Female Prolapse Research Articles

Differences in help-seeking behaviour between men and women with multiple pelvic floor symptoms: a qualitative study.

Pelvic floor symptoms, such as lower urinary tract symptoms, defecation problems, sexual dysfunction, pelvic pain, and pelvic organ prolapse in females, are common and frequently co-occur. Despite negatively affecting quality of life, few patients seek help. Most studies assessing help-seeking behaviour have focused on a single pelvic floor symptom. We aimed to explore the barriers and facilitators of help-seeking behaviour in males and females with at least two pelvic floor symptoms. This interview study included participants based on age and symptoms (number and type) from a larger group taking part in a survey on pelvic floor symptoms in the general population. Two researchers independently encoded and analysed the semi-structured interviews, continuing until saturation for both the male and female cohorts. Of the 25 participants (13 male, 12 female), 9 sought help for all of their pelvic floor symptoms, 10 did not seek help for any symptom, and 6 sought help for some of their pelvic floor symptoms. We identified themes in domains related to the patient, healthcare professional, environment, and symptom. Although most themes applied to both males and females, some had greater sex specificity. Males and females have more similarities than differences in help-seeking behaviour. Healthcare providers should be aware that patients who seek help for one symptom probably have multiple pelvic floor symptoms that the patient has not reported.

Analysis of risk factors for pelvic organ prolapse in females after hysterectomy

Aim. To identify risk factors for pelvic organ prolapse in females after hysterectomy.
 Materials and methods. A cross-sectional study from August 2019 to October 2021 in women after hysterectomy for benign neoplasms (n=91) analyzed history, outpatient medical record data, and clinical examination findings. Pelvic organ prolapse was assessed using the POP-Q (Pelvic Organ Prolapse Quantification) international classification. All patients were divided into two groups: Group 1 (n=61) included patients with the pelvic organ prolapse; Group 2 (n=30) included patients without the pelvic organ prolapse.
 Results. Post-hysterectomy pelvic organ prolapse was observed in 67% (61/91) patients, including grade 1 in 49.2% (30/61), grade 2 in 36.0% (22/61), and grade 3 in 14.8% (9/61). The significant risk factors include obstetric trauma (41 83.7%; odds ratio OR 5.6, 95% confidence interval CI 2.114.8; p=0.00034), age (49 84.5%; OR 19.7, 95% CI 0.5990.831; p=0.00001) and lifestyle associated with weight lifting (32 72.1%; OR 9.8, 95% CI 0.63.9; p=0,00267). No statistically significant differences were observed when comparing the prolapse rate with the presence of connective tissue dysplasia and somatic disorders. Analysis of cumulative risk factors showed significant differences; in Group 1, the mean number of risk factors was 4.61.6 (95% CI 3.26.1), and in Group 2, 2.71.8 (95% CI 2.53.8), t-test value was 6.76, p0.001.
 Conclusion. Genital prolapse occurs in more than 1/2 of females after hysterectomy. The most significant risk factors are obstetric trauma, age, and a lifestyle associated with weight lifting. The incidence of pelvic organ prolapse increases when several risk factors are combined.

A0988 - Is there an added value of dynamic MRI of the pelvic floor to the Clinical POP-Q Examination before management of Pelvic Organ Prolapse in females? A double blinded prospective study in a tertiary care center

A0988 - Is there an added value of dynamic MRI of the pelvic floor to the Clinical POP-Q Examination before management of Pelvic Organ Prolapse in females? A double blinded prospective study in a tertiary care center

