Prolapse

PURPOSE: The aim of this study was to evaluate 5-year and 10-year disease-free survival, urinary dysfunction, and sexual activity after nerve-sparing radical surgery, including lumboaortic lymphadenectomy for rectosigmoid cancer. METHODS: Since 1980 to 1992, 302 consecutive patients affected with rectal (188) or sigmoid (114) resectable cancer underwent radical surgery. Lumboaortic lymphadenectomy was routinely performed and total mesorectal dissection was always accomplished in rectal cancer. Splanchnic nerves, superior hypogastric plexus, hypogastric nerves, and sacral parasympathetic nerves were sought, identified, and preserved or, when necessary, unilaterally sacrificed. Fifty-three (17.6 percent) patients were classified Dukes A, 145 (48.0 percent) B, 46 (15.2 percent) C1, and 17 (5.6 percent) C2. Thirtynine (12.9 percent) patients were Dukes D. In 85 rectal cancer patients, tumor was located at the lower third. Eighty-six of 210 Dukes B and C patients were submitted to systemic chemotherapy and/or high-dose pelvic radiotherapy. RESULTS: The actuarial 5-year disease-free survival was 58.5 percent in rectal and 65.7 percent in sigmoid cancer patients, median follow-up time was 47 months. During the follow-up, each patient was interviewed about sexual activity and urinary dysfunction and a questionnaire was filled out. Urinary dysfunction was not frequently observed, while a definitive sexual impotence was reported in 27.6 percent of the patients. The age under 60 years and sphincter-saving surgery were demonstrated as significantly contributing to retaining a satisfactory sexual activity. CONCLUSIONS: Unexpectedly high disease-free survival was observed in the Dukes C2 subgroup. It allows us to hypothesize that lumboaortic lymphadenectomy could remove neoplastic microfoci present at this level in those patients, enhancing surgical chances of cure. The majority of male patients under 60 years old can retain a satisfactory sexual activity after undergoing a nerve-sparing sphincter-saving cancer surgery.

Two hundred and thirty two patients with genitourinary prolapse were operated via an abdominal incision between 1981 and 1994. The technique consisted of retroperitoneal promontofixation, systematically associated with a retropubic colposuspension, levator myorrhaphy, Douglassectomy and uterosacral ligamentoplasty. The mean age of operated patients was 52.57 years (30-85 years), the mean follow-up was 17.8 months (1-105). 65 patients (27.7%) had a history of foetal macrosomy, 125 women (53.4%) were delivered without forceps or expression, and 2 patients (0.8%) had never procreated. The main presenting complaint was prolapse in 197 patients (84.4%), while 140 patients complained of urinary incontinence (60.3%). A urodynamic assessment was systematically performed before the operation and revealed defective transmission in 160 cases (71%); sphincter incompetence in 62 cases (62/228 cases, i.e. 27%); a combination of sphincter incompetence and defective transmission in 40 cases (17.7%)...

We aimed to gain insight into umbilical cord prolapse (UCP) reported by primary care midwives in the Netherlands. Cases of UCP were reported by midwives who participated in a postgraduate training programme developed for community-based midwives. Cases were analysed using midwifery charts, ambulance report forms and discharge letters. Procedures to alleviate cord pressure, ambulance timing, mode of birth and neonatal outcomes were inventoried. Diagnosis to delivery interval (DDI) and risk factors were identified. Eight cases of UCP in primary midwifery care were reported of which six occurred at home. Risk factors such as malpresentation (breech) and/or unengaged presenting part were found in four cases, two (unengaged fetal head) were known to the midwife prior to birth. Retrograde bladder filling (2/8), manual elevation of the fetal head (7/8) and Trendelenburg position (1/8) were applied. One infant died of severe birth asphyxia; the other infants recovered and were discharged in...

Prolapse of the lacrimal gland is an acquired clinical condition caused mainly by relaxation of the local suspending ligaments. Before an aesthetic blepharoplasty, there should be a preoperative clinical suspicion of lacrimal gland pathology for patients with bulging lateral thirds of the upper eyelids. It should be borne in mind that inadvertent removal of the lacrimal gland can lead to important alterations in ocular lubrication. This report describes two clinical cases of patients with lacrimal gland prolapse associated with dermatochalasis and their treatment.

To describe fornix reconstruction for conjunctival prolapse occurring after ocular surgery. Two patients with persistent conjunctival prolapse of variable duration following ocular surgery underwent fornix reconstruction using the method described by Barrett. The two patients underwent different surgical methods. In the second patient, no attempt was made to include the malar periosteum. Case 1 with longer duration of prolapse needed further surgery to excise residual prolapsing conjunctiva that had hyperplastic squamous epithelium. Case 2 in which fornix reconstruction was done 2 months after prolapse showed a good result after only one surgical operation. Forniceal reconstruction is recommended for persistent postoperative conjunctival prolapse. Early surgery appears to have better results.

