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Uterine Prolapse [keywords]
- Knowledge on uterine prolapse among married women of reproductive age in Nepal. [Journal Article]
- Int J Womens Health 2014.:771-9.
Uterine prolapse (UP), which affects about 10% of women of reproductive age in Nepal, is the most frequently reported cause of poor health in women of reproductive age and postmenopausal women. Currently, women's awareness of UP is unknown, and attempts to unravel the UP problem are inadequate. This study aims to assess UP knowledge among married reproductive women, and determine the association between UP knowledge and socioeconomic characteristics.Our cross-sectional descriptive study investigated 25 districts representing all five administrative regions, three ecological zones, and urban and rural settings. We used structured questionnaires to interview 4,693 married women aged 15-49 years. We assessed UP knowledge by asking women whether they had ever heard about UP, followed by specific questions about symptoms and preventive measures. Descriptive statistics characterized the study population regarding socioeconomic status, assessed how many participants had ever heard about UP, and determined UP knowledge level among participants who had heard about the condition. Simple regression analysis identified a possible association between socioeconomic characteristics, ever heard about UP, and level of UP knowledge.Mean age of participants was 30 years (SD [standard deviation] 7.4), 67.5% were educated, 48% belonged to the advantaged Brahmin and Chhetri groups, and 22.2% were Janajati from the hill and terai zones. Fifty-three percent had never heard about UP. Among women who had heard about UP, 37.5% had satisfactory knowledge. Any knowledge about UP was associated with both urban and rural settings, age group, and education level. However, satisfactory knowledge about UP was associated with administrative region, ecological zones, caste/ethnic group, and age group of women.Fifty-three percent of participants had never heard about UP, and UP knowledge level was satisfactory in 37.% of those who had ever heard about UP. Any knowledge was associated with urban/rural setting, age group, and education level, whereas satisfactory knowledge was associated with geography, caste/ethnic group, and age group. UP-related health promotion programs should target women from all caste/ethnic groups, age groups, and education levels, including urban and rural communities.
- [Sling suspension: a new technique of treating uterine prolapse]. [English Abstract, Journal Article]
- Zhonghua Yi Xue Za Zhi 2014 Jun 3; 94(21):1664-6.
To report a novel surgical technique of laparoscopic extraperitoneal sling suspension for uterine prolapse and evaluate its efficacy.A total of 21 consecutive patients of symptomatic uterovaginal prolapse with POP-Q (pelvic organ prolapse quantification system) stage ≥ 2 and aged 59 (42-76) years were enrolled for this procedure between September 2011 and December 2012. In brief, uterus was suspended to anterior abdominal wall fascia using an inelastic nonabsorable mesh extraperitoneally under laparoscopic guidance. The outcomes of interest included total operative duration, estimated blood loss, surgical length of stay POP-Q score change and quality of life questionnaire in pelvic floor distress inventor [PFDI-20] and pelvic floor impact questionnaire [PFIQ-7]. Follow-ups were scheduled at 1, 6 and 12 months and then annually. Comparisons were made between at preoperation and 6 and 12 months. The surgical success was defined as both subjective cure and significant improvement of POP-Q.This procedure was performed successfully in all patients. The estimated blood loss 10 (10-40) ml, operative duration 30 (25-90) minutes and postoperative hospital stay 1 (1-5) day. There were no major intraoperative or postoperative complications. The median follow-up was 20 (12-26) months. There were significant improvements in POP-Q measurements of Ba and C (P < 0.01) and quality-of-life scores (P < 0.01) at 6 and 12 months. The subjective cure rate was 100% and surgical success rate at 12 months 100%.This new sling suspension technique for uterine prolapse is safe, well-tolerated and effective so that it offers a simple alternative of laparoscopic uterine suspension.
- Assessing Adequacy of Cervical Core Specimens from Extirpated Uteri: Implications for Laparoscopic Supracervical Hysterectomy with Transcervical Coring. [JOURNAL ARTICLE]
- J Minim Invasive Gynecol 2014 Aug 19.
To describe the histopathologic adequacy of cervical specimen after ex vivo excision of the cervical canal with cervical coring.Cervical tissue analysis from 11 hysterectomy specimens was performed on samples collected with a 15mm or 20mm Classic Intrafascial Supracervical Hysterectomy (CISH) instrument set (WISAP GmbH, Munich, Germany). Demographic information was collected as well as indication for hysterectomy. Gross specimen evaluation and histopathologic assessment were completed.Classification: Descriptive study (Canadian task force classification III) SETTING: Community based medical center with university affiliation in Cambridge, MA INTERVENTION: Endocervical coring MEASUREMENTS AND MAIN RESULTS: Eleven cervical core samples from hysterectomy specimens were evaluated. Cervical coring was performed with a 15mm and 20mm CISH instrument for 6 and 5 specimens respectively. Mean age of patient was 49 years, median parity 2 (0-3). Three (27.3%) patients were post menopausal. The majority of the patients (72.7%) had leiomyomata and abnormal uterine bleeding as indication for hysterectomy whereas 3 (23.3%) patients had uterovaginal prolapse. The most common cervical pathologic diagnosis was chronic cystic cervicitis (72.7%). Histopathologic presence of the entire cervical transformation zone was present in all eleven cervical core samples. Endocervical glands were absent in the radial margins of all samples. Endometrial glands were absent in the radial margins in seven samples (63.6%). There was no statistically significant difference in age, parity, cervical remnant and cervical core dimensions between both core sizes (p > 0.05).Cervical coring to remove the endocervical canal at the time of hysterectomy resulted in adequate removal of endocervical glands and endometrial glands in majority of cases using either the 15mm or 20mm CISH instrument.
