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1.
Relationship Between Surgically Induced Neuropathy and Outcome of Pelvic Organ Prolapse Surgery 总被引:1,自引:1,他引:0
J. A. Welgoss V. Y. Vogt E. J. McClellan J. T. Benson 《International urogynecology journal》1999,10(1):11-14
The aim of the study was to determine whether surgically induced perineal neuropathy relates to the outcome of surgery for
the correction of pelvic organ prolapse. Perineal nerve terminal motor latencies (PeNTML) were obtained in 31 women prior
to and following transvaginal surgery for the correction of pelvic organ prolapse consisting of bilateral sacrospinous ligament
vault suspension and bilateral paravaginal cystocele repair. Mean follow-up was 32 months (range 12–60). Surgical outcome
was defined as optimal (asymptomatic, with the apex of the vagina above the levator plate with no tissue protruding beyond
the hymen in the upright position with maximum Valsalva), or suboptimal (apical descent of >50%, or any vaginal wall protrusion
beyond the hymen in the upright position with maximum Valsalva). Surgically induced neuropathy was defined as an increase
of 0.6 ms or more in the averaged right and left PeNTML measurements following the surgery. All women had preoperative symptomatic
prolapse and the mean preoperative PeNTML was prolonged compared to established normals. Using strict definitions, 11 women
had optimal outcome and 20 had suboptimal outcome. The outcome groups were similar with respect to age, weight, parity, degree
of preoperative prolapse and preoperative perineal neuropathy. Eleven women had surgically induced perineal neuropathy. This
was associated with suboptimal outcome compared to optimal outcome (P = 0.03). The relative risk of suboptimal outcome with surgically induced neuropathy was 1.82 (95% CI 1.13–2.93). It was concluded
that a relationship exists between the outcome of organ prolapse surgery and surgically induced perineal neuropathy as measured
by PeNTML. Such neuropathy may play a role in failed pelvic reconstructive surgery. 相似文献
2.
Peter Takacs Mehdi Nassiri Anita Viciana Keith Candiotti Alessia Fornoni Carlos A. Medina 《International urogynecology journal》2009,20(2):207-211
The aim of this study was to compare fibulin-5 expression in women with and without anterior vaginal wall prolapse. Vaginal
tissues were sampled in a standardized fashion from women with (n = 12) or without (n = 10) anterior vaginal wall prolapse. Quantitative real-time polymerase chain reaction was performed to measure mRNA levels
of fibulin-5 (FIB-5). FIB-5 protein expression was assessed by immunohistochemistry. There were no significant differences
in demographic data between the two groups. FIB-5 mRNA expression was significantly decreased in women with anterior vaginal
wall prolapse compared to women without prolapse [(FIB-5 mean ± SD mRNA expression in relative units) 0.01 ± 0.01 vs. 0.09 ± 0.14,
P = 0.04]. Fibulin-5 staining intensity was diminished in women with prolapse compared to women without prolapse [intensity
score, median (range), 1 (1–2) vs. 3 (2–3), P = 0.04]. Fibulin-5 expression is decreased in vaginal biopsies from women with prolapse. Changes in fibulin expression may
play a role in the development of pelvic organ prolapse. 相似文献
3.
E. H. M. Sze N. Kohli J. R. T. Roat M. M. Karram 《International urogynecology journal》1999,10(6):390-393
The objective of this study was to compare the surgical outcome of abdominal sacrocolpopexy and Burch colposuspension with
sacrospinous fixation and transvaginal needle suspension in the management of vaginal vault prolapse and coexisting stress
incontinence. One hundred and seventeen women with vaginal vault prolapse and coexisting stress incontinence were surgically
managed over a 7-year period. The first 61 consecutive women who underwent sacrospinous fixation and transvaginal needle suspension
comprised the vaginal group, and the following 56 consecutive women who underwent abdominal sacrocolpopexy and Burch colposuspension
comprised the abdominal group. Office records were reviewed to assess the presence of recurrent prolapse and urinary incontinence
during postoperative follow-up. Objective follow-up was available for 101 women. Mean duration of follow-up was 24.0 ± 15
months for the vaginal group, and 23.1 ± 12.6 months for the abdominal group. The incidence of recurrent prolapse to or beyond
the hymen (33% vs. 19%, P = 0.0505) and lower urinary tract symptoms (26% vs. 13%, P = 0.0506) were significantly higher in the vaginal group than in the abdominal group. Our data suggest that the combined
abdominal approach has a lower incidence of recurrent prolapse and lower urinary tract symptoms than the combined vaginal
approach in managing vaginal vault prolapse and coexisting stress incontinence. 相似文献
4.
