Vaginal Wall Prolapse Research Articles

Современные лазерные технологии в гинекологической практике: возможности инновационного неодимового лазера

Aim. To summarize a review of modern literature and present a clinical observation of the use of the Magic Gyno Nd:YAG laser for the treatment of vulvovaginal atrophy in postmenopausal patients. Key points. One of the most significant problems of the menopausal period is genitourinary syndrome of menopause (GSM), the symptoms of which have a significant impact on the quality of life and sexual health of most women during menopause and occur in more than 50% of patients. The search and study of new effective and safe methods for treating the symptoms of GSM is an extremely urgent task, the importance of which, taking into account existing demographic and social trends, will only increase in the coming years. In addition to the objective risks associated with hormonal therapy, which is the "gold standard" in the treatment of GSM, it should be noted that for some patients it is contraindicated for medical reasons, and sometimes women themselves do not want to use hormone-containing drugs. Thus, there is a need to select other methods of therapy that will provide long-term symptomatic effect. Based on the available data, treatment of GSM using laser devices may be comparable in effectiveness to local hormonal therapy, and superior in safety. One of the most promising instruments of this class is the Nd:YAG laser, successfully used in cosmetology, ophthalmology, dentistry, surgery, urology, as well as in gynecology. After therapy with a neodymium laser, an improvement in lubrication and elasticity of the tissues of the vulva and vagina, normalization of the pH of the vaginal discharge was shown, as well as a significant reduction in the manifestations of sexual dysfunction and an increase in the quality of sexual life noted by patients. Conclusion. The neodymium laser method in gynecological practice is a new promising method of treatment. Although further randomized controlled trials are required, it has now been successfully used in the treatment of GSM and for patients who are contraindicated for hormonal therapy, or those who do not want to use even topical estrogens due to obsessive stereotypes and unreasonable fears. may become an alternative to local estrogen therapy. Key words: vulvovaginal atrophy, neodymium laser, Nd:YAG laser, genitourinary syndrome of menopause, hormone replacement therapy, estriol, vaginal wall prolapse.

Results of surgical correction for cervical elongation with vaginal wall prolapse in patients of reproductive and premenopausal age

BACKGROUND: The problem of cervical elongation is becoming increasingly important due to the rising prevalence of pelvic organ prolapse. In Russia, descent and prolapse of pelvic organs account for 39% of all gynecological pathologies.
 AIM: This study aimed to compare the immediate and long-term results of surgical treatment for cervical elongation in combination with vaginal wall prolapse in patients of three clinical groups.
 MATERIALS AND METHODS: A total of 105 patients aged 30 to 55 years with a combination of cervical elongation and vaginal wall prolapse of degrees III were followed up. The patients were divided into three clinical groups based on the implemented surgical techniques, including group 1 (n=36) with Moscow surgery, group 2 (n=35) with modification of the Manchester surgery using synthetic implants, and group 3 (n=34) with Manchester surgery.
 The patients underwent a comprehensive clinical examination, surgical treatment, and follow-up in the early and long-term postoperative periods (1, 6, 12, 24, and 36 months). The efficacy of surgical treatment was assessed using a questionnaire. During dynamic monitoring, a gynecological examination with a Valsalva maneuver, and transperineal, and transvaginal echography were performed.
 RESULTS: During the first month after the surgery, patients noted irregular dragging pains in the perineum and/or inguinal region every second. A frequent urge to urinate was reported in 16.7%, 17.1%, and 17.6% of patients in groups 1, 2, and 3, respectively. A further survey revealed that the surgical treatment results were satisfactory, as it had a positive effect on the quality of life and mood and contributed to an increase in social and sexual activity. According to the physical examination, there were no signs of prolapse recurrence and mesh-associated complications. Erosion of the anterior vaginal wall over the polypropylene endoprosthesis was detected 6 months after the surgery in 3 (8.6%) patients of group 2.
 Genital prolapse recurrence was diagnosed after 1236 months in 7 (20.6%) patients of group 3. After 36 months, degree I prolapse of the posterior (n=1) and anterior (n=1) walls of the vagina was revealed in patients of groups 1 and 2, respectively.

