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1: BMJ 2002;324:1258-1262 ( 25 May ) [Texto completo]

Management of genital prolapse.

Ranee Thakar, Stuart Stanton.

Department of Urogynaecology, St George's Hospital, London. Correspondence to: R Thakar, Department of Obstetrics and Gynaecology, Mayday University Hospital, Croydon CR7 7YE e-mail: bthakar@doctors.org.uk

Publication Types:

Review

2: Curr Opin Obstet Gynecol  2001 Oct;13(5):499-505

Genital prolapse: vaginal versus abdominal route of repair.

Carey MP, Dwyer PL.

Department of Urogynaecology, Royal Women's Hospital and Mercy Hospital for Women, Melbourne, Australia. mcarey@netlink.com.au

In the presence of an ageing population, we can expect to see a dramatic increase in the prevalence of genital prolapse including vault and recurrent vaginal prolapse. The best approach for managing upper genital prolapse remains controversial. We review the surgical management of genital prolapse, with a focus on comparing the vaginal and abdominal approaches.

Publication Types:

Review

3: J Reprod Med  2000 Oct;45(10):789-97 [Texto completo en formato PDF]

Nonsurgical management of genital prolapse. A review and recommendations for clinical practice.

Poma PA.

Department of Obstetrics and Gynecology, University of Illinois at Chicago, Illinois, USA. ppoma@rhmc.com

The prevalence of genital prolapse increases with age. Because more women are living longer, genital prolapse will become even more common in our daily practices. Currently this complication is treated surgically, and there is minimal information about nonsurgical treatments. The National Library of Medicine was electronically searched for current information about the nonsurgical treatment of genital prolapse. This article summarizes the anatomic basis, the standard nomenclature, common symptoms and nonsurgical treatment of prolapse. Pessaries offer an alternative, even temporarily, to surgical therapy. Some women use a pessary on a long-term basis. There is no evidence in the literature that monthly follow-up improves outcome. Once fitted satisfactorily, women who wear pessaries need to be evaluated every three to six months.

Publication Types:

Review

4: Surg Clin North Am  2000 Oct;80(5):1443-64

Advanced laparoscopic gynecologic surgery.

Meeks GR.

The Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson 39216-4505, USA. rmeeks@ob-gyn.umsmed.edu

What is the future for laparoscopy? Any procedure thought to be impossible to perform by laparoscopy or procedures that, based on conventional wisdom, should not be done laparoscopically are being performed or developed as the reader peruses this article. Technical advances in the endoscopic equipment and development of laparoscopic instruments have allowed for performance of sophisticated procedures with laparoscopic assistance. Appropriate laparoscopic skills allow surgeons to perform these procedures in a fashion nearly identical to an open procedure; however, modifications of historically proven techniques are controversial regarding the expenses generated, equipment necessary to perform the procedure, training necessary, and potential for complications. Has the obituary of laparotomy been written? The benefits of laparoscopically assisted or performed procedures are continuing to be analyzed. LAVH has been touted as a way to reduce the number of abdominal hysterectomies while increasing the number of vaginal hysterectomies. Therefore, indications for LAVH would ideally more resemble indications for abdominal hysterectomy than vaginal hysterectomy; however, LAVH does not seem to have increased the total number of vaginal hysterectomies. Conversely, the number of abdominal hysterectomies seems to be roughly the same, whereas the number of vaginal hysterectomies has decreased and the number of LAVHs has increased. Therefore, surgeons seem to be substituting LAVH for vaginal hysterectomy. Studies comparing laparoscopic Burch procedures and open Burch procedures are just now being reported. Many early reports described procedures that are not classic Burch colposuspensions. These changes make it impossible to assume that overall success and rate of complications are the same. The same can be said for techniques for correction of pelvic organ prolapse. Although laparoscopic performance and laparoscopic assistance are increasing in popularity, most cases are not handled in this way. Clearly, not every surgeon has embraced using the laparoscope to treat patients who would otherwise have undergone abdominal or vaginal surgery.

Publication Types:

Review

5: Prim. Care Update Ob Gyns  1998 Jul 1;5(4):201

Abdominal sacral colpopexy for massive genital prolapse.

Powell JL, Joseph DB.

Department of Obstetrics and Gynecology, Coastal Area Health Education Center, New Hanover Regional Medical Center, North Carolina, Wilmington, USA

Objective: A retrospective study to determine the success and complications of abdominal sacral colpopexy in correcting massive genital prolapse over an 8-year period between September 1989 and January 1997.Methods: The charts were reviewed for 3 patients with massive procidentia and 15 patients with symptomatic posthysterectomy vaginal vault prolapse, who desired preservation of sexual function and underwent abdominal sacral colpopexy with Marlex mesh at two community teaching hospitals.Results: In 16 of the 18 patients, one or more concurrent procedures were performed at the same time, including three Burch colpocystourethropexies and one Raz bladder neck suspension, which successfully controlled urinary stress incontinence. In three cases, staging procedures were done for ovarian neoplasia. There were no intraoperative complications. One patient developed a superficial abdominal wound infection, one patient had a deep venous thrombosis in her left leg 7 days postoperatively, and one patient experienced a 1 cm area of graft erosion 10 months postoperative requiring partial resection. Duration of follow-up has varied from 8 months to 5 years. One patient died 43 months after surgery of unrelated causes. No patients developed recurrent prolapse.Conclusions: Abdominal sacral colpopexy is a successful operation for the correction of prolapse. Serious complications are infrequent. Photographs of the technique and a review of the literature are presented.

6: Eur J Obstet Gynecol Reprod Biol  1999 Jul;85(1):57-62

Laparoscopic management of pelvic organ prolapse.

Margossian H, Walters MD, Falcone T.

