Extensive cervical prolapse during labor: a case report

BACKGROUND: An extensive, irreducible cervical prolapse during pregnancy is a rare condition and can lead to various complications, including severe cervical edema and dystocia in labor. Treatment options are very limited. CASE: A 33-year-old woman with spina bifida and a history of multiple intraabdominal operations and extensive intraperitoneal adhesions was admitted in labor at 36(6/7) weeks' gestation with an irreducible cervical prolapse. The cervical prolapse was reduced by topical application of concentrated magnesium sulfate. CONCLUSION: In active labor, a prolapsed cervix that is enlarged and edematous can be managed with a topical concentrated magnesium solution to prevent cervical dystocia and lacerations.     

Infracoccygeal sacropexy for uterovaginal prolapse

OBJECTIVE: To report on the efficacy and safety of infracoccygeal sacropexy for the treatment of uterovaginal prolapse. METHOD: A retrospective analysis of 87 women who underwent an infracoccygeal sacropexy procedure, 53 receiving a multifilament and 34 receiving a monofilament tape. RESULTS: The mean follow-up was 27 months. Postoperative perineal pain was reported by 7 women (10%), and dyschesia and dyspareunia were observed de novo in 4 (5%) and 5 women (6%), respectively. There were 5 cases (9%) of vaginal extrusion and 9 cases (18%) of prolapse recurrence in the multifilament tape group, and in the monofilament tape group there were no cases of vaginal extrusion and 4 cases (14%) of prolapse recurrence (P=0.79 for prolapse recurrence). The recurrence-free survival curves of the 2 groups were similar. Univariate analysis revealed no independent factors of recurrence. CONCLUSION: Although infracoccygeal sacropexy was found to be associated with few prolapse recurrences, complications were not rare.     

Transurethral bladder eversion concurrent with uterovaginal prolapse

BACKGROUND:Transurethral bladder eversion is rare. A case of transurethral bladder eversion with concurrent uterovaginal prolapse is presented.CASE:The patient was postmenopausal, had a long history of uterovaginal prolapse, and developed bladder eversion. Examination under anesthesia revealed full-thickness transurethral bladder eversion and complete uterine procidentia. Temporary reduction of the prolapse was done initially because of her unstable medical condition. After medical stabilization, definitive surgical reconstruction was completed by a vaginal approach.CONCLUSION:Full-thickness, transurethral bladder eversion can be surgically treated by a vaginal approach.     

Avulsion injury of uterovaginal prolapse and bladder.

A 40-year-old postmenopausal female with complete uterine prolapse received an avulsion injury when her sari was caught in the fast-moving belt of a flour mill machine. Part of the prolapsed anterior vaginal wall with underlying bladder wall was torn off. Primary repair together with vaginal hysterectomy led to an uneventful recovery.     

腹腔镜下骶棘韧带固定术治疗子宫阴道残断脱垂疗效分析

目的 探讨腹腔镜下骶棘韧带固定术(LSSLF)治疗子宫脱垂和阴道穹窿脱垂的手术技巧和临床疗效.方法 自2004年5月至2006年3月,对第三军医大学第一附属医院妇产科收治的29例子宫脱垂和阴道穹窿脱垂患者行LSSLF,术后第1、3、6、9、12个月定期随访.主观治愈定义为:术后患者无任何自觉症状;客观治愈定义为术后子宫脱垂和阴道穹窿脱垂POP-Q分期为0期.结果 平均手术时间75min(55～120 min),术中平均失血量105mL(60～200mL),手术中有1例在分离腹膜时损伤膀胱,在腹腔镜下完成修补,术中未发生其他并发症.术后平均住院时间4.7d(4～8d),尿管引流2.6(2～7d).术后随访8个月(1～22个月),主观治愈率和客观治愈率均为100%.结论 对于子宫脱垂和阴道穹窿脱垂患者,采用LSSLF是一种安全有效的治疗方法.     

Non-surgical treatment of uterovaginal prolapse using double vaginal rings

A new technique of using double vaginal ring pessaries to treat uterovaginal prolapse in a group of elderly women is described. Eighteen women with a mean age of 82 years and advanced Stage III or IV uterovaginal prolapse had double vaginal rings inserted. All of them previously had used single vaginal ring pessaries or had undergone pelvic floor repair surgery. Double ring pessaries were successful in 13 of the 18 women. They are a useful treatment of advanced prolapse in women unsuitable for surgery.     