We aimed to gain insight into eight cases of umbilical cord prolapse (UCP) reported by primary care midwives in the Netherlands. Diagnosis-to-delivery interval (DDI) and risk factors were identified. Six cases occurred at home. Risk factors were found in four cases, but only two (unengaged fetal head) were known to the midwife prior to birth. One infant died of severe birth asphyxia; the other infants recovered and were discharged in good condition. The DDI varied from 13 to 72 minutes (median 41 minutes). The shortest DDI was found in the two cases of UCP occurring in hospital and birthing centre. In the six cases of UCP at home, DDI ranged from 31-72 minutes. The DDI is increased when UCP occurs at home, but no association with a less favourable perinatal outcome was found. Continuing multidisciplinary training is encouraged and guidelines should be developed and implemented.

Purpose The aim of this study was to compare the incidence of recurrence and residual skin tag after the procedure for prolapse and hemorrhoids (PPH) versus conventional hemorrhoidectomy (CH) in the Chinese- and English-language literature to explore the definition of recurrence after PPH. Methods Related Chinese- and English-language literature was collected by several methods. Meta-analysis was used to compare the incidence of recurrence and residual skin tag of PPH versus CH. Results In China, 13.94% of hemorrhoids had a skin tag after PPH. The mean recurrence rate after PPH was 3.23% (range 0.40–26.44%). Our meta-analysis of PPH versus CH of the Chinese studies showed that PPH had a significantly lower recurrence rate—13 studies, odds ratio (OR) 0.27, 95% confidence interval (CI) 0.17–0.42, p < 0.00001—and a higher incidence of skin tags with no significance—6 studies, OR 3.42, 95% CI 0.49–24.04, p = 0.22. Our meta-analysis of PPH versus CH among the English-language studies showed that PPH had a significantly higher recurrence rate—17 studies, 636 patients in the PPH group vs. 625 patients in the CH group, OR 2.96, 95% CI 1.57–5.56, p = 0.0008—and a significantly higher incidence of residual skin tags—8 studies, 297 patients in the PPH group vs. 289 patients in the CH group, OR 1.88, 95% CI 1.15–3.05, p = 0.01. However, the recurrence of prolapse was stated to be ascertained by anorectal examination in only six studies; meta-analysis of the six studies showed that PPH was not associated with a higher recurrence—six studies, 230 patients in the PPH group vs. 220 patients in the CH group; OR 1.87, 95% CI 0.70–5.00, p = 0.22. Conclusions PPH is not associated with a higher recurrence rate but is associated with a higher incidence of skin tags compared with CH. The reported high recurrence rates are probably caused by improper inclusion of residual skin tags into the recurrence data. Surgeons should perform anorectal examinations to differentiate a residual skin tag from a recurrence.

It is simply an eversion of the uterus which turns inside out as t passes through the vagina. Prolapse of the uterus generally occurs immediately after or a few hours of parturation when the cervix is open and the uterus lacks tone (Hanie, 2006). Post partum uterine prolapse occurs in all large animal species. It is most common in the cow and ewe, less common in the doe goat and rare in the mare. In sheep, the condition is usually seen in mature females in the last trimester of pregnancy. Predisposing factors include increased intra-abdominal pressure associated with increased size of the pregnant uterus, intra-abdominal fat, or rumen distention superimposed upon relaxation and softening of the pelvic girdle and associated soft-tissue structures in the pelvic canal and perineum. The prolapse is visible as a large mass protruding from the vulva, often hanging down below the animal’s hock. The placenta may likely be retained during this period (Roberts, 1982). Animals with uterine prolapse treated promptly recovers without complication while delay treatment could result in death of the animal in a matter of hour or so from internal hemorrhage caused by the weight of the organ which tears the mesovarium and artery (Noakes et al., 2001). Success of treatment depends on the type of case, the duration of the case, the degree of damage and contamination.

A 4 year old, intact Spitz bitch weighing 12 kg with a mass outside from the vulvar lips seen by the owner described in this case report. At the examination the mass was examined, condition diagnosed as cervico-vaginal prolapse, necrotic part, along with secondary miasis and ultrasonography examination confirmed retrofelxion of urinary bladder. Animal undergone surgery for necrotic cervico-vaginal prolapsed mass underneath of general anaesthesia. Here, it might be the 1 st case report of necrosis, incidence of miasis in cervico-vaginal prolapsed mass. Here in this case report, describe the surgical excision of a cervico-vaginal prolapse with retroflexion of urinary bladder with secondary miasis and successful reproduction following estrous.

