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Context
Pelvic organ prolapse is a common condition affecting at least a half of adult women. Most women are asymptomatic, but a significant proportion of women choose to have an operation.Objective
The aim of this paper is to review the various surgical procedures for the correction of pelvic organ prolapse.Evidence acquisition
Guidelines from professional organizations, meta-analysis, reviews, and high-quality studies were referred to collect the evidence for the various surgical techniques.Evidence synthesis
Management of pelvic organ prolapse is considered under anterior vaginal wall prolapse, apical prolapse, and posterior vaginal wall prolapse to help the reader organize the information to counsel women in a systematic way.Conclusions
Surgical management of prolapse can be challenging, and various factors affect the procedure of choice and the outcomes. Providing information, careful counseling, and informed choice are crucial to deliver patient expectations. All these factors should be considered when deciding on the surgical procedure. 相似文献2.
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Female Pelvic Organ Prolapse and Voiding Function 总被引:7,自引:5,他引:2
It is accepted that pelvic organ prolapse impairs voiding, in particular as regards the anterior vaginal wall. The influence
of central and posterior prolapse is more controversial. Mechanical effects, i.e. urethral distortion and compression, have
been advanced as causative mechanisms. This study attempts to further elucidate the effect of prolapse on voiding. We investigated
228 patients with symptoms of lower urinary tract dysfunction and/or prolapse using independent flowmetry, clinical and ICS
prolapse assessment and translabial ultrasound. As expected, age (P<0.001), previous hysterectomy (P= 0.002) and/or incontinence surgery (P<0.001) negatively influenced flow. As regards prolapse, only enterocele had a consistently negative effect on flow (P<0.001 for clinical staging, P= 0.002 for ICS assessment, P= 0.005 for ultrasound imaging). The relationship between anterior vaginal wall prolapse and voiding was complex: funneling
and opening of the retrovesical angle on ultrasound was associated with improved voiding (P<0.001), but a cystocele with intact retrovesical angle had the opposite effect (P<0.001). 相似文献
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Since the U.S. Food and Drug Administration (FDA) statement on mesh in July of 2011, there has been controversy regarding synthetic mesh repairs for vaginal prolapse. In this article, we review the biochemical basis for the use of synthetic mesh in prolapse repair as well as clinical results of anterior compartment prolapse repair with synthetic mesh. Finally, we discuss the FDA warning regarding mesh. 相似文献
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S. W. Bai M. J. Jeon J. Y. Kim K. A. Chung S. K. Kim K. H. Park 《International urogynecology journal》2002,13(4):256-260
We investigated the objective coexisting rate of stress urinary incontinence and pelvic organ prolapse, and also compared
the treatment outcomes in patients who had both conditions, treated by a corrective operation on the basis of a precise preoperative
evaluation. We reviewed 97 cases who underwent urodynamic studies and evaluation of the prolapse according to the Pelvic Organ
Prolapse Quantification (POP-Q) system from among patients who were admitted for treatment of either stress urinary incontinence
or pelvic organ prolapse. A Burch urethropexy, either alone or with a parvaginal repair, was done to correct the stress urinary
incontinence, as well as additional operations to correct prolapse of stage II or more. The patients were evaluated postoperatively
for the stress urinary incontinence and the degree of prolapse at every visit. Nineteen of 30 (63.3%) patients who were admitted
with stress urinary incontinence had a coexisting pelvic organ prolapse, most often of the anterior wall. In 42 of 67 (62.7%)
cases admitted with pelvic organ prolapse there was a coexisting stress urinary incontinence. A total of 61 patients who had
both conditions were followed for 12 months postoperatively. The recurrence rate of stress urinary incontinence and prolapse
(all of which were stage II) was 3.3% and 18.0%, respectively. It was noted that the greater the preoperative stage, the higher
the recurrence rate (stage II 4.35%; stage III 25.0%; stage IV 33.6%). The coexisting rates of pelvic organ prolapse in patients
having stress urinary incontinence, and stress urinary incontinence in patients having a pelvic organ prolapse, were both
high. Therefore, when a preoperative evaluation that simultaneously considers both conditions and the correcting surgery is
based on this evaluation, the recurrence rates of both conditions could be lowered. 相似文献
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Aaron D. Benson Brandan A. Kramer Robert O. Wayment Bradley F. Schwartz 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2010,14(4):525-530
Background:
Supracervical robotic-assisted laparoscopic sacrocolpopexy (SRALS) is a new surgical treatment for pelvic organ prolapse that secures the cervical remnant to the sacral promontory. We present our initial experience with SRALS in the same setting as supracervical robotic-assisted hysterectomy (SRAH).Methods:
Women with vaginal vault prolapse and significant apical defects as defined by a Baden-Walker score of ≥3 who had not undergone hysterectomy were offered SRALS in combination with SRAH. A chart review was performed to analyze operative and perioperative data. Outcome data also included patients who underwent robotic-assisted laparoscopic sacrocolpopexy (RALS) without any other procedure.Results:
Thirty-three patients underwent RALS, including 12 patients who underwent SRALS. All SRALS were performed following SRAH in the same setting. The mean follow-up for the RALS and SRALS patients was 38.4 months and 20.7 months, respectively. One patient in the RALS group had an apical recurrence. There were no recurrences in the SRALS group.Conclusions:
SRALS is effective for repair of apical vaginal defects in patients with significant pelvic organ prolapse who have not undergone previous hysterectomy. Complications are few and recurrences rare in short- and medium-term follow-up. Greater follow-up and numbers are needed to further establish the role of this procedure. 相似文献9.
