MyMedR

The management of irreducible rectal prolapse is controversial. Surgeons may attempt conservative management by application of sugar. When surgery becomes inevitable the choice of procedure varies. We reviewed eight cases and noted the clinical findings and the results of conservative and surgical management. In four cases sugar was applied first, and failed. Emergency surgery always gave good outcomes. The procedures included simple reduction, rectopexy, laparotomy with resection, Delorme's repair, and perineal resection. Our experience and review of the literature indicate that surgery should be performed early in irreducible prolapse. Perineal resection may be the most suitable emergency procedure.

Matched MeSH terms: Rectal Prolapse/etiology; Rectal Prolapse/pathology; Rectal Prolapse/surgery*

Influence of anterior vaginal mesh with concomitant mid-urethral sling surgery on stress urinary incontinence: clinical and sonographic outcome

Lo TS, Tan YL, Cortes EF, Lin YH, Wu PY, Pue LB

Aust N Z J Obstet Gynaecol, 2015 Dec;55(6):593-600.

PMID: 26299981 DOI: 10.1111/ajo.12397

To clinically and sonographically evaluate the influence of anterior vaginal mesh (AVM) surgery with concomitant mid-urethral sling surgery (MUS) for stress urinary incontinence (SUI).

Matched MeSH terms: Pelvic Organ Prolapse/complications; Pelvic Organ Prolapse/surgery*; Pelvic Organ Prolapse/ultrasonography*

Defect-specific rectocele repair: medium-term anatomical, functional and subjective outcomes

Guzmán Rojas R, Kamisan Atan I, Shek KL, Dietz HP

Aust N Z J Obstet Gynaecol, 2015 Oct;55(5):487-92.

PMID: 26172410 DOI: 10.1111/ajo.12347

Rectocele is a herniation of the anterior wall of the rectal ampulla through a defect in the rectovaginal septum causing protrusion of the posterior vaginal wall. Common symptoms include symptoms of prolapse and obstructed defecation.

Matched MeSH terms: Prolapse

Clinical and urodynamic assessment in patients with pelvic organ prolapse before and after laparoscopic sacrocolpopexy

Abdullah B, Nomura J, Moriyama S, Huang T, Tokiwa S, Togo M

Int Urogynecol J, 2017 Oct;28(10):1543-1549.

PMID: 28283710 DOI: 10.1007/s00192-017-3306-7

INTRODUCTION AND HYPOTHESIS: We hypothesized that patient-reported urinary symptoms and urodynamic evaluation improve after laparoscopic sacrocolpopexy (LSC) despite deeper vesicovaginal space dissection.

METHODS: This was a retrospective study of women with pelvic organ prolapse who underwent LSC from January 2013 to January 2016 in a tertiary center. Urinary function was clinically evaluated using the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), the Overactive Bladder Symptom Score (OABSS) and the Pelvic Floor Distress Inventory Questionnaire- - Short Form 20 (PFDI-20). Urodynamic assessment was performed before and 6 months after surgery. The Wilcoxon signed-ranks test and the McNemar test were applied with p

Matched MeSH terms: Pelvic Organ Prolapse/complications; Pelvic Organ Prolapse/physiopathology*; Pelvic Organ Prolapse/surgery

Fulltext Retrospective study of transobturator polypropylene mesh kit for the management of pelvic organ prolapse

Vaiyapuri GR, Han HC, Lee LC, Tseng AL, Wong HF

Singapore Med J, 2012 Oct;53(10):664-70.

PMID: 23112018

This retrospective study assessed the surgical outcomes of patients for whom the transobturator polypropylene mesh kit was used for the management of pelvic organ prolapse (Gynecare Prolift) in a tertiary urogynaecological centre in Singapore from January 1, 2006 to December 31, 2007.

Matched MeSH terms: Uterine Prolapse/surgery; Pelvic Organ Prolapse/surgery*

Heavy Trichuris infection and amoebic dysentery in Orang Asli children. A comparison of the two diseases

Gilman RH, Davis C, Fitzgerald F

Trans R Soc Trop Med Hyg, 1976;70(4):313-6.

PMID: 1006759

Children with heavy Trichuris infestation were compared with paediatric amoebic dysentery patients and normal children. Heavy Trichuris infestation was diagnosed by visualization of worms on anoscopy. Patients with heavy Trichuris infection had a longer duration of disease, more frequent hospitalization and a higher rate of rectal prolapse than did patients with amoebiasis. Five Trichuris children also had clubbing. Trichuris patients had lower mean haematrocrits (27%) and serum albumin (3-3 gm%) than did patients with amoebiasis (32% and 3-7 gm% respectively). Coinfection with Shigella and Salmonella was significantly increased in patients with heavy Trichuris infection compared to both amoebic and control group children. Trichuris patients were infected with Entamoeba histolytica more frequently (46%) than normal children. Heavy Trichuris infection is the probable cause of symptoms and signs seen in these patients.