The purpose of this study was to assess the effect on quality of life and prolapse severity of traditional anterior repair compared to anterior repair with a small intestine submucosa (SIS) graft. This report was designed as a case-control study. The sample of this study consisted of 14 women who underwent traditional anterior repair and 14 women who underwent anterior repair with SIS graft (SG) at a London teaching hospital. All women were assessed preoperatively and at 6 and 24 months postoperatively using a validated prolapse quality of life questionnaire and pelvic organ quantification system (POP-Q). Quality-of-life outcomes included the following: (1) General health perception, (2) Prolapse impact, (3) Role limitations, (4) Physical limitations, (5) Social limitations, (6) Personal relationships, (7) Emotions, (8) Sleep/Energy, and (9) Severity measures. The pelvic organ quantification measurement measured nine specific points relating to the anterior and posterior wall of the vagina, vaginal apex, genital hiatus (GH) and perineal body (PB). At 6-month follow-up, the SG repair group showed significant improvement in all quality-of-life parameters measured. In comparison to traditional repair, it was significantly better in improving role limitations, physical limitations and emotions. Both operations significantly improved prolapse quality-of-life severity measures. SG repair improved all POP-Q measurements significantly, except total vaginal length (TVL), whereas traditional repair improved some measurements (AA, midline point of anterior vaginal wall 3 cm proximal to the external urethral meatus; BA, most distal dependant position of the anterior vaginal wall from the vaginal vault or anterior fornix to AA; C, most distal/dependant edge of cervix or vault; AP, point on midline posterior vaginal wall 3 cm proximal to hymenal ring; BP, most distal/dependant point on the posterior vaginal wall from vault or posterior fornix to AP) but not others (location of posterior fornix (D), TVL, GH and PB). At 2-year follow-up, there was no significant difference between the two groups in terms of quality-of-life outcomes or prolapse severity measurements. Surgery for vaginal prolapse results in marked improvement in quality of life and prolapse severity. The greater improvement seen initially in the SG anterior group was not seen at 2-year follow-up.

Objective  To determine whether the introduction of multi-professional simulation training was associated with improvements in the management of cord prolapse, in particular, the diagnosis–delivery interval (DDI).Design  Retrospective cohort study.Setting  Large tertiary maternity unit within a University Hospital in the United Kingdom.Sample  All cases of cord prolapse with informative case record: 34 pre-training, 28 post-training.Methods  Review of hospital notes and software system entries; comparison of quality of management for umbilical cord prolapse pre-training (1993–99) and post-training (2001–07).Main outcome measures  Diagnosis–delivery interval; proportion of caesarean section (CS) in whom actions were taken to reduce cord compression; type of anaesthesia for CS births; rate of low (<7) 5-minute Apgar scores; rate of admission to neonatal intensive care unit (NICU) (if birthweight >2500 g).Results  After training, there was a statistically significant reduction in median DDI from 25 to 14.5 minutes (P < 0.001). Post-training, there was also a statistically significant increase in the proportion of CS where recommended actions had been performed (from 34.78 to 82.35%, P = 0.003). There was a nonsignificant increase in the use of spinal anaesthesia for CS, from 8.70 to 17.65%, and a nonsignificant reduction in the rate of low Apgar scores from 6.45 to 0% and in the rate of admission to NICU from 38.46 to 22.22%.Conclusions  The introduction of annual training, in accordance with national recommendations, was associated with improved management of cord prolapse. Future studies could assess whether this improved management translates into better outcomes for babies and their mothers.

Prolapsed orbital fat has rarely been described and is often confused with other conjunctival tumours, such as dermolipoma. We describe the clinical features and treatment of 15 patients with prolapsed orbital fat. We report here our experience in 15 consecutive patients who presented to the Vision Institute of Federal University of São Paulo, Brazil, between July 2004 and December 2007. Age, sex, presenting complaint, physical findings, associated local and systemic diseases, type of treatment, and complications were recorded. Ten patients were men, and ages ranged from 44-86 (mean 68). Eleven patients presented with unilateral disease. Thirteen had superotemporal prolapse, and two atypical superonasal prolapse. Two gave a history of trauma. All patients had the prolapsed fat excised for cosmetic reasons. There were no complications. Orbital fat prolapse is usually superotemporal, mainly in men, and is easily differentiated from other lesions, such as prolapsed lacrimal gland. Excision is always indicated, usually for cosmetic reasons.