China
Africa
Explore chapters and articles related to this topic
Urogenital prolapse
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Sushma Srikrishna, Dudley Robinson
A longitudinal posterior vaginal wall incision is performed to expose the rectovaginal space. The right ischial spine is then identified and exposed using sharp and blunt dissection. The sacrospinous ligament may then be palpated running from the ischial spine to the lower aspect of the sacrum. An absorbable braided polyglycolic suture (Dexon, Davies + Geck) is passed through the ligament using a Miya hook ligature carrier and then through the vaginal vault. Care must be taken to avoid the sacral plexus and sciatic nerve, which are superior, and the pudendal vessels and nerve, which are lateral to the ischial spine. Once the enterocele has been secured using two purse-string sutures, the upper third of the vagina is closed as previously described. The sacrospinous sutures are then tied to support the vaginal vault from the sacrospinous ligament, following which a perineorrhaphy is performed.
Prolapse of Uterus and Vagina
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
This is the prolapse of the vault of vagina, usually after an abdominal or vaginal hysterectomy. Small vault prolapse may be dealt with conservatively by perineal floor exercises. A shelf pessary may be used if surgery is not considered an option. However, large vault prolapses usually require surgical treatment. Vaginal sacrospinous ligament fixation is done by the vaginal route by tying the vaginal vault with the sacrospinous ligament. For more severe vault prolapse, an abdominal sacrocolpopexy (open or laparoscopic) is a better choice of procedure. In this case, a Mersilene tape strip is attached to the vault and the vault is attached to the sacral promontory.
Vaginal Vault Prolapse: Sacrofixation
Published in Victor Gomel, Bruno van Herendael, Female Genital Prolapse and Urinary Incontinence, 2007
Jacques Donnez, Jean-Paul Squifflet, Pascale Jadoul, Mireille Smets
Sacrofixation, in contrast to sacrospinous ligament fixation, is a more anatomical repair. It does not favor development of a secondary cystocele, it does not cause vaginal shortening and, provided that prevertebral dissection is well performed and particular care is taken to insert the springs into the central part of the body of the vertebra, it is without risk for the nerves. Difficulties can be encountered in overweight women who have a deep layer of adipose tissue between the prevertebral peritoneum and the vertebral bone itself.
Postoperative indications for further surgery following post-transvaginal ProliftTM mesh repair after a two-year follow-up period: a single-centre study
Published in Journal of Obstetrics and Gynaecology, 2022
Hirotaka Sato, Katsuhiko Sato, Junichi Mochida, Satoru Takahashi, Sachiyuki Tsukada
Surgeries were performed at the hospital by a trained urologist, as previously described (Fatton et al. 2007). The surgical technique included a wide dimension, hydro-dissection of the vaginal wall overlying the bladder or rectum, using 50 mL of 1% adrenaline, diluted 1:1,000,000 in 500 mL of normosaline solution. The anterior incision was prolonged in the paravesical space, ischial spine, and arcus tendinous fasciae pelvis (ATFP). The anterior mesh was configured with its two lateral arms on either side, which perforated the obturator foramen at the ATFP level. The posterior mesh configuration consisted of a lateral arm on either side that perforated the sacrospinous ligaments. The artificial implant was a polypropylene mesh (ProliftTM Pelvic Floor Repair System; Ethicon). The vaginal epithelium was closed using continuous absorbable sutures. The ProliftTM surgery type (separated anterior, posterior, or total ProliftTM) was based on the prolapse stage and the compartment. Concomitant surgery including native-tissue repair (e.g. colporrhaphy and perineoplasty) was performed where necessary.
Hysteropexy with single-incision vaginal support system associated with a modified culdoplasty for enterocele prevention
Published in Journal of Obstetrics and Gynaecology, 2020
Giuseppe Ettore, Gabriella Torrisi, Carla Ettore, Vincenzo Guardabasso
The surgical procedure involved the single-incision mesh kit plus a modified culdoplasty. The Uphold™ LITE Vaginal Support System (Boston Scientific Co., Marlborough, MA, USA) utilises a lightweight mesh, made from uncoated monofilament macroporous polypropylene. This is designed to provide level I support at the vaginal apex, at the same time providing level II support where a concomitant cystocele is likely to occur. The Capio® Suture Capturing Device was used to connect the mesh to the sacrospinous ligaments and suspend the apex. The surgical steps of the modified culdoplasty (Figure 2) were: (a) transverse posterior 2 cm colpotomy at the cervico-vaginal junction; (b) opening of the Douglas pouch; (c) locating the utero-sacral ligaments; (d) preparation of the rectovaginal septum; (e) transfiction of the uterosacral ligaments with a ‘U-shaped stitch’ tailoring two hemisutures which close the Douglas pouch. PDS® II 0 sutures were used (Ethicon, Bridgewater, NJ, USA). The ‘U-shaped stitch’, which was passed bilaterally, in sequence trans-fixed the upper margin of a transverse posterior colpotomy, the peritoneum, the utero-sacral ligament (at the level where the ligament converges in the uterine torus). Leaving the peritoneal cavity, it transfixed the rectovaginal fascia, the posterior vaginal wall and, retracing the same path in reverse, the vaginal wall, the rectovaginal fascia, the peritoneum, the utero-sacral ligament, exiting at the upper margin of the colpotomy, next to the entry point. The transverse posterior colporrhaphy and perineal body reconstruction were the conclusive step of the tri-compartmental repair.
PNF- based Gait Rehabilitation-training after a Total Hip Arthroplasty in congenital pelvic malformation; A case report
Published in Physiotherapy Theory and Practice, 2022
Fred Smedes, Marianne Heidmann, James Keogh
Since the pelvic girdle has not been developed, in the described case, the stability of the pelvis likely depends on the strength of the sacroiliac ligaments. This involves the anterior sacroiliac ligaments, the interosseous ligaments, and the posterior sacroiliac ligaments in the posterior area (Verbruggen and Nowlan, 2017). In the inferior parts, the Sacro-tuberous and sacrospinous ligaments connect the ilia to the sacrum and are continuous with the pelvic floor and hamstrings (Vleeming et al., 2012; Vrahas, 1997). This posterior weight bearing complex is essential for normal weight bearing and force distribution from propulsion forces (Vleeming et al., 2012; Vrahas, 1997).