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Gynaecological Considerations and Urogenital Fistulas
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Brooke Gurland, André D’Hoore, Paul Hilton
Oestrogen deficiency has been implicated in the development of lower urinary tract symptoms.7 Urge incontinence in particular is more prevalent following menopause, and the prevalence would appear to rise with increasing years of oestrogen deficiency. Urinary incontinence may be an isolated symptom, or it can coexist with pelvic organ prolapse.8 Pelvic organ prolapse is a complex disorder resulting from abnormal descent of the pelvic organs from their original attachment in the pelvis. The pelvic structures that may be involved include the bladder and anterior vagina (cystocoele), the posterior vagina (rectocoele), the uterus (utero-vaginal prolapse), the vagina in patients with no uterus (vaginal vault prolapse), the perineum (perineocoele) and the rectum (rectal prolapse).
Gynaecology
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Pelvic organ prolapse refers to the protrusion or displacement of the pelvic organs from their normal anatomical position into or through the vagina to varying degrees (Figure81.9). It is said to affect up to 40% of women at some time in their lifetime. A prolapse can have a detrimental impact on normal organ performance, including anorectal, urinary and sexual function.
Conditions
Published in Sarah Bekaert, Women's Health, 2018
Pelvic organ prolapse is most commonly caused by pregnancy, labour and childbirth. However, it can also be associated with any condition that causes increased pressure in the abdomen, such as obesity, respiratory problems with a chronic cough, constipation, and pelvic organ cancers. Pelvic organ prolapse can also occur after hysterectomy.
Spontaneous vaginal cuff dehiscence with evisceration in a woman with vaginal vault prolapse long after hysterectomy: a case report
Published in Journal of Obstetrics and Gynaecology, 2023
Lu Jiang, Peng Jia, Baofeng Duan, Zixuan Yang, Yan Zhang
Ideally, pelvic organ prolapse should be repaired at the time of initial hysterectomy to reduce the risk of vaginal vault prolapse. In addition to the traditional McCall culdoplasty, duplication of the uterosacral ligaments during laparoscopic hysterectomy can effectively prevent vaginal vault prolapse following surgery (Serati et al.2020). For the patients with second recursion of vaginal vault prolapse, transvaginal bilateral sacrospinous fixation is an effective surgical method, which can significantly improve the quality of life and sexuality (Vitale et al.2018). However, additional measures should be performed to reinforce vaginal cuff once VCD has occurred. During the present case, the rectal lateral ligament was used to reinforce the original weak tissue. In addition, tissues which were used to reinforce vaginal cuff include the pubocervical fascia, the rectovaginal fascia, omental flap, polyglactin mesh, as well as the anterior and posterior vaginal walls (Narducci et al.2003, Hur et al.2016, Ben Safta et al.2017).
Intrinsic factors contributing to elevated intra-abdominal pressure
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Stefan Niederauer, Grace Hunt, K. Bo Foreman, Andrew Merryweather, Robert Hitchcock
Pelvic floor disorders (PFDs) often result from damage or weakening of the musculoskeletal tissues that line the bottom of the abdominal cavity. PFDs will affect 1 in every 4 women during their lifetime (Nygaard 2008). A woman’s lifetime risk of surgical intervention for PFDs is 10%, and 30% of women receiving surgery will undergo 2 or more procedures (Nygaard 2008; DeLancey 2005). The pelvic floor is responsible for supporting pelvic organs, such as the bladder, uterus, and rectum, and plays a key role in proper function of these organs. When the pelvic floor cannot provide adequate support, symptoms of urinary incontinence, fecal incontinence, and pelvic organ prolapse develop. The weight of pelvic organs produces strain on the pelvic floor, and this strain can increase during dynamic activities and is often measured as intra-abdominal pressure (IAP). While the exact role of IAP on PFDs is still uncertain, there is a predominant hypothesis that high IAP overloads the pelvic floor, and over time can damage the musculoskeletal tissues (Bø and Nygaard 2020).
Long-term experience with a modified ERAS protocol for urogynaecology day procedures
Published in Journal of Obstetrics and Gynaecology, 2022
Sandhya Gupta, Ajay Rane, Venkat Vengavati, Mugundan Achari, Anusheh Mubeen, Umesh Gupta
Pelvic organ prolapse and urinary incontinence are debilitating conditions impacting the quality of life of patients. Current procedures for these conditions are increasingly performed using minimally invasive methods, thus, making it possible for them to be performed in an ambulatory setting. Urogynaecology day-procedures have been offered at our private surgical service for more than 15 years. In 2008, an audit of day surgeries performed over 22 months at this service was published by Kannan et.al, showing a 1.6% readmission rate within 72 hours post-operatively. This study established the viability of providing surgeries for pelvic organ prolapse in an ambulatory setting. A precursor model of ERAS was used for patient selection, perioperative care and post-op follow-up (Kannan et al. 2008). Literature published since has shown that adopting urogynaecology-specific ERAS protocols is associated with a significant reduction in length of hospital admission, increased same-day discharges and overall improved patient satisfaction (Modesitt et al. 2016; Carter-Brooks et al. 2018).