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1.
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
2.
V. L. Handa K. Jain K. McCue P. D. Schneider 《International urogynecology journal》2001,12(4):279-281
A woman with complete vaginal eversion was found to have a large pelvic mass, extending from the rectovaginal septum to the
presacral space. This 66-year-old woman with posthysterectomy vaginal eversion complained of pelvic fullness. A pessary provided
relief of the prolapse, but the symptom of fullness persisted. Physical examination did not identify a pelvic mass. Computed
tomography (CT) and magnetic resonance imaging (MRI) demonstrated a 9 cm tumor of the rectovaginal septum, extending to the
presacral space. At laparotomy the patient had a massive neurofibroma arising from the anterior rectal wall. This case is
of interest because the complete vaginal prolapse obscured the diagnosis of this large pelvic tumor. CT and MRI were useful
in identifying and characterizing the mass. To our knowledge, this is the first reported case of vaginal prolapse with a large
pelvic mass. 相似文献
3.
Multiple large bladder stones resulting in complete procidentia present unique operative challenges. A 71-year-old postmenopausal
multipara was admitted to the intensive care unit for urosepsis. A firm irreducible 15 × 10 × 10 cm procidentia was noted
on exam with surface erythema, erosions, and edema. A computed tomography scan of the pelvis reported a staghorn calculus
in the right renal pelvis and a large calcified fibroid uterus which had prolapsed completely out of the pelvis. After resolution
of her urosepsis, the patient was taken to the operating room for a vaginal hysterectomy and surgical correction of her prolapse.
A small uterus weighing 67 g was identified with a large bladder mass. Cystotomy revealed multiple bladder calculi, the largest
measuring 8.1 × 6.8 × 4.6 cm. Cystolithiasis should be considered when evaluating patients with large calcified prolapse. 相似文献
4.
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
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.
Yvonne Hsu Luyun Chen Aimee Summers James A. Ashton-Miller James O. L. DeLancey 《International urogynecology journal》2008,19(1):137-142
The objective of the study was to determine the relationship between midsagittal vaginal wall geometric parameters and the
degree of anterior vaginal prolapse. We have previously presented data indicating that about half of anterior wall descent
can be explained by the degree of apical descent present (Summers et al., Am J Obstet Gynecol, 194:1438–1443, 2006). This
led us to examine whether other midsagittal vaginal geometric parameters are associated with anterior wall descent. Magnetic
resonance (MR) scans of 145 women from the prior study were suitable for analysis after eight were excluded because of inadequate
visibility of the anterior vaginal wall. Subjects had been selected from a study of pelvic organ prolapse that included women
with and without prolapse. All patients underwent supine dynamic MR scans in the midsagittal plane. Anterior vaginal wall
length, location of distal vaginal wall point, and the area under the midsagittal profile of the anterior vaginal wall were
measured during maximal Valsalva. A linear regression model was used to examine how much of the variance in cystocele size
could be explained by these vaginal parameters. When both apical descent and vaginal length were considered in the linear
regression model, 77% (R
2 = 0.77, p < 0.001) of the variation in anterior wall descent was explained. Distal vaginal point and a measure anterior wall shape,
the area under the profile of the anterior vaginal wall, added little to the model. Increasing vaginal length was positively
correlated with greater degrees of anterior vaginal prolapse during maximal Valsalva (R
2 = 0.30, p < 0.01) determining 30% of the variation in anterior wall decent. Greater degrees of anterior vaginal prolapse are associated
with a longer vaginal wall. Linear regression modeling suggests that 77% of anterior wall descent can be explained by apical
descent and midsagittal anterior vaginal wall length. 相似文献
7.
Chrystèle Rubod Malik Boukerrou Mathias Brieu Clay Jean-Charles Patrick Dubois Michel Cosson 《International urogynecology journal》2008,19(6):811-816
The aim of this study is to characterise the biomechanical properties of vaginal tissue to develop an accurate cure of pelvic
organ prolapse (POP). Prolapsed vaginal tissues were extracted during the prolapse cure of five patients (POP) and on five
cadavers without noticed pelvic floor dysfunction (non-pelvic organ prolapse) with agreement of the ethics committee. Uni-axial
tension was performed, and the results were analysed. Individual reproducibility of experimental results was good, and the
results highlight the non-linear relationship between stress (force per unit of surface) and strain (l − l
0 / l
0) and very large deformation before rupture appearance. This experimental study has proven for the first time that the mechanical
behaviour of vaginal tissue has to be defined as hyperelastic with a large deformation. This response has to be taken into
account to develop accurate synthetic prostheses for POP cure and in the numerical simulation of the pelvic floor.
