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Uterine Prolapse [keywords]
- Reinforcement of suspensory ligaments under local anesthesia cures pelvic organ prolapse: 12-month results. [JOURNAL ARTICLE]
- Int Urogynecol J 2013 Dec 7.
In 2005, a new minimally invasive procedure, the tissue fixation system (TFS) was reported. Like TVT (tension-free vaginal tape), the TFS works by creating a foreign body collagenous tissue reaction that reinforces a weakened pelvic ligament. The objective was to assess the effectiveness and perioperative safety of TFS in a day surgery clinic for the treatment of pelvic organ prolapse (POP).The TFS tape was applied in a tunnel adjacent to natural ligaments to repair the anterior cervical ring and cardinal ligament, paravaginal tissues and uterosacral ligaments under local anesthesia/sedation. We prospectively studied 60 patients, mean age 67, between October 2008 and February 2010 at Women's Clinic LUNA. Levels of POP were grade 2 (n = 20; 7 %), grade 3 (n = 30; 55 %), and grade 4 (n = 4; 7 %) according to the ICS POPQ classification. Fifty-four patients (90 %) who underwent a total of 162 POP operations presented for review. Follow-up was performed at 12 months. We defined surgical failure according to the ICS POPQ classification. We used prolapse quality of life (P-QOL) questions for QOL measurement.Ninety-eight percent of patients were discharged on the day of surgery. Of the162 TFS operations reviewed, 157 were successful and 5 failed. The 5 failed operations comprised 4 cystoceles and 1 rectocele. Two patients developed cervical protrusions at the introitus at 6 months with no prolapse of the uterine body. We found 5 cases of erosion in 162 tape insertions. The total number of patients who had no complications, no surgical failures, no erosions, no sensation of bulging, and no cervical protrusions was 47 (87 %).The TFS uses the same surgical principle for repair as the TVT; this principle vastly minimizes the volume of mesh used, erosions, and other complications.
- In Vivo Properties of Uterine Suspensory Tissue in Pelvic Organ Prolapse. [JOURNAL ARTICLE]
- J Biomech Eng 2013 Dec 1.
Introduction: The uterine suspensory tissue (UST) complex, which includes the cardinal (CL) and uterosacral ligaments (USL), plays an important role in resisting pelvic organ prolapse (POP). We described a novel technique for quantifying the in vivo time-dependent force-displacement behavior of the UST, demonstrated its feasibility in situ, and used the results to identify the viscoelastic properties of the CL and USL via biomechanical modeling. Methods: Fourteen women with prolapse were selected from an ongoing study of POP. The mean ± SD age was 53.9 ± 11.9 years, parity was 2.9 ± 1.2, and body mass index was 29.1 ± 4.7 kg/m2. We developed a computer-controlled linear servoactuator with a force transducer which applied a continuous force and simultaneously record cervical displacement. In each patient three "ramp and hold" test trials were applied. After a 1.1 N preload was applied to remove slack in the UST, a ramp rate of 4 mm/s was used up to a maximum force of 17.8 N (or 4 lbs). The test result for each trial was analyzed and compared with the tissue stiffness and the energy absorbed during the ramp phase, and normalized final force during the hold phase. A simplified four-cable biomechanical model was used to analyze the material behavior of each ligament. Results: The average stiffnesses of the UST complex were 0.49, 0.61 and 0.59 N/mm from trial 1 to 3, with the latter two values differing significantly from the first. The energy absorbed significantly decreased from trial 1 (0.27 J or N*m) to trial 2 (0.23 J) and 3 (0.22 J), but not from trial 2 to 3. The normalized final relaxation force increased significantly with each trial 1. Modeling results for trial 1 showed that the stiffnesses of CL and USL cables were 0.17 N/mm and 0.11 N/mm, respectively. Under maximum load, the strain in the CL and USL approached nearly 100%. In the relaxation phase, the peak force decreased by 20% after 5 s and by 34% after 60 s. Conclusions: A novel servo-actuator apparatus and intra-operative testing strategy proved successful in obtaining in vivo time-dependent material properties data in representative pilot sample of women with prolapse. The UST exhibited visco-hyperelastic behavior. The elasticities of the CL and USL were three orders of magnitude greater than those reported for the anterior cruciate ligament in the literature. In these women with prolapse, the strain approached near 100% at maximum load.
