The female pelvic floor through midlife and aging

Female pelvic floor is a complex functional unit involved in multiple functions that extend beyond the sole support of pelvic organs. Pelvic floor dysfunction globally affects micturition, defecation and sexual activity. Evolutionary modifications such ad adaptation to upright standing, walking and the need to deliver fetuses with larger head diameters made the fascial and muscle support of the pelvic floor vulnerable, therefore predisposing women to pelvic organ prolapse and incontinence. Different than in males, the female pelvic floor undergoes a number of adaptive changes related to life and endocrine events. Most of the clinical manifestations of these changes become apparent after menopause and throughout aging in women. This review article summarizes the key aspects of the pathophysiology and the clinics of the modifications of the pelvic floor in women through midlife and beyond. A particular focus is given to the relationship between urinary and bowel dysfunction.     

Vertical pelvic ring displacement in pelvic ring injury: Measurements in pelvic outlet radiograph and in cadavers

Background:Vertical pelvic ring displacement (VPRD) is a serious injury and needs assessment. Pelvic outlet radiographs are routinely taken. However, relationship of radiographic and actual VPRD is still in question. Thus, measurement of VPRD from pelvic radiographs was studied.Results:Radiographic VPRD from outlet and anteroposterior pelvic views at 10 mm actual displacement were 20.12 ± 1.98 and 4.08 ± 3.76 mm, at 20 mm were 40.31 ± 1.97 and 9.94 ± 7.27 mm and at 30 mm were 58.56 ± 2.53 and 11.29 ± 2.89 mm. Statistical analyses showed that radiographic VPRD from pelvic outlet view is 1.95 times of actual displacement with strong correlation at 0.992 coefficient and strongly significant regression analysis (P < 0.001) with 0.984 of R² value. Whereas, the measurement from anteroposterior pelvic radiograph was not strongly significant.Conclusion:Pelvic outlet radiograph provides efficient measurement of VPRD with 2 times of actual displacement.     

The operative treatment of pressure sores in the pelvic region: A 10-year period overview

Context

Pelvic region pressure sores often develop following spinal cord injury. Surgery is often necessary for long standing, large-sized pressure sores not responding to conservative treatment. Authors analyze their results of a 10-year period, and identify factors contributing to the reduction of the recurrence rate.

Methods

A total of 119 pressure sores were operated on 98 patients in two institutions during a 10-year period (1 January 2003 to 31 December 2012). The encountered perioperative complications are summarized, and the recurrence rate is analyzed with a patient follow-up questionnaire.

Results

We experienced 15 perioperative complications (12.6%). All complications were fully resolved by conservative treatment. Fifty-eight returned patient replies were processed. The average follow-up time after surgery was 5.2 years. The recurrence rate was 5.47%.

Conclusion

The strict adherence to surgical indications, full patient compliance, specialized pre- and post-operative patient care, our routinely used preferred surgical method, all contribute to a low post-operative complication rate, long-term flap survival, and an extended recurrence free period.     

Endometriosis in Adolescents

Background and Objectives:

Women with endometriosis often report onset of symptoms during adolescence; however, the diagnosis of endometriosis is often delayed. The aim of this study was to describe the experience of adolescents who underwent laparoscopy for pelvic pain and were diagnosed with endometriosis: specifically, the symptoms, time from onset of symptoms to correct diagnosis, number and type of medical professionals seen, diagnosis, treatment, and postoperative outcomes.

Methods:

We reviewed a series of 25 females ≤21 years of age with endometriosis diagnosed during laparoscopy for pelvic pain over an 8-year period. These patients were followed up for 1 year after surgery.

Results:

The mean age at the time of surgery was 17.2 (2.4) years (range, 10–21). The most common complaints were dysmenorrhea (64%), menorrhagia (44%), abnormal/irregular uterine bleeding (60%), ≥1 gastrointestinal symptoms (56%), and ≥1 genitourinary symptoms (52%). The mean time from the onset of symptoms until diagnosis was 22.8 (31.0) months (range, 1–132). The median number of physicians who evaluated their pain was 3 (2.3) (range, 1–12). The adolescents had stage I (68%), stage II (20%), and stage III (12%) disease. Atypical endometriosis lesions were most commonly observed during laparoscopy. At 1 year, 64% reported resolved pain, 16% improved pain, 12% continued pain, and 8% recurrent pain.