- Differential expression profiling of matrix metalloproteinases and tissue inhibitors of metalloproteinases in females with or without pelvic organ prolapse. [JOURNAL ARTICLE]
- Mol Med Rep 2014 Aug 8.
Pelvic organ prolapse (POP) is a common disorder that can disturb the health and quality of life of females. However, the basic pathophysiology and underlying mechanism of POP are not fully understood. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) have been reported to be associated with the onset and development of POP. In the present study, to characterize the differential expression profile of MMPs and TIMPs in female patients with and without POP, a total of 72 POP patients were sampled as a patient group and 72 non-POP patients that underwent hysterectomy due to benign tumors were sampled as a control group. Immunohistochemistry and polymerase chain reaction analysis were used to detect the expression levels of MMP-1, -2, -3 and -9 as well as TIMP-1 protein and mRNA in the anterior vaginal wall tissues. The expression levels of MMP-1, -2, -3 and -9 in the patient group were found to be significantly higher than those in the control group. By contrast, TIMP-1 expression levels in the patient group were significantly lower than those in the control group. Correlational analysis revealed a significantly positive correlation among the expression levels of MMP-2, -3 and -9. TIMP-1 expression levels were significantly negatively correlated with the expression levels of MMP-3 and -9. In addition, the expression levels of MMP-1 exhibited a positive correlation with those of MMP-2, -3 and -9, but a negative correlation with those of TIMP-1. The results demonstrated that the increased expression levels of MMPs and the reduced expression levels of TIMPs were directly associated with the presence of uterine prolapse, indicating that the differential expression levels of MMPs and TIMPs were correlated with the occurrence and development of POP. This data may assist in elucidating the molecular mechanism of MMP and TIMP involvement in POP, and also provide an underlying theoretical basis for the prevention and treatment of POP.
- [Richter's sacrospinous ligament fixation and its place in current gynecology]. [English Abstract, Journal Article]
- Akush Ginekol (Sofiia) 2014; 53(2):21-4.
In 1968 K. Richter treated post-hysterectomy prolapse of the vaginal stump by fixating the vaginal stump to the sacrospinous ligament via transvaginal route. Nowadays most authors perceive this technique as an inseparable component of vaginal hysterectomy, for the purpose of preventing vaginal stump prolapse. The authors present the results of Richter's operation among 53 patients, 33 of whom operated on in the Department of General and Oncological Gynaecology at the Military Medical Academy (Sofia), 12 operated on in the Department of Gynaecology at the Military Medical Academy (Varna), 4 in the Municipal Maternity Hospital "St Sofia" (Sofia) and 4 in the Department of Obstetrics and Gynaecology at the Multi-profile Hospital for Active Medical Treatment (Samokov) during the period 2009-2013. In 26 of the cases (49%) the operative indication was a severe vaginal descensus, in 23 (44%)--total uterine prolapse, in 4 (7%)--prolapse of the vaginal stump following hysterectomy. Twenty-six of those women (56%) didn't have any symptoms of urinary incontinence, as 20 (38%) had symptoms of urinary stress incontinence. The median age of operated women is 64 (age range: 43-78 y.o.). All of them experienced at least once a vaginal birth (average parity: 2). The average duration of subjective complaints caused by their condition was 41 months (range: 2-120 months.) The average duration of the operation was 122 minutes (range: 60-210 min). The average amount of blood lost during the operation was 218 ml (range: 60-400 ml). No intraoperative complications were registered. Early postoperative complications consisted in 3 cases of considerable bleeding through the stitches which faded without any special measures, blood transfusion included. One patient developed a haematoma in the ischiorectal fossa which was incised and evacuated. The long-term results, recorded at post-op visits 1 and 6 months after the operation, were satisfactory: regardless their age and their preoperative genital status, surgery in 93% of the cases has led to stable correction of the pelvic statics and disappearance of urinary incontinence in case the latter did exist. Recurrent prolapse was noted in 4 cases (7%), in two of which the condition was diagnosed as a partial recurrence. The authors regard those recurrences as resulting from technical errors, rather than as a shortcoming of the surgical procedure.
- [Indications and methods of hysterectomy]. [English Abstract, Journal Article]
- Orv Hetil 2014 Jul 1; 155(29):1152-7.