Do Pessaries Prevent the Progression of Pelvic Organ Prolapse? 总被引:1,自引:0,他引:1
Pessaries are used for the management of pelvic organ prolapse, but it is unknown whether a pessary will prevent progression
of this condition. The purpose of this study was to describe the course of pelvic organ prolapse among women using a pessary
for at least 1 year. Among 56 consecutive women fitted with a pessary, 19 (33.9%) continued its use under our care for at
least 1 year. We compared baseline and follow-up examinations, using the Pelvic Organ Prolapse Quantitation examination system.
At baseline, 16 (84.2%) had stage 3 or 4 prolapse. After 1 year we observed a significant improvement in the stage of disease
(P = 0.045, Wilcoxon signed rank test). Four women (21.1%, 95% confidence interval −0.2, 43.7%) had an improvement in stage.
No women had worsening in stage of prolapse. These data suggest that there may be a therapeutic effect associated with the
use of a supportive pessary.
Correspondence and offprint requests to: Dr V. L. Handa, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, Harvey
319, Baltimore, MD 21287, USA. Tel: (410) 614-4495; Fax: (410) 955-1003; Email: vhanda1@jhmi.edu 相似文献
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Melissa R. Kaufman 《Current urology reports》2018,19(3):18
Purpose of Review
Classic bladder exstrophy (BE) remains one of the most demanding reconstructive challenges encountered in urology. In female BE patients, the long-term sequela of both primary and revision genitoplasty, as well as intrinsic pelvic floor deficits, predispose adult women to significant issues with sexual function, pelvic organ prolapse (POP), and complexities with reproductive health.Recent Findings
Contemporary data suggest 30–50% of women with BE develop prolapse at a mean age of 16 years. Most women will require revision genitoplasty for successful sexual function, although in some series over 40% report dyspareunia. Current management for pregnancy includes elective cesarean section with involvement of high-risk obstetrics and urologic surgery.Summary
This review encapsulates contemporary concepts of etiology, prevalence, and management of POP and pregnancy in the adult female BE patient.11.
《Journal of orthopaedic science》2022,27(2):380-383
BackgroundThe Hand10 Questionnaire is composed of 10 short, easy to understand and illustrated questions and was developed to measure upper extremity disorders. Thanks to these features, unlike other questionnaires that assess upper extremity disorders, it can be used in the elderly and children as well as adults. The aim of this study was to cross-culturally adapt the Hand10 into Turkish and to test its reliability and validity.MethodsTranslation and back-translation of the Hand10 were performed according to Beaton guidelines. Patients completed the Disabilities of the Arm, Shoulder and Hand Questionnaire once and the final version of the Hand10 Questionnaire twice, with 7-days interval. Test-retest reliability and internal consistency were determined using Intraclass Correlation Coefficient analysis and Cronbach's alpha, respectively. Convergent validity of Hand10 was determined with Disabilities of the Arm, Shoulder and Hand Questionnaire using Pearson Correlation Coefficient analysis.ResultsOne hundred patients participated in the study. Cronbach's alpha value was 0.919, indicating an excellent internal consistency. Intraclass Correlation Coefficient value for test-retest reliability were found to be 0.890 that indicates a high reliability. Hand10 showed very good correlation with Disabilities of the Arm, Shoulder and Hand Questionnaire (r: 0.669).ConclusionsThe Turkish version of the Hand10 met set criteria of reliability and validity. As a result of this study, we determined that Hand10 is a useful instrument to measure upper extremity disorders in Turkish-speaking patients. It is recommended to be used in clinical settings and researches. 相似文献
