Total Uterine Prolapse Research Articles

Хирургическая коррекция пролапса тазовых органов при полном выпадении матки

Total prolapse of the uterus is a common pathology in older women who have given birth. To date, there is no single ‘gold standard’ in the surgical management of women with total uterine prolapse. Using the example of this case report, we would like to demonstrate that the operation of choice should be considered – vaginal extirpation of the uterus without appendages. This is due to the lower frequency of intraoperative complications and the peculiarities of the course of the postoperative period, as well as early activation and rehabilitation

Hourglass appearance in cystocele with an impacted vesical calculus.

A 62-year-old hypertensive female presented with a mass protruding from the vagina for the past 20 years. She complained of dysuria and urinary incontinence for the past 3 months. There was no history of surgical intervention in the past. The examination revealed a tender irreducible total uterine prolapse (procidentia) and cystocele with a decubitus ulcer. Computed tomography urogram showed a total uterine prolapse along with the prolapse of a part of urinary bladder, with a vesical calculus of size 2.8 cm × 2.7 cm in the prolapsed part of the bladder, below the level of the pubic symphysis, with minimal wall thickening. After optimization, vesical lithotripsy and bilateral ureteric stenting were performed, followed by hysterectomy after 2 days.

Congenital Uterine Anomaly and Pelvic Organ Prolapse: A Rare Case of Pelvic Organ Prolapse in a Complete Bicornuate Uterus with Successful Pregnancy Outcomes Undiagnosed until the Time of Sacrocolpopexy.

Müllerian development anomalies (MDAs) are most commonly diagnosed in the reproductive period. A bicornuate uterus is the result of a fusion defect of the Müllerian ducts, causing an abnormal fundal outline. Most of the cases are diagnosed early in life and present with obstetrical complications, such as recurrent pregnancy loss, preterm birth, intrauterine growth restriction, placental abruption, and cervical incompetence. Pelvic organ prolapse (POP) in women with MDAs has been reported; however, all reported cases were when MDAs are diagnosed before or simultaneously with the development of POP in premenopausal young women aged < 35. A 52-year-old menopausal woman, who successfully delivered vaginally at term, was presented with protruding mass through vaginal introitus. On POP-Q examination, the cervix was elongated and descended to 1 cm out of the hymen during bearing down; however, the uterine bodies were confined in the pelvic cavity, which is commonly encountered among POP patients with large uterus due to uterine fibroids or adenomyosis. She also diagnosed for complete bicornuate uterus and underwent robotic sacrocolpopexy for advanced stage POP. It is presumed to have been caused by the bicornuate uterus that prevented the total uterine prolapse with the effect of extending both uterine horns bilaterally inside the pelvic cavity and trapping the uterus within the pelvis. Herein, we report a rare case of complete bicornuate uterus with multiple successful vaginal deliveries at term without obstetric complications, which remained undiagnosed until she was managed for the POP in her postmenopausal period.

Pregnancy with Preexisting Total Uterine Prolapse

Management of pregnancy with uterine prolapse is challenging. Physician may encounter scenario which endanger both mother and baby during pregnancy, at labor and also after birth. Here, we present conservative management of a pregnancy with preexisting total uterine prolapse up to term. We performed cesarean section due to previous delivery by cesarean section. Interestingly, prolapse did not recur after delivery at two years follow up period.

Hysteropexy in the Treatment of Total Uterine Prolapse in a Brazilian Molosser Bitch