Новый способ органосберегающей хирургической коррекции элонгации шейки матки с использованием сетчатых титановых имплантатов – «Московская» операция

Objective. To study the efficacy and safety of the original technique for surgical correction of cervical elongation with vaginal wall prolapse (stage I–II) in patients of reproductive and menopause age. Patients and methods. The study included 17 patients aged 30 to 56 years with cervical elongation and vaginal wall prolapse. All patients underwent the original surgery – cervical amputation along with combined transobturator and sacrospinous TiMeshligature cervical suspension. Results. The patients were observed 1, 6, 12 and 18 months after surgery. Comparison of the patients’ questionnaire data in the pre- and postoperative periods showed an improvement in their quality of life, an increase in their social and sexual activity. During the first month, 10 (58.8%) patients noted intermittent episodes of perineal pain and 3 (17%) – frequent urination. Comprehensive clinical examination after 6, 12, and 18 months revealed complete preservation of surgical correction of prolapse in all patients. Gynecological and rectal examinations, transperineal and transvaginal ultrasound revealed no displacement of pelvic organs and titanium implants. There were no mesh-associated complications during follow-up. Conclusion. The developed original technique for surgical correction of cervical elongation with vaginal wall prolapse (stage I–II) using a combination of titanium mesh implants and non-absorbable ligatures with two-lateral suture anchor was shown to be effective and safe, as evidenced by normalization of the uterus position in the pelvis and absence of pelvic organ displacement and mesh-associated complications during follow-up. Key words: cervical elongation, stage I–II vaginal wall prolapse, titanium mesh implants, mesh-ligature correction of prolapse

Pelvic Organ Prolapse in Countries of Different Economy: A Systematic Review

Aims: This review was done to identify the reported prevalence rate of pelvic organ prolapse among the different world populations.
 Methods: Systematic review of Pelvic Organ Prolapse (POP) using the PRISMA checklist; PubMed database was searched on reportingthe prevalence of POP and its management measures in January 2020. Medical Subject Headings (MeSH) like "Pelvic Organ Prolapse"OR "Uterine Prolapse" OR “Vaginal Wall Prolapse” OR "Cystocele"AND "Prevalence [key word/s]" were used. Additional articles were identified through the reference list of the retrieved articles.
 Results: Out of 91 screened articles, 46 full articles were eligible and only 15 satisfied by selection criteria for the systematic review.The methodological score rated for the quality of studies is 4.5±1.7 (range=2-7) out of 8 points. The mean prevalence of POP diagnosis was 40%; with 42.44% in low and lower-middle-income countries,and 35.56%in upper-middle and high-income countries. Increasing age and parity, body mass indexand fetal macrosomia were found to be the significant risk factors irrespective of the country’s economy.
 Conclusions:The low and lower-income countries have almost twice the burden of prolapse than the countries of the higher economy. The major risk factors associated with prolapse remain common in all countries irrespective of national income or development.

Medical Malpractice Litigation in Non-Mesh-Related Pelvic Organ Prolapse Surgery: An Analysis of 91 Cases.

Malpractice litigations have significant implications for patients and physicians. Studies have investigated mesh litigations in female pelvic reconstructive surgery, but none on nonmesh pelvic organ prolapse (POP) surgery. Our purpose is to determine the reasons for and outcomes of medical malpractice after nonmesh POP surgery. Westlaw (Thompson Reuters, New York, New York) is a legal research database of US court records. We identified completed POP litigations from 1987 to 2018 using the following: "pelvic organ prolapse," "enterocele," "rectocele," "cystocele," "uterine prolapse," and "vaginal wall prolapse." Mesh-related cases were excluded. Outcomes included reasons for litigation, verdict, injury, and payments. Statistical analysis was performed with nonparametric tests and χ2 independence test. Ninety-one litigations were included. The median plaintiff age was 53 years (range, 36-85 years). The leading allegation was negligence of surgery (n = 59; 65%). The jury sided with the defendant physician in 67% of cases (n = 61). There was no association between case verdict and patient age (P = 0.781), geographic region (P = 0.824), or allegation (P = 0.904). The primary complications were urinary tract injury (n = 24; 26%), need for additional surgery (n = 22; 24%), and new postoperative urinary symptoms (n = 22; 24%). The median payout was $280,000 (interquartile range, $137,250-$1,300,000), with no difference between plaintiff awards or settlements (P = 0.659). The leading allegation of malpractice litigations for nonmesh POP surgery is negligence of surgery, whereas the most common complication was urinary tract injury. A verdict in favor of the physician defendant was the most likely outcome. Plaintiff awards and settlements were not statistically different with no variation by region or time.

