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We describe a 76-year-old woman with severe uterine prolapse with secondary bilateral ureterohydronefrosis and acute renal failure, which improved after the reposition of the uterus. Physiopathological mechanisms and treatment of obstructive uropathy related with uterine prolapse are discussed.
We present a case of a patient developing uterine prolapse during pregnancy. The cervix reached the introitus at 10 weeks gestation and subsequently protruted progressively as the pregnancy advanced. The patient was conservatively treated with bed rest and the main maternal and fetal risks are avoided. At 4 months postpartum follow-up there was no evidence of uterine prolapse.
Six women with advanced uterine prolapse underwent examination by drip infusion urography. A new hypothesis is proposed for the pathogenesis of bilateral hydroureteronephrosis: the ureters are entrapped by the hiatus genitalis, not against the bladder but against the fundus of the fully prolapsed uterus. Drip infusion urography should include an exposure area of about 15 centimeters below the pubis, and at least one exposure should be taken with the patient in the standing position. Thus, the hourglass appearance of the prolapsed bladder will not be overlooked and would be helpful in explaining the cause of the hydroureteronephrosis.
Three women are described in whom obstructive uropathy was found secondary to uterine prolapse. Two of these patients had severe renal failure. It is important to exclude this condition in any woman presenting with renal functional impairment. Potentially damaging urinary tract obstruction should be considered in every patient with a uterine prolapse.
A case of a recurrent incomplete uterine prolapse in a two year-old cow of the German Black Pied breed delivered into the clinic at the 16th day after parturition is described. An inversio uteri that possibly relapsed very soon following reposition of an uterine prolapse post partum is presumably the reason of the prolapsus uteri beyond the early puerperal period. The prolapsed left uterine horn was enclosed tightly by the cervix. Due to severe inflammatory changes a reduction was not practicable.
Vaginal pessaries are useful for treating uterine prolapse when surgical intervention is not a safe option. This article covers recommendations for selection, insertion and care of the appliance. Careful follow-up is necessary to minimize possible complications, which can include infection, ulceration of the mucosa, incarceration of the pessary, and an increased incidence of vaginal and cervical malignancy. Disagreement within the literature about the proper schedule for follow-up, and inadequate documentation of the risks of pessary usage underscore the need for clinical research in this area.
Pagetoid dyskeratosis, is considered a reactive process in which a small part of the normal population of keratinocytes is induced to proliferate. The lesion is characterized by pale cells resembling those of Paget's disease within the epidermis. These cells have been seen as an incidental finding in a variety of benign papules most commonly located in intertriginous areas. Among the inductors of the lesion, friction is suspected. To the best of our knowledge, these pale cells have not been reported in the cervix. We describe the location of the lesion in the ectocervix and the incidence of this lesion in a group of 100 unselected patients surgically treated for uterine prolapse. Another group of 100 unselected patients treated for uterine leiomyoma was used as a control. Pagetoid dyskeratosis was found in 37 cases (37%) of uterine prolapse and in five cases (5%) of uterine leiomyomas. The lesion is more common in uterine prolapse (p <0.001) and is not significantly associated with cornification of the epithelium (p = 0.72343). The cells of pagetoid dyskeratosis show an immunohistochemical profile different from the surrounding squamous cells characterized by premature keratinization. Pagetoid dyskeratosis cells have shown positivity for high molecular weight cytokeratin and negative reaction for low molecular weight cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, and human papilloma virus. Pagetoid dyskeratosis cells must be distinguished from artefactual clear cells, glycogen-rich cells, koilocytes, extramammary Paget's disease cells, and pagetoid spread of carcinoma cells to the cervix. In cases in which pagetoid dyskeratosis shows a florid expression, there is a hazard of overdiagnosis. The pathologist should be aware of the histologic features of pagetoid dyskeratosis in the ectocervix to avoid misdiagnosis and unnecessary treatment. Routine histologic study is usually sufficient to identify the lesion.
