Introduction: Traditionally, a cystocele caused by a midline defect of the pelvic fascia is treated by vaginal fascia duplication, also known as anterior colporraphy. The rectocele is managed by suturing the posterior fascia and, frequently, the levator ani muscles. We developed the approach of laparoscopic anterior and posterior fascia repair by native tissue.
Material and methods: The methods were based on anterior and posterior exposure of pelvic fascia similar to the preparation of an extended sacral colpopexy. The fascia was compressed and narrowed by absorbable woven sutures, size 1. Twenty-seven patients were followed up for 6–13?months. All patients received additional apical fixation by pectopexy.
Results: In the examination group, 13 patients underwent anterior laparoscopic fascia repair and 23 had posterior repair. We detected one apical and one posterior relapse, and also one in the anterior repair group. The patient with the apical relapse reported pain and de novo urgency. Anatomical reconstruction was achieved in all other patients.
Summary: Laparoscopic anterior and posterior native tissue repair appears to be a feasible method for the treatment of midline cystocele and rectocele. No new risks were observed. The technique leaves no scar in the vagina and is well accepted.
Abbreviations: POPQ: Pelvic Organ Prolapse Quantification System; FDA: Food and Drug Association; US: United States; Fig: Figure; ICIQ: International Consultation on Incontinence Questionnaire 相似文献
We present the case of a patient who delivered her baby through the perineal body with an intact vaginal introitus. Damage to the perineal body through its connection to the external anal sphincter can involve the rectovaginal septum with increased morbidity and thought to be linked to rectocele development. 相似文献
The functional outcome after a low anterior resection for rectal cancer is improved by a colonic J-pouch reconstruction. One
functional problem with J-pouches is difficulty in evacuation, which is more common with large reconstructions. Since rectoceles
are common findings on defecography in patients with evacuation difficulties, we proposed that a rectocele-like prolapse may
be thus found in patients with large J-pouches. Pouchography was used to identifya rectocele-like prolapse (RP) in 26 patients with a 10-cm J-pouch (10-J group) and 27 patients with a 5-cm J-pouch (5-J group).
Pouchography was performed at 3 months, 1 year, and 2 years after surgery. Functional assessments were performed 1 year postoperatively.
Clinical function was evaluated using a questionnaire. The evacuation function was evaluated by the balloon expulsion and
saline evacuation test. No patients had an RP at 3 months or 1 year after surgery. An RP was significantly more common in
the 10-J group than in the 5-J group at 2 years after surgery (P=0.0374). An evacuation difficulty was significantly more common in the 10-J group than in the 5-J group. The evacuation function
in the 10-J group was also significantly inferior to that in the 5-J group. An RP appearing 2 years after surgery is more
common in patients with evacuation difficulties and large colonic J-pouch reconstructions.
This work was supported in part by a Grant-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture
and Science, and a grant for Cancer Research from the Osaka Cancer Foundation. 相似文献
Pelvic organ prolapse is a common and costly women's health problem. Prevention of prolapse continues to play a role in the debate about the risks and benefits of elective cesarean section, making this an important topic for midwives to understand. While some women appear to be at higher risk for prolapse because of intrinsic anatomic and physiologic factors, others have modifiable risk factors that can be addressed by health care providers. This article discusses the current knowledge related to the etiology of prolapse and related components of pelvic anatomy. Biomechanical principles are then applied to enhance the understanding of prolapse development and prevention. Clinical recommendations are based on current evidence regarding topics such as physical activity during pregnancy, treatment of vaginal atrophy, and optimal pelvic floor muscle exercises. 相似文献
OBJECTIVE: The purpose of this study was to describe the natural history of pelvic organ prolapse after menopause. STUDY DESIGN: Over 2 to 8 years, participants in the estrogen plus progestin trial of the Women's Health Initiative at the University of California Davis had annual pelvic examinations, with an assessment of uterine prolapse, cystocele, and rectocele. The findings from these examinations were used to describe the incidence of pelvic organ prolapse, the probability of progression or regression, and the associated risk factors. RESULTS: At baseline, 31.8% of women had pelvic organ prolapse (n=412 women). The annual incidences of cystocele, rectocele, and uterine prolapse were 9.3, 5.7, and 1.5 cases per 100 women-years, respectively. Incident prolapse was associated with increasing parity and waist circumference. The progression rates for grade 1 pelvic organ prolapse (per 100 women-years) were 9.5 for cystocele, 13.5 for rectocele, and 1.9 for uterine prolapse. The annual rates of regression (per 100 women-years) was 23.5, 22, and 48, respectively. CONCLUSION: Our data suggest that pelvic organ prolapse is not always chronic and progressive as traditionally thought. Spontaneous regression is common, especially for grade 1 prolapse. 相似文献