Сучасні аспекти використання лазерної терапії у гінекологічній практиці

The article highlights the latest approaches to the use of CO2-laser in modern gynecological practice. After all, patients with urinary incontinence, urogenital disorders in the menopausal period, vaginal relaxation syndrome, vaginal wall prolapse and scarring of the vulva make the main contingent of aesthetic gynecology offices in Ukraine. The main reasons that lead to the occurrence of these complications include changes in the genital organs during pregnancy and childbirth, the tension of the pelvic floor diaphragm muscles, connective tissue dysplasia, estrogen deficiency and, as a consequence, the loss of collagen and elastin in the tissues of the genital organs. Today, there are a number of techniques that allow the correction of these complications - conservative, surgical, physiotherapy and psychological. The newest method in the treatment of vagina and vulva atrophic is the application of CO2-laser, which is widely used outside of Ukraine. Under the influence of laser in tissues remodeling processes occur as a response to their damage, enhanced synthesis of collagen and elastic fibers. The positive effect of the latest technique is highlighted in the works of Italian researchers. However, in Ukraine, this method is not common, and the experience of its own use is not sufficient, which led to the prospect of further research. Key words: aesthetic gynecology, urinary incontinence, vaginal mucosa atrophy, vaginal wall prolapse, vaginal deformation, CO2-laser.

Опыт применения влагалищной полидиоксаноновой нити при мини-перинеопластике для лечения опущения стенок влагалища

Опыт применения влагалищной полидиоксаноновой нити при мини-перинеопластике для лечения опущения стенок влагалища

Vaginal Changes Due to Varying Degrees of Rectocele Prolapse: A Computational Study.

Pelvic organ prolapse (POP), downward descent of the pelvic organs resulting in a protrusion of the vagina, is a highly prevalent condition, responsible for 300,000 surgeries in the U.S. annually. Rectocele, a posterior vaginal wall (PVW) prolapse of the rectum, is the second most common type of POP after cystocele. A rectocele usually manifests itself along with other types of prolapse with multicompartment pelvic floor defects. To date, the specific mechanics of rectocele formation are poorly understood, which does not allow its early stage detection and progression prediction over time. Recently, with the advancement of imaging and computational modeling techniques, a plethora of finite element (FE) models have been developed to study vaginal prolapse from different perspectives and allow a better understanding of dynamic interactions of pelvic organs and their supporting structures. So far, most studies have focused on anterior vaginal prolapse (AVP) (or cystocele) and limited data exist on the role of pelvic muscles and ligaments on the development and progression of rectocele. In this work, a full-scale magnetic resonance imaging (MRI) based three-dimensional (3D) computational model of the female pelvic anatomy, comprising the vaginal canal, uterus, and rectum, was developed to study the effect of varying degrees (or sizes) of rectocele prolapse on the vaginal canal for the first time. Vaginal wall displacements and stresses generated due to the varying rectocele size and average abdominal pressures were estimated. Considering the direction pointing from anterior to posterior side of the pelvic system as the positive Y-direction, it was found that rectocele leads to negative Y-direction displacements, causing the vaginal cross section to shrink significantly at the lower half of the vaginal canal. Besides the negative Y displacements, the rectocele bulging was observed to push the PVW downward toward the vaginal hiatus, exhibiting the well-known "kneeling effect." Also, the stress field on the PVW was found to localize at the upper half of the vaginal canal and shift eventually to the lower half with increase in rectocele size. Additionally, clinical relevance and implications of the results were discussed.

Intraoperative cervix location and apical support stiffness in women with and without pelvic organ prolapse