Background: Uterine prolapse is an obstetric emergency because the exposed tissue can present edema, devitalization or even gangrene, depending on the evolution time and on the severity of circulatory changes. Haemorrhage due to the rupture of ovarian or uterine vessels can evolve rapidly to hypovolemic shock. More rarely, secondary thromboembolism to the uterine strangulation can be developed, complication that can also lead to death. This study reports the case of a Brazilian Molosser bitch treated by reducing total uterine prolapse, complemented with hysteropexy, in order to prevent recurrence and maintain its reproductive ability. Case: A 5-year-old Brazilian Molosser bitch was attended presenting double firm and tubular mass protruding through the vulva. The patient gave birth to five live pups, the last two of which needed to be pulled. Two days after parturition, she had abdominal contraction when a mass protruded from the vagina. A total uterine prolapse was diagnosed, since both uterine horns were found exposed and inverted, with exposition of the endometrium and the areas of placental implantation, together with the body of the uterus. The tissue was apparently edematous and lightly parched, with the presence of strange bodies, but without signals of circulatory complications or lacerations that could turn a possible reduction and maintenance of the uterus unfeasible. Due to interest of the tutor in preserving the reproductive ability, an internal reduction via ventral medial celiotomy and the fixation of the uterus in the lateral abdominal wall (hysteropexy) was chosen in order to diminish the possibility of relapse in future parturition.Discussion: The definitive treatment of the uterine prolapse can be realized through ovariohysterectomy when the exposed uterine tissue is highly compromised or there is vessel rupture or no reproductive purpose for the female. The amputation of everted tissue through the vulva is also an option, but the risk of intracavitary bleeding during tissue resection must be considered when the uterine and ovarian artery and vein escape to the interior of the abdomen without according hemostasis. In cases which there are no complications of the prolapsed tissue and is desired to maintain the reproductive ability of the female, the internal reduction with hysteropexy is recommended. As the etiology of the uterine prolapse is a condition bound to several factors, in between them multiple pregnancies, relaxation of the uterine ligaments and genetic factors, conditions which can be associated to the cause of the prolapse in the mentioned patient, the hysteropexy was preferred as a complementary technique to uterine preservation and prevention of the prolapse relapse in a possible new parturition. In this case, the reduction of prolapse followed by hysteropexy was preferred, because the female dog was apparently well, without signs of complication of the prolapsed tissue and with satisfactory preoperative evaluation. Adding these to the request of the tutor in maintaining the reproductive ability of the female, since the procedure would not pose as a life risk to it. The absence of severe lacerations and circulatory complications in the prolapsed uterus of the bitch under study and the non-detection of toxemia and septicemia corroborated to the reduction and preservation of the uterus. Even though the uterine prolapse is a rare disease, it is necessary to improve surgical techniques that enable the conservation of the female dog in reproduction. In situations of viability of the prolapsed tissue, the technique of hysteropexy in abdominal wall showed itself effective, concluding that hysteropexy is feasible and efficient as a complementary procedure to the reduction of uterine prolapse, having contributed to avoid relapse and maintaining the reproductive of the subject related in this article.

Vaginal cancer occurring in a woman with longstanding untreated total uterine prolapse

Objective: To report on the rare case of a vaginal malignancy occurring in uterovaginal prolapse. Case Report: A 94-year-old postmenopausal woman with underlying diabetes mellitus who had been bedridden for over ten years is presented. She also had untreated longstanding uterovaginal prolapse with unknown HPV status. The investigation showed the squamous cell carcinoma (SCC) of the vagina at the lower two-thirds of the posterior vaginal wall with evidence of metastasis to the left high external iliac and internal iliac lymph nodes. Stage III primary carcinoma of the vagina with fourth-degree uterovaginal prolapse was diagnosed according to FIGO classification. Due to the patient’s frail, elderly, and bedridden status, she was given palliative radiotherapy as a treatment. The patient passed away after the fifth course of radiotherapy. Conclusion: Vaginal cancer occurring in uterovaginal prolapse patients is exceedingly rare. The incidence of vaginal cancer is commonly seen in elderly women. The management of vaginal cancer should adhere to the same guidelines, regardless of uterovaginal prolapse and its complications.

Профілактика ускладнень вагінальної гістеректомії

The article presents data on the improved technique of vaginal hysterectomy (GE) with the use of medications and technical support in case of genital prolapse. The objective: was to determine the clinical effectiveness of preventive measures, the improved technique of vaginal GE in case of complete loss of the uterus with the use of drugs and technical support. Patients and methods. The main group included 21 women with total uterine prolapse, who underwent vaginal GE without uterine appendages according to the procedure we improved, and in the control group – 17 women, who underwent vaginal GE with a standard procedure. In the two groups after the vaginal GE, anterior and posterior colpoperineoraphy was performed with levatoroplasty. Results. We have improved the technique of conducting vaginal GE with the use of medications (hydroparreparation of the solution with 0.4 mg of terlipressin) and technical support (use of the radiofrequency scalpel and argon-plasma tissue coagulation), according to our study, significantly reduces the likelihood of intraoperative complications and improves postoperative period with respect to reparative Processes and a decrease in the frequency of hemorrhagic and pyoinflammatory diseases after surgery Skogen intervention. Conclusion. The clinical study determined the effectiveness of a comprehensive surgical technique for the complete loss of the uterus and prevention of possible complications of surgical intervention. Key words: vaginal hysterectomy, colpo-perineorrhaphy, levatoroplasty, synthetic analogue of vasopressin, argon-plasma coagulation of tissues.