A Brief Review on Mycoplasma

Mycoplasma genitalium are a finicky creature belonging to the Mollicutes class, the tiniest prokaryote ability of self. Most remains unclear about its normal evolution in uncontrolled illness, despite the fact that it was originally discovered in 1981.
 It's a sexually transmissible bacterium that can cause short term and long - term non-gonococcal urethritis (NGU) in males, and there's strong evidence that it could also cause cervicitis and pelvic organ prolapse in females. Its significance in a number of different medical symptoms is unknown. The majority of people infected remain asymptomatic and clear infection without developing disease; asymptomatic screening is therefore not recommended. Prevalence rates are higher in patients attending sexual health clinics and in men with NGU. Limited availability of diagnostics has encouraged syndromic management, resulting in widespread antimicrobial resistance and given that few antimicrobial classes have activity against Mycoplasma there is significant concern regarding the emergence of untreatable strains.
 Symptomless monitoring also isn't suggested so because bulk of those affected stay silent and recover illness without acquiring illness. Individuals who visit private clinics and males having NGU have greater prevalence. Due to the scarcity of diagnosing, symptomatic leadership is becoming popular, resulted in massive resistant bacteria. Provided which only very few antibiotic class possess action against M. genitalium, this same occurrence of incurable isolates is a serious worry. Screening must be made more widely available, and it will include discovery of erythromycin tolerance causing alterations. Competence in the evaluation of microbiology findings in relation to medical association provides appropriate therapies while trying to minimize antimicrobial use. Observation of population health on a worldwide stage is critical for tracking and adapting to shifting epidemiological patterns. We summarised existing understanding of M. genitalium, along with epidemiological data, diagnostic, and bacteriological data, as well as topic obstacles with in era of growing resistant strains in this evaluation.

Clinical efficacy of integral theory-guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females.

BACKGROUNDInternal rectal prolapse (IRP) is one of the most common causes of obstructive constipation. The incidence of IRP in women is approximately three times that in men. IRP is mainly treated by surgery, which can be divided into two categories: Abdominal procedures and perineal procedures. This study offers a better procedure for the treatment of IRP.AIMTo compare the clinical efficacy of laparoscopic integral pelvic floor/ligament repair (IPFLR) combined with a procedure for prolapse and hemorrhoids (PPH) and the laparoscopic IPFLR alone in the treatment of IRP in women.METHODSThis study collected the clinical data of 130 female patients with IRP who underwent surgery from January 2012 to October 2014. The patients were divided into groups A and B. Group A had 63 patients who underwent laparoscopic IPFLR alone, and group B had 67 patients who underwent the laparoscopic IPFLR combined with PPH. The degree of internal rectal prolapse (DIRP), Wexner constipation scale (WCS) score, Wexner incontinence scale (WIS) score, and Gastrointestinal Quality of Life Index (GIQLI) score were compared between groups and within groups before surgery and 6 mo and 2 years after surgery.RESULTSAll laparoscopic surgeries were successful. The general information, number of bowel movements before surgery, DIRP, GIQLI score, WIS score, and WCS score before surgery were not significantly different between the two groups (all P > 0.05). The WCS score, WIS score, GIQLI score, and DIRP in each group 6 mo, and 2 years after surgery were significantly better than before surgery (P < 0.001). In group A, the DIRP and WCS score gradually improved from 6 mo to 2 years after surgery (P < 0.001), and the GIQLI score progressively improved from 6 mo to 2 years after surgery (P < 0.05). In group B, the DIRP, WCS score and WIS score significantly improved from 6 mo to 2 years after surgery (P < 0.05), and the GIQLI score 2 years after surgery was significantly higher than that 6 mo after surgery (P < 0.05). The WCS score, WIS score, GIQLI score, and DIRP of group B were significantly better than those of group A 6 mo and 2 years after surgery (all P < 0.001, Bonferroni) except DIRP at 2 years after surgery. There was a significant difference in the recurrence rate of IRP between the two groups 6 mo after surgery (P = 0.011). There was no significant difference in postoperative grade I-III complications between the two groups (P = 0.822). CONCLUSIONIntegral theory–guided laparoscopic IPFLR combined with PPH has a higher cure rate and a better clinical efficacy than laparoscopic IPFLR alone.

Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females

Clinical efficacy of integral theory–guided laparoscopic integral pelvic floor/ligament repair in the treatment of internal rectal prolapse in females

Robotic-assisted repair of pelvic organ prolapse: a scoping review of the literature.