It is unknown how initial cervix location and cervical support resistance to traction, which we term "apical support stiffness," compare in women with different patterns of pelvic organ support. Defining a normal range of apical support stiffness is important to better understand the pathophysiology of apical support loss. The aims of our study were to determine whether: (1) women with normal apical support on clinic Pelvic Organ Prolapse Quantification, but with vaginal wall prolapse (cystocele and/or rectocele), have the same intraoperative cervix location and apical support stiffness as women with normal pelvic support; and (2) all women with apical prolapse have abnormal intraoperative cervix location and apical support stiffness. A third objective was to identify clinical and biomechanical factors independently associated with clinic Pelvic Organ Prolapse Quantification point C. We conducted an observational study of women with a full spectrum of pelvic organ support scheduled to undergo gynecologic surgery. All women underwent a preoperative clinic examination, including Pelvic Organ Prolapse Quantification. Cervix starting location and the resistance (stiffness) of its supports to being moved steadily in the direction of a traction force that increased from 0-18 N was measured intraoperatively using a computer-controlled servoactuator device. Women were divided into 3 groups for analysis according to their pelvic support as classified using the clinic Pelvic Organ Prolapse Quantification: (1) "normal/normal" was women with normal apical (C < -5 cm) and vaginal (Ba and Bp < 0 cm) support; (2) normal/prolapse had normal apical support (C < -5 cm) but prolapse of the anterior or posterior vaginal walls (Ba and/or Bp ≥ 0 cm); and (3) prolapse/prolapse had both apical and vaginal wall prolapse (C > -5 cm and Ba and/or Bp ≥ 0 cm). Demographics, intraoperative cervix locations, and apical support stiffness values were then compared. Normal range of cervix location during clinic examination and operative testing was defined by the total range of values observed in the normal/normal group. The proportion of women in each group with cervix locations within and outside the normal range was determined. Linear regression was performed to identify variables independently associated with clinic Pelvic Organ Prolapse Quantification point C. In all, 52 women were included: 14 in the normal/normal group, 11 in the normal/prolapse group, and 27 in the prolapse/prolapse group. At 1 N of traction force in the operating room, 50% of women in the normal/prolapse group had cervix locations outside the normal range while 10% had apical support stiffness outside the normal range. Of women in the prolapse/prolapse group, 81% had cervix locations outside the normal range and 8% had apical support stiffness outside the normal range. Similar results for cervix locations were observed at 18 N of traction force; however the proportion of women with apical support stiffness outside the normal range increased to 50% in the normal/prolapse group and 59% in the prolapse/prolapse group. The prolapse/prolapse group had statistically lower apical support stiffness compared to the normal/normal group with increased traction from 1-18 N (0.47 ± 0.18 N/mm vs 0.63 ± 0.20 N/mm, P= .006), but all other comparisons were nonsignificant. After controlling for age, parity, body mass index, and apical support stiffness, cervix location at 1 N traction force remained an independent predictor of clinic Pelvic Organ Prolapse Quantification point C, but only in the prolapse/prolapse group. Approximately 50% of women with cystocele and/or rectocele but normal apical support in the clinic had cervix locations outside the normal range under intraoperative traction, while 19% of women with uterine prolapse had normal apical support. Identifying women whose apical support falls outside a defined normal range may be a more accurate way to identify those who truly need a hysterectomy and/or an apical support procedure and to spare those who do not.

Long-term outcome after transvaginal mesh repair of pelvic organ prolapse.

The aim of this study was to report long-term subjective and objective outcomes after the transvaginal mesh (TVM) procedurein long-term. Possible late-onset complications were of particular interest. This was a retrospective analysis of TVM performed using Prolift™ transvaginal mesh measuring subjective outcome using validated questionnaires. Objective outcome was assessed using the Pelvic Organ Prolapse Quantification (POP-Q) system using two definitions: POP-Q stage ≤ 1, and vaginal wall prolapse at or above the hymen or vaginal apex not descending below the upper third of the vagina. Complications were reported with the Prosthesis/Graft Complication Classification Code designed by the International Continence Society/International Urogynecological Association (ICS/IUGA). Of 195 patients, 161 (82.6%) participated this study after a median of 7 years. The scores in questionnaires evaluating urinary (UI) or anal incontinence and constipation or pelvic floor symptoms were low, indicating favorable surgical outcomes. Altogether, 80.1% of patients were satisfied with the procedure. Anatomical cure was 56.4% and 69.3% depending on the definition used. Reoperation due to POP in any compartment was performed in 16.2% of patients. Mesh exposure rate was 23%, most of these being asymptomatic and of late onset. Outcome of the TVM procedure was satisfactory. Anatomical cure was inferior to subjective cure. Mesh exposure rate was high; most exposures observed in the long-term were of late onset and were asymptomatic.

