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Uterine Prolapse [keywords]
- Insights into potential pathogenesis mechanisms associated with Campylobacter jejuni -induced abortion in ewes. [JOURNAL ARTICLE]
- BMC Vet Res 2014 Nov 25; 10(1):274.
Background Campylobacter jejuni is commonly found in the gastrointestinal tract of many food-animals including sheep without causing visible clinical symptoms of disease. However, C. jejuni has been implicated in ovine abortion cases worldwide. Specifically, in the USA, the C. jejuni sheep abortion (SA) clone has been increasingly associated with sheep abortion. In vivo studies in sheep (the natural host) are needed to better characterize the virulence potential and pathogenesis of this clone.ResultsPregnant ewes intravenously (IV) or orally inoculated with ovine and bovine abortion-associated C. jejuni SA clones exhibited partial or complete uterine prolapse with retained placenta, and abortion or stillbirth, whereas delivery of healthy lambs occurred in pregnant ewes inoculated with C. jejuni 81¿176 or in the uninfected group. In sheep inoculated with the SA clone, histopathological lesions including suppurative necrotizing placentitis and/or endometritis coincided with: 1) increased apoptotic death of trophoblasts, 2) increased expression of the host genes (e.g. genes encoding interleukin IL-6 and IL-15) related to cellular necrosis and pro-inflammatory responses in uterus, and 3) decreased expression of the genes encoding [GATA binding protein 6, chordin, and insulin-like 3 (INSL3)] that account for embryonic development in uterus. Immunohistochemistry revealed localization of bacterial antigens in trophoblasts lining the chorioallantoic membrane of ewes inoculated with the C. jejuni SA clone.ConclusionsThe results showed that C. jejuni SA clones are capable of causing abortion or stillbirth in experimentally infected sheep. Furthermore, down- or up-regulation of specific genes in the uterus of infected pregnant ewes might implicate host genes in facilitating the disease progression. Since the C. jejuni SA strains share genotypic similarities with clones that have been isolated from human clinical cases of gastroenteritis, these strains might represent a potential public health risk.
- Is Sacrocolpopexy Adequate for Cervico-uterine Prolapse in Patients with Classical Bladder Exstrophy? [Journal Article]
- J Obstet Gynaecol India 2014 Dec; 64(Suppl 1):83-4.
- A multicenter, prospective trial to evaluate mesh-augmented sacrospinous hysteropexy for uterovaginal prolapse. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Nov 14.
Hysterectomy is often part of pelvic organ prolapse repair. However, this may offer no benefit when compared to uterine preservation. We aimed to prospectively evaluate a minimally invasive bilateral sacrospinous hysteropexy using polypropylene mesh. We hypothesized that anatomic success and patient satisfaction can be achieved with this technique.Women with uterovaginal prolapse desiring surgery who had completed childbearing were enrolled. Preoperative assessment included standardized prolapse examination and validated symptom and pain scale questionnaires. Women with prior pelvic organ prolapse repair or any contraindication to uterine preservation were excluded. Data including demographic, operative and postoperative information was collected on patients for 1 year following surgery. Continuous variables are summarized as means (standard deviation) and categorical variables are summarized as frequencies and percentages. A mixed-effects model was used to evaluate the changes in questionnaire scores and outcomes at 6 months and 12 months after surgery with random effects accounting for the center effect with adjustment for age.The study group comprised 99 women from three female pelvic medicine and reconstructive surgery (urogynecology) centers. The average age of the participants was 67.0 years (11.32 years), BMI 26.04 kg/m(2) (3.56 kg/m(2)), and the majority were multiparous (98.9 %) and menopausal (90.9 %). Overall success at 12 months, as measured by composite outcome was 97.7 % (with the Ba point as the anatomic landmark) and 96.6 % (with the C point as the anatomic landmark). The overall exposure rate was 6.52 % and reoperation rate was 7.53 %. All subjective questionnaire scores and anatomic outcomes had improved at 12 months.Sacrospinous hysteropexy using a minimally invasive polypropylene mesh kit is an effective and safe technique for addressing uterovaginal prolapse as an alternative to hysterectomy at the time of pelvic reconstructive surgery.
- Trends in bilateral salpingo-oophorectomy among Taiwanese women undergoing benign hysterectomy: a population-based, pooled, cross-sectional study. [JOURNAL ARTICLE]
- Menopause 2014 Nov 10.