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Alternations of the pelvic structure with an emphasis on those of the levator ani muscle, associated with uterine prolapse, were studied using sagittal magnetic resonance images obtained from 19 subjects without and 14 with uterine or vaginal prolapse of varied degree and 3 patients with Rokitansky syndrome who had undergone a McIndoe operation. Two additional patients with a grade III uterine prolapse were also studied before and 2-3 months after corrective surgery consisting of vaginal hysterectomy combined with anterior colporrhaphy and posterior colpoperineorrhaphy. Absence or presence of prolapse, irrespective of its grade, was found to be related to whether or not a reference line extrapolated from the levator plate crossed the pubis on sagittal images. This was the case as well in patients with Rokitansky syndrome with a neovagina and loss of such crossings was restored in patients with prolapse after surgery. Backward bending of the upper vagina noted in nonprolapse conditions was usually absent in patients with uterine prolapse. These results document that topographical changes involving the levator ani muscle and the vagina occur in association with uterine prolapse.
BACKGROUND: A vesical calculus in a prolapsed cystocele is rare. OBJECTIVE: To highlight bladder calculi as a cause of irreducible uterine prolapse. CASE REPORT: A case of irreducible total uterine prolapse caused by multiple vesical calculi is presented. Bladder stones were removed through vaginal cystolithotomy followed by vaginal hysterectomy. CONCLUSION: In cases of acute irreducible pelvic organ prolapse, the possibility of bladder stones should be kept in mind and X-ray pelvis including the prolapsed mass should be done to confirm the diagnosis.
OBJECTIVE: To study long-term results of Shirodkar procedure for treatment of uterine prolapse in women wishing to retain their uterus. STUDY DESIGN: Fifty-one patients with a symptomatic uterine prolapse who desire to preserve their uterus without further childbearing were treated between 1988 and 2000. By the vaginal route, uterosacral ligaments were separated from the uterus, shortened, transposed in front of the uterine isthmus, and fixed bilaterally under the opposite lateral surface of the cervix or of the cervical stump after amputation. RESULTS: Median age of patients was 37 years. Median operating time was 120 min (range 60-190). One patient was re-operated four days after the initial surgery to drain a haematoma. Median follow-up was 81 months (range 11-134). Eight patients were lost of follow-up. Eleven (25.6%) patients underwent iterative surgery. The indication for re-operation was recurrence of prolapse in four patients, introital dyspareunia in three patients, cervix stenosis in two patients, urinary incontinence in one patient and pyosalpinx in one patient. Only one patient (2.3%) experienced a recurrence of the uterine prolapse. CONCLUSION: Shirodkar procedure is safe and effective. Long-term functional results are satisfactory but associated procedures may alter patient satisfaction.
Five patients are described with hydronephrosis and hydroureter associated with advanced uterine prolapse. Various hypotheses have been advanced in the literature to account for this neglected syndrome. A trial was carried out to assess whether all patients presenting with uterine prolapse should be screened to exclude urinary tract obstruction. Thirty-seven patients on the waiting list for surgery for various degrees of prolapse had an IVU and a blood urea estimation. No cases of ureteric obstruction were found, presumably because the lesser grades of prolapse predominated. It is, therefore, considered that all patients with prolapse do not need intravenous urography, which should be restricted to women with complete procidentia.
Our objective was to compare the amount of collagen in parametrium and vaginal apex between women with uterine prolapse at pre- and postmenopause, and in women without prolapse. The study included 22 premenopausal women without prolapse (group A), 10 premenopausal women with prolapse (group B), and 23 postmenopausal women with prolapse (group C) (total 55). Patients in group A underwent abdominal hysterectomy for uterine leiomyoma, and patients in groups B and C underwent vaginal hysterectomy. During the surgical procedure we obtained biopsies from the lateral parametrium and vaginal apex. The tissue was stained for histological analysis with picrosirius. We observed a lower amount of collagen in the parametrium of women with uterine prolapse, both in menacme and in postmenopause, than in the parametrium of women without prolapse. We observed no statistically significant difference in vaginal apex between the groups.