POP-Q indication points, Aa and Ba, involve in diagnosis and prognosis of occult stress urinary incontinence complicated with pelvic organ prolapse

To investigate the correlation between pelvic organ prolapse quantitation (POP-Q) indication points and the incidence of occult stress urinary incontinence (OSUI) and its impact on prognosis. Retrospective study medical records of 93 patients with pelvic organ prolapse (POP) staged at III-IV, of which underwent pelvic reconstruction operations with Prolift system from Jan. 2007 to Sept. 2012. None of these patients had clinical manifestations of stress urinary incontinence (SUI) before surgery, and in which 44 patients were included in study group (POP complicated with OSUI) because they were identified with OSUI, another 49 patients as control group (simple POP). Follow-up and collecting datas including POP-Q, stress test, urodynamic recordings, incidence of de novo SUI, statistic analyzing by logistic regression and receiver operating characteristic curve (ROC). (1) The study group had a much higher incidence of 30% (13/44) on de novo SUI than that of control group (4%, 2/49; P < 0.01). (2) Vaginal delivery (OR = 5.327, 95% CI: 1.120-25.347), constipation (OR = 5.789, 95% CI: 1.492-22.459), preoperative OSUI (OR = 13.695, 95% CI: 2.980-62.944), anterior vaginal wall prolapse (OR = 6.115, 95% CI: 1.231-30.379) were identified as dependent risk factors for de novo SUI by logistic regression analysis. (3) For POP patients that complicated with OSUI, we chose a cutoff value of +1.5 cm for Aa point as the threshold to predicting incidence of de novo SUI according to ROC curve, area under the curve (AUC) was 0.889 (P < 0.05), the sensitivity reached 88.9% and specificity was 73.9%. According to ROC curve of Ba point, a cutoff value of +2.5 cm was chosen as the threshold to predicting incidence of de novo SUI post-operation, it had a sensitivity of 66.7% and specificity of 82.6%, AUC was 0.766 (P < 0.05). Pre-operative OSUI is a dependent risk factor of de novo SUI for advanced POP patients. Aa and Ba points are correlated with preoperative OSUI, and it is worthy to be considered as a risk predictor on forecasting the incidence of de novo SUI post pelvic reconstruction surgery.

Robotically assisted laparoscopic repair of anterior vaginal wall and uterine prolapse by lateral suspension with mesh: our experience

Robotically assisted laparoscopic repair of anterior vaginal wall and uterine prolapse by lateral suspension with mesh: our experience

Ultrasonic imaging of female cystocele subtypes: a preliminary study

Objective To investigate the pelvic floor in cystocele patients using translabial ultrasound, and discuss the ultrasound appearance. Methods Translabial 2D ultrasound was performed on 136 patients who were diagnosed or suspected as anterior vaginal wall prolapse or cystocele using pelvic organ prolapse quantitation system, the position of bladder, the retrovesical angle and urethral rotation were measured during maximum Valsalva maneuver. Cystocele subtypes were diagnosed according to the ultrasound findings. Results Translabial 2D ultrasound diagnosed 88 cases cystocele based on the position of bladder, retrovesical angle and urethral rotation, including ten cases cystocele type Ⅰ, 32 cases type Ⅱ and the remaining 46 classified as type Ⅲ. Conclusions Translabial 2D ultrasound successfully acquired the ultrasonic characteristics of cystocele subtypes, which could provide imaging evidence for clinic diagnosis of this disease. Key words: Ultrasonography; Pelvic floor; Cystocele

Is the Female Sexual Function Affected by the Vaginal Wall Prolapse?

Background: Female sexual dysfunction is a condition that describes patients with low libido, problems with sexual arousal, inability to achieve orgasm, and dyspareunia. Although not consistent, studies have found that sexual complaints are common in women with pelvic floor disorders. Aim: The aim of this study was to evaluate the impact of vaginal wall prolapse on the female sexual function (FSF). Material and Methods: The study was conducted at Suez Canal University Hospital, Ismailia at outpatient clinic from October 2012 to April 2013. Sixty patients with vaginal wall prolapse were selected randomly. Data on female sexual function and satisfaction were obtained by female sexual function index questionnaire from 60 patients with vaginal prolapse and 60 controls women. The six domains of the female sexual function questionnaire (desire, arousal, lubrication, orgasm, satisfaction, and pain) were compared between both groups. A score of 26.55 was defined as the optimal cut score between normal and pathological values. Results: The means of the six domains of the Female Sexual Function Index (FSFI) were significantly different between both groups (p <0.0001).There was a significant difference in the mean of the total score between patient and control group (20.92, and 28.03 respectively) taking in consideration that all women in the patient group had vaginal wall prolapse. Conclusion: Vaginal wall prolapse has a major poor effect on the female sexual function.

