 2008 to Nov. 2009, clinical documents and examination of anorectal manometry of 40 patients with posterior vaginal prolapse were studied retrospectively. Anal physiologic testing was performed for 40 patients. These patients were classified into group A (stage 0 and I posterior vaginal prolapse, represented normal) and group B (stage II-IV). Results of anorectal manometry, constipation and symptoms of defecation were compared. RESULTS The average anal canal resting pressure and squeeze pressure of 40 patients were (40 ± 21) and (96 ± 33) mm Hg (1 mm Hg = 0. 133 kPa). In group A, the anal canal resting pressure and squeeze pressure were (37 ± 21) and (78 ± 43) mm Hg, rectal sensation threshold and rectal maximum volume were (106 ± 61) and (183 ± 51) ml. In group B, the anal canal resting pressure and squeeze pressure were (42 ± 21) and (102 ± 30) mm Hg, rectal sensation threshold and rectal maximum volume were (90 ± 44) and (171 ± 61) ml. Apart from maximum squeeze pressure (P = 0.039), the other clinical index did not show statistical difference (P > 0.05). Rectal sensation threshold, intended volume and maximum capacity of (116 ± 69), (170 ± 90), (191 ± 75) ml in patients with constipation were higher than (84 ± 31), (121 ± 37), (169 ± 45) ml in patients without constipation. In addition to maximum capacity (P = 0.281), the other clinical index reached statistical difference between patients with and without constipation (P < 0.05). Patients with defecation symptoms have higher rectal sensation threshold, intended volume and maximum capacity than those of patients without defecation symptoms. CONCLUSIONS As gradually increased in the degree of prolapse, resting pressure and squeeze pressure tend to be increased, while the rectal sensation threshold and rectal maximum volume tend to be decreased. Patients with defecation symptoms and constipation have increased the initial feeling of volume and maximum tolerated volume.
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Affiliation(s)
- Xiao-wei Li
- Department of Gynecology, Peking University People's Hospital, Beijing 100044, China
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Haverkorn RM, Williams BJ, Kubricht WS, Gomelsky A. Is obesity a risk factor for failure and complications after surgery for incontinence and prolapse in women? J Urol 2011; 185:987-92. [PMID: 21247603 DOI: 10.1016/j.juro.2010.10.064] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [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: 07/01/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE Obese women (body mass index 30 kg/m2 or greater) are considered to be at risk for postoperative complications and failure after stress incontinence surgery. We compare the outcomes in this population with nonobese women (body mass index less than 30 kg/m2) undergoing rectus fascia, porcine dermis and polypropylene sling procedures. MATERIALS AND METHODS We retrospectively identified 412 women with a body mass index less than 30 kg/m2 (94 autologous rectus fascia, 157 acellular porcine dermis, 161 transobturator polypropylene mid urethral sling) and 297 with a body mass index of 30 kg/m2 or greater (66 autologous rectus fascia, 114 acellular porcine dermis, 117 transobturator polypropylene mid urethral sling) who underwent sling procedures and other pelvic surgery. Evaluation included SEAPI assessment and quality of life questionnaires. Global cure equaled subjective SEAPI composite=0 and subjective satisfaction. Stress urinary incontinence cure equaled SEAPI (S)=0 and negative cough stress test. Chart review for perioperative data was conducted. Groups and outcomes were statistically compared. RESULTS All women had a minimum followup of 12 months. After controlling for body mass index preoperative demographics, SEAPI scores and quality of life indices were not statistically different within each sling group. Global cure and stress urinary incontinence cure rates were significantly higher for nonobese women in each sling group. Statistically significant improvement in SEAPI scores and quality of life indices was achieved for all groups, and there were no statistical differences within each sling group. Overall obese women had no increase in complications compared with nonobese women. The incidence of obstructive sequelae was statistically higher in nonobese women undergoing autologous rectus fascia and transobturator polypropylene mid urethral sling procedures. CONCLUSIONS Although cure rates are lower, obese women have significant improvements in quality of life after surgery for stress urinary incontinence. Obesity does not appear to be a risk factor for additional complications during sling and prolapse surgery.