- [Should we perform intra-operative endometrial biopsy during pelvic reconstructive surgery with uterine preservation?] [JOURNAL ARTICLE]
- J Gynecol Obstet Biol Reprod (Paris) 2013 Dec 2.
To evaluate the interest of systematic endometrial biopsy at the time of vaginal reconstructive surgery with uterine preservation.We performed a retrospective monocentric study on all women who had vaginal reconstructive surgery with uterine preservation from 2005 to 2012. All following parameters have been studied: baseline characteristics (age, parity, BMI, hormonal status, medical history), prolapse stage using the POP-Q, preoperative pelvic ultrasound (endometrial thickness), and type of surgery. Women with previous hysterectomy were excluded.Four hundred and fourteen patients were operated during this period, and 268 have uterine preservation (64.7%). Baseline characteristics were mean age 64.7±10.7 (39 to 92), mean parity 2.6±1.5, mean BMI 25.5±4.2, menopause 238 (88.8%), HRT 32 (12%), previous breast cancer 16 (6%), diabetes mellitus 31 (11.6%), and hypertension 87 (32.5%). Prolapse were at stage II in 127 (47.3%), stage III in 99 (36.9%) and stage IV in 17 (6.3%). Preoperative pelvic ultrasound has been done in 255 patients (95.2%), and mean endometrial thickness was 5.1mm (range 1.6-16). Overall, 152 intra-operative endometrial biopsies were assessable (56.7%). In 24 cases (15.8%), samples were too small to be interpretable. Finally, the 128 interpretable biopsies (82.2%) have shown one carcinoma (0.8%), four hyperplasia (3.2%), two endometrial polyps (1.6%), and 121 normal endometria (94.5%). The only cancer was discovered on a 77year old patient, with a history of previous breast cancer, and with a preoperative endometrial thickness of 7mm. No patient with normal preoperative ultrasound endometrial screening had abnormal endometrial biopsy.Vaginal reconstructive surgery with uterine preservation implicates a preoperative endometrial evaluation by ultrasound. Intra-operative endometrial biopsy does not seem to be justified.
- Cervical elongation following sacrospinous hysteropexy: a case series. [JOURNAL ARTICLE]
- Int Urogynecol J 2013 Dec 3.
In recent years, pelvic floor surgeons have increasingly repaired pelvic organ prolapse around an intact uterus. Uterine conservation and hysteropexy have been driven by patient preference, less risk of mesh erosion, shorter operative time, and decreased blood loss and postoperative pain. We present a case series of patients with cervical elongation after vaginal sacrospinous hysteropexy using polypropylene mesh arms, a novel technique developed by the senior author. We defined cervical elongation as greater than or equal to a two-fold increase in cervical length compared with preoperative measurements. Of the 8 patients who underwent this procedure, 5 (62.5 %) had cervical elongation during the first year postoperatively. In the most severe case, the cervix extended to 4 cm beyond the hymenal ring. Most of the patients were mildly symptomatic and chose expectant management. The cases are reviewed in detail. A brief literature review on cervical elongation is presented.
- cAMP based awareness and screening programme of cervical cancer in rural area of bangladesh. [Journal Article]
- Mymensingh Med J 2013 Oct; 22(4):640-5.