N. Rajamaheswari K. Seethalakshmi K. B. Gayathri 《International urogynecology journal》2009,20(12):1509-1510
Longitudinal vaginal septum is a rare mullerian anomaly and its association with pelvic organ prolapse (POP) is unusual. A
case of longitudinal vaginal septum with stage IV POP in a 35-year-old multiparous woman is being reported. Examination revealed
an incomplete longitudinal vaginal septum (9 × 6 × 2 cm) with stage IV POP. Vaginal hysterectomy with repair and reconstruction
was done along with excision of the longitudinal vaginal septum which was technically challenging due to proximity to rectum.
This is the only case report of stage IV pelvic organ prolapse associated with a thick longitudinal vaginal septum in a multiparous
woman without any obstetric complications. Surgery required increased caution per operatively while dissecting the septum
from the vaginal wall and the adjacent organs. 相似文献
5.
Farnaz A. Ganj Okechukwu A. Ibeanu Ahmet Bedestani Thomas E. Nolan Ralph R. Chesson 《International urogynecology journal》2009,20(8):919-925
Introduction and hypothesis This study aimed to document intraoperative and postoperative complications associated with the use of transvaginal polypropylene
mesh in the repair of pelvic organ prolapse (POP).
Methods This is a retrospective review of 127 cases of transvaginal repair of POP using synthetic mesh.
Results Mean postoperative value (±SD) for pelvic organ prolapse quantification (POPQ) measurements Aa, Ap, and C were: −2.4 ± 1.1
(cm), −2.4 ± 0.9 (cm), and −7.7 ± 1.2 (cm), respectively. The difference between preoperative and postoperative values of
these points was significant (p < 0.0001). Mesh erosion rate was 13/127 (10.2%) with significant correlation between mesh erosion and concurrent vaginal
hysterectomy (p = 0.008). Combined anterior and posterior vaginal mesh surgery increased the risk of intraoperative bleeding and blood transfusion
(p < 0.05).
Conclusions Concurrent vaginal hysterectomy is associated with increased risk of vaginal mesh erosion. Combined anterior and posterior
vaginal mesh repair is an increased risk factor for intraoperative bleeding and blood transfusion. 相似文献
6.
Uterine Preservation or Hysterectomy at Sacrospinous Colpopexy for Uterovaginal Prolapse? 总被引:6,自引:5,他引:1
C. F. Maher M. P. Cary M. C. Slack C. J. Murray M. Milligan P. Schluter 《International urogynecology journal》2001,12(6):381-385
This study retrospectively compared 34 women who had a sacrospinous hysteropexy and 36 who had a vaginal hysterectomy and
sacrospinous fixation for symptomatic uterine prolapse. All women underwent independent review and examination, with a mean
follow-up of 36 months in the hysterectomy group and 26 months in the hysteropexy group.
The subjective success rate was 86% in the hysterectomy group and 78% in the hysteropexy group (P = 0.70). The objective success rate was 72% and 74%, respectively (P = 1.00). The patient-determined satisfaction rate was 86% in the hysterectomy group and 85% in the hysteropexy group (P = 1.00). The operating time in the hysterectomy group was 91 minutes, compared to 59 minutes in the hysteropexy group (P<0.01). The mean intraoperative blood loss in the hysterectomy group was 402 ml, compared to 198 ml in the hysteropexy group
(P<0.01). The sacrospinous hysteropexy is effective in the treatment of uterine prolapse. Vaginal hysterectomy may not be necessary
in the surgical treatment of uterine prolapse. 相似文献
7.
Planned cesarean section versus planned vaginal delivery: comparison of lower urinary tract symptoms
Åsa Ekström Daniel Altman Ingela Wiklund Christina Larsson Ellika Andolf 《International urogynecology journal》2008,19(4):459-465
We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth
or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women
delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower
urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean
section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435
subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary
tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress
urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p < 0.001) and 9 months (p = 0.001) follow-up. In a multivariable risk model, vaginal delivery was the only obstetrical predictor for SUI [relative
risk (RR) 8.9, 95% confidence interval (CI) 1.9–42] and for urinary urgency (RR 7.3 95% CI 1.7–32) at 9 months follow-up.
