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Longitudinal vaginal septum, a rare congenital fusion defect of mullarian ducts rarely causes dystosia of labour and total uterine prolapse. Several surgical techniques were developed for repair of prolapse but no consensus has been reached on one type of operation.
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OBJECTIVE: To compare tissue markers of collagen metabolism in the uterosacral ligaments with those in vaginal tissue in women with uterine prolapse. DESIGN: Prospective observational experimental study. SETTING: A tertiary urogynaecology unit. POPULATION: Women referred for hysterectomy for prolapse or benign gynaecological disease. METHODS: Matrix metalloproteinase (MMP)-2 and -9 expression, tissue inhibitors of metalloproteinase (TIMP)-2 expression and hydroxyproline content were measured in the uterosacral ligaments and vaginal tissue from 14 women with prolapse compared with 14 controls. MAIN OUTCOME MEASURES: Levels of MMP, TIMP and hydroxyproline in the uterosacral ligaments and vaginal tissue of women with prolapse and controls. RESULTS: Fourteen women with prolapse and 14 women without prolapse (controls) were included. A significant increase in pro MMP-2 expression was seen in vaginal tissue from women with prolapse (P < 0.05) but not activated MMP-2, MMP-9 and TIMP-2. For uterosacral ligaments, the differences were not statistically significant. No significant difference in hydroxyproline content was found between control and prolapse in either tissue. Significant correlations exist in expression of pro-MMP-2, activated MMP-2, MMP-9 and TIMP-2 in vaginal tissue with that in uterosacral ligaments. CONCLUSIONS: Correlations existed between markers of collagen metabolism in the vaginal and uterosacral tissues. This suggests vaginal tissue reflects the endopelvic fascia. The changes which are more pronounced in vaginal tissue may be as a result of prolapse rather than cause.
The histological structure of the vaginal fascia was studied in two groups of patients: 10 consecutive women having a vaginal repair for uterine prolapse or descent and 10 consecutive women having an abdominal hysterectomy for fibroids. Abnormal histological changes were found in 7 out of 10 patients with uterine descent as compared to 2 out of 10 controls (P less than 0.05). This suggests a correlation between histological changes in vaginal connective tissue and pelvic laxity.
A 12-month study was undertaken in a 9-veterinarian dairy practice to determine patterns of uterine prolapse and factors associated with posttreatment survival. Of 220,000 cows in herds visited by veterinarians from the practice, 200 (0.09%) developed prolapses mostly (155/169 with data) in the first 24 hours after calving. Most cows (130/200) had prolapses during fall and winter months, and assistance was required in 47 of 200 calvings that resulted in prolapses. Treatment of affected cows (n = 196) consisted of cleansing and replacement of the uterus, insertion of perivulvar retention sutures, local and systemic administration of antibiotics, and parenteral administration of dexamethasone and oxytocin. Calcium was administered to cows with milk fever (n = 117) and to multiparous cows without milk fever attended by veterinarian 9 (n = 8). Crude recovery rate after 2 weeks was 72.4%, but recovery was significantly better if the calf was born alive (P = 0.001), the cow was primiparous (P = 0.03), the cow did not have stage-3 milk fever (P = 0.003), or if the cow was attended by veterinarian 9 (P = 0.01). Time to treatment was not significantly associated with recovery, but affected cows were treated mostly (127/156) within 2 hours of occurrence of the prolapse. By multivariable analysis, presence of a liveborn calf, parity, and lack of stage-3 milk fever, but not attending veterinarian, were significant (P less than 0.05) prognostic indicators of 2-week survival.
OBJECTIVE: The study measured ureteral and cervical locations during vaginal hysterectomy for prolapse and the extent of parametrial ligament shortening possible. STUDY DESIGN: Cervical and ureteral position were measured in 26 women undergoing uterine prolapse correction. Parametrial clamp tip location was also measured. RESULTS: The cervix lay between 0 and -14.5 cm (below) the hymen (mean +/- SD -5.35 +/- 3.96 cm) and the ureters lay +5.0 to -4.0 cm (mean +/- SD +1.89 +/- 1.99 cm). Correlation of ureteral with cervical position was 0.69 (P <.01) and correlation with ipsilateral uterosacral ligament clamp positions was 0.80 (P <.01). Regression line slope relating cervical descent and cervix to ureter distance was 0.65, indicating that for every 3 cm of cervical descent there was 2 cm widening of the gap between the cervix and ureters and 1 cm descent of the ureter. CONCLUSION: For every 3 cm of cervical descent the ureters descend 1 cm, thereby widening the ureterocervical gap and permitting ligament shortening during vaginal hysterectomy.