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Affiliation(s)
- Rashel M Haverkorn
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
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Banerjee C, Noé KG. Laparoscopic pectopexy: a new technique of prolapse surgery for obese patients. Arch Gynecol Obstet 2010; 284:631-5. [PMID: 20941503 DOI: 10.1007/s00404-010-1687-7] [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] [Received: 07/21/2010] [Accepted: 09/13/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Obesity is a chronic disease which affects a substantial number of patients. It also increases a person's risk of genital prolapse. Conventional techniques of prolapse repair (sacropexy, transvaginal meshes and sacrospinal fixation) are used in very adipose women, but the effectiveness of this technique is sometimes restricted due to the difficultly of performing the surgery. METHOD Here we will describe a new method of endoscopic prolapse surgery, which is especially developed for obese patients. The lateral parts of the iliopectineal ligament are used for a bilateral mesh fixation of the descended structures. We have already used this method successfully in 12 patients without any complications. RESULT AND CONCLUSION This method provides a stable and durable repair. The laparoscopic access reduces morbidity. The operation time for this procedure is approximately 50 min.
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Affiliation(s)
- Carolin Banerjee
- Hospital Dormagen, Teaching Hospital of the University of Cologne, Dr. Geldmacherstr. 20, 41539 Dormagen, Germany
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45
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Nechiporenko NA, Nechiporenko AN, Iutsevich GV. [Synthetic prosthesis in surgical treatment of females with stress urinary incontinence combined with genital prolapse]. Urologiia 2010:25-29. [PMID: 20886728] [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: 05/29/2023]
Abstract
Simultaneous surgical treatment of females with genital prolapse and stress urinary incontinence using Gynecare Prolift, TVT techniques with use of mesh, colpo-urethrosuspension with threads corrected static disorders of the genital organs in 96.7 +/- 3.3% cases, resulted in adequate continence in 93.3 +/- 4.6% operated patients. A 1.5 to 8 month postoperative follow-up registered adequate urination (no residual urine, complete continence) in 93.3 +/- 4.6% patients.
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Adedipe TO, Vine SJ. Immediate and perioperative outcomes of polypropylene mesh in pelvic floor repair in a predominantly obese population. CLIN EXP OBSTET GYN 2010; 37:266-268. [PMID: 21355454] [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]
Abstract
This retrospective study was to identify perioperative and postoperative complications associated with use of polypropylene mesh for pelvic floor repair in a UK district general hospital in a predominantly obese population. The sample size was 27 women with data retrieved from records. Total mesh was used in 37.1%, isolated anterior mesh in 44.4%, and an isolated posterior mesh in 18.5%. There was a high incidence of obese (BMI kg/m2 > or = 30.0) women (66.67%). The highest recorded thus far. A high proportion of the women (44.4%) were also over the age of 65 years with attendant comorbidities. The age range was 45-77 years. Complications included mesh exposure (7.4%), catheterization at discharge (7.4%), bladder injury during dissection (3.7%) and recurrent prolapse (7.4%). In the carefully selected individuals, polypropylene mesh for prolapse repair appears to be a safe technique to correct pelvic organ prolapse. However, long-term follow-up is needed with further research.
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Affiliation(s)
- T O Adedipe
- Department of Obstetrics and Gynecology, Prince Charles Hospital, Merthyr Tydfil, UK.