Department of Obstetrics and Gynecology, Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, OH 44195, USA.

Until recently, most major gynecologic surgery was performed either vaginally or by laparotomy. In the last decade, surgeons have explored laparoscopic access for many gynecologic surgical disorders. Pelvic reconstructive surgery can be performed laparoscopically but demands a high skill level especially in suturing. Initial reports for laparoscopic bladder neck suspension for genuine stress urinary incontinence are encouraging but lack long term follow-up. The literature contains only a few case studies addressing pelvic support procedures. In this review we present our methods for laparoscopic management of different types of pelvic floor support defects. We view laparoscopy as a method of access rather than a procedure. We present laparoscopic techniques that do not modify the surgical procedures that have been validated by conventional surgery.

Publication Types:

Review

7: Medscape Womens Health  1997 Mar;2(3):5

Vaginectomy: Profile of Success in Treating Vaginal Prolapse.

Smale LE, Smale CL, Mundo NG, Rivera R.

Department of Obstetrics and Gynecology at Kern Medical Center, Bakersfield, Calif.

Treatment of procidentia and vaginal inversion in older women either with pessaries or surgery commonly brings poor results. Women are unable to retain the pessary; they develop vaginitis and vaginal ulcerations; and surgical "correction" fails due to age-induced genital atrophy or previous obstetrical trauma. We performed a retrospective chart review to assess results of our own technique of vaginectomy/hysterectomy and pelvic floor closure for vaginal vault prolapse and procidentia in 26 aged sexually inactive women seen in our practice. The women ranged from 63 to 83 years of age and had borne 0 to 9 children. Where possible, an estrogen-containing medication was introduced into the vagina preoperatively to stimulate thickening of the vaginal mucosa. A standard Heaney or Doderlein vaginal hysterectomy was performed. Operative time averaged 100 minutes, blood loss averaged 278mL, and 5 patients required a blood transfusion. All patients were discharged in good condition after an average stay of 4.67 days, although 9 of the 24 patients had complications. Since body-cavity invasion was minimal, postoperative care was simple, consisting of hydration with intravenous fluids, urine drainage utilizing an indwelling catheter, (while preventing bladder distension), early ambulation, and prophylaxis against infection and thromboembolism.

8: Pediatr Clin North Am  1997 Oct;44(5):1091-115

Common office problems in pediatric urology and gynecology.

Brown MR, Cartwright PC, Snow BW.

Department of Urology, University of Utah School of Medicine, Salt Lake City, USA.

The number of genital problems that pediatricians encounter is substantial. The most common ones have been reviewed in this article. Perhaps the most important point to reinforce is the appropriateness of nonintervention in uncircumcised boys whose foreskins have not become retractile during early school years. Without infections or pathologic phimosis, these boys do well, and most foreskins become retractile as they approach puberty. Abnormalities beyond those discussed or those not fitting the anticipated pattern probably warrant specialty referral.

Publication Types:

Review

9: Am Fam Physician  1997 Feb 15;55(3):827-34

Erratum in:

 Am Fam Physician 1997 Apr;55(5):1586

Comment in:

 Am Fam Physician. 1997 Feb 15;55(3):774-6.

 Am Fam Physician. 1997 Sep 15;56(4):1064, 1067-8.

Hysterectomy: indications, alternatives and predictors.

Kramer MG, Reiter RC.

University of Iowa College of Medicine, Iowa City, USA.

Hysterectomy, the most common major nonobstetric operation, is performed in more than 570,000 women in the United States each year. Although the number of hysterectomies has decreased in recent years, many authorities believe that hysterectomy is often unnecessary and unjustified. There is no universally accepted set of criteria regarding the appropriate indications for hysterectomy. The main indications for hysterectomy include the following conditions: uterine leiomyomas, dysfunctional uterine bleeding, endometriosis/adenomyosis, chronic pelvic pain and genital prolapse. Current literature, however, routinely recommends conservative management of most nonmalignant gynecologic conditions, with hysterectomy reserved for refractory cases. Several nonmedical factors, such as patient race, age, geographic location, medical history and background, as well as health care provider characteristics, such as time since completion of training, gender, and affiliation with teaching hospitals, are also associated with hysterectomy rates.

Publication Types:

Review

10: J Endourol  1996 Jun;10(3):259-65

Correction of genital prolapse.

Liu CY, Reich H.

Chattanooga Women's Laser Center, TN, USA.

Massive eversion of the vagina is one of the most disturbing disorders confronting a woman. It is a complex disorder that always coexists with other pelvic floor defects. The management is almost always surgical, and all defects must be repaired concomitantly. Current surgical practice relies primarily on the strength of the endopelvic fascia and certain ligaments, which clearly is not ideal for providing the kind of support needed. Current understanding of the neurophysiology, neuroanatomy, and biophysics of the pelvic floor give us hope that management will be more effective in the future. Laparoscopic repair techniques are described.

Publication Types:

Review

11: Obstet Gynecol Surv  1996 Apr;51(4):253-60

Management of genital prolapse in neonates and young women.

Loret de Mola JR, Carpenter SE.

Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, USA.

The presence of genital prolapse in neonates and young women poses a challenging management problem to the gynecologist. Neonatal uterine prolapse is associated with congenital spinal defects, and successful correction has been achieved mainly with simple digital reduction or the use of a small pessary. Uterine prolapse can also occur in young or nulliparous woman who wish to preserve their fertility. Operations using sling, sacral cervicopexy, or transvaginal sacrospinal fixation techniques seem to provide excellent repair for these patients, including the possibility of childbearing. A review of the pathophysiology of genital prolapse in neonates and young women with emphasis on the surgical and nonsurgical options for management is presented.

Publication Types:

Review