The authors thank the Foundation for Medical Research for financing this study and the ethics committee for their approval. 相似文献
8.
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
9.
Aylin Pelin Cil M. Murad Basar Simay Altan Kara Pinar Atasoy 《International urogynecology journal》2008,19(5):735-737
Benign cystic lesions of the vagina are uncommon and may become symptomatic. We describe two symptomatic anterior vaginal
wall cysts in a virgin patient and the usefulness of imaging modalities. A 36-year-old virgin woman presented with a complaint
of vaginal bulging and pelvic pressure. Pelvic examination revealed a cystic mass protruding from the vagina surrounded by
the intact hymen. The initial abdominopelvic ultrasound showed a hypoechoic cystic mass measuring 42 × 20 mm in the vagina.
She then had a pelvic magnetic resonance imaging (MRI) that revealed two anterior vaginal wall cysts with no communication
with the urethra or bladder. The cysts were excised and histologic examination with mucicarmine revealed mucin-secreting tall
columnar cells consistent with a diagnosis of mullerian cyst. While both ultrasonographic examination and MRI are helpful
in localizing vaginal cysts, MRI is superior in showing multiple cystic lesions of the vagina and their communication with
the surrounding structures. 相似文献
10.
Patrick Dällenbach Isabelle Kaelin-Gambirasio Sandrine Jacob Jean-Bernard Dubuisson Michel Boulvain 《International urogynecology journal》2008,19(12):1623-1629
Our objective was to estimate the incidence and identify the risk factors for vaginal vault prolapse repair after hysterectomy.
We conducted a case control study among 6,214 women who underwent hysterectomy from 1982 to 2002. Cases (n = 32) were women who required vaginal vault suspension following the hysterectomy through December 2005. Controls (n = 236) were women, randomly selected from the same cohort, who did not require pelvic organ prolapse surgery. The incidence
of vaginal vault prolapse repair was 0.36 per 1,000 women-years. The cumulative incidence was 0.5%. Risk factors included
preoperative prolapse (odds ratio (OR) 6.6; 95% confidence interval (CI) 1.5–28.4) and sexual activity (OR 1.3; 95% CI 1.0–1.5).
Vaginal hysterectomy was not a risk factor when preoperative prolapse was taken into account (OR 0.9; 95% CI 0.5–1.8).Vaginal
vault prolapse repair after hysterectomy is an infrequent event and is due to preexisting weakness of pelvic tissues. 相似文献
11.
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
12.
The objective was to determine whether vaginal topography accurately predicts the location of the pelvic viscera on fluoroscopy
in women with pelvic organ prolapse. Eighty-nine women undergoing preoperative evaluation for reconstructive pelvic surgery
at a tertiary care referral practice formed the study population. Each woman completed a comprehensive urogynecologic history
and physical examination, which included a quantified (POP-Q) assessment of her vaginal topography, as described by Bump et
al. In addition each woman underwent pelvic floor fluoroscopy (PFF). Visceral sites were selected which corresponded clinically
to the vaginal sites measured by the POP-Q. The most dependent portion of the bladder, small intestine, rectum and urethrovesical
junction was measured. Twenty-five (28%) women had stage II prolapse, 34 (38%) had stage III prolapse, and 28 (32%) had stage
IV prolapse. The remaining 2 women were symptomatic, with stage I prolapse. For the entire study population there was no correlation
between the fluoroscopic position of the small bowel and/or rectum and any apical or posterior wall POP-Q site (C, Ap or Bp).