Long-term outcomes of the high vaginal uterosacral ligament suspension in treatment of the severe pelvic organ prolapse

To investigate the long-term objective and subjective outcomes of the transvaginal high uterosacral ligament suspension(HUS) in treatment of severe pelvic organ prolapse (POP) . From Jun. 2003 to Mar.2013, 136 patients with severe POP quantitation (POP-Q) stage III-IV underwent transvaginal hysterectomy and HUS operation in the First Affiliated Hospital, General Hospital of People's Liberation Army. And 125 patients (91.9%, 125/136) were followed up at a mean of 5.4 years (range of 4.2-9.2 years) . Anterior colporrhaphy (79.2%, 99/125), posterior colporrhaphy (64.0%, 80/125), the perineorrhaphy (96.0%, 120/125) and tension-free suburethral slings (37.6%, 47/125) were performed concurrently, in which 53 (65%, 53/81) patients with severe cystocele and 5 patients (15%, 5/34) with rectocele were augmented with mesh, respectively. Concurrent operation and complications were studied. The objective success of the operation was defined as the leading vaginal edge above hymen.Subjective results were obtained quality-of-life questionnaires, including pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). The mean interval of following up was (5.4 ± 1.2) years.Four patients presented mild anterior vaginal wall prolapse, and the recurrence rate were 3.2% (4/125), but no reoperation and pessary treatment were needed. Therefore, the subjective and objective satisfaction rate was 94.4% (118/125) and 96.8% (121/125). The mean scores of PFDI-20 and PFIQ-7 at 5 years after the operations were 8, 7, significantly lower than 62, 64 (P < 0.01). There were 3 cases of ureter obstruction. Tension-free vaginal tape was performed on 47 cases with stress urinary incontinence (SUI) as indicated. The symptom of 2 patients was not improved significantly after the operation, but one was improved after 6 months. The rate of denovo SUI was in 2(1.6%, 2/125) patients, but no further treatment was needed. The transvaginal HUS was then conformed to be a safe, minimal traumatic, highly successful and durable procedure for severe POP, so it is worthy of being popularized for clinical application.

Pelvic Organ Prolapse in Female Kidney Transplant Recipients:The Pelvic Reconstructive Surgeries

Purpose: Pelvic organ prolapse in female postmenopausal kidney transplant recipients may be complicated by adverse events affecting the graft function. We present our experience with pelvic reconstructive surgery in renal transplant recipients. Material and methods: Pelvic reconstructive surgery was performed in 32 female renal transplant recipients with pelvic organ prolapse with or without stress urinary incontinence. Intra- and postoperative data including medical and surgical history, POP-Q measurements, twenty-four hours PAD-count, quality of life measurements and graft outcome were recorded prospectively. Patients were followed for up to 12 months. Results: Mean age at surgery was 58.3±7.7 years (50-66 years), and the mean distance to renal transplantation was 54.2 ± 15.1 months (range; 38-123 months). A total of 24 anterior and 8 combined anterior/ posterior colporrhaphy procedures were performed. Concomitant suburethral single incision transobturator sling procedure was performed in 16 women. There were no bladder and rectal injuries, no bleeding necessitating transfusion and no case of infections. Pelvic floor testing at follow-up of 12 months postoperatively showed only 4 patients (25%) with stage I vaginal wall prolapse. None of the patients had evidence of denovo incontinence, synthetic sling infection, erosion or rejection. Further, all women reported an improvement in quality of life as measured by SF-36 questionnaire. Renal graft function remained stable in all patients. Conclusions: Pelvic reconstructive surgery is feasible for management of pelvic organ prolapse in patients with kidney allograft being under immunosuppression. However, concern about impairment of graft function, infection and wound healing remain important.