Matched MeSH terms: Rectal Prolapse/etiology

The association between different measures of pelvic floor muscle function and female pelvic organ prolapse

Oversand SH, Atan IK, Shek KL, Dietz HP

Int Urogynecol J, 2015 Dec;26(12):1777-81.

PMID: 26249237 DOI: 10.1007/s00192-015-2793-7

INTRODUCTION AND HYPOTHESIS: We aimed to compare palpatory and translabial ultrasound (TLUS) measurements of pelvic floor muscle (PFM) function with symptoms and signs of female pelvic organ prolapse (FPOP) to determine a possible association.

METHODS: We analysed data from 726 women with a mean age of 56 (SD 13.7, range 18-88) years, seen for symptoms of pelvic floor dysfunction between August 2011 and April 2013. The examination included a standardised interview and clinical assessment of FPOP with Pelvic Organ Prolapse Quantification (POP-Q) measurements, Modified Oxford Scale (MOS) grading and 4D TLUS.

RESULTS: Symptoms of prolapse were reported in 51.4% (373 out of 726) with a mean bother score of 5.8 (SD 2.91, range 0-10). A clinically significant POP (Incontinence Society [ICS]-POP-Q stage ≥ 2) in any compartment was diagnosed in 77.1%. Mean MOS was 2.4 (SD 1.1, range 0-5). Significant POP on TLUS was seen in 54.6% (389 out of 712). TLUS volumes at rest and on maximal PFM contraction were analysed on a desktop PC, to assess the degree of bladder neck (BN) cranioventral shift and levator antero-posterior (AP) diameter reduction, blinded against other data. Mean cranioventral BN shift was 7.11 (SD 4.36, range 0.32-25.32) mm and mean levator AP diameter reduction was 8.6 (SD 4.8, range 0.3-31.3) mm. MOS was strongly associated with subjective and objective POP (P ≤ 0.001), whereas this was not true for TLUS measurements of tissue displacement.

CONCLUSION: The MOS seems to be a more valid measure of PFM function than sonographically determined BN displacement or reduction of hiatal AP diameter observed on PFM contraction.

Matched MeSH terms: Pelvic Organ Prolapse/complications; Pelvic Organ Prolapse/diagnosis*; Pelvic Organ Prolapse/physiopathology*

Fulltext 12. Concurrent utero-vaginal prolapse with cervical angiomyofibroblastoma: a rare disease with distinct entity

Lee, CL, Ng, Beng Kwang, Chew, KT, Aruku, N, Lim, PS

Journal of Surgical Academia, 2015;5(2):58-61.

MyJurnal

We report the case of a rare, benign mesenchymal tumour arising from the cervix. A 53-year-old post-menopausal woman presented with mass per vagina. Examination revealed stage 2 utero-vaginal prolapse and multiple elongated polyps seen at the cervix. She underwent local excision. Histopathological examination findings and the immunohistochemical studies were consistent with Angiomyofibroblastoma.

Matched MeSH terms: Uterine Prolapse

Prolapse and presentation of the umbilical cord

LLEWELLYN-JONES D

Med J Malaya, 1958 Sep;13(1):70-3.

PMID: 13589373

Matched MeSH terms: Prolapse

Uterine inversion with massive uterovaginal prolapse and multiple bladder stones

Naidu A, Nusee Z, Tayib S

J Obstet Gynaecol Res, 2011 Jun;37(6):633-5.

PMID: 21349130 DOI: 10.1111/j.1447-0756.2010.01401.x

A non-puerperal uterine inversion in advanced uterovaginal prolapse is a rare occurrence. Even more unusual is the presence of bladder calculi in these two conditions, which has not been documented before. We report a case of acute urinary retention secondary to severe uterovaginal prolapse associated with uterine inversion and multiple bladder calculi.

Matched MeSH terms: Uterine Prolapse/complications*; Uterine Prolapse/physiopathology

Fulltext Vaginal vault prolapse--a case report

Tharmaseelan NK

Singapore Med J, 1991 Jun;32(3):187-8.

PMID: 1876896

Vaginal vault prolapse after hysterectomy is a distressing complication for both the patient and the surgeon. Successful repair of post-hysterectomy vault prolapse is one of the most difficult problems in gynaecological surgery. The aim of the surgery should be to restore coital function and cure the prolapse permanently.

Matched MeSH terms: Uterine Prolapse/etiology; Uterine Prolapse/surgery*

Fulltext Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women

Tan YL, Lo TS, Khanuengkitkong S, Krishna Dass A

Taiwan J Obstet Gynecol, 2014 Sep;53(3):348-54.

PMID: 25286789 DOI: 10.1016/j.tjog.2013.08.004

The objective of this study was to estimate the association of vaginal sacrospinous ligament fixation with anterior-transobturator mesh repair surgery for advanced pelvic organ prolapse in patients of two different age groups.