The effect of uterovaginal prolapse on urethrovesical pressure dynamics

Complete urodynamic evaluations were performed on patients with severe uterovaginal prolapse with the prolapse protruding and after reduction with a pessary. These results were compared with those from patients with genuine stress incontinence without prolapse. There was a significant increase in urethral closure pressure in patients with prolapse on the assumption of a more erect posture or on Valsalva maneuver. The opposite relationship was observed in patients with genuine stress incontinence in whom the urethral closure pressure significantly decreased under similar conditions. These results strongly suggest that the mechanism of continence in patients with significant prolapse is urethral obstruction. Reduction of the prolapse with a pessary can differentiate those patients who will require urethrovesical neck suspension.     

Uterine inversion with massive uterovaginal prolapse and multiple bladder stones

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.     

Transvaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse.

OBJECTIVE: The transvaginal sacrospinous ligament fixation technique was used as part of the vaginal repair procedure for marked uterovaginal prolapse, and in the treatment of vault prolapse. METHOD: Out of the 26 women treated with sacrospinous ligament suspension of the vaginal vault, 23 had marked uterovaginal prolapse and three had vault prolapse following hysterectomy. Patients with vault prolapse underwent posterior vaginal repair, obliteration of the enterocele sac and sacrospinous colpopexy. Patients with marked uterovaginal prolapse underwent vaginal hysterectomy with high ligation of the enterocele sac, anterior and posterior vaginal repair, and sacrospinous colpopexy. Bilateral salpingoopherectomy was added to the procedure in five patients. All patients were examined 6 weeks after the operation and, subsequently, on an annual basis. The mean follow-up period was 2.6 years (1-5 years). RESULTS: Out of the three patients with previous vault prolapse, none had recurrences. Out of the 23 patients with previous marked uterovaginal prolapse, only two had small cystocele, and one had small enterocele at 36 months following the operation. These patients were asymptomatic and did not need an operation. Vaginal vault prolapse was not observed in any of these patients. Two women had post-operative urinary tract infection and five had buttock discomfort, which subsided after 2 months. No other intra- or post-operative complications occurred. CONCLUSION: Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, and anterior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse, and low intra- and post-operative complication rates.     

Sacrohysteropexy with synthetic mesh for the management of uterovaginal prolapse

Objective To study the ongoing results of sacrohysteropexy with Teflon mesh for treatment of uterovaginal prolapse in women who desire to preserve their uterus.
Design Prospective observational study.
Setting Tertiary referral urogynaecology unit.
Participants Thirteen consecutive women with uterovaginal prolapse wishing to retain their uterus operated on by one surgeon.
Surgical method Sacrohysteropexy with Teflon mesh attached to the uterine isthmus and to the anterior longitudinal ligament of the first or second sacral vertebra in a tension-free fashion.
Main outcome measures Subjective and objective cure of uterine prolapse and operative and post-operative complications.
Results The mean age of the women was 38 years (range 27–60). Eight women were multiparous. Twelve women had second degree uterine prolapse and one woman had third degree of uterine prolapse. Mesh was extended to correct a cystocele in one woman and a rectocele in three women. In four women colposuspension was performed at the same time. There were no intra- and post-operative complications. The mean follow up time was 16 months (range 4–49). At follow up only one woman had a first degree uterine prolapse. A total of seven women (53.8%) reported constipation which had been experienced pre-operatively by four women (30.8%).
Conclusions We consider the sacrohysteropexy with Teflon mesh a safe, effective and durable surgical procedure for the management of uterovaginal prolapse in young women and those who desire to retain their uterus.     

Urodynamic comparison of continent and incontinent women with severe uterovaginal prolapse