Anesthesia and Perioperative Management of a Pneumonectomized Dog

Although left- or right-sided pneumonectomy is tolerated by normal dogs, complications impacting the respiratory, cardiovascular, and gastrointestinal systems are not uncommon. Pneumonectomy in dogs results in secondary changes in the remaining lung, which include: decreased compliance and vital capacity; and increased pulmonary vascular resistance potentially leading to right ventricular hypertrophy. Such alterations make the anesthetic management of an animal with one lung particularly challenging. This report describes a dog with a history of left pneumonectomy due to Aspergillus fumigatus pneumonia 3 yr before presentation. The dog presented with a vaginal wall prolapse, and surgical resection of the protruding vaginal wall, ovariectomy, and prophylactic gastropexy were performed. Anesthesia was induced with midazolam, fentanyl, and propofol and was maintained with isoflurane using intermittent positive pressure ventilation and a constant rate infusion of fentanyl. Epidural anesthesia was also used. Recovery and postoperative management were uncomplicated. Intensive hemodynamic and respiratory monitoring and appropriate response and treatment of any detected abnormalities, taking into consideration the pathophysiologic alterations occurring in a pneumonectomized animal, are required for successful perianesthetic management.

Overactive Bladder Prevalence after Surgery for Pelvic Organ Prolapse

In this review, we set out to address the clinically complex question of how patients with overactive bladder (OAB) syndrome and pelvic organ prolapse (POP) fare with respect to symptomatic improvement after surgical treatment of POP. Our objectives are to use the current literature to define appropriate patient expectations for improvement and cure and to look for factors predicting divergent outcomes, with the goal of offering realistic preoperative patient counseling. Secondary aims include highlighting areas of needed research, defining outcome measures, and examining theories regarding the relationship between OAB and POP. Relevant original papers and review articles were identified by conducting a literature search using PubMed and Medline. The cause of OAB symptoms and the relationship between vaginal wall prolapse and OAB remain unclear. However, POP repair seems to improve the symptoms of OAB syndrome in 30% to 80% of patients, with a small but significant percentage of patients (≤20%) developing de novo symptoms of OAB.

Laparoscopic management of genital prolapse

Genital prolapse is one of the most common indications for gynaecological surgery. Surgery is performed traditionally via abdominal, vaginal and laparoscopic approaches. A MEDLINE computer search was performed to explore the recent evidence behind laparoscopic surgery for female pelvic organ prolapse. Advances in minimal access surgery have led to an increase in adoption of laparoscopic techniques. Current evidence supports the use of laparoscopy for sacrocolpopexy and colposuspension as an alternative to open surgery. However, the introduction of less invasive midurethral sling procedures for stress incontinence has reserved laparoscopic colposuspension for special indications. The scientific evidence regarding uterosacral suspension procedures and paravaginal and vaginal prolapse repairs are sparse. The current evidence supports the outcome of laparoscopic sacrocolpopexy as an alternative to open surgery. Further studies are required on the long-term efficiency in laparoscopic paravaginal repair and vaginal wall prolapse.

Pelvic Organ Prolapse Management in Female Kidney Transplant Recipients

Pelvic organ prolapse in female postmenopausal kidney transplant recipients may be complicated by adverse events affecting graft function. We describe our experience with pelvic reconstructive surgery in renal transplant recipients. Pelvic reconstructive surgery was done in 16 female renal transplant recipients with pelvic organ prolapse with or without stress urinary incontinence. Intraoperative and postoperative data were recorded prospectively, including medical and surgical history, pelvic organ prolapse quantification measurement, 24-hour pad count, quality of life measurements and graft outcome. Patients were followed up to 12 months. Mean +/- SD age at surgery was 58.3 +/- 7.7 years (range 50 to 66). Mean time to renal transplantation was 54.2 +/- 15.1 months (range 38 to 123). A total of 12 anterior and 4 combined anterior/posterior colporrhaphies were done. A concomitant suburethral single incision transobturator sling procedure was performed in 8 women. We noted no bladder or rectal injury, bleeding necessitating transfusion or infection. Pelvic floor testing at 12-month followup showed stage I vaginal wall prolapse in only 4 patients (25%). No patient had evidence of de novo incontinence, synthetic sling infection, erosion or rejection. All women reported improved quality of life on the SF-36 questionnaire. Renal graft function remained stable in all patients. Pelvic reconstructive surgery is feasible for pelvic organ prolapse in patients with a kidney allograft on immunosuppression. However, concern about impaired graft function, infection and wound healing remains important.