Biomedical subjects

K Baessler

Publications and source records attributed to K Baessler.

8 recordsLinked to original sources

PubMed2004

Surgical management of pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse. OBJECTIVES: To determine the effects of surgery in the management of pelvic organ prolapse. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (8 June 2004) and reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. DATA COLLECTION AND ANALYSIS: Trials were assessed and data extracted independently by at least two reviewers. Four investigators were contacted for additional information with two responding. MAIN RESULTS: Fourteen randomised controlled trials were identified evaluating 1004 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were to evaluate other clinical outcomes and adverse events. For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by Vicryl mesh overlay (RR 1.39, 95% CI 1.02 to 1.90) but data on morbidity and other clinical outcomes were too few for reliable comparisons. For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh overlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new symptoms after surgery. However, more women with occult stress urinary incontinence developed postoperative stress urinary incontinence after endopelvic fascia plication alone than after endopelvic fascia plication and tension-free vaginal tape (RR 5.5, 95% CI 1.36 to 22.32). REVIEWERS' CONCLUSIONS: Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of a polyglactin mesh overlay at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. Adequately powered randomised controlled clinical trials are urgently needed.

Female↗

PubMed2004

Pelvic floor dysfunction in women after pelvic trauma.

The aim was to assess symptoms of pelvic floor dysfunction in women following pelvic trauma. A retrospective questionnaire survey of 24 consecutive women was performed in a tertiary referral orthopaedic centre and urogynaecology unit. Sixteen women had a type B and eight a type C pelvic fracture (Association Osteosynthesis manual classification). The median age was 24 years (11-92). Twenty-one women were nulliparous. Sixteen women reported de novo pelvic floor dysfunction. Bladder symptoms occurred in 12, bowel problems in 11 and sexual dysfunction in 7 of 17 sexually active women. Pelvic fracture seems to be a risk factor for pelvic floor dysfunction.

Adolescent↗

PubMed2001

Obstructed defecation caused by a cystourethrocele and mobile posterior vaginal wall: a case report.

Obstructed defecation may be caused by a rectocele and/or enterocele. Rectal wall procidentia may be due to an enterocele bulging into the rectum. Another cause of rectal procidentia resulting in obstructed defecation is presented. A 65-year-old woman complained of vaginal prolapse and incomplete bowel emptying. Pelvic examination revealed that a stage III anterior vaginal wall prolapse caused a mobile posterior vaginal wall to prolapse into the anal canal, resulting in rectal procidentia and subsequently in obstructed defecation. Careful assessment of all pelvic floor compartments is important to identify the cause of obstructed defecation, particularly in the absence of a rectocele.

Aged↗

PubMed2001

Abdominal sacrocolpopexy and anatomy and function of the posterior compartment.

OBJECTIVE: To assess the effect of abdominal sacrocolpopexy with obliteration of the pouch of Douglas on anatomy and function of the posterior compartment. METHODS: We prospectively studied 33 consecutive women with pelvic organ prolapse who had abdominal sacrocolpopexies [expanded polytetrafluoroethylene (Gore-Tex)] with pouch of Douglas obliterations and posterior extensions of mesh, using a standardized questionnaire, urodynamic studies, pelvic floor fluoroscopies, and vaginal-rectal examinations (Baden-Walker classification). Concomitant colpoperineorrhaphy was done if rectoceles remained at rectovaginal examination at the end of sacrocolpopexy. The goal was to correct rectoceles transabdominally. RESULTS: Thirty-one women returned for follow-up investigations after 12--48 months (mean 26 months). Mean age was 61 years (range 41--77 years). There was no recurrence of vaginal vault prolapse, enterocele, or anterior rectal wall prolapse. Among 28 preoperative rectoceles, 16 recurred (57%) and one occurred de novo. Defecation problems (outlet constipation) were present in 21 women (64%) preoperatively and persisted or were altered in 12 (57%) after sacrocolpopexy. Grade of rectocele was associated significantly with symptoms of outlet constipation preoperatively, but not postoperatively (P =.002). CONCLUSION: Abdominal sacrocolpopexy with obliteration of the pouch of Douglas and posterior extension of the mesh was effective for vaginal vault prolapse, enterocele, and anterior rectal wall procidentia, but not concomitant rectocele. Twenty-eight percent of women described altered defecation with stool stopping higher in the rectosigmoid colon ("high outlet constipation"), which might have been caused by denervation during rectal mobilization.

Adult↗

PubMed2000

Can uroflowmetry patterns in women be reliably interpreted?

Our aim was to investigate the proposition that uroflowmetry patterns can be reliably interpreted and correspond with specific urodynamic diagnoses. Uroflowmetry traces from 129 women with diagnoses of either genuine stress incontinence or detrusor instability were interpreted by four physicians with a minimum of 6 months experience in urogynecology. To test intraobserver variability, the traces were classified a second time 8 weeks later. Inter- and intraobserver variability was calculated by kappa analysis. There was marked intra- and interobserver variability in classification of traces, but no evidence of a correlation between urodynamic diagnosis and uroflowmetry pattern. Neither peak flow, total voided volume nor rate of acceleration of flow correlated with diagnosis. Although flow rates are important in predicting possible problems following surgery for stress incontinence, there is no evidence that flow patterns can be used as a screening test for specific urodynamic diagnoses.

