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Laparoscopic Rectopexy for Rectal Prolapse
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Sanjiv Haribhakti, Jitender Singh Chauhan
The presence of external rectal prolapse (ERP) is an indication for surgical repair because of the eventual progression of symptoms, weakening of the sphincter complex, and risk of bleeding and incarceration. Fecal incontinence and/or constipation associated with rectal procidentia are also indications of surgery.
DRCOG MCQs for Circuit C Answers
Published in Una F. Coales, DRCOG: Practice MCQs and OSCEs: How to Pass First Time three Complete MCQ Practice Exams (180 MCQs) Three Complete OSCE Practice Papers (60 Questions) Detailed Answers and Tips, 2020
Procidentia is defined as a third-degree uterine prolapse or a complete prolapse of the uterus outside the vagina. Symptoms may include a dragging sensation with a lump lying outside the vulva, intermittent urinary retention, stress incontinence and difficulty in defecation. The exposed cervix may become ulcerated, infected and bleed. Most affected women are > 60 years of age. The condition is not commonly painful and is caused from laxity of the cardinal and uterosacral ligaments. The main predisposing factor is childbirth.
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
Women with a minor degree of prolapse may be asymptomatic, but with more significant degrees the patient usually complains of a sensation of ‘something coming down’. A cystocoele (bladder prolapse) and a cystourethrocoele (prolapse of the bladder and urethra) lead to the sensation of a lump in the vagina, and may be associated with urinary urgency (overactive bladder symptoms) and recurrent urinary tract infections. Uterine descent can lead to a lump in the vagina or a dragging sensation; with complete prolapse of the uterus (procidentia) there may be vaginal discharge, ulceration of the vaginal skin and bleeding. A rectocoele (prolapse of the rectum into the vagina) may cause difficulties with defaecation or a sensation of incomplete emptying, which can be relieved by digital reduction of the prolapse.
Staged repair of concomitant rectovaginal fistula and pelvic organ prolapse after removal of a neglected pessary
Published in Baylor University Medical Center Proceedings, 2020
Stacy Mathews, Shaked Laks, Carola LaFollette, T. Ignacio Montoya, Pedro A. Maldonado
A 66-year-old woman, gravida 4 para 4, with a history of stage 4 uterovaginal prolapse managed with a Gellhorn pessary was referred for evaluation of prolapse. After 5 years without pessary care, the patient presented with a 2-month history of a vaginal bulge, constipation, urinary frequency, urinary urgency, and spotting. On physical exam, uterine procidentia was noted. When the prolapse was reduced, a Gellhorn pessary was visualized. The decision was made to perform an exam under anesthesia not only to remove the pessary but also to better characterize the suspected rectovaginal fistula. As part of the preoperative evaluation, a computed tomography (CT) scan of the abdomen and pelvis with contrast revealed the displaced Gellhorn pessary posterior to the prolapsed vagina (Figure 1a). The pessary stem eroded through the anterior wall of the rectum, resting against the posterior rectal wall and sacrum (Figure 1b, 1c).
Pelvic floor dysfunction in midlife women
Published in Climacteric, 2019
Pelvic visceral support is assessed by first observing the presence or absence of a bulge at the introitus with Valsalva effort. Not seeing a bulge of course does not rule out prolapse. Speculum examination is required to accurately assess support. This is best done using the POP-Q system. It was initially described in 1996 by Bump et al.23. The locations of nine defined points in the anterior, apical, and posterior compartments and on the perineum are defined and each is measured at maximal Valsalva effort. Either a Simms speculum or the bottom blade of a bivalved speculum is used to isolate individual vaginal compartments. The fixed reference point for the scale is the hymenal ring. Stages range from 0 (normal support) to 4 (complete procidentia). The POP-Q system is easily learned and provides an objective, reproducible assessment. It also provides a standardized tool to measure treatment outcomes.
Long-Term Functional Outcome after Internal Delorme's Procedure for Obstructed Defecation Syndrome, and the Role of Postoperative Rehabilitation
Published in Journal of Investigative Surgery, 2018
C. A. Leo, P. Campennì, J. D. Hodgkinson, P. Rossitti, F. Digito, G. De Carli, L. D'Ambrosi, P. Carducci, L. Seriau, G. Terrosu
Obstructed Defecation Syndrome (ODS) is a well-recognized problem that affects the quality of life of many patients. It is known as a functional and anatomical disorder of the pelvic floor. Rectocele, rectal intussusception, rectal prolapse (also known as procidentia), enterocele, and pelvic dissynergies (including anismus, levator muscle spasm) are all known to be associated with ODS. ODS occurs in approximately 7% of the population, and nearly 50% of patients with chronic constipation have ODS. Women are more likely to be affected than men are, and the prevalence increases with age. Treatment of ODS is not standardized and many different operative and nonoperative approaches have been described [1–4].