Near Term Pregnancy in a Patient with Total Uterine Prolapse

: Uterine prolapse is herniation of the pelvic organ to vaginal walls or beyond the vaginal, walls as well as it is the most common gynecologic problem that has made by stretching and weakening of muscles and connective tissues. Incidence of total and partial uterine prolapse is around one per 10000 to 15000 deliveries. This study is about a 33- year-old Iranian (Balouch lady) G5P4L4 who had been reffered to maternal ward of Emam Ali hospital of Zahedan city in the 35 weeks and 3 dayes of gestation age with uterine prolapse and labor pain. She was prepared to Cesarian Section with normal lab analysis and was done emergency caesarean section and was born a baby boy with 2150 g and Apgar score10/10.

Uncomplicated struma ovarii in an old-aged woman with total uterine prolapse

Uncomplicated struma ovarii in an old-aged woman with total uterine prolapse

Acute Renal Insufficiency Caused by Total Uterine Prolapse: A Case Report and Review of the Literature

We aimed to report a case with acute renal insufficiency and hydronephrosis treated by surgical repair of the total uterine prolapse. A 61-year-old woman presented to our clinic with a general weakness, lower abdominal pain, decreased urination and dysuria. Her pelvic examination revealed the fourth-degree uterine prolapse and blood tests demonstrated failure of renal function tests. Abdominal computed tomography showed bilateral hydroureteronephrosis and the prolapsed uterus and the bladder through the pelvis. After acute vital intervention surgical repair of the pelvic floor with vaginal hysterectomy was performed. There were no complications associated with the surgery. The patient’s renal function tests returned to normal and urine extraction increased. We suggest renal evaluation should be considered for cases with severe prolapse of the uterus and if hydroureteronephrosis exists, surgical treatment should be performed as soon as possible to prevent irreversible consequences.

A Sacrospinous Ligament Fixation Under Local Anesthesia in Djibouti

Abstract Background: Pelvic organ prolapse (POP) is a common condition in postmenopausal women all over the world. Pelvic-floor relaxation and POP are regarded by many experts as a pelvic-floor herniation process caused by obstetrical trauma to the pelvic floor or/and existing fascial weakness. Postmenopausal women with POP may have systematic diseases, such as diabetes mellitus, hypertension, cardiac failure, and other conditions that render applying general anesthesia and thus any surgical treatment unavailable. Case: A 70-year-old woman, 160 cm tall and weighing 80 kg, was referred with total uterine prolapse (stage 4 uterovaginal prolapse but not urinary incontinence). She had 8 children, all of whom were delivered vaginally. She had smoked cigarettes for 45 years, and had chronic obstructive pulmonary disease and cardiac failure, which made it unsafe to use general or regional anesthesia. She underwent sacrospinous ligament fixation (SSLF) under local anesthesia. Results: This patient was fully mobil...

Total Uterine Prolapse in a 15 Years Aged Doe

Total Uterine Prolapse in a 15 Years Aged Doe

Clinical Management of Post-partum total uterine prolapse following excessive traction during delivery of kid in a NonDescript Goat

Clinical Management of Post-partum total uterine prolapse following excessive traction during delivery of kid in a NonDescript Goat

Successful treatment of uterine prolapse by abdominal hysteropexy performed during cesarean section

Uterine prolapse complicating pregnancy is extremely rare. This report presents the surgical correction of uterine prolapse during cesarean section. We report a case of a 33-year-old woman with twin gestation who admitted to obstetric clinic with labor pain and total uterine prolapse at 33 weeks of gestation. An emergent cesarean section was performed for the indication of acute fetal distress. At the same operation, following cesarean delivery, abdominal hysteropexy using rectus fascia strips was performed successfully. On control performed 6 months later, patient was examined and it was detected uterine prolapse had regressed and babies were uneventful. This surgical method offers effective treatment of uterine prolapse.