The purpose of this article is to perform a scoping review of the medical literature regarding the efficacy, safety, and cost of robotic-assisted procedures for repair of pelvic organ prolapse in females. Sacrocolpopexy is the “gold standard” repair for apical prolapse for those who desire to maintain their sexual function, and minimally-invasive approaches offer similar efficacy with fewer risks than open techniques. The introduction of robotic technology has significantly impacted the field, converting what would have been a large number of open abdominal sacrocolpopexy (ASC) procedures to a minimally-invasive approach in the United States. Newer techniques such as nerve-sparing dissection at the sacral promontory, use of the iliopectineal ligaments and natural orifice vaginal sacrocolpopexy may improve patient outcomes. Prolapse recurrence is consistently noted in at least 10% of patients regardless of route of mesh placement. Ancillary factors including pre-operative prolapse stage, retention of the cervix, type of mesh implant, and genital hiatus (GH) size all adversely affect surgical efficacy, while trainees do not. Minimally-invasive apical repair procedures are suited to early recovery after surgery protocols but may not be appropriate for all patients. Studies evaluating longer-term outcomes of robotic sacrocolpopexies are needed to understand the relative risk/benefit ratio of this technique. With several emerging robotic platforms with improved features and a focus on decreasing costs, the future of robotics seems bright.

MR Defecography in Assessing Functional Defecation Disorder: Diagnostic Value of the Defecation Phase in Detection of Dyssynergic Defecation and Pelvic Floor Prolapse in Females

Objective: Dyssynergic defecation (DD) and pelvic floor prolapse often coexist in female functional defecation disorder. A retrospective study was performed to evaluate the ability of dynamic MR sequences with the straining and defecation phase to detect paradoxical puborectalis contraction and occult multiple-compartments disorders. Methods: Fifty-three females clinically diagnosed with DD underwent magnetic resonance defecography. The dynamic sequences consist of rest, squeeze, straining, and defecation. The straining phase (pre rectal filling) and defecation phase (post rectal filling) were acquired to assess for pelvic floor relaxation and pelvic organ descent. MR images were analyzed by 2 radiologists with regard to paradoxical puborectalis contraction (changes in the anorectal angle [ARA]) and the presence of pelvic organ prolapse in straining phase and defecation phase independently. Statistical analysis was performed using Wilcoxon’s matched-pairs signed-ranks test and Crosstabs test for matched pairs. Results: Among the 53 patients with DD, 24 individuals (45.3%) were diagnosed DD with multifocal disorders. Comparison between the straining and the defecation phase revealed that there was no significant difference in the change of the ARA (p > 0.05), while significant differences were found in cystocele, vaginal or cervical prolapse, rectocele and descending perineum syndrome between the straining and the defecation phase (p < 0.05). The defecation phase with impaired evacuation distinguished additional anterior/middle compartments findings in female DD patients. Conclusion: The straining phase and the defecation phase have the same ability in assessing paradoxical puborectalis contraction of the DD. Compared with the straining phase, the defecation phase provides the maximum stress to the pelvic floor resulting in complete levator ani relaxation. In addition to diagnosing the abnormal anorectal function, the defecation phase with the discharge of the rectal filling demonstrates maximum anterior/middle pelvic organ descent in DD patients.

Computational comparison of different textile implants to correct apical prolapse in females

Abstract Prosthetic textile implants of different shapes, sizes and polymers are used to correct the apical prolapse after hysterectomy (removal of the uterus). The selection of the implant before or during minimally invasive surgery depends on the patient’s anatomical defect, intended function after reconstruction and most importantly the surgeon’s preference. Weakness or damage of the supporting tissues during childbirth, menopause or previous pelvic surgeries may put females in higher risk of prolapse. Numerical simulations of reconstructed pelvic floor with weakened tissues and organ supported by textile product models: DynaMesh®-PRS soft, DynaMesh®-PRP soft and DynaMesh®-CESA from FEG Textiletechnik mbH, Germany are compared.