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Spontaneous large bowel perforations have been associated with chronic constipation. The previously reported episodes of anal evisceration of small intestine have occurred in patients with a rectal prolapse. An end-stage complication of chronic third degree uterine prolapse is presented. A laceration of the anterior rectosignoid colon wall permitted small bowel extrusion through the anus. The tearing effect exerted by the prolapsed uterus at the rectouterine fold presumably caused the rectosigmoid laceration.
The literature review and a case report of a 25 years old patient who started to suffer from an extemely large abdomen, sever oedema, dyspnea, and uterine prolapse from the 30th week in her third pregnancy because of a very large mucinous cyst. The prolapsed uterus improved with bed rest. She delivered at term with no complication. The cyst was removed three weeks after the delivery with about ten litres of mucoid secretion in it. The patient left hospital on the tenth post operative day.
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OBJECTIVE: To determine the outcome of sacrocervicopexy and combined operations in the treatment of uterovaginal prolapse in women with desire to preserving both uterus and fertility. CLINICAL PRESENTATION AND INTERVENTION: Sacrocervicopexy with Prolene mesh and combined operations were performed in 3 women with total uterine prolapse because of the patient's desire to retain fertility in 2 cases and refusal of hysterectomy in the 3rd patient. The 1st case was a 38-year-old woman, gravida 2, parity 1; the 2nd case a 42-year-old woman, gravida 3, parity 2, and the 3rd a 39-year-old woman, gravida 1, parity 1. Douglas pouch was obliterated with Moschcowitz operation. All of the women underwent sacrocervicopexy with Prolene mesh. The repair of a paravaginal defect and prophylactic Burch urethropexy were accomplished through entering Retzius' space. Genital hiatus was narrowed via approximating levator muscles transvaginally. No serious intraoperative complications occurred and no recurrence was detected during the follow-up period. There was no postoperative complication except for some degree of pain in the 1st postoperative month in 1 case. CONCLUSION: The results indicate that sacrocervicopexy and repair of all concomitant defects in the pelvic floor are effective procedures in the treatment of uterovaginal prolapse in cases where there is a desire to retain fertility and uterus.
Interest in vaginal hysterectomy is rising. Controversy remains regarding the value of conservation of the cervix at hysterectomy. Subtotal vaginal hysterectomy is a simple procedure that carries a low risk of morbidity. In combination with sacrospinous fixation it can be an option in the management of patients with marked uterine prolapse who desire retention of the cervix. The technique is described, and a case is reported.
THE AIM: A successful reposition of a subtotal gravid uterus of an 29 year old patient and prevention of a spontaneous abortion is presented. METHODS AND RESULTS: An 29 year old patient was admitted to the clinic due to pains in the lower abdomen, miction difficulties and a subtotal uterine prolapse. During the examination in the gynecological position upon disinfection completed, a manual reposition of a gravid uterus was performed. During the reposition, we found the uterus in contraction and the cervical channel one-finger size opened up to the internal cervical os. We introduced Mikulitz tampon as a support while the patient undergone laboratory and anesthesiology pre-operative program. In a short OET anesthesia, the uterine reposition was performed by Smith-Hodge pessary 85 mm and cerclage sec. McDonald in order to prevent a spontancous abortion caused by cervical insufficiency. The postoperative status of the patient was regular/normal. We recommended a bed rest and diazcpam (Apaurin) tbl a 3 mg 3 x 1. CONCLUSION: Complete treatment was performed under the short OET anesthesia, and a recovery of the patient was successful. All parameters of the pregnancy were normal.
BACKGROUND: The finding of unanticipated pathology in a uterus after vaginal hysterectomy for prolapse is uncommon. CASE: An incidental small malignant mixed mesodermal tumor was found at vaginal hysterectomy in a 68-year-old woman. CONCLUSION: A MED-LINE search found no other reported cases of malignant mixed mesodermal tumor in a patient undergoing vaginal hysterectomy for uterine prolapse. Unexpected endometrial and cervical lesions will be discovered occasionally after hysterectomy for benign disease.
BACKGROUND: Primary carcinoma of the rectovaginal septum is very rare. Most cases are associated with documented endometriosis, and patients will often present with vaginal or rectal bleeding. CASE: A 47-year-old woman presented to the emergency department complaining of urinary symptoms and "something falling out of the vagina." She was diagnosed initially as having uterine prolapse. However, further investigations and surgery showed that she had a primary papillary serous carcinoma of the rectovaginal septum, and the carcinoma later metastasized to the lymph nodes. No evidence of endometriosis was found. Assessment and subsequent treatment of this aggressive tumour was likely delayed because of its initial benign presentation. CONCLUSION: Our presentation of the case of a woman with primary carcinoma of the rectovaginal septum not associated with a focus of endometriosis shows that this rare aggressive cancer may present in a clinically benign fashion.
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