Conclusions:

Timely referral to a gynecologist experienced with laparoscopic diagnosis and treatment of endometriosis is critical to expedite care for adolescents with pelvic pain. Once the disease is diagnosed and treated, these patients have favorable outcomes with hormonal and nonhormonal therapy.     

Dega osteotomy for the management of developmental dysplasia of the hip in children aged 2–8?years: results of 58 consecutive osteotomies after 13–25?years of follow-up

PurposeDevelopmental dysplasia of the hip (DDH) is a term used to cover a broad spectrum of anomalies ranging from mild dysplasia to high-riding dislocations. We report the management of DDH in children using the Dega osteotomy and their long-term follow-up.MethodsFifty-eight hips from 48 children younger than 8 years treated using the Dega osteotomy between January 1988 and October 2000 were included in this multcenter study. Both prospective (41 hips) and retrospective (17 hips) cases were included, and follow-up was for a minimum of 13 years. Radiographs were made preoperatively, immediately postoperatively, after 6 weeks or at removal of the spica cast if any, at 6-month intervals and/or as indicated for 3 years postoperatively and then on annual basis until the last follow-up. A single-cut computed tomographic scan was performed for all prospective patients. Special attention was paid to the predictive measures of hip arthrosis and the survival of the hip after Dega osteotomy. ResultsThe final clinical outcome was favorable in 44 hips (75.9 %). Eleven hips needed a second surgery (acetabuloplasty and/or arthroplasty) during the follow-up period.Conclusions In our pediatric patient population the Dega osteotomy proved to be an adequate measure for the management of this complex condition. The worst complication was avascular necrosis, and all of the affected hips ended with failure (pain, another surgery, or both).     

腹壁自体筋膜盆底悬吊术治疗盆底器官脱垂40例

目的探讨腹壁自体筋膜盆底悬吊术治疗盆底器官脱垂的临床疗效和应用价值。方法对40例经腹壁自体筋膜盆底悬吊术治疗的盆底器官脱垂患者进行回顾性分析,术后1个月门诊随访,了解术后近期情况,以后每半年随访1次,随访1年。结果40例患者腹壁自体筋膜盆底悬吊术均在全麻下进行,整体手术时间平均为（133.41±56.57）min（含妇科其他操作,如子宫切除术、卵巢囊肿剥除术、阴道后壁修补术等,单独行盆底悬吊术2例）,平均失血量为（109.71±70.71）mL,术后平均住院时间为（8.94±0.71）d,其中2例因腹部切口液化,术后尿管保留时间为（4.26±1.41）d,其中1例术中膀胱损伤,术后保留导尿14 d。随访1年,2例术后阴道后壁膨出。生活质量未受影响。结论腹壁自体筋膜盆底悬吊术是一种治疗子宫阴道脱垂的简单、有效、容易掌握的手术方式,可以进行临床术式的推广。     

The Number of Positive Pelvic Lymph Nodes and Multiple Groups of Pelvic Lymph Node Metastasis Influence Prognosis in Stage ⅠA-ⅡB Cervical Squamous Cell Carcinoma

Background:Pelvic lymph node metastasis (LNM) is an important prognostic factor in cervical cancer.Cervical squamous cell carcinoma accounts for approximately 75-80％ of all cervical cancers.Analyses of...     

腹腔镜应用于盆腔炎患者诊断及治疗的临床价值研究

目的：探究腹腔镜手术在盆腔炎患者中的诊断以及治疗价值。方法选择我院2010－09～2014－08间住院部的110例盆腔炎患者进行研究,根据不同的临床治疗方法将所有患者进行分组,予以药物治疗患者为对照组,予以药物治疗＋腹腔镜手术治疗患者为研究组,分析对比两组患者治疗后临床效果、白细胞降低时间、症状好转时间、住院时间及生存质量评分等情况。结果两组患者经临床治疗后总有效率比较χ2＝22.1111（ P＝0.0000）,差异具有统计学意义;两组患者白细胞降低时间以及症状好转时间、住院时间比较,研究组均比对照组短,差异具有统计学意义（均P＜0.01）;两组患者总生存质量评分比较t＝14.7615（ P＝0.0000）,P＜0.01,差异具有统计学意义。结论腹腔镜是临床诊断盆腔炎的金标准,其用于临床治疗盆腔炎效果显著,创伤小,安全可行,患者恢复健康更快,且能显著提升患者治疗后生存质量,具有极高的临床应用价值。