Vaginal sacrocolporectopexy for the surgical treatment of uterine and vaginal vault prolapses: confirmation of the surgical method and perioperative results of 101 cases

In this study, we sought to confirm the surgical method of vaginal sacrocolporectopexy and previously reported positive perioperative results of this procedure in a large patient group. We describe the approach which offers a vaginal, safe alternative to sacrospinous repair, laparoscopic or open vaginosacropexy and the use of synthetic meshes to treat pelvic organ prolapse. We conducted a monocentric, prospective, nonrandomized study for treatment of patients with uterine and vaginal vault relapse (grade 2-4). All patients underwent a preoperative urogynecological urodynamic examination. We focus on method, operative time, complications, blood transfusions, hospital stay and clinical data. Between March 2006 and March 2011, 101 consecutive patients of mean age 64 (40-89) years, with sub or total uterine prolapse (n=69, grade 2-4) and vaginal vault prolapse (n=32, grade 2-4) were treated with vaginal sacrocolporectopexy. Cystocele (grade 2-4) was found in 88 (87.1%) and rectocele (grade 2-4) in 43 (42.5%) patients. Mean duration of surgery with sacrocolporectopexy was 70 min (28-165) without hysterectomy, and 76 min (40-219) with hysterectomy. Regression analysis of all patients (n=101) showed a significant decrease of operative time in the group without hysterectomy after 40 cases. Three bladder lesions, two in patients with a history of hysterectomy, occurred during surgery and were corrected intraoperatively without further complications. No patient required a blood transfusion. Hemoglobin levels decreased slightly from a preoperative mean of 13.6 mg/dl (10.3-15.7) to a postoperative mean of 11.7 mg/dl (8.6-14.7). Vaginal sacrocolporectopexy is a safe vaginal method for the treatment of sub-/total uterine/vaginal vault prolapse.

Obstructive anuria resulting from total uterine prolapse: A case report

Obstructive anuria resulting from total uterine prolapse: A case report

Complete bladder eversion concurrent with total uterine prolapse

Complete eversion of the urinary bladder is rare, and a case with concurrent total uterine prolapse is an extremely rare problem. A 75-year-old multiparous, postmenopausal female presented with two huge masses protruding from the vagina. Total transurethral eversion and concurrent uterine procidentia were noted. Manual reduction of the bladder, vaginal hysterectomy, suprapubic cystostomy, and urethral closure were performed under general anesthesia. The neck of the bladder was reinforced with retropubic prolene mesh to prevent recurrence. The patient was well, with no eversion, prolapse of bladder, or other pelvic organ prolapse at 6 months follow-up.

Procidentia-induced perinephric and subcutaneous abscesses

Total uterine prolapse, or procidentia, rarely causes obstructive uropathy. Procidentia-induced perinephric abscess has not been reported to date. We present a case of perinephric and subcutaneous abscesses secondary to procidentia-induced hydronephrosis and forniceal rupture of Staphylococcus aureus-infected urine.

Lipogranuloma of the cervix in a postmenopausal patient with a uterine prolapse

Lipogranuloma is a rare inflammatory reactive process related to exogenous or endogenous lipids with an admission to the dermis and subcutis. It is described most frequently in the penis and scrotum of young adults. Lipogranuloma of the female genitalia is a rather uncommon condition. The lesion is histopathologically characterized by fat vacuoles with foreign body type giant cells and scattered lymphocytes. We described an incidental lipogranuloma of the cervix in a 60-year-old woman who presented with total uterine prolapse. Although lipogranuloma mostly occurs in young male patients, especially in the genital tract, clinicians should be aware of this entity in the cervix of a postmenopausal woman with uterine prolapse, which may challenge the differential clinical diagnosis.

Multiple bladder calculi: a rare cause of irreducible uterine prolapse

A vesical calculus in a prolapsed cystocele is rare. To highlight bladder calculi as a cause of irreducible uterine prolapse. 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. 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.