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Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Prolapse can cause much distress and embarrassment for women who suffer from it. A prolapse is when weakness of the supporting structures allows pelvic organs to protrude into the vagina. It is strongly although not exclusively associated with pregnancy and childbirth with perineal repair. Many women present post-menopausal as surrounding supports have reduced further. Third-degree uterine prolapse is where the uterus is outside of the introitus and can cause ulceration and ureteric obstruction. Symptoms include a mass sensation, dragging, sexual dysfunction and difficulty with defecation. Manual reduction may be needed in order to pass stool. Non-surgical candidates can be treated conservatively with pelvic floor physiotherapy, weight loss, smoking cessation, vaginal oestrogens and ring or shelf pessaries, which sit in the vagina and support prolapsed tissue. Surgical prolapse management involves excision of loose tissue and resuturing to strengthen support. Hysterectomy can be considered for severe prolapse.
Fecal Incontinence, Physical Examination
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
The diagnosis of internal prolapse is often delayed and difficult to demonstrate on physical examination. Ulceration, mucosal edema, erythema, or proctitis may incorrectly lead the physician to the diagnosis of inflammatory bowel disease. Internal prolapse can best be demonstrated by asking the patient to strain during withdrawal of the rigid proctoscope. The invagination of the bowel is readily visualized and may be followed downward as the scope is slowly withdrawn. But the most effective diagnostic method for intussusception is defecography. Barium enema or colonoscopy need not be performed routinely unless indicated, since diagnostic yield is low in evaluation of anal incontinence.
Paediatric Surgery: What the Adult Surgeon Needs to Know
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
Marc A. Levitt, Richard J. Wood
Secondary surgery is indicated for iatrogenic prolapse after a pull-through operation in symptomatic patients. Typical symptoms include bleeding and leakage of mucus. The prolapse can also interfere with the patient’s potential for bowel control. In patients with mucosal prolapse, treatment involves excision of the mucosal ectopia and reconstruction of a skin-lined anal canal. Patients with a complete prolapse may require a repeat posterior reconstruction of the levator funnel and external sphincter complex, and rectal suspension.
Profile of women with pelvic organ prolapse at the University Hospital of the West Indies risk factors and presentation
Published in Journal of Obstetrics and Gynaecology, 2022
Michelle Campbell, Carol Rattray, Primelia Stewart, Kimberly Stewart, Brittni Stewart, Donnette Simms Stewart
Data suggest that African-American women have a lower prevalence of symptomatic POP than other racial or ethnic groups in the USA. One study concluded that African-American women were significantly less likely to report symptomatic prolapse compared with white women (Rortveit et al. 2007). Another study concluded that compared with African-American women, Latina and white women had four to five times higher risk of symptomatic prolapse. In addition, this study concluded that white women had a 1.4-fold higher risk of objective prolapse with leading edge of prolapse at or beyond the hymen when compared with African-American women (Whitcomb et al. 2009). Hendrix et al. also found that after controlling for age, body mass index and other health/physical variables, African American women demonstrated the lowest risk for prolapse (Hendrix et al. 2002). In contrast, Sears et al. concluded that there is a similar ethnic distribution of POP in an equal access health care system. This study found that there was no difference in the prevalence of POP between black and white women (Sears et al. 2009).
Factors associated with long-term pessary use in women with symptomatic pelvic organ prolapse
Published in Climacteric, 2019
M. Mao, T. Xu, J. Kang, Y. Zhang, F. Ai, Y. Zhou, L. Zhu
We recorded baseline characteristics of the patients who participated in the pessary fitting trial, including demographic data, medical comorbidities, obstetric history, previous pelvic surgery, and prolapse and urinary symptoms. Prolapse symptoms included vaginal bulging and pelvic pressure. The following coexisting urinary symptoms were assessed: stress urinary incontinence (SUI), urgency urinary incontinence, voiding difficulty, and a need for splinting to void. All patients were examined by one experienced urogynecologist and staged according to the POP-Q18. The vaginal introitus width was not included in the POP-Q system; thus, we measured this parameter according to the methods described in prior literature19. The Pelvic Floor Impact Questionnaire (PFIQ-7) and Pelvic Floor Distress Inventory (PFDI-20) were applied to assess the extent to which all forms of pelvic floor disorders affected the patients’ baseline QOL20. We collected PFIQ-7 data at the beginning of the study and PFDI-20 data beginning in August 2015. The PFDI-20 questionnaire contains subscales for urinary, prolapse, and colorectal–anal symptoms.
Robotic sacrocolpopexy for recurrent vaginal vault prolapse after sex reassignment surgery in a trans-woman
Published in Journal of Obstetrics and Gynaecology, 2019
Tilemachos Kavvadias, Hans Helge Seifert, Jan Ebbing, David Nunez Garcia, Andre Boris Kind
The exact prevalence of vaginal vault prolapse after sex reassignment surgery is unknown. One report of Kuhn et al. estimates this prevalence at 7.5% (Kuhn et al. 2011). The data on recurrence of prolapse and its management are even more limited and the current literature presents results only regarding open abdominal procedures (Bucci et al. 2014). The difficulties of the neovaginal prolapse are derived mostly from the different properties of the neovaginal tissue, which appears to be thinner and less flexible compared to native vaginal tissue. The dissection of the bladder peritoneum can also be challenging due to the complexity of the prostatic area, which was more so in our case since the patient already had a previous vaginal fixation to the Denonvilliers fascia. An interdisciplinary surgical management between gynaecological and urological teams should be considered in these cases.