Urogenital prolapse
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Urogenital prolapse is classified anatomically depending on the site of the defect and the pelvic viscera that are involved. Urethrocele: prolapse of the lower anterior vaginal wall involving the urethra only.Cystocele: prolapse of the upper anterior vaginal wall involving the bladder. Generally, there is also associated prolapse of the urethra and hence the term cystourethrocele is used.Uterovaginal prolapse: this term is used to describe prolapse of the uterus, cervix and upper vagina.Enterocele: prolapse of the upper posterior wall of the vagina, usually containing loops of small bowel. A traction enterocele is secondary to uterovaginal prolapse, a pulsion enterocele is secondary to chronically raised intraabdominal pressure, and an iatrogenic enterocele is caused by previous pelvic surgery. An anterior enterocele may be used to describe prolapse of the upper anterior vaginal wall following hysterectomy.Rectocele: prolapse of the lower posterior wall of the vagina involving the anterior wall of the rectum.
History and Clinical Investigations: Patient Complaints in Perspective
Victor Gomel, Bruno van Herendael in Female Genital Prolapse and Urinary Incontinence, 2007
To know whether a specific symptom can be attributed to a prolapse as such or more specific to the anterior, apical or posterior compartment, the correlation between symptoms and POP-Q stage was studied according to site by Ellerkmann et al. (10) and by Mouritsen and Larsen (11). Urinary stress incontinence is inversely related to the stage of cystocele; however, there is a positive correlation with the difficulty of voiding. This can be explained by the increased kinking of the urethra in the higher stages of cystocele. Incomplete evacuation of stools or the need of digital manipulation (“splinting the vagina”) is only related to the stage of rectocele. Impairment of sexual life seems mostly related to apical (enterocele and uterine or vaginal vault prolapse) and anterior prolapse. A lump at the introitus (visualization of a bulge) is seen more frequently in cases of the combination of anterior and posterior prolapse (11). Complaints attributed to the different sites of prolapse and their sometimes widely ranging frequencies are listed in Table 1.
Complications of Female Incontinence Surgery
Kevin R. Loughlin in Complications of Urologic Surgery and Practice, 2007
Ureteral ligation is another potential complication of transvaginal cystocele repair, but this complication should always be recognized and remedied intraoperatively. Cystourethroscopy is absolutely indicated, and visualization of urine efflux should be observed from both ureteral orifices. Difficulty visualizing efflux may be overcome by administration of intravenous indigo carmine, and fluid challenge. Lack of visualization should be further investigated with attempted passage (and then removal) of a ureteral stent. Inability to pass a stent implies ureteral ligation, and requires removal of the offending suture, which usually involves the cardinal ligament or posterior pubocervical fascial suture(s). Subsequent confirmation of urine reflux should suffice, without the need for further evaluation or treatment.
Pelvic floor dysfunction in midlife women
Published in Climacteric, 2019
S. L. Johnston
Prolapse presents with mechanical symptoms (pelvic heaviness, introital bulging, vaginal pain, and possibly low back pain). Prolapse can create relative mechanical obstruction, requiring manual prolapse reduction (splinting) or at least perineal pressure to achieve bladder or bowel emptying. It can additionally cause difficulty with coital penetration and/or dyspareunia. Findings on examination include laxity or descent of the anterior vaginal compartment (commonly referred to as cystocele), posterior compartment (rectocele/enterocele), and/or apical compartment (uterine/vault prolapse). Prolapse is in general diagnosed clinically when descent of the vaginal walls is identified on pelvic examination, ideally using a standardized and validated method such as the Pelvic Organ Prolapse Quantification system (POP-Q)23. Importantly, however, the diagnosis should not rest alone on examination, as most women are not significantly bothered by prolapse until its leading edge presents 1.0 cm beyond the hymen24.
Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse
Published in Journal of Obstetrics and Gynaecology, 2021
Hirotaka Sato, Hirokazu Abe, Atsushi Ikeda, Tomoaki Miyagawa, Katsuhiko Sato
The anatomical result in terms of objective outcomes reported in our study was 93.5% at 12 months, which was similar to the results of another study by Sarlos et al. (2014). We encountered three cases of recurrent cystocele; two cases occurred at the 12-month follow-up, and one at the six-month follow-up. The two patients were asymptomatic and were placed under observation. The patient with recurrence at six months had symptomatic prolapse and was treated with a pessary. Generally, most recurrences occur in the anterior compartment (Maher et al. 2011; Vandendriessche et al. 2015; Vandendriessche et al. 2017). During LSC, we performed the anterior vaginal wall dissection procedure reported by Abdullah et al. (2017), i.e. we performed dissection until we reached the boundary between the trigone of the bladder and the urethra and anchored the mesh to the anterior vaginal wall using a five-point fixation with non-absorbable sutures. It was speculated that insufficient anchoring to the anterior vaginal wall was a factor in cases of recurrence.
The transvaginal mesh: an overview of indications and contraindications for its use
Published in Expert Review of Medical Devices, 2023
Alessandro Ferdinando Ruffolo, Marine Lallemant, Sophie Delplanque, Michel Cosson
POP is the result of laxity in the four main suspensory pelvic ligaments (pubourethral, cardinal, arcus tendinous of pelvic fascia and uterosacral) and of perineal body defects [44]. The bladder (cystocele), the uterus (hysterocele), the pouch of Douglas (elytrocele) and the rectum (rectocele) may be involved in the vaginal prolapse, differently from the rectal prolapse that is an exteriorization of the rectum through the anal orifice. The restoration of ligaments’ length and tension leads to anatomical and functional improvement [44].
Related Knowledge Centers
- Bladder
- Childbirth
- Constipation
- Quality of Life
- Urinary Incontinence
- Urinary Retention
- Urinary Tract Infection
- Vagina
- Frequent Urination
- Urethrocele
- Quality of Life