Adult↗

PubMed2000

The depth of the pouch of Douglas in nulliparous and parous women without genital prolapse and in patients with genital prolapse.

OBJECTIVES: This study was undertaken to assess the depth of the pouch of Douglas among nulliparous women and to compare it with those among parous women and patients with genital prolapse. STUDY DESIGN: The depth of the pouch of Douglas was measured in 22 nulliparous women and 28 parous women without genital prolapse and in 18 patients with prolapse of the posterior vaginal wall. RESULTS: The pouch of Douglas extended from 11% to 89% of the total vaginal length among nulliparous and parous women, without significant difference between these groups (mean, 49% and 45%, respectively). It was significantly deeper in patients with prolapse, ranging from 25% to 96% (mean, 72%). CONCLUSION: There is an extensive variation in the depth of the pouch of Douglas. A deep pouch of Douglas is frequently present in young nulliparous women and may increase the risk for development of a posterior vaginal wall prolapse.

Adult↗

PubMed1996

Postpartum pelvic floor conditioning using vaginal cones: not only for prophylaxis against urinary incontinence and descensus.

Seventy-one women were examined 6-8 weeks after spontaneous delivery by pelvic floor (PF) palpation, inspection, manometry and gravimetry. Re-examination was performed in the same way after 4-6 weeks of daily cone training. Control groups included 20 women prior to and after conventional puerperal exercises, and 8 nulliparae prior to and after the same cone training, using a five-cone set. The number of puerperae not capable of voluntary PF contraction declined from 34% before to 6% after training. Optimum initial and post-training responses were exhibited by all nulliparae. Differences between cone and conventional exercise groups were of minor importance. Contractility increased from 5 to 10 mmHg on average in puerperae and from 15 mmHg to 21 mmHg in nulliparae. Cone nos. 1-3 were most frequently required at the beginning of training, and nos. 3-5 towards the end. Cone training works well as an alternative or complement to conventional postpartum exercises, and may therefore be recommended especially to puerperae who are not capable of holding vaginal cones of 20-70 g 6 weeks after delivery.

Adult↗

PubMed1996

[Pelvic floor conditioning with vaginal weights--post partum and in urinary incontinence].

To check on the efficacy of cone training 71 women were thoroughly examined six to eight weeks after spontaneous deliveries at various risk levels. Their pelvic floor was examined by palpation, inspection, manometry and gravimetry. All of them were re-examined in the same way after four to six weeks of daily cone training. Thirty women with moderate genuine stress incontinence (16) or stress/urge incontinence (14) were evaluated by the same procedure, independent of gestation. A control group included 20 women prior to and after conventional puerperal pelvic floor exercises and eight nulliparae of the same age prior to and after the same cone training, using a five-cone set. The number of puerperae not capable of voluntary pelvic floor contraction declined from 34 % before to 6 % after training. Optimum initial and posttraining responses, on the other hand, were exhibited by all nulliparae. Differences in childbirth risk for pelvic floor damage played a less important role than childbirth proper. Training related differences were of minor importance, as well, between cone and conventional exercise groups. Notwithstanding different initial values, all puerperae increased their contractility to 10 mm Hg on average, while the increase accomplished by nulliparae was from 15 mm Hg to 21 mm Hg. Cone Nos. 1-3 (20.0-45.0g) were most frequently required at the beginning of training and Nos. 3-5 (45.0-70.0 g) towards the end, for an average increase by one or two cone numbers. 25 % of the cone women and 35 % of the conventional exercise probands failed to complete the training, which was indicative of limited patient compliance after delivery. A positive correlation was found to exist between motivation and training success. Cone training also had positive effects on sexuality. It has proved to work well alternatively or complementary to conventional postpartum exercises and, therefore, may be recommended to all women who are not capable of holding with their pelvic floor vaginal cones of 20-70 g in the postpartum period. In women with urinary incontinence (UI) no pelvic floor response was recordable, prior to training, from five women (17 %). Response was not even recorded from eight women (21 %) by palpation. After training, the capability of voluntary and reflex contraction of pelvic floor muscles was restored in all women. The best post-training result was obtained from palpation (27 positive responses). Manometry and capability of the pelvic floor to hold vaginal cones were other suitable methods in this context: in 15 women (50 %) cone weights were extremely low at the beginning of treatment (Cone no. 1-2), while after treatment 19 women (63 %) held cones up to Nos. 4-5. All healthy women of the control group started with Cone No. 5. In conformity with postpartum groups average increase in pelvic floor contractility was from 5 mm to 10 mm Hg in UI patients. Twenty-four women (80 %) were cured from UI (57 %) or were improved (23 %). Twenty-six women asked for continuation of cone training. Pelvic floor conditioning, using vaginal cones, is a good alternative to poor acceptance or insufficient availability of conventional pelvic floor exercises in conservative treatment of urinary incontinence and descensus.

Adult↗