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Zielina P, Schreier R. [Acute hysterectomy for huge submucous leiomyoma prolaps]. Ceska Gynekol 2009; 74:389-392. [PMID: 20063844] [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
OBJECTIVE To present a case of huge submucous leiomyoma prolaps to the vagina with severe haemorrhage and its management and to analyse current articles with this rare complication. DESIGN A case report, review article. SETTING Department of Gynecology and Obstetrics Trinec Hospital. RESULTS A case report of huge submucous leiomyoma prolaps in 49-year-old woman. The patient presented at our department with sudden onset of profuse vaginal bleeding. The vaginal and utrasound examination was performed with diagnosis of huge submucous leiomyoma obturating upper third of the vagina. The cervix was not palpable, rised up. While manipulating with the leiomyoma the bleeding exceeded. The patient agreed with abdominal hysterectomy without adnexectomy. Then the patinent colapsed and the operation was performed immediately, taking care of changed anatomy--the line between the vaginal wall and the uterus was almost invisible caused by "non-existing cervix" and the uterus was partialy inverted into the vagina. The haemoglobin level failed from 124 g/l to 95 g/l with no need of tranfusion. The patient quickly recovered and was dimised the sixth day after the operation. CONCLUSION Uterine myomas in their submucous localisation may protrude through the cervix into the vagina and cause rare but very serious complications--profuse vaginal bleeding and non-puerperal inversion of the uterus, and thus need very urgent management.
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Affiliation(s)
- P Zielina
- Gynekologicko-porodnické oddelení nemocnice Trinec.
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Ramezani A, Ghandi N, Akhyani M, Daneshpazhooh M, Naraghi ZS, Chams-Davatchi C. Erosions on a prolapsed uterine in an old woman: an unusual manifestation of pemphigus vulgaris. Dermatol Online J 2009; 15:9. [PMID: 19930996] [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
Vaginal involvement in pemphigus vulgaris has previously been described. In all those cases a pelvic examination was needed to explore the lesions. We describe a patient with pemphigus vulgaris who had pemphigus erosions on a prolapsed uterus (i.e., on the everted surface of vagina). The patient had widespread lesions of pemphigus in other mucosal and cutaneous sites. Biopsy, antibodies against desmoglein 1 and 3, and direct and indirect immunofluorescence were confirming. The erosions on the prolapsed uterus were resistant to treatment; other mucosal and cutaneous lesions responded rapidly to prednisolone and azathioprine. After lowering the dose of prednisolone the patient was referred to a gynecologist for a vaginal hysterectomy. This case was unique because her vaginal lesions could be easily examined and followed.
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Affiliation(s)
- Ali Ramezani
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Omotosho TB, Rogers RG. Shortcomings/strengths of specific sexual function questionnaires currently used in urogynecology: a literature review. Int Urogynecol J 2009; 20 Suppl 1:S51-6. [PMID: 19440783 DOI: 10.1007/s00192-009-0829-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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: 11/26/2022]
Abstract
Pelvic floor disorders are common and although not life-threatening, have a significant impact on a patient's quality of life. Sexual health is an essential component of a women's overall well-being. In clinical practice and research it is important that the symptoms and impact of these disorders are assessed in an objective fashion. The most valid instruments to measure the presence, severity, and impact of a patient's pelvic floor symptoms on function and quality of life are sexual function questionnaires. Sexual function questionnaires range from ad hoc questionnaires to condition-specific validated measures. This review article will describe the shortcomings and strengths of a variety of validated sexual function questionnaires currently used to measure sexual function in women with pelvic floor disorders.
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Affiliation(s)
- Tola B Omotosho
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10 5580, Albuquerque, NM 87131-0001, Mexico.
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Patel M, O'Sullivan DM, Steinberg AC. Symptoms of anal incontinence and impact on sexual function. J Reprod Med 2009; 54:493-498. [PMID: 19769195] [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
OBJECTIVE To evaluate whether symptoms of anal incontinence (AI) have an impact on sexual function in a cohort of women with pelvic floor disorders and/or incontinence. STUDY DESIGN We analyzed a cohort of women presenting to an academic urogynecology practice. The control group consisted of those who answered "no" to questions 9-11 on the Pelvic Floor Distress Inventory. The AI group consisted of those selecting "yes" to at least 1 of these questions. Student t test was used to compare differences between groups for the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). RESULTS The control group had a significantly lower mean score on the PISQ-12 than the AI group. There was no difference in PISQ-12 scores when controlling for stage of prolapse. CONCLUSION Symptoms of AI were not associated with worse sexualfunction as measured by the PISQ-12.
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Affiliation(s)
- Minita Patel
- Division of Urogynecology, Hartford Hospital, Hartford, Connecticut, USA.
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