A history of SUI before pregnancy (OR 5.2, 95% CI 1.5–19) and at 3 months follow-up (OR 3.9, 95% CI 1.7–8.5) were independent
predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms
9 months after childbirth when compared to elective cesarean section. 相似文献
8.
Peter Takacs Marc Gualtieri Mehdi Nassiri Keith Candiotti Carlos. A. Medina 《International urogynecology journal》2008,19(11):1559-1564
To compare the smooth muscle content and apoptosis of the vagina in women with and without anterior vaginal wall prolapse.
Vaginal tissues were sampled in women with (n = 6) or without (n = 6) anterior vaginal wall prolapse undergoing hysterectomy. Smooth muscle of the vagina was studied by immunohistochemistry.
Digital image analysis was used to determine the fractional area of smooth muscle in the histologic cross-sections. Apoptosis
was assessed by TUNEL assay. The fractional area of non-vascular smooth muscle in the vagina of women with anterior vaginal
wall prolapse was significantly decreased compared to women without prolapse (0.36 ± 0.12 vs. 0.16 ± 0.12 P = 0.021) and the apoptotic index was significantly higher compared to women without prolapse (0.04 ± 0.01 vs. 0.02 ± 0.03,
P = 0.041). The fraction of smooth muscle in the vagina is significantly decreased and the rate of apoptosis is higher in women
with anterior vaginal wall prolapse compared to women without prolapse. 相似文献
9.
Stephen H. Gray Catherine C. Vick Laura A. Graham Kelly R. Finan Leigh A. Neumayer Mary T. Hawn 《Journal of gastrointestinal surgery》2008,12(4):675-681
Objective This study was undertaken to examine the effect of cirrhosis on elective and emergent umbilical herniorrhapy outcomes.
Methods Procedures were identified from the Veterans’ Affairs National Surgical Quality Improvement Program at 16 hospitals. Medical
records and operative reports were physician abstracted to obtain preoperative and intraoperative variables.
Results Of the 1,421 cases reviewed, 127 (8.9%) had cirrhosis. Cirrhotics were more likely to undergo emergent repair (26.0% vs. 4.8%,
p < 0.0001), concomitant bowel resection (8.7% vs. 0.8%, p < 0.0001), return to operating room (7.9% vs. 2.5%, p = 0.0006), and increased postoperative length of stay (4.0 vs. 2.0 days, p = 0.01). Best-fit regression models found cirrhosis was not a significant predictor of postoperative complications. Significant
predictors of complications were emergent case (OR 5.4; 95% CI 3.1–9.4), diabetes (OR 2.1; 95% CI 1.2–3.8), congestive heart
failure (OR 4.0; 95% CI 1.4–11.4), and chronic obstructive pulmonary disease (OR 2.0; 95% CI 1.1–3.6). Among emergent repairs,
cirrhosis (OR 4.4; 95% CI 1.3–14.3) was strongly associated with postoperative complications.
Conclusion Elective repair in cirrhotics is associated with similar outcomes as in patients without cirrhosis. Emergent repair in cirrhotics
is associated with worse outcomes. Early elective repair may improve the overall outcomes for patients with cirrhosis. 相似文献
10.
The purpose of this study was to examine the association between pessary use, smoking and changes in the vaginal flora. Patients
using pessaries were age matched with non-pessary using controls. All candidates examined were women attending the Mount Sinai
Hospital, Toronto, for genitourinary problems. Vaginal cultures were routinely performed on all women attending the unit,
irrespective of symptoms. Forty-four pessary users were age matched with 176 controls (4 controls per case). The mean age
was 60.1 ± 12.6 years, and 15% of these were premenopausal. The duration of pessary use ranged from 0.5 to 8 years (mean 3.3
± 1.7). Weight, parity, smoking status, diabetes mellitus, thyroid disease, UTI and postvoid residual urine volume were not
significantly different between pessary users and controls. Bacterial vaginosis (BV) was noted in 32% of pessary users, versus
10% of controls. The relative risk of developing BV in pessary users was 3.3 (OR, 4.37; 95% CI, 2.15–9.32), P= 0.0002. Smoking independently affected the vaginal flora, increasing the relative risk of developing BV to 2.9 (OR, 3.78;
95% CI, 2.05–8.25), P = 0.0013. It was concluded that pessary use is a very effective and conservative method for the treatment of genital prolapse.