BACKGROUND: The risk of women who undergo surgery for the treatment of pelvic organ prolapse (POP) by the age of 80 is reported to exceed 10%, and is expected to rise with the increase in life expectancy. Most women affected are in their 5th or 6th decade, and the majority will suffer other medical problems. The current medical literature asserts that the vaginal surgical approach for POP operations are followed by less complications and provide a shorter rehabilitation period than the abdominal route. Hysterectomy is widely accepted as part of POP reconstructive surgery whenever the uterus is significantly prolapsed, however, there is no clear evidence to support the role of hysterectomy in improving surgery outcome. We present our experience with a new minimally invasive procedure - the posterior intravaginal slingplasty (IVS) for utero-suspension in the presence of moderate and advanced uterine prolapse. AIM: To evaluate the feasibility, intra- and post-operative complications and short term results of the posterior IVS procedure and uterosuspension for uterine prolapse. METHODS: Reconstructive surgery using the posterior IVS was performed on 18 women with moderate to severe uterine prolapse who chose to preserve their uterus. Patients were then followed 1,6,12 months and 2 years post-operatively to assess any recurrence of pelvic organ prolapse. RESULTS: No major intra- or post-operative complications were reported. Follow-up of one to 13 months showed good results. CONCLUSIONS: Reconstructive POP surgery may not necessitate hysterectomy. The posterior IVS is a novel safe, minimally invasive, simple and effective surgical procedure for the treatment of POP, permitting uterine preservation. A larger number of patients and a longer follow-up period are required for proper evaluation of the actual safety and efficacy of this procedure.
Upper urinary dilatation caused by a protracted total uterine prolapse and resulting in end-stage chronic renal failure in a 66-year-old women is described. A gynecological examination is advised in females with renal insufficiency of unknown etiology.
OBJECTIVE: To evaluate the clinical characteristics, complications, and satisfaction scores of patients who underwent the Manchester operation. METHODS: This retrospective observational study evaluated data from 204 women who underwent the Manchester operation at the Department of Obstetrics and Gynecology of Hacettepe University School of Medicine, Ankara, Turkey, from January 1985 to April 2004. RESULTS: Mean age was 34.68+/-4.24 years and parity 2.47+/-0.96; 85.8% of the patients were premenopausal; 176 patients (86.28%) had grade 3 and 28 (13.72%) had grade 2 uterine prolapse; 95.1% of the patients had associated cystoceles and 51.3% had associated rectoceles; and 81.4% had urinary incontinence. Regarding early postoperative complications, 27 patients (13.23%) had febrile morbidity; retroperitoneal hematoma occurred in 1 patient (0.49%); urinary retention occurred in 45 patients (22.05%), and cervical stenosis occurred in 23 patients (11.27%). At 1 year, 1 patient had undergone abdominal hysterectomy because of unsuccessful cervical dilatation; and a mean of 3.6 years following the operation, 8 patients (3.9%) had undergone the tension-free vaginal tape procedure plus a vaginal hysterectomy for recurrent stress urinary incontinence and uterine prolapse. The mean satisfaction/acceptance score for the operation was 8.52+/-2.13 (range, 2-10). CONCLUSION: A high degree of acceptance/satisfaction and a low morbidity rate show the Manchester operation to be a good option for the treatment of uterine prolapse in women who wish to keep their uterus.
A patient developed uterine prolapse during pregnancy. Conservative management consisted of bed rest and use of a pessary. A viable infant was delivered at 30 weeks' gestation following premature rupture of the membranes. A review of the literature suggests that maintaining conservative treatment of these patients throughout pregnancy can result in uneventful, normal, spontaneous delivery.