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Uterine Prolapse [keywords]
- Laparoscopic Reconstructive Surgery is Superior to Vaginal Reconstruction in the Pelvic Organ Prolapse. [Journal Article]
- Int J Med Sci 2014; 11(11):1082-8.
Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse.Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade ≥ 2 were selected and divided into two groups as follows: vaginal approach group (n=120) and laparoscopic approach group (n=54). We compared the results of clinical outcome by analyzing Student's t-test and χ(2)-test or the Fisher exact test as appropriate.There were significant difference in success rates without reoperation for recurrence as 91.7% (vaginal approach group, n=110) vs 100% (laparoscopic approach group, n=54), p=0.032. Mean follow-up duration was 31.3 ± 7.6 months for vaginal approach group and 29.7 ± 9.7 months for laparoscopic approach group. The Foley catheter indwelling duration (4.7± 1.9 vs 3.4±2.1 days, p< 0.001) and the length of postoperative hospitalization (6.4 ± 2.1 vs 5.0 ± 1.9 days, p <0.001) were significantly longer in vaginal approach group, whereas the operative time was significantly longer (108.2 ± 38.6 vs 168.3 ± 69.7 minutes, p <0.001) in laparoscopic approach group.Our result suggest there is significantly lower recurrence rate requiring reoperation and less catheterization time but increased operative time for laparascopic sacrocolpopexy.
- [Method and significance of ultrasonographic assessment of the uterine weight before pelvic floor reconstruction.] [JOURNAL ARTICLE]
- Zhonghua Fu Chan Ke Za Zhi 2014 Jun; 49(6):437-440.
To investigate the accuracy of ultrasonographic assessment of the total uterine weight and the feasibility of using this method in the pelvic floor reconstruction.Firstly, 81 cases with hysterectomy due to benign uterine diseases or uterine prolapse were studied. The preoperative dimensions and gravities of corpus uteri and cervix were calculated by formulas, and were then compared with the postoperative measurements. Subsequently, 46 cases with pelvic floor reconstruction and preserved the uterus were subjected to retrospectively analysis of uterine measurement parameters.There were no statistically differences between the preoperative and postoperative diameters of corpus uteri and cervix (P > 0.05), and no statistically differences between the weight of corpus uteri and cervix estimated by the formulas [(87 ± 55), (32 ± 6) g] and the true weight [(88 ± 57), (33 ± 6) g; P > 0.05]. In 46 cases that underwent the pelvic floor reconstruction by transvaginal mesh repair and preserved the uterus, 42 cases were successful treated and the average weight of total uterus was (49 ± 13) g (95%CI: 39.90-49.88 g); the 4 relapsed cases were treated with hysterectomy and the weight of total uterus were 85.24, 82.69, 92.67 and 120.06 g which were consistent with the weights estimated by the formulas (87.36, 82.00, 90.88, 123.12 g; all P > 0.05).The uterine weight might be a significant factor for uterus preservation in pelvic floor reconstruction, while ultrasonographic assessment can accurately estimate the uterine weight preoperatively. All these raised the feasibility of assessing uterine weight preoperatively in pelvic floor reconstruction.
- [Preliminary study on clinical application of robotic sacral hysteropexy in treatment of uterine prolapse.] [JOURNAL ARTICLE]
- Zhonghua Fu Chan Ke Za Zhi 2014 Jun; 49(6):428-431.
To study the clinical efficacy of robotic sacral hysteropexy in treatment of uterine prolapse.From January 2012 to December 2013, 3 patients undergoing robotic sacral hysteropexy in treatment of uterine prolapse in General Hospital of People's Liberation Army were studied retrospectively. Operation time, blood loss and postoperative recovery exhaust time and pelvic organ prolapse quantification (POP-Q) staging were evaluated.Three patients were treated by robotic sacral hysteropexy successfully. The mean operation time was 221 minutes (210-240 minutes), mean blood loss was 45 ml. One case with II degree perineal laceration patients simultaneously perineal repair, neither intra-nor post-operative complications occurred. The mean postoperative recovery exhaust time was 16 hours. At three months of follow-up, all 3 patients got satisfaction. Although one patient at the first six months of postoperation had leakage of urine when coughing, instruct exercise pelvic floor muscle function and acupuncture one month their symptoms disappear.Robotic sacral hysteropexy pave the way for an effective option in the management of uterine prolapse.
- 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.
- 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.