However, we found that the presence of a foreign body was associated with changes in the vaginal flora, thereby increasing
the odds of developing bacterial vaginosis to 4.37; this was further compounded by smoking. 相似文献
11.
Emily S. Lukacz Einat DuHamel Shawn A. Menefee Karl M. Luber 《International urogynecology journal》2007,18(4):397-400
A retrospective case-control study was designed to assess risks for elevated post void residual (PVR) in women with pelvic
floor disorders. The 1,399 women underwent evaluation including standardized questionnaire, examination, and catheterized
PVR. Elevated PVR was defined as ≥100 ml and anterior and apical prolapse was defined as at or beyond the hymen. Overall,
the prevalence of elevated PVR was 11%. After matching, the absence of stress incontinence symptoms (OR 0.55, CI 0.33–0.92),
the symptoms of vaginal bulge (OR 2.19, CI 1.38–3.48), pelvic pressure (OR 1.79, CI 1.14–2.86), urinary splinting (OR 2.89,
CI 1.24–6.74), and presence of prolapse (OR 2.60 CI 1.62–4.18) were significantly associated with an elevated PVR. Only prolapse
(OR 1.96 CI 1.37–2.79) maintained a significant association after multivariate analysis. Symptoms alone do not predict which
women may have an elevated PVR, but the finding of prolapse at or beyond the hymen is associated with incomplete emptying.
Elevated post void residuals cannot be predicted based on symptoms alone; however, prolapse beyond the hymen may help identify
women with incomplete bladder emptying.
Presented at the annual Pacific Coast Obstetrics and Gynecology Society meeting, Phoenix, AZ, October 2004 and at the International
Continence Society meeting, Montreal, CA, September 2005. 相似文献
12.
Peter Takacs Marc Gualtieri Mehdi Nassiri Keith Candiotti Alessia Fornoni Carlos A. Medina 《International urogynecology journal》2009,20(8):985-990
Introduction and hypothesis The purpose of this study is to compare vaginal caldesmon expression in women with and without anterior vaginal wall prolapse.
Methods Vaginal tissues were sampled in women with (n = 11) or without (n = 11) vaginal wall prolapse. Caldesmon messenger RNA (mRNA) expression was assessed by quantitative real-time polymerase
chain reaction. Immunohistochemistry and digital image analysis were used to determine caldesmon protein expression in the
histologic sections.
Results There were no significant differences in demographic data between the two groups. Caldesmon mRNA expression was significantly
decreased in the vaginal tissue from women with anterior vaginal wall prolapse compared to women without prolapse [(caldesmon
mean ± SD mRNA expression in relative units) 0.03 ± 0.03 vs 0.17 ± 0.17, P = 0.02]. The fractional area of nonvascular caldesmon staining in the vagina of women with anterior vaginal wall prolapse
was significantly decreased compared to women without prolapse [mean ± SD (0.09 ± 0.04 vs 0.16 ± 0.09, P = 0.03)].
Conclusions Vaginal caldesmon expression is significantly decreased in women with anterior vaginal wall prolapse compared to normal subjects. 相似文献
13.
Wassim Badiou Guillaume Granier Philippe-Jean Bousquet Xavier Monrozies Pierre Mares Renaud de Tayrac 《International urogynecology journal》2008,19(5):723-729
The purpose of this study was to compare smooth muscle content of anterior vaginal wall in women with pelvic organ prolapse
(POP) and control subjects. Specimens were taken in the midline from the apex of anterior vaginal cuff from eleven women with
POP and eight control subjects operated for hysterectomy without prolapse. Masson’s trichrome stain was used to determine
the distribution of collagen in the extracellular matrix of the vaginal muscularis and to quantify the collagen in area of
interest. Slides of alpha smooth muscle actin were detected using antibodies. Morphometric analysis was used to compare and
to quantify the smooth muscle content of the vaginal muscularis. Fractional area of nonvascular vaginal smooth muscle of women
with POP was significantly decreased in comparison to control subjects (41.9 vs 61.9%, p = 0.005). Fractional area of connective tissue was significantly increased (56.8 vs 35%, p = 0.004). Fractional area of blood vessels was similar (2.2 vs 3.4%, p = 0.20). 相似文献
14.