Prevalence and risk factors for pelvic organ prolapse in female citizens of Baku

Aim. Study of prevalence and risk factors of pelvic organ prolapse in females in Baku.&#x0D; Methods. Statistical observation unit was a woman aged 45-74 years. The sample size (710 women) was determined taking into account probable prevalence of pelvic organ prolapse (20% according to literature) and margin of error (3%). All women were invited to maternity welfare centre, and a thorough examination was performed after their written consent was obtained.&#x0D; Results. The proportion of women aged 45-49, 50-54, 55-59, 60-64, 65-69, and 70-74 years was 26.5±1.7, 24.9±1.6, 23.1±1.6, 10.9±1.2, 8.2±1.0 and 6.4±0.9%, respectively. Prevalence of obesity in the named groups was 31.9, 34.5, 35.4, 36.4, 27.8 and 34.8%. Proportion of women with secondary and specialized secondary education was 58.5, 58.8, 53.7, 51.9, 51.7 and 67.4% resepctively. Among women of the corresponding age groups, physical work was recorded in 47.9, 53.7, 59.8, 58.4, 13.8 and 17.4% of cases, respectively. In past medical history, no surgeries were observed in 68.1, 77.4, 73.2, 77.9, 84.5 and 84.8% of cases, resepectively. Some women had no labour in past medical history (2.1, 2.3, 2.5, 2.6, 3.5 and 4.3% in the same age groups). Statistically significantly prevalence of pelvic organ prolapse increases among those aged 60 years and older (51.6±3.6% at age 45-49 years and ≥76.6±4.8% at age 60 years and older, р=0.001), with a body mass index less than 25.0 and more than 30 kg/м2 (69.7±3.3 and 66.7±3.0%, р=0.01), with high parity and remarkable family history (63.0±2.6, р=0.01), severe connective tissue dysplasia (72.6±2.5%, р=0.001), in postmenopausal period (63.8±2.0%, р=0.01), and depending on education level (88.0±2.4% among those with pre-secondary education: р=0.001). Relative risk of pelvic organ prolapse in the population of Baku is lower compared to the literature data in the background of obesity, but is higher in the background of positive family history and depending on the amount of deliveries (p=0.05).&#x0D; Conclusion. In Baku 59.9±1.8% of women aged 45-75 years have pelvic organ prolapse of different severity, incomplete uterine and vaginal prolapse are more prevalent (41.3±1.8 per 100 women); prevalence of pelvic organ prolapse is higher in women aged 60 years or older compared to those aged 45-49 (76.6±4.8% vs 51.6±3.6%, р=0.001).

An International Urogynecological Association (IUGA) / International Continence Society (ICS) Joint Report on the Terminology for Female Pelvic Organ Prolapse (POP).

The terminology for female pelvic floor prolapse (POP) should be defined and organized in a clinically-based consensus Report. This Report combines the input of members of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of fourteen rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). A Terminology Report for female POP, encompassing over 230 separate definitions, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction and POP. Female-specific imaging (ultrasound, radiology and MRI) and conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 year) review is anticipated to keep the document updated and as widely acceptable as possible. A consensus-based Terminology Report for female POP has been produced to aid clinical practice and research.

Dynamic magnetic resonance imaging; reliability of assessment and correlation with clinical findings of pelvic organ prolapse

IntroductionPelvic floor dysfunction and prolapse affect about 50% of women past middle age. Failure to recognize the complex set of pelvic floor defects in individuals leads to most postsurgical failures. Diagnosis and grading of pelvic floor dysfunction is primarily done by physical examination. Imaging does not have yet an established role in the investigation of prolapse, yet it is expected to play a role in preoperative planning identifying soft tissue abnormalities which will help avoiding recurrence. Aim of the workThis is a prospective study targeted at defining the role of MRI in assessment of pelvic floor prolapse in females. MethodsDynamic and static MRI was performed in 40 female patients complaining of pelvic organ prolapse and/or stress urinary incontinence or fecal incontinence. Full history was taken and clinical examination performed and findings compared with MRI results. ResultsGood concordance was found between dynamic MRI and clinical examination in all three compartments, it was 82.5% in the anterior compartment, 80% in the posterior compartment, 85% in enteroceles and 65.0% in the middle compartment. ConclusionDynamic MRI is expected to be a promising imaging tool and to play a larger role in the preoperative planning of pelvic organ prolapse in the near future.