This population based cross sectional study was carried out in Muktagacha Upazilla Health Complex, Mymensingh, Bangladesh during the period of 26th to 28th June, 2012. The objective was to create awareness, to find out the precancerous lesion of cervix and to evaluate the effectiveness of this approach for prevention of cervical carcinoma. Women who were married and between 30-60 years and also women of below 30 years (who were married below the age of 18) were included in this study. All pregnant women were excluded from this study. After counseling, pelvic examination and VIA (visual inspection of cervix with application of 5% acetic acid) test was done. If the squamo-columner junction of cervix turned to white then it was called VIA positive (+ve) cases. Then they were referred to colposcopy clinic of Mymensingh Medical College with a red card for evaluation and management. During the 3 days campaign, 395 cases were examined. Among them, majority (49%) of the women were below the age of 30. It was observed that still 48.2% were married below the age of 18 and 31% had first pregnancy at an age or below 18 years. But number of grand multiparity is lowering now a days. Only 25% had para ≥4. Others have para 1-3. During pelvic examination, the common cervico-uterine pathologies like chronic cervicities (16.5%), cervical erosion (14.4%), uterine prolapse (2.3%), cervical polyp (1%), myomatous polyp (0.3%) and advanced cervical carcinoma (0.5%) were also diagnosed clinically. Among the participants, 11.9% was detected as VIA+ve cases. A significant association of VIA+ve cases with low socio-economic conditions, hindu religion, early age at marriage and high parity were observed in this study (p<0.05). The findings of this study highlight the utility and need of camp based cervical cancer screening service at regular interval in the community.
- Laparoscopic Modified Sacral Hysteropexy: Initial Experience With An Original Surgical Approach to Uterovaginal Prolapse. [JOURNAL ARTICLE]
- J Minim Invasive Gynecol 2013 Nov 26.
The objective of this retrospective study was to evaluate the feasibility of a modified laparoscopic approach to correct uterovaginal prolapse using cervical cerclage tape to attach the uterine isthmus to the sacral promontory.A retrospective study DESIGN: Classification: Canadian Task Force classification III SETTING: A tertiary referral center (West China Second University Hospital) PATIENTS: From January 2011 to February 2013, 33 patients underwent laparoscopic modified sacral hysteropexy with cervical cerclage tape at the West China Second University Hospital. All of the patients had POP-Q stage 2 to 4 uterovaginal prolapse.The outcome was assessed by preoperative and postoperative pelvic examinations and the surgical results were evaluated. The average surgery time was 90.0min and the blood loss was 80.5ml. No intraoperative or postoperative complications occurred. At the minimum 6-month follow up, all of the patients had prolapse of stage I or less.After larger trials are performed to assess the safety and efficacy of this modified laparoscopic sacral hysteropexy, this novel approach might be considered as an alternative treatment option for patients with uterovaginal prolapse.
- [Laparoscopic Y-shaped polypropylene mesh for uterine and vaginal vault prolapse]. [English Abstract, Journal Article]
- Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013 Sep; 27(9):1106-9.
To investigate the effectiveness oflaparoscopic Y-shaped polypropylene mesh in the treatment of uterine and vaginal vault prolapse.Between June 2010 and December 2012, 24 patients with uterine and vaginal vault prolapse were treated by laparoscopic pelvic reconstruction (vagina and uterus-sacral fixation) with Y-shaped polypropylene mesh. The age of patients was 35-60 years (mean, 48.6 years). The disease duration was 2-8 years (mean, 5 years). According to the pelvic organ prolapse quatitative (POP-Q) classification by International Continence Society (ICS), 16 cases were classified as uterine prolapsed degree II and 8 cases as degree III; 15 cases were classified as vaginal prolapse degree I, 7 cases as degree II, and 2 cases as degree III. All patients received postoperative follow-up regularly. Subjective evaluation was done based on prolapse quality of life questionnaire (P-QOL), and objective evaluation based on POP-Q classification.All the patients were operated successfully. The operation time was 22-68 minutes (mean, 33 minutes); the blood loss was 30-80 mL (mean, 51 mL); the indwelling urethral catheter remain was 3-7 days (mean, 4 days); and the hospitalization days were 4-9 days (mean, 6.8 days). Twenty-four patients were followed up 3-12 months (mean, 9 months), of whom, 2 were followed up less than 6 months. All patients had normal urination after withdrawal of urethral catheter, and the residual urine volume was in normal range. No patients had mesh erosion and discomfort during sex, vaginal and anal bearing down. The P-QOL scores at 3, 6, and 12 months after operation were significantly improved when compared with the preoperative value (P < 0.05); but there was no significant difference among 3, 6, and 12 months after operation (P > 0.05). The postoperative POP-Q classification was degree 0 in 19 cases and degree I in 3 cases, and the objective cure rate was 91.7%. No recurrence was found during followup.Laparoscopic Y-shaped polypropylene mesh for treatment of uterine and vaginal vault prolapse is a safe and effective method, especially applicable to preserve the uterus, and higher requirements of sexual life of patients.