G. Alessandro Digesu Stefano Salvatore Charlotte Chaliha Stavros Athanasiou Rodolfo Milani Vik Khullar 《International urogynecology journal》2007,18(12):1439-1443
This study aims to evaluate the changes of overactive bladder symptoms to anterior vaginal wall prolapse repair. Ninety-three
consecutive women with symptomatic anterior vaginal wall prolapse ≥ stage II and coexistent overactive bladder symptoms were
prospectively studied using a urinalysis, urodynamics, King’s Health Questionnaire (KHQ), Prolapse Quality of Life (P-QOL)
questionnaire and pelvic organ prolapse quantification (POP-Q) system before and 1 year after surgery. All women underwent
a standard fascial anterior repair. Postoperatively, urinary frequency, urgency and urge incontinence disappeared in 60, 70
and 82% of women respectively (p value < 0.001). The vaginal examination findings as well as the quality of life of the women assessed using KHQ and P-QOL
significantly improved after surgery (p value < 0.001). This study has demonstrated that anterior vaginal repair does produce significant improvement in overactive
bladder symptoms. A larger longer-term study is required to assess if these changes persist over time. 相似文献
15.
Huey-Yi Chen Tsan-Hung Chiu Ming Ho Yao-Ching Hung 《International urogynecology journal》2009,20(4):387-391
The goal of this study was to analyze the potential risk factors determining surgical failure after sacrospinous suspension
for uterine or vaginal vault prolapse. Each woman underwent a detailed history taking and a vaginal examination before treatment.
Follow-up evaluations were at immediate post-operation, 1 week, 1 to 3 months, 6 months, 9 months, and annually after the
operation. The surgical failure rate (27/168) following sacrospinous suspension was 16.1%. Using multivariable logistic regression,
women with the presence of C or D point stage I at immediate post-operation were a significant risk factor for surgical failure
after sacrospinous suspension (odds ratio, 35.34; 95% confidence interval, 8.75–162.75; p < 0.001). The success rate during the 18-month follow-up decreased significantly in women with the presence of C or D point
stage I at immediate post-operation than stage 0. Although the sample size of women with symptomatic uterine or vaginal vault
prolapse is small, impaired correction of anatomic defects is a significant risk factor for surgical failure of sacrospinous
suspension. 相似文献
16.
A meta-analysis was performed to assess risks of intraoperative and postoperative urologic complications in laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH). We searched Pubmed, EMBASE, and Cochrane library for studies published up to December, 2018. Manual searches of related articles and relevant bibliographies of published studies were also performed. Two researchers independently performed data extraction. Inclusion criteria of studies were: (1) had information of perioperative complications, and (2) had at least ten patients per group. A total of 38 eligible clinical trials were collected. Intraoperative and postoperative urologic complications were reported by 34 studies and 35 studies, respectively. When all studies were pooled, odd ratios (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.40 [95% confidence interval (CI) 1.05–1.87]. The OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 1.01–1.80]. However, significant adverse effects of intraoperative urologic complications in LRH were not observed among articles published after 2012 (OR 1.12, 95% CI 0.77–1.62) in cumulative meta-analysis or subgroup analysis. The incidence of bladder injury was statistically higher than that of ureter injury (p = 0.001). In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. LRH is associated with significantly higher risk of intraoperative and postoperative urologic complications than abdominal radical hysterectomy. 相似文献
17.
Thomas L. WheelerII Kimberly A. Gerten Holly E. Richter Angela G. Duke R. Edward Varner 《International urogynecology journal》2007,18(10):1207-1213
The aim of this study was to describe an approach for performing a high uterosacral vaginal vault suspension and to report
anatomical and subjective results. Anatomic measures and validated symptom-specific questionnaires were performed pre- and
postoperatively. Patient satisfaction was also ascertained. Thirty-five women, who underwent a two-suture high uterosacral
suspension, participated. Mean follow-up interval was 23.1 ± 10.1 months. Postoperative point C was −7.8 ± 1.60 (median, −8.0,
range, −4.0 to −10.0), and the mean preoperative to postoperative change in point C was 5.9 ± 5.56 cm (median 4.75, range
−3.0 to 20.0, p-value < 0.0001). Patient satisfaction was high with 88.9% indicating that they would have the surgery again. There were no
ureteral injuries or kinks noted on intraoperative cystoscopy. No patient required reoperation for recurrent prolapse or urinary
incontinence. Overall, the two-suture high uterosacral vaginal vault suspension is an acceptable technique for repairing apical
prolapse. 相似文献
18.