OBJECTIVE: To compare the clinical and urodynamic characteristics of continent and incontinent women with severe uterovaginal prolapse. STUDY DESIGN: Fifty-eight consecutive women with stage III or IV pelvic organ prolapse between June 1998 and December 2001 were enrolled. Each woman had a urinalysis, pelvic examination and urodynamic study and answered a urinary questionnaire. They were divided into clinically continent (n = 20) and incontinent (n = 38) groups. The clinical symptoms and urodynamic results in the 2 groups were compared statistically with the chi 2 test, Fisher's exact test and Mann-Whitney U test. RESULTS: Incontinent women with severe genital prolapse were more likely to report urinary frequency, urgency and nocturia than were continent women (P < .05). However, the incidence of voiding hesitancy was significantly higher for members of the continent group as compared to the incontinent group (P = .002). With respect to urodynamic variables, including detrusor pressure at peak flow, maximal urethral closure pressure and pressure transmission ratio, significantly higher values occurred in the continent group as compared with the incontinent group; they were 38 (range, 12-66) vs. 24 cm H2O (range, 10-49) (P < .01), 84 (range, 39-117) vs. 63 cm H2O (range, 45-84) (P = .033) and 102% (range, 66-135) vs. 66% (range, 14-98) (P = .019), respectively. All other parameters and the incidence of bladder outlet obstruction and detrusor instability did not differ significantly between the 2 groups (P > .05). CONCLUSION: The results of this study suggest that severe uterovaginal prolapse could produce obstructive symptoms and prevent or reduce urinary leakage, but whether urethral kinking or external urethral compression causes the obstruction remains unclear. More studies on different types of isolated pelvic organ prolapse are needed to elucidate the mechanism, and specific strategies can be developed to aid urogynecologists in their goal of restoring normal anatomy.     

Morbidity associated with posterior intravaginal slingplasty for uterovaginal and vault prolapse

Objective This study was carried out to evaluate the safety and efficacy of posterior intravaginal slingplasty (IVS) for upper genital prolapse. Setting Gynaecology Department, Benenden Hospital, Kent, UK. Materials and methods An observational study was conducted on 127 women, who underwent posterior IVS using the IVS Tunneller (Tyco HealthCare, USS, Norwalk, CT, USA). The indications for surgery were uterovaginal prolapse in 65% and vault prolapse in 35%. Patient follow-up was at 6 weeks, 6 months, 1 year and annually thereafter. Results In addition to posterior IVS, hysterectomy was performed in 22 patients, anterior colporrhaphy in 63 patients and transobturator mid-urethral tape insertion in eight patients. The mean operating time was 46 ± 18.5 min and for posterior IVS alone was 27.4 ± 10 min, and the mean peri-operative drop in haemoglobin level was 1.4 ± 0.75 gm/dL. There were no rectal, vesical or ureteric injuries. After a mean follow-up of 14 months (range 2–26 months), upper genital support was maintained in 88%, cystocele formation occurred in 8% and recurrent rectocele was seen in 11%. There was a 17% risk of tape erosion (21/127) and a re-operation rate of 24% (30/127). The risk of tape erosion was related to patient age above 60 years (RR = 1.6, 95% CI 1.02–2.5) and current treatment for diabetes (RR = 4, 95% CI 1.7–9.2). Parity, body mass index, menopausal status, HRT use, hysterectomy and surgeon’s experience were not found to influence tape erosion rate. Conclusion Posterior intravaginal slingplasty is a minimally invasive procedure for upper genital prolapse with an acceptable success rate. However, the operation is associated with high vaginal erosion and re-operation rates. No financial support was granted to this study.     

Abdominal sacrohysteropexy in young women with uterovaginal prolapse: long-term follow-up

OBJECTIVE: The purpose of this study was to evaluate the long-term efficiency after abdominal sacrohysteropexy in women with uterovaginal prolapse. STUDY DESIGN: We conducted a retrospective chart review at our tertiary referral urogynecology unit. Thirty women of childbearing age with uterovaginal prolapse who wanted uterine preservation underwent abdominal sacrohysteropexy between 1987 and 1999. RESULTS: The mean age of the women was 35.7 years (range, 29-43 years). All women were parous. Thirteen women had grade 2 uterovaginal prolapse, and 17 women had grade 3 prolapse. In all women, the Burch procedure and posterior colporrhaphy were performed at the same time. Intraoperative and postoperative complications occurred in 2 patients (6.6%) and 4 patients (13.3%), respectively. The mean objective and subjective follow-up periods were 44.5 months (range, 2-156 months) and 94.6 months (range, 8-160 months), respectively. At the time of the last physical examination, there were two cases of recurrent uterovaginal prolapse (6.6%), which was symptomatic in 1 patient and required repeat surgical treatment. At the time of the last questionnaire, apart from the patient who underwent repeat surgery, no patients had any uterovaginal prolapse symptoms. Three women had pregnancies that were conceived spontaneously, which led to three early legal abortions. CONCLUSION: The abdominal sacrohysteropexy is effective and safe in the treatment of uterovaginal prolapse in women of childbearing age. This procedure has a high success rate in correcting prolapse without a time-dependent decrease in efficiency.