This study aims to examine recent trends in the performance of elective bilateral salpingo-oophorectomy at benign hysterectomy and to identify associated patient and provider-related characteristics from 2000 to 2010.We conducted a population-based, pooled, cross-sectional study using claims data from Taiwan's National Health Insurance program. Women aged 20 years or older who underwent concurrent oophorectomy at benign hysterectomy (n = 26,419) were compared with women who did not undergo concurrent oophorectomy at benign hysterectomy (n = 153,793). A generalized estimating equation model was applied to logistic regressions, and separate models were estimated to account for age interactions.The overall oophorectomy rate declined steadily from 22.1% in 2000 to 9.9% in 2010, particularly in women aged 45 to 49 years (decreased by 80%). Women aged 55 years or older who had a comorbid illness or a catastrophic illness, underwent abdominal or laparoscopic surgical operation, and were admitted to regional hospitals or medical centers were more likely to undergo oophorectomy at hysterectomy, whereas women with a preoperative diagnosis of uterine prolapse, with a well-defined monthly wage, and undergoing vaginal hysterectomy were less likely to undergo oophorectomy.Age, socioeconomic status, presence of comorbid illness, hysterectomy approach, hospital accreditation level, and disease diagnosis influence oophorectomy rate in Taiwan, a country with national health insurance. Studies on the possible long-term health risks of elective oophorectomy and the emergence of increasing evidence on ovarian cancers of serous histology (such as tubal carcinoma) since the early 2000s may have influenced patients' and physicians' decision-making in favor of ovarian conservation, leading to the observed downward trend among Taiwanese women from 2000 to 2010.
- A case of vaginal cancer with uterine prolapse. [Journal Article]
- J Menopausal Med 2013 Dec; 19(3):139-42.
Primary vaginal cancer combined with uterine prolapse is very rare. We present a case of 80-year-old postmenopausal women complaints of something coming out per vagina for the past 20 years, along with blood stained discharge, foul odor leukorrhea, and severe pelvic pain for the last 3 months. A 4 × 5 cm ulcer was present on middle third of vaginal wall with marked edema and ulceration of surrounding tissue. The prolapse was reduced under intravenous sedation in operating room. On gynecologic examination, uterus was normal in size, no adnexal mass was examined, and both parametrium were thickened. Papanicolaou smear was normal. Biopsy of the ulcer at vaginal wall revealed invasive squamous cell carcinoma of vagina. Magnetic Resonance Imaging of abdomen and pelvis showed left hydronephrosis and liver metastasis. Positron emission tomography (PET)/computed tomography (CT) revealed metastasis to lung, liver and iliac bone. She died from progression of disease one month after diagnosis.
- The status of the pelvic floor in young primiparous women. [JOURNAL ARTICLE]
- Ultrasound Obstet Gynecol 2014 Oct 31.
To investigate the postnatal prevalence of sonographically diagnosed pelvic floor trauma, and the correlations with various antenatal/intrapartum predictors in primiparous women.A prospective cohort study, performed in a tertiary hospital with 9000 deliveries per annum. 202(23.2% of those recruited) primiparous participants were clinically assessed at least one year postnatally, with Pelvic Organ Prolapse Quantification (POPQ), 2/3D-transperineal ultrasound (TpUS) and collagen type III levels quantification.Clinically significant POP had a high prevalence on POPQ staging: uterine prolapse-63%, cystocele-42%, rectocele-23%. Ballooning of the levator ani muscle (LAM) hiatus was detected in 33.2% and LAM avulsion in 29% of participants, with partial LAM avulsion in 15% and complete in 14%. Postnatal POP symptoms were positively associated with similar prepregnancy symptoms (OR [95% CI]) (OR 7.2 [1.19-44.33]), LAM avulsion (OR 4.8 [1.99-11.34]), forceps delivery (OR 1.8 [0.96-3.25]) and negatively associated with Caesarean Section (CS) (OR-0.2 [0.09-0.63]). LAM abnormality was associated with forceps delivery (OR 4.9 [1.44-16.97]) and prolapse (OR between 6.8 and 11.7 [2.34-78.51]), where as collagen levels did not play a role 1.007 [0.99-1.02].Clinically significant POP was common in relatively young premenopausal primiparae. A partial or full levator avulsion was seen in 29% of participants, being associated with POP and symptoms related to it. Congenital factors seem to play little role in the etiology of levator muscle trauma, whereas the main risk factor seems to be forceps delivery. Avoidance of difficult vaginal deliveries may prevent severe pelvic floor trauma.
- Quality of information on pelvic organ prolapse on the Internet. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Oct 25.
This study aimed to determine the quality of available patient-centered information for pelvic organ prolapse (POP) on the Internet using a modified validated scale.Two independent investigators using three search engines (Google, Yahoo, Bing) searched and reviewed the top 30 unique sites for four terms: bladder prolapse; dropped bladder; uterine prolapse; dropped uterus. A total of 219 websites were reviewed by both reviewers excluding redundancies. A two-stage, 6-point rating scale with score range per question of 0-5 was developed from the DISCERN instrument. Also recorded was whether a site had Health On the Net (HON) Foundation certification. The 400 sites were (as stated) a separate search where in the the domain suffix for the top 100 sites per serach term was recorded.The summary of 400 sites reviewed across the four search terms identified 64 % .com, 19 % .org, 8 % .edu, 6 % other and 3 % .gov; .gov yielded the highest quality information. Only 23 (9.5 %) sites were HON certified, yet these sites possessed higher DISCERN scores (p < 0.0001). For the three questions referencing conservative treatments (i.e., pessary, physical therapy, watchful waiting), 115 (52 %) sites indicated a summed mean score of ≤3, indicating less complete information regarding these treatments.Web-based information available to women regarding treatment for POP based on the modified DISCERN instrument is incomplete and biased toward surgical treatments. Government-sponsored websites (.gov) appear to provide the best quality information regarding this condition.