Mark S. Shimko Eric C. Umbreit George K. Chow Daniel S. Elliott 《Journal of robotic surgery》2011,5(3):175-180
We describe efficacy and safety of robotic-assisted laparoscopic vaginal vault prolapse repair with long-term follow-up. We
reviewed the records of 40 consecutive patients with posthysterectomy vaginal vault prolapse who underwent a robotic-assisted
laparoscopic sacrocolpopexy at our institution between September 2002 and September 2006. Patient analysis focused on complications,
patient satisfaction, and morbidity, with a minimum of 36 months’ follow-up. Median follow-up was 62 months (range 36–84)
and mean age was 67 (43–83) years. Mean operating time was 3.1 (2.15–5) h with a median operating time of 2.9 h. All but four
were discharged home on postoperative day one; three patients left on postoperative day two and one left on postoperative
day seven. Three developed recurrent grade 3–4 rectoceles and two vaginal extrusion of mesh. Thirty-eight of the 40 patients
(95%) were satisfied with their outcome. Robotic-assisted laparoscopic sacrocolpopexy is a minimally invasive technique for
vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with the decreased morbidity of laparoscopy.
We found a short hospital stay, low complication rates, and high patient satisfaction with a minimum of 3 years’ follow-up. 相似文献
19.
Shameem Abbasy Lior Lowenstein Thythy Pham Elizabeth R. Mueller Kimberly Kenton Linda Brubaker 《International urogynecology journal》2009,20(2):213-216
The purpose of this study was to evaluate the effect of colpocleisis and concomitant mid-urethral sling on voiding function.
This is an IRB-approved, retrospective case series of women who underwent a colpocleisis with concomitant synthetic mid-urethral
sling for treatment of stress urinary incontinence (SUI) between January 2005 and September 2007. Thirty-eight women with
pelvic organ prolapse and SUI symptoms were included. Thirty percent had a post-void residual (PVR) greater than 100 ml preoperatively.
PVRs were normal in all but two women after surgery. Median prolapse and urinary subscales of the pelvic floor distress inventory
improved significantly after surgery [75 (50–100) vs. 0 (0–38), p < 0.0001 and 44 (8–100) vs. 0 (0–50), p < .0001, respectively]. Colpocleisis with concomitant mid-urethral sling improves urinary symptoms without causing significant
urinary retention. This combination may be offered to elderly women with SUI who are undergoing colpocleisis regardless of
preoperative PVR. 相似文献
20.
Surgical management of pelvic organ prolapse in women: a short version Cochrane review 总被引:1,自引:0,他引:1
BACKGROUND: Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse. OBJECTIVES: To determine the effects of the many different surgeries in the management of pelvic organ prolapse. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 3 May 2006) and reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. DATA COLLECTION AND ANALYSIS: Trials were assessed and data extracted independently by two reviewers. Six investigators were contacted for additional information with five responding. MAIN RESULTS: Twenty two randomised controlled trials were identified evaluating 2368 women.Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were too few to evaluate other clinical outcomes and adverse events. The three trials contributing to this comparison were clinically heterogeneous. For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by polyglactin mesh inlay (RR 1.39, 95% CI 1.02 to 1.90) or porcine dermis mesh inlay (RR 2.72, 95% CI 1.20 to 6.14), but data on morbidity, other clinical outcomes and for other mesh or graft materials were too few for reliable comparisons. For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh inlay or porcine small intestine graft inlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new urinary symptoms after surgery. Although the addition of tension-free vaginal tape to endopelvic fascia plication (RR 5.5, 95% CI 1.36 to 22.32) and Burch colposuspension to abdominal sacrocolpopexy (RR 2.13, 95% CI 1.39 to 3.24) were followed by a lower risk of women developing new postoperative stress incontinence, but other outcomes, particularly economic, remain to be evaluated. AUTHORS' CONCLUSIONS: Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of mesh or graft inlays at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. The addition of a continence procedure to a prolapse repair operation may reduce the incidence of postoperative urinary incontinence but this benefit needs to be balanced against possible differences in costs and adverse effects. Adequately powered randomised controlled clinical trials are urgently needed. 相似文献