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Surgical treatment of pelvic organ prolapse has evolved from the use of pomegranates as pessary devices to contemporary robot-assisted laparoscopic sacral colpopexy. Symptomatic pelvic organ prolapse requires correction of all the defects to achieve optimal outcomes. Factors to consider in selecting the appropriate repair include patient's age; stage of prolapse; vaginal length; hormonal status; desire for uterine preservation and coitus; symptoms of sexual, urinary, or bowel dysfunction; and any comorbidities that influence her eligibility for anesthesia or chronically increase intra-abdominal pressure. There is currently no consensus as to the best surgical approach for advanced pelvic organ prolapse. Reconstructive surgery for pelvic organ prolapse is currently performed by vaginal or abdominal (open, laparoscopic, and robotic approaches) approaches or a combination. It is important to maintain skills in proven procedures such as abdominal sacrocolpopexy and sacrospinous ligament suspension. This paper discusses the historical evolution of surgery for pelvic organ prolapse from antiquity to date. 相似文献
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Purpose of Review
Women have an estimated 12.6% lifetime risk of undergoing surgery for pelvic organ prolapse in the USA (Wu et al. in Obstet Gynecol 123(6): 1201–6, 2014). Surgical repair of uterovaginal prolapse most commonly includes hysterectomy and vaginal vault suspension; however, the value of concomitant hysterectomy is uncertain, and there appears to be growing interest in uterine conservation. Multiple procedures have evolved using a variety of approaches. The aim of this paper is to review uterine sparing (hysteropexy) prolapse repair techniques and outcomes.Recent Findings
Several randomized controlled trials (RCT) have shown comparable success rates for apical compartment support with sacrospinous hysteropexy as compared to vaginal hysterectomy with uterosacral ligament suspension, with shorter hospitalization and quicker return to work. (Detollenaere et al. in BMJ 351: h3717, 2015); (Dietz et al. in Int Urogynecol J Pelvic Floor Dysfunct 21(2): 209–16, 2010). Available data suggest vaginal mesh hysteropexy is as effective as vaginal mesh with hysterectomy, with lower rates of mesh exposure. (Maher et al., 2017) To date, no RCTs have been published comparing sacral hysteropexy to hysterectomy with sacral colpopexy. Overall, there is a higher reoperation rate for sacral hysteropexy and a higher mesh exposure rate for hysterectomy with sacral colpopexy. (Maher et al., 2017) No RCTs have been published comparing hysteropexy surgical approaches.Summary
Although hysteropexy data is expanding, there is a need for more information regarding long-term surgical durability, appropriate patient selection, and whether one approach is superior to another.16.
目的 评价我院传统阴式手术治疗盆腔脏器脱垂的效果,探讨导致手术后复发的危险因素. 方法 对我院2000年1月~2005年12月因中重度盆腔脏器脱垂行首次传统手术治疗(经阴道全子宫切除、阴道前后壁修补以及会阴修补)的73例进行回顾分析以及随访.问卷调查主观症状治愈、手术前后尿失禁情况,依据POP-Q(Pelvic Organ Prolapse Quantification)评分判定客观治愈情况.比较复发组与客观治愈组之间的差异. 结果 73例随访8~62个月,平均28.6月.主观治愈率94.5%(69/73),客观治愈率61.6%(45/73).单纯前壁膨出复发24.7%(18/73),单纯后壁膨出复发8.2%(6/73),同时存在阴道前壁以及后壁的膨出复发5.5%(4/73).无阴道穹隆脱垂或子宫脱垂.因复发二次手术2.7%(2/73).复发组与未复发组在手术时年龄、手术时是否绝经、手术前脱垂程度、是否伴慢性咳嗽等方面差异均无显著性(P>0.05).手术后35例原有尿失禁患者中有17.1%(6/35)症状消失,5.7%(2/35)尿失禁加重.术前无尿失禁患者23.7%(9/38)手术后出现尿失禁.73例中共有11例手术后尿失禁加重. 结论 传统手术方式治疗中重度盆腔脏器脱垂,客观治愈率低,阴道前壁膨出复发率高.对前盆腔的修补以及对潜在的尿失禁的治疗应该引起足够重视. 相似文献
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Pelvic organ prolapse (POP) is a common disorder estimated to affect 15%-30% of women over the age of 50 years. About 11% of women will require surgery by the age of 80 years and there is an estimated 30% rate of prolapse recurrence. In an attempt to improve surgical outcomes, biologic grafts and synthetic meshes have been implemented in the repair of POP. Biologic grafts have been used with the hope of avoiding complications associated with synthetic mesh. This presents the existing data surrounding the use of biologic grafts in the surgical repair of anterior compartment, vaginal vault, and posterior compartment prolapse. 相似文献
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Assessment of voiding dysfunction in Parkinson's disease: Reliability and validity of the Turkish version of the Danish Prostate Symptom Score 下载免费PDF全文
Yeşim Akkoç Haydar Gök Hale Karapolat Murat Ersöz Ulaş Sungur Kurtuluş Köklü Ebru Alemdaroğlu Hakan Tunç Ahmet Acarer İnci Şule Özer Cenk Akbostancı Berna Arlı Tahir Kurtuluş Yoldaş 《Neurourology and urodynamics》2017,36(7):1903-1909
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Maurizio Rosati Silvia Bramante Umberto Bracale Giusto Pignata Guglielmo Azioni 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(2):235-244