Is Pelvic Osteotomy Associated with Lower Risk of Pelvic Organ Prolapse in Postpubertal Females with Classic Bladder Exstrophy?

Bladder exstrophy is a major congenital anomaly involving defects in the genitourinary tract and pelvic musculoskeletal system. It appears intuitive that closure of the pelvic ring using osteotomy would be associated with a decreased risk of pelvic organ prolapse. We investigated whether osteotomy is associated with a decreased risk of pelvic organ prolapse in females with classic bladder exstrophy. We searched our institutional review board approved exstrophy database of 1,078 patients and identified 335 females. We excluded patients who were younger than 13 years, had cloacal exstrophy or epispadias and did not have postpubertal imaging for measurement of pubic diastasis available. Our final study population consisted of 67 females. Univariate analysis was performed using t test or rank sum test for continuous variables and chi-square test for categorical variables. Logistic regression was used for multivariate analysis. Median patient age was 23 years (range 13 to 60). A total of 20 patients (29.9%) had pelvic organ prolapse at a median age of 20 years (range 11 to 43). Of the 67 patients 25 (37.3%) had undergone osteotomy at a median age of 6 months (range birth to 10 years). Seven patients had at least 1 pregnancy (range 1 to 3), and 24 patients had undergone vaginoplasty. On univariate analysis only diastasis was associated with pelvic organ prolapse, with smaller diastasis associated with a decreased risk of prolapse. On multivariate analysis including diastasis and osteotomy only diastasis was statistically significant. Osteotomy does not decrease the risk of pelvic organ prolapse in patients with classic bladder exstrophy. Rather, degree of diastasis is significantly associated with pelvic organ prolapse.

