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Urogenital prolapse
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Sushma Srikrishna, Dudley Robinson
This procedure is only rarely performed nowadays. Cervical amputation is followed by approximating and shortening the cardinal ligaments anterior to the cervical stump and elevating the uterus. This is combined with an anterior and posterior colporrhaphy. The operation has fallen from favour, as the long-term complications include fertility problems in addition to recurrent uterovaginal prolapse and enterocele formation.
Urogynecologic Pelvic Floor Dysfunction
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
Vivian C. Aguilar, Willy Davila
Anterior colporrhaphy is regularly used to correct prolapse arising from a central defect. The procedure is begun using a midline vertical incision and the vaginal mucosa is separated from the underlying endopelvic fascia. Dissection is then carried out laterally to each vaginal sulcus and proximally to the vaginal apex or cervix. Once the dissection is accomplished, the endopelvic fascia is plicated in the midline, thereby repairing the central defect and elevating the bladder base. Subsequently, the fascia is reattached to the vaginal apex or cervix. Finally, excess vaginal mucosa may be trimmed and closed with 2–0 polyglycolic acid suture, and the vagina is packed for further postoperative hemostasis.
The Classical Techniques for Rectocele Repair: Complications and Outcome
Published in Victor Gomel, Bruno van Herendael, Female Genital Prolapse and Urinary Incontinence, 2007
P. Mendes da Costa, Robrecht Van Hee, Christian Ngongang
Surgical treatment is indicated whenever symptoms of disabling defecation or vaginal discomfort occur. Many surgical treatments have been proposed since the earliest reports of posterior colporrhaphy. Different types of surgical approach may be used, either transvaginal, transanal, transperineal or transabdominal (1,2).
Ultralight type I transvaginal mesh: an alternative for recurrent severe posterior vaginal prolapse
Published in Climacteric, 2022
W. Tian, Y. Dai, P. Feng, Y. Ye, Q. Gao, J. Guo, Z. Zhang, Q. Yu, J. Chen, L. Zhu
A previously described standard surgical procedure was used [16,17]. We performed preoperative skin preparation, vaginal irrigation and enema, and administered prophylactic intravenous antibiotics of cephalosporins combined with metronidazole just before incision to minimize the infection. The middle and posterior compartments were reconstructed in the same procedure. A senior urogynecologist, Lan Zhu, performed all operations and a supplementary video of operation demonstrated the detailed procedure. The rectovaginal fascia was hydro-dissected, and the posterior vaginal mucosa was incised longitudinally to separate the posterior vaginal wall from the rectum. The ultralight mesh was cut into three parts, one cruciform mesh to repair the posterior wall and two rectangular mesh to reinforce the apex. Next, an especially designed needle was used to puncture from within the vagina to the skin 3 cm anterior to the ischial spines and the posterior meshes pulled through the ischial spinous fascia. Silk threads were left protruding from the skin. Rectangular mesh strips were pulled from inside the vagina to outside the skin and fixed to the posterior vaginal mucosa using a Prolene suture. The mesh was placed, so it was not under tension, after which any superfluous mesh was trimmed. The distal two-thirds of the posterior vaginal wall was then repaired as necessary by performing standard posterior colporrhaphy.
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.
The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2021
Alexandros Derpapas, Gopalan Vijaya, Kostis Nikolopoulos, Manolis Nikolopoulos, Dudley Robinson, Ruwan Fernando, Vik Khullar
More importantly though, we have demonstrated that 3D translabial ultrasonography of the pelvic floor is a useful tool for surgeons in evaluating the outcome of surgical management of prolapse by depicting the reduction in the urogenital hiatus postoperatively, which complements the examination by POP-Q. Using a reference line connecting the inferior pubic rami to the perineal body, urogenital hiatal dimensions can be ultrasonagraphically calculated with moderate to very good inter- and intra-rater reliability. Postoperative reduction in the GH size as measured by ultrasound in this cohort corresponded with the anatomical improvement in GH measured by POP-Q. This was evident even by comparing the two surgical techniques; women who were allocated to the FEP technique demonstrated a narrower urogenital hiatus than those in the standard colporrhaphy group. A greater reduction in the urogenital hiatus following fascial and epithelial plication could possibly be attributed to the conservation and utilisation of the excessive vaginal epithelium, which helps approximate the lateral attachments of the endopelvic fascia to the midline.