Hysterectomy is one of the most frequently performed gynecological operations. The most common indications for hysterectomy are symptomatic uterine fibroids, endometriosis, and uterine and pelvic organ prolapse. The procedure can be performed by vaginally or abdominally and with laparoscopic assistance. Choosing the perfect method the gynecologist should take into consideration how the procedure can be performed most safely to fulfill the needs of the patient. In the last few years the number of the laparoscopic procedures has been increasing. Orv. Hetil., 2014, 155(29), 1152-1157.
- Long-term Clinical Outcomes Following Resectoscopic Endometrial Ablation of Non-Atypical Endometrial Hyperplasia in Women with Abnormal Uterine Bleeding. [JOURNAL ARTICLE]
- J Minim Invasive Gynecol 2014 Jul 15.
To determine the feasibility, efficacy, and long-term clinical outcomes of resectoscopic endometrial ablation as primary treatment of simple and complex endometrial hyperplasia without atypia in women with abnormal uterine bleeding.From January 1990 through December 2012, the senior author (GAV) performed 4 729 primary resectoscopic endometrial ablations to treat women with abnormal uterine bleeding. This group included 161 women with endometrial hyperplasia, identified either by office biopsy (n = 62) or incidentally during routine hysteroscopic endometrial ablation (n =99). Endometrial tissue by D&C and/or resected during resectoscopic surgery identified 6 women with atypical hyperplasia (4 complex, 2 simple) and 1 with adenosarcoma. One atypical complex hyperplasia and the adenosarcoma received hysterectomy. The remaining 159 women, including 5 with atypical hyperplasia (3 complex, 2 simple), received resectoscopic endometrial ablation (102 simple, 52 complex) as primary treatment. The median (range) age and BMI was 50 years (30-87) and 32 kg/m(2) (17-59), respectively. Comorbidities included, hypertension in 25, diabetes in 14, cerebrovascular disease in 3, cardiovascular disease in 7 and hypothyroidism in 8 women. Office biopsy was proliferative endometrium in 68, simple hyperplasia in 43, complex hyperplasia in 19 and inadequate in13 women. In 18 women, we were unable to perform biopsy due to cervical stenosis, morbid obesity or patient intolerance. Endometrium was resected in 120 women, electrocoagulated in 34 and combination in 5 women, using a 9 mm (26F) resectoscope, 1.5% glycine and 120 w of power. Patients were followed up annually. Three patients were lost to follow up and one died from unrelated cause 5 years after surgery.There was one uterine perforation requiring no additional treatment. Simple and complex endometrial hyperplasia was identified in 70 and 35 women after endometrial ablation, respectively. At a median follow up of 7 years (1.5-18), 12 patients had hysterectomy for; persistent bleeding-6, benign ovarian cyst-2, pelvic organ prolapse-1, chronic pelvic pain-2, fibroids-1. Uterine histopathology in 11 patients indicated no residual endometrial hyperplasia. We were unable to obtain pathology report in one. The remaining 138 women were very satisfied with their treatment with no further bleeding or pain in 132 (95.7%). Six patients (4.3%) had monthly spotting.Resectoscopic endometrial ablation is feasible, safe and effective treatment of simple and complex endometrial hyperplasia without atypia in women with abnormal uterine bleeding by experienced hysteroscopic surgeons.
- Vaginal hysterectomy: past, present, and future. [Journal Article]
- Int Urogynecol J 2014 Sep; 25(9):1161-5.
Vaginal hysterectomy is the oldest and least invasive of the hysterectomy techniques and fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Currently, vaginal hysterectomy is commonly utilized for treating uterine prolapse, but despite proven safety and effectiveness, the use of vaginal hysterectomy for treating non-prolapse conditions has been and remains underutilized in surgical practice. Improving the use of vaginal hysterectomy in the future will likely depend on addressing the key issues of training and maintaining skills in the technique and increasing awareness of the scientific evidence supporting its use.
- PLD.23 Management of transverse and unstable lie at term. [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A112-3.
To determine current practice and outcomes in women admitted to antenatal ward with diagnosis of transverse or unstable lie.Fetal lie (other than longitudinal) at term may predispose to prolapse of cord or fetal arm and uterine rupture. Local guidelines recommend admission at 37+0 (RCOG guidelines after 37+6 weeks) but give no specific recommendations regarding further management.A retrospective study was conducted at St Thomas' Hospital, London from 2009-2012 of all women admitted with unstable/transverse lie. The diagnosis was based on ultrasound examination. Women with placenta praevia and non-singleton deliveries were excluded.Study included 198 cases of unstable/transverse lie. 58% were admitted before 38 weeks. The average length of admission was 7 days (IQR 4-11). There were no cases of cord prolapse or need for an immediate caesarean section from the antenatal ward. 73% of women had a caesarean section at a median gestation of 39+1 weeks (IQR 38+4 - 40+2) although almost half of these (41%) had a cephalic presentation at the time of elective caesarean sections. None of these had an absolute indication for Caesarean section.The diagnosis of unstable/transverse lie leads to a prolonged inpatient stay and a high Caesarean section rate. From our study and the evidence from the available literature, we recommend delaying admission until at least 38 weeks and awaiting spontaneous version. Future research should focus on the safety of outpatient management with consideration of utilising techniques such as cervical length and fetal fibronectin.