Matched MeSH terms: Pelvic Organ Prolapse/classification; Pelvic Organ Prolapse/surgery*

Anterior-apical single-incision mesh surgery (SIMS): surgical and functional outcomes at 1 year

Lo TS, Tan YL, Cortes EF, Pue LB, Wu PY, Al-Kharabsheh A

J Minim Invasive Gynecol, 2015 Jan;22(1):50-6.

PMID: 25017520 DOI: 10.1016/j.jmig.2014.07.002

To study the surgical and functional outcomes of single-incision mesh surgery for treatment of advanced pelvic organ prolapse (POP).

Matched MeSH terms: Pelvic Organ Prolapse/complications; Pelvic Organ Prolapse/surgery*

The Association Between Levator-Urethra Gap Measurements and Symptoms and Signs of Female Pelvic Organ Prolapse

Kamisan Atan I, Shek KL, Furtado GI, Caudwell-Hall J, Dietz HP

Female Pelvic Med Reconstr Surg, 2016 Nov-Dec;22(6):442-446.

PMID: 27465815

OBJECTIVES: Levator avulsion is associated with pelvic organ prolapse in women. It is diagnosed clinically by a widened gap on palpation between the insertion of the puborectalis muscle on the inferior pubic ramus and the urethra. This gap can also be assessed on imaging. This study aimed to determine the association between sonographically determined levator-urethral gap (LUG) measurements and symptoms and signs of prolapse.

METHODS: This is a retrospective study on 450 women seen in a tertiary urogynecological center for symptoms of pelvic floor dysfunction between January 2013 and February 2014. All had a standardized interview, International Continence Society Pelvic Organ Prolapse Quantification assessment and 4-dimensional translabial ultrasound. Post-imaging analysis of archived ultrasound volumes for LUG measurement was undertaken on tomographic slices at the plane of minimal hiatal dimensions and within 5-mm cranial to this plane, bilaterally at an interslice interval of 2.5 mm, blinded against all clinical data. A LUG of 25 mm or greater was considered abnormal.

RESULTS: Mean LUG and maximum LUG in individuals were 22.5 mm (SD, 4.6) and 26.4 mm (SD, 6.0), respectively, with at least 1 abnormal LUG in 51% (n = 222). An abnormal LUG in all 3 slices involving the plane of minimal hiatal dimensions and within 5 mm cranial to this plane on at least 1 side was fulfilled in 24% (n = 103). The LUG measurements were strongly associated with bother, symptoms and signs of prolapse (P < 0.001 to 0.002). This remained significant on multivariate analysis controlling for potential confounding factors.

CONCLUSIONS: Sonographically determined LUG is strongly associated with symptoms, symptom bother, and pelvic organ prolapse on clinical examination and imaging.

Matched MeSH terms: Pelvic Organ Prolapse/pathology*; Pelvic Organ Prolapse/physiopathology

The association between vaginal parity and hiatal dimensions: a retrospective observational study in a tertiary urogynaecological centre

Kamisan Atan I, Gerges B, Shek KL, Dietz HP

BJOG, 2015 May;122(6):867-872.

PMID: 24942229 DOI: 10.1111/1471-0528.12920

OBJECTIVE: Vaginal childbirth has a substantial effect on pelvic organ supports, which may be mediated by levator ani (LA) avulsion or hiatal overdistension. Although the impact of a first vaginal delivery on the hiatus has been investigated, little is known about the effect of subsequent births. This study was designed to evaluate the association between vaginal parity and hiatal dimension.

DESIGN: Retrospective observational study.

SETTING: A tertiary urogynaecological unit in Australia.

POPULATION: A total of 780 archived data sets of women seen for symptoms of lower urinary tract and pelvic floor dysfunction.

METHODS: Standardised in-house interview and assessment using the International Continence Society (ICS) pelvic organ prolapse quantification (POP-Q), and four-dimensional translabial ultrasound. Offline analysis for hiatal dimensions was undertaken blinded to history and clinical examination.

MAIN OUTCOME MEASURES: Hiatal area on maximum Valsalva.

RESULTS: Of 780 women, 64 were excluded because of missing ultrasound volumes, leaving 716 for analysis: 96% (n = 686) were parous, with a median parity of three (interquartile range, IQR 2-3), and 91.2% (n = 653) were vaginally parous. Levator avulsion was found in 21% (n = 148). The mean hiatal area on Valsalva was 29 cm(2) (SD 9.4 cm(2) ). On one-way anova, vaginal parity was significantly associated with hiatal area (P < 0.001). Most of the effect seems to occur with the first delivery. Subsequent deliveries do not seem to have any significant effect on hiatal dimensions. This remained true after controlling for potential confounding factors using multivariate regression analysis (P = 0.0123).

CONCLUSIONS: Vaginal parity was strongly associated with hiatal area on Valsalva. Most of this effect seems to be associated with the first vaginal delivery.

Matched MeSH terms: Pelvic Organ Prolapse/etiology*; Pelvic Organ Prolapse/pathology

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