There was no correlation with the fluoroscopic position of the UVJ at rest or with straining and the corresponding POP-Q site
(Aa). The fluoroscopic position of the most dependent portion of the bladder correlated only modestly with the upper (Ba,ρ=0.51) and lower Aa,ρ=0.68) anterior vaginal wall POP-Q sites. In women without prior surgery (n=33) there was only modest correlation between the fluoroscopic position of the bladder and the corresponding POP-Q site (Aa,ρ=0.71). In this unoperated subpopulation there was no correlation with PFF and any other POP-Q site. In women who had undergone
prior hysterectomy (n=25) or hysterectomy with anterior and/or posterior colporrhaphy (n=17), there was only a modest correlation of the most dependent portion of the bladder and the upper anterior vaginal wall
site (Bb,ρ=0.67 andρ=0.55, respectively). It was concluded that vaginal topography does not reliably predict the position of the associated viscera
on PFF in women with primary or recurrent pelvic organ prolapse.
EDITORIAL COMMENT: The authors seek to evaluate whether physical examination of vaginal prolapse using the POP-Q test correlates
with fluoroscopic findings of visceral position. Surprisingly, little correlation is found, even in previously unoperated
patients. One reason for this lack of correlation between the two modalities of evaluation may lie in the use of two different
fixed points of reference: the POP-Q examination uses the hymen as the fixed point of reference, whereas the investigators
chose to use the posterior edge of the femur as a fixed bony point of reference when evaluating pelvic floor fluoroscopy in
the same patient. The lack of correlation between visual inspection of vaginal wall prolapse and what lies deep to that prolapse
should not be used to invalidate the use of the POP-Q as a means to evaluate pelvic prolapse. Rather, the findings support
the premise behind the ICS/AUGS/SGS committee on pelvic organ prolapse, specifically that clinical pelvic examination of the
vaginal walls looks at surfaces only, and as such cannot determine what, if any, organ lies deep to that surface. 相似文献
13.
May Alarab Maria AT Bortolini Harold Drutz Stephen Lye Oksana Shynlova 《International urogynecology journal》2010,21(11):1397-1404
Introduction and Hypothesis
The extracellular matrix proteins collagen and elastin provide tissue strength and resilience, whereas lysyl oxidase enzymes play a major role in their stabilization. This study examines the expression and tissue localization of lysyl oxidase family proteins in the anterior vaginal wall of premenopausal women with advanced pelvic organ prolapse (POP, n = 15) and asymptomatic controls (n = 11). All women were in the proliferative phase of menstrual cycle. 相似文献14.
The prolapse is the exteriorization of the pelvic organs through the vagina, this condition may affect the quality of life. The prolapse was diagnosed in 50% of multiparous women. It is estimated that a woman throughout her life, has 11% risk of needing surgery for correction of pelvic organ prolapse or urinary incontinence. The prolapse may occur at the anterior vaginal wall (cystocele) at the vaginal, uterus (histerocele) or at the posterior wall (or rectocele enterocele). For the unfit patient obliteratives procedures may be indicated and recontructives for pacients wih good performance status. It is important for reconstructive surgery a correct diagnosis, for the specific defect repair. When indicated, meshes can be used to add strength to the poor quality tissues. 相似文献
15.
Victoria L. Handa Mark E. Lockhart Kimberly S. Kenton Catherine S. Bradley Julia R. Fielding Geoffrey W. Cundiff Caryl G. Salomon Christiane Hakim Wen Ye Holly E. Richter 《International urogynecology journal》2009,20(2):133-139
To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders.
We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6–12-months postpartum. Anatomy was compared
between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P < 0.01 was considered statistically significant. A deeper sacral hollow was significantly associated with fecal incontinence
(P = 0.005). Urinary incontinence was marginally associated with a wider intertuberous diameter (P = 0.017) and pelvic arch (P = 0.017). There were no significant differences in pelvimetry measures between women with and without prolapse (e.g., vaginal
or cervical descent to or beyond the hymen). We did not detect meaningful differences in soft tissue dimensions for women
with and without these pelvic floor disorders. Dimensions of the bony pelvis do not differ substantially between primiparous
women with and without postpartum urinary incontinence, fecal incontinence and prolapse. 相似文献
16.
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
17.