1614 IS PELVIC OSTEOTOMY ASSOCIATED WITH LOWER RISK OF PELVIC ORGAN PROLAPSE IN PATIENTS WITH CLASSIC BLADDER EXSTROPHY?

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia II1 Apr 20121614 IS PELVIC OSTEOTOMY ASSOCIATED WITH LOWER RISK OF PELVIC ORGAN PROLAPSE IN PATIENTS WITH CLASSIC BLADDER EXSTROPHY? Ifeanyi Anusionwu, Nima Baradaran, Bruce Trock, Andrew Stec, John Gearhart, and E. James Wright Ifeanyi AnusionwuIfeanyi Anusionwu Baltimore, MD More articles by this author , Nima BaradaranNima Baradaran Baltimore, MD More articles by this author , Bruce TrockBruce Trock Baltimore, MD More articles by this author , Andrew StecAndrew Stec Baltimore, MD More articles by this author , John GearhartJohn Gearhart Baltimore, MD More articles by this author , and E. James WrightE. James Wright Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1409AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder exstrophy is a congenital anomaly with defects in genitourinary tract and pelvic musculoskeletal system. It appears intuitive that closure of the pelvic ring with osteotomy will be associated with decreased risk of pelvic organ prolapse in this population. The aim of this study is to determine whether osteotomy is associated with a lower risk of pelvic organ prolapse in females with classic bladder exstrophy. METHODS We queried our institutional bladder exstrophy database, and identified 335 females. We excluded patients who were younger than 13 years old, those who had cloacal exstrophy or female epispadias, and those who had missing data. Our final study population consisted of 90 females. Univariate analysis was performed using t-test for continuous variables and chi-squared test for categorical variables. Logistic regression was used for multivariable analysis. RESULTS Median patient age was 20 years (range 13-60). Twenty-four patients (26.7%) developed pelvic organ prolapse at median age of 19 (range 11-43). Forty-five patients (50%) had undergone osteotomy at median age of 6 months (range birth to 16 years) and seven patients had at least one pregnancy (range 1-3 pregnancies). On univariate analysis (Table 1), only diastasis was significantly associated with prolapse, with smaller diastasis associated with lower risk of prolapse. On multivariable analysis including diastasis and osteotomy, only diastasis was statistically significant. Mean diastasis in patients who underwent osteotomy was 5.34 while for those who did not undergo osteotomy it was 7.72 (p =0.0013). Table 1. Logistic regression model to predict pelvic organ prolapse in patients with classic bladder exstrophy Prolapse No Prolapse P-value Diastasis (cm) 8.45(3.74) 5.7(2.67) 0.002 Osteotomy (%) 47.8 55.7 0.52 Age (years) 26.23(12.06) 22.49(10.54) 0.16 Pregnancies (%) 8.3 7.6 0.91 CONCLUSIONS Pelvic osteotomy does not appear to predict risk of pelvic organ prolapse in patients with classic bladder exstrophy. Rather, it is the degree of sympheseal diastasis that is significantly associated with pelvic organ prolapse. Table 2. Logistic regression model to predict pelvic organ prolapse in patients with classic bladder exstrophy Univariate analysis Multivariable analysis Variables OR(95%CI) p-value OR(95%CI) p-value Diastasis (cm) 1.32(1.09-1.60) 0.005 1.31(1.07-1.62) 0.01 Osteotomy (yes/no) 0.73(0.28-1.90) 0.52 0.89(0.25-3.21) 0.86 Age (years) 1.03(0.99-1.07) 0.16 - - Pregnancies(yes/no) 1.11(0.20-6.14) 0.91 - - © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e653 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ifeanyi Anusionwu Baltimore, MD More articles by this author Nima Baradaran Baltimore, MD More articles by this author Bruce Trock Baltimore, MD More articles by this author Andrew Stec Baltimore, MD More articles by this author John Gearhart Baltimore, MD More articles by this author E. James Wright Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical Management of Pelvic Organ Prolapse in Females: Functional Outcome of Mesh Sacrocolpopexy and Rectopexy as a Combined Procedure

Urogenital prolapse is relatively common compared with rectal prolapse and the combination of urogenital prolapse and rectal prolapse is still more infrequent. This study was designed to evaluate the functional outcome of a series of patients who have undergone open mesh sacrocolporectopexy surgery for combined vaginal and rectal prolapse. Consecutive patients from June 2000 to June 2004 with confirmed vaginal and rectal prolapse subsequently underwent open mesh sacrocolporectopexy. The Cleveland Clinic Short Form-20 Pelvic Floor Distress Inventory questionnaire with Urinary Distress Inventory, Pelvic Organ Prolapse Distress Inventory, and Colorectal-Anal Distress Inventory subscales was completed by all patients preoperatively and at six months postoperatively. There were 29 patients with a median age of 66 (interquartile range, 59-73) years. Median period of follow-up was 26 (interquartile range, 15-33) months. Median global pelvic floor distress inventory scores were lower postoperatively compared with preoperatively (96.4 (interquartile range, 50.8-149.7) vs. 182.3 (interquartile range, 140.6-208.6; P = 0.001). All three median subscales scores also were significantly lower postoperatively compared with preoperatively. In patients with concurrent vaginal and rectal prolapse, open mesh sacrocolporectopexy confers good symptomatic improvement for urinary-, vaginal-, and rectal-related symptoms.