- Prevention and management of pelvic organ prolapse. [Journal Article, Review]
- F1000Prime Rep 2014.:77.
Pelvic organ prolapse is a highly prevalent condition in the female population, which impairs the health-related quality of life of affected individuals. Despite the lack of robust evidence, selective modification of obstetric events or other risk factors could play a central role in the prevention of prolapse. While the value of pelvic floor muscle training as a preventive treatment remains uncertain, it has an essential role in the conservative management of prolapse. Surgical trends are currently changing due to the controversial issues surrounding the use of mesh and the increasing demand for uterine preservation. The evolution of laparoscopic and robotic surgery has increased the use of these techniques in pelvic floor surgery.
- Postprocessing of pelvic floor ultrasound data: How repeatable is it? [JOURNAL ARTICLE]
- Aust N Z J Obstet Gynaecol 2014 Oct 22.
Translabial 3D/4D pelvic floor ultrasound (PFUS) is increasingly used in the evaluation of pelvic floor disorders. Commonly, this involves the analysis of stored volume data sets by postprocessing. In this study, we aimed to assess the time requirement to reaching acceptable repeatability for commonly employed outcome measures in PFUS.Between 2010 and 2013, 20 individuals from 11 countries underwent training in postprocessing of PFUS volume data sets. They undertook test-retest series (n ≥ 20) between day 2 and day 15 of training. Outcome measures tested included levator hiatal area on Valsalva, descent of the bladder neck, bladder, uterus and rectal ampulla, and rectocele depth. After an initial training session of 10-20 cases, test-retest series were undertaken between the trainee and measurements obtained by the author or senior trainees.Trainees were obstetricians/gynaecologists in training (n = 4), obstetricians/gynaecologists or subspecialty trainees (n = 13), medical students (n = 1) and physiotherapists (n = 2). A total of 58 repeatability series were analysed, obtained between days 2 and 15 of training. When second or third retest series were necessary, there always was improvement in repeatability except for one series in one individual. Satisfactory repeatability (ICC > 0.7) was achieved by all trainees for all parameters required by them. Training lasted from 3 to 15 days, with means between 4 and 5.8 days.Postprocessing analysis of commonly used PFUS parameters can be taught to an acceptable standard within 1 week. Most commonly used ultrasound parameters obtained by postprocessing for prolapse assessment can be taught to an acceptable standard of repeatability within one week.
- Determinants and management outcomes of pelvic organ prolapse in a low resource setting. [Journal Article]
- Ann Med Health Sci Res 2014 Sep; 4(5):796-801.
The last decade has seen significant progress in understanding of the pathophysiology, anatomy and management modalities of pelvic organ prolapse. A review of the way we manage this entity in a low resource setting has become necessary.The aim of the study is to determine the incidence, risk factors and management modalities of pelvic organ prolapse.A 5-year cross-sectional study with retrospective data collection of women who attended the gynecologic clinic in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south-east Nigeria and were diagnosed of pelvic organ prolapse was made. Proforma was initially used for data collection before transfer to Epi-info 2008 (v 3.5.1; Epi Info, Centers for Disease Control and Prevention, Atlanta, GA) software.There were 199 cases of pelvic organ prolapse, out of a total gynecologic clinic attendance of 3082, thus giving an incidence of 6.5%. The mean age was 55.5 (15.9) years with a significant association between prolapse and advanced age (P < 0.001). The age range was 22-80 years. The leading determinants were menopause, advanced age, multiparity, chronic increase in intra-abdominal pressure (IAP) and prolonged labor. Out of the 147 patients with uterine prolapse, majority, 60.5% (89/147) had third degree prolapse. Vaginal hysterectomy with pelvic floor repair was the most common surgery performed. The average duration of hospital stay following surgery was 6.8 (2.9) days and the most common complication was urinary tract infection, 13.5% (27/199). The recurrence rate was 13.5% (27/199). Most of the patients who presented initially with pelvic organ prolapse were lost to follow-up.The incidence of pelvic organ prolapse in this study was 6.5% and the leading determinants of pelvic organ prolapse were - multiparity, menopause, chronic increase in IAP and advanced age. Most were lost to follow-up and a lesser proportion was offered conservative management. Early presentation of women is necessary so that conservative management could be offered if feasible.