AIMS: To evaluate if pelvic floor innervation differed in patients with rectocele compared to control subjects and to assess if nerve fiber density of the rectovaginal wall correlated to the clinical presentation of rectocele. METHODS: Biopsies from 24 female patients with posterior vaginal wall prolapse stage II (ICS-classification) and rectocele verified at defecography were compared to specimens from age and parity-matched control subjects without posterior vaginal wall prolapse. Nerve fiber density was measured using protein gene product (PGP-9.5) antibodies at immunohistochemistry. Anorectal symptoms were recorded using bowel and anorectal function questionnaires. RESULTS: The two groups were comparable in age and parity. Mean nerve fiber immunofluorescence intensity was 150.3 +/- 12.5 SD in the patient group compared to 139.3 +/- 8.5 SD in the control group (P < 0.01). Symptoms of anorectal dysfunction were more common in the patient group compared to control subjects (P < 0.01) but there was no difference in anal continence. At logistic regression analysis, nerve fiber immunofluorescence intensity showed no significant correlation to age, menopausal age, parity, body mass index (BMI), prolapse quantification, or any specific self-reported anorectal symptom. Increased nerve fiber immunofluorescence intensity was correlated to increased perineal descent (OR 1.3, 95% CI 1.1-2.1) although not to the size of the rectocele (OR 0.5, 95% CI 0.9-1.2). CONCLUSIONS: Our results show that rectocele may be associated with increased rectovaginal innervation, suggestive of reinnervation of the rectovaginal wall. Nerve fiber density correlated poorly with findings at clinical and radiological examination. Neurochemical characterization of the rectovaginal wall may provide further understanding of the pathogenesis of rectocele. 相似文献
18.
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
19.
A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh 总被引:4,自引:0,他引:4
Renaud de Tayrac Olivier Picone Aurélia Chauveaud-Lambling Hervé Fernandez 《International urogynecology journal》2006,17(2):100-105
This study reports the 2-year results of an original technique for rectocele repair by the vaginal route, using a combined sacrospinous suspension and a polypropylene mesh. Twenty-six women were successively operated between October 2000 and February 2003. Mean age was 63.7 years [range 35–92]. 19 women had had previous pelvic surgery for prolapse and/or urinary incontinence (73.1%), but none had had a previous rectocele repair. Patients underwent physical examination staging of prolapse in the international pelvic organ prolapse staging system. Eleven women had stage 2 posterior vaginal wall prolapse (42.3%), seven had stage 3 (26.9%) and eight had stage 4 (30.8%). The procedure included a bilateral sacrospinous suspension and a polypropylene mesh (GyneMesh, Gynecare, Ethicon France) attached from the sacrospinous ligaments to the perineal body. We did not perform any associated posterior fascial repair, nor myorraphy. Patients were followed up for 10–44 months, with a median follow-up (±SD) of 22.7±9.2 months. Functional results and sexual function were evaluated using the PFDI, the PFIQ and the PISQ-12 self-questionnaires. Twenty-five women returned for follow-up (96.2%). At follow-up, 24 women were cured (92.3%) and one had asymptomatic stage 2 rectocele. All the patients but one had symptoms and impact on quality of life improved. No postoperative infection of the mesh or rectovaginal fistula was found, but there were three vaginal erosions (12%) and one out of 13 had de novo dyspareunia (7.7%). 相似文献
20.
《Seminars in Colon and Rectal Surgery》2016,27(1):51-58
The main objective of this article is to review the management of patients with posterior vaginal wall prolapse. The posterior vaginal wall is inconsistent both in terms of correlating patient symptoms to objective findings and correlating correction of anatomic defects to symptom relief. Therefore, the management of patients with pelvic organ prolapse is challenging and emphasizes the need for surgeons to clearly communicate expectations of surgical repair. Despite these limitations, surgical repair of pelvic organ prolapse in properly selected patients can provide symptomatic relief and improvement in their quality of life and functional status. Review of the literature suggests that traditional posterior colporrhaphy without levatorplasty has superior objective outcomes compared with site-specific posterior repair (grade B), there is a higher dyspareunia rate reported when levatorplasty is employed (grade C), the transvaginal approach is superior to the transanal approach (grade A), there is no benefit of mesh overlay or augmentation of a suture repair (grade B), and while modified abdominal sacrocolpopexy results have been reported, data on how these results would compare with traditional transvaginal repair are lacking. Further studies are needed to optimize the care of patients with posterior vaginal wall prolapse. 相似文献