Utilidad de la historia clínica para el diagnóstico de obstrucción del tracto urinario inferior en pacientes con retención aguda de orina

To determine the diagnostic usefulness of data provided by clinical history for the diagnosis of lower urinary tract obstruction in patients with acute urinary retention. We performed a transversal study in a series of 70 patients (19 women and 51 men) with a mean age of 61.5 years (typical deviation 20.7 years), who underwent urodynamic study due to acute urinary retention. Past medical history was recorded in all patients. Physical exam was also carried out, evaluating prostate size in males, presence of genital prolapse in females, and neurourological examination. Urodynamic tests consisted on flowmetry, pressure/flow studies with simultaneous perineal electromyography, and voiding cystourethrogram or videocystogram. Student's t mean comparison and chi-square tests were used for the statistical analysis. The only clinical data that showed a statistically significant relationship with obstruction of the lower urinary tract were: age, sex, prostate size, and existence of infrasacral neurological lesion (absence of bulbocavernous reflex). Age > 74 years showed a sensitivity of 71 % for lower urinary tract obstruction and a specificity of 60%. Male sex showed a sensitivity of 88% and specificity of 36%. Prostate size > or ='3d grade II sensitivity was 58% and specificity 82%; and absence of infrasacral lesion a sensitivity of 77% and specificity of 48%. Provided that a negative result in a test with high sensitivity makes the likelihood of disease low, in women the presence of infrasacral neurogenic dysfunction or age < or ='3d74 years diminish the probability of obstruction in patients with acute urinary retention. On the other side, if a negative result of a test with high specificity increases the probability of having the disease, a prostate size > or ='3d grade II and age > 74 years favour the likelihood of having urinary tract obstruction for a patient with acute urinary retention.

MR imaging findings with female prolapse

MR imaging findings with female prolapse

Prevalence and severity of urinary incontinence and pelvic genital prolapse in females with anal incontinence or rectal prolapse.

The aim of this study was to determine the prevalence, severity, and associations between urinary incontinence and genital prolapse in females after surgery for fecal incontinence or rectal prolapse. All patients who underwent surgery for fecal incontinence (Group I) or rectal prolapse (Group II) were compared with a control group of females (Group III) by 43 questions regarding demographic data, past medical and surgical history, and diagnosis and treatment of anal and urinary incontinence and genital and rectal prolapse. The type (stress, urge, and total) of urinary incontinence was determined and graded using an incontinence severity questionnaire (Individual Incontinence Impact Questionnaire). Overall response rate in the three groups of patients was 40.1 percent. The questionnaire was sent to 240 patients operated on for fecal incontinence or rectal prolapse, and 83 of them responded (34.5 percent). The patients were distributed into three groups: Group I consisted of 51 patients (mean age 56.7 +/- 14); Group II consisted of 32 patients (69.7 +/- 11); and Group III consisted of 40 patients (60.5 +/- 16). The prevalence of urinary incontinence in Group I was 27 (54 percent), in Group II was 21 (65.6 percent), and Group III was 12 patients (30 percent; P = 0.003). Genital prolapse was present in 9 (17.6 percent), 11 (34.3 percent), and 5 patients (12.5 percent), respectively (P = 0.03). The prevalence of coexistent urinary incontinence and genital prolapse in both study groups was 22.8 percent (19 patients). There were no statistically significant differences between Groups I and II relative to prevalence, type, and severity of urinary incontinence and genital prolapse, but there were significant differences between the two study groups and the control group. Of the patients in the study group, 67 percent had urinary incontinence before or at the time of surgery. There is a higher prevalence and severity of urinary incontinence and pelvic genital prolapse in females operated on for either fecal incontinence or rectal prolapse than in a control group. Therefore, female patients with fecal incontinence or rectal prolapse should be evaluated and treated by a multidisciplinary group of pelvic floor clinicians, including a gynecologist or urologist with special training in female pelvic floor dysfunction and a colorectal surgeon.

Strangulated prolapse of female urethra

Two cases are reported of urethral prolapse in females. Invariably, symptoms are due to venous obstruction and strangulation. The clinical features and differential diagnosis are presented and recommendations made for treatment which should, in all cases, be surgical.