- Medicinal plants for women's healthcare in southeast Asia: A meta-analysis of their traditional use, chemical constituents, and pharmacology. [JOURNAL ARTICLE]
- J Ethnopharmacol 2013 Nov 21.
This is an extensive review of plants used traditionally for women's healthcare in Southeast Asia and surrounding countries. Medicinal plants have a significant role in women's healthcare in many rural areas of the world. Plants with numerous efficacious observations have historically been used as a starting point in the development of new drugs, and a large percentage of modern pharmaceuticals have been derived from medicinal plants.A review was conducted for all plant use mentioned specifically for female healthcare, such as medicine to increase fertility, induce menstruation or abortion, ease pregnancy and parturition, reduce menstrual bleeding and postpartum hemorrhage, alleviate menstrual, parturition and postpartum pain, increase or inhibit lactation, and treat mastitis and uterine prolapse, in 200 studies focusing on medicinal plant use, either general studies or studies focusing specifically on women's healthcare.Nearly 2000 different plant species are reported to be used in over 5000 combinations. Most common are Achyranthes aspera, Artemisia vulgaris, Blumea balsamifera, Carica papaya, Curcuma longa, Hibiscus rosa-sinensis, Leonurus japonicus, Psidium guajava and Ricinus communis, and each of these species had been reported in more than 10 different scientific articles.This review provides a basis for traditional plant use in women's healthcare, and these species can be used as the starting point in the discovery of new drugs.
- [Objective assessment of symptoms and informing female patients]. [English Abstract, Journal Article]
- J Med Liban 2013 Jan-Mar; 61(1):23-35.
Genital prolapse is a functional pathology presenting with numerous urinary, genito-sexual, and anorectal symptoms. These symptoms are responsible for an alteration of the quality of life, sometimes associated to a real anxiety-depressive syndrome. Because of these complex intricacies, the management of these disorders became multidisciplinary. Tools to measure the impact of prolapse symptoms on the quality of life became a necessity. Such instruments should allow a correlation of the functional symptomatology at the anatomic stage, raise a surgical indication based on the functional disturbance and evaluate the effectiveness and tolerance of the various therapeutic procedures. Two validated self-questionnaires in French (short versions of the Pelvic Floor Distress Inventory [PFDI-20] and the Pelvic Floor Impact Questionnaire [PFIQ-7]) are presently available. Moreover, the physician has the legal obligation to provide detailed presurgical information on frequent and severe hazards, expected benefits, functional consequences, therapeutic alternatives and the consequences of nonintervention. Before surgery takes place, the surgical approach, the benefit of using synthetic prostheses, the possibility of uterine and/or ovarian conservation, and some risky conditions such as smoking, obesity and estrogen deficiency should be discussed.
- Defect in the uterine wall with prolapse of amniotic sac into it at 32 weeks' gestation in a primigravida woman without any previous uterine surgery. [JOURNAL ARTICLE]
- J Obstet Gynaecol Res 2013 Nov 18.
We experienced a case of uterine wall defect with amniocele in a primigravida woman without any history of uterine surgery. On admission due to acute abdominal pain at 32 weeks' gestation, an ultrasound examination showed a 9 × 7-cm sized echogenic cystic area in the Morrison pouch. Color Doppler revealed a flow from the uterus into the cystic area through a myometrial defect. During the operation, a 1-cm defect in the uterine myometrium was found on the right fundus. An intact amniotic sac was prolapsed into the abdominal cavity through the myometrial defect. This was an extremely rare case of unexplained uterine wall defect.