del Prolapso Genital
1: BMJ 2002;324:1258-1262 ( 25 May ) [Texto
Management of genital prolapse.
Ranee Thakar, Stuart Stanton.
Department of Urogynaecology, St George's
Hospital, London. Correspondence to: R Thakar, Department of Obstetrics
and Gynaecology, Mayday University Hospital, Croydon CR7 7YE e-mail:
2: Curr Opin Obstet Gynecol
Genital prolapse: vaginal versus abdominal route
Carey MP, Dwyer PL.
Department of Urogynaecology, Royal Women's
Hospital and Mercy Hospital for Women, Melbourne, Australia.
In the presence of an ageing population, we can
expect to see a dramatic increase in the prevalence of genital prolapse
including vault and recurrent vaginal prolapse. The best approach for
managing upper genital prolapse remains controversial. We review the
surgical management of genital prolapse, with a focus on comparing the
vaginal and abdominal approaches.
3: J Reprod Med 2000 Oct;45(10):789-97 [Texto
completo en formato PDF]
management of genital prolapse. A review and recommendations for clinical
Department of Obstetrics and Gynecology,
University of Illinois at Chicago, Illinois, USA. firstname.lastname@example.org
The prevalence of genital prolapse increases
with age. Because more women are living longer, genital prolapse will
become even more common in our daily practices. Currently this
complication is treated surgically, and there is minimal information about
nonsurgical treatments. The National Library of Medicine was
electronically searched for current information about the nonsurgical
treatment of genital prolapse. This article summarizes the anatomic basis,
the standard nomenclature, common symptoms and nonsurgical treatment of
prolapse. Pessaries offer an alternative, even temporarily, to surgical
therapy. Some women use a pessary on a long-term basis. There is no
evidence in the literature that monthly follow-up improves outcome. Once
fitted satisfactorily, women who wear pessaries need to be evaluated every
three to six months.
4: Surg Clin North Am 2000
laparoscopic gynecologic surgery.
The Department of Obstetrics and Gynecology,
University of Mississippi Medical Center, Jackson 39216-4505, USA.
What is the future for laparoscopy? Any
procedure thought to be impossible to perform by laparoscopy or procedures
that, based on conventional wisdom, should not be done laparoscopically
are being performed or developed as the reader peruses this article.
Technical advances in the endoscopic equipment and development of
laparoscopic instruments have allowed for performance of sophisticated
procedures with laparoscopic assistance. Appropriate laparoscopic skills
allow surgeons to perform these procedures in a fashion nearly identical
to an open procedure; however, modifications of historically proven
techniques are controversial regarding the expenses generated, equipment
necessary to perform the procedure, training necessary, and potential for
complications. Has the obituary of laparotomy been written? The benefits
of laparoscopically assisted or performed procedures are continuing to be
analyzed. LAVH has been touted as a way to reduce the number of abdominal
hysterectomies while increasing the number of vaginal hysterectomies.
Therefore, indications for LAVH would ideally more resemble indications
for abdominal hysterectomy than vaginal hysterectomy; however, LAVH does
not seem to have increased the total number of vaginal hysterectomies.
Conversely, the number of abdominal hysterectomies seems to be roughly the
same, whereas the number of vaginal hysterectomies has decreased and the
number of LAVHs has increased. Therefore, surgeons seem to be substituting
LAVH for vaginal hysterectomy. Studies comparing laparoscopic Burch
procedures and open Burch procedures are just now being reported. Many
early reports described procedures that are not classic Burch
colposuspensions. These changes make it impossible to assume that overall
success and rate of complications are the same. The same can be said for
techniques for correction of pelvic organ prolapse. Although laparoscopic
performance and laparoscopic assistance are increasing in popularity, most
cases are not handled in this way. Clearly, not every surgeon has embraced
using the laparoscope to treat patients who would otherwise have undergone
abdominal or vaginal surgery.
5: Prim. Care Update Ob Gyns
1998 Jul 1;5(4):201
sacral colpopexy for massive genital prolapse.
Powell JL, Joseph DB.
Department of Obstetrics and Gynecology, Coastal
Area Health Education Center, New Hanover Regional Medical Center, North
Carolina, Wilmington, USA
Objective: A retrospective study to determine
the success and complications of abdominal sacral colpopexy in correcting
massive genital prolapse over an 8-year period between September 1989 and
January 1997.Methods: The charts were reviewed for 3 patients with massive
procidentia and 15 patients with symptomatic posthysterectomy vaginal
vault prolapse, who desired preservation of sexual function and underwent
abdominal sacral colpopexy with Marlex mesh at two community teaching
hospitals.Results: In 16 of the 18 patients, one or more concurrent
procedures were performed at the same time, including three Burch
colpocystourethropexies and one Raz bladder neck suspension, which
successfully controlled urinary stress incontinence. In three cases,
staging procedures were done for ovarian neoplasia. There were no
intraoperative complications. One patient developed a superficial
abdominal wound infection, one patient had a deep venous thrombosis in her
left leg 7 days postoperatively, and one patient experienced a 1 cm area
of graft erosion 10 months postoperative requiring partial resection.
Duration of follow-up has varied from 8 months to 5 years. One patient
died 43 months after surgery of unrelated causes. No patients developed
recurrent prolapse.Conclusions: Abdominal sacral colpopexy is a successful
operation for the correction of prolapse. Serious complications are
infrequent. Photographs of the technique and a review of the literature
6: Eur J Obstet Gynecol Reprod Biol
management of pelvic organ prolapse.
Margossian H, Walters MD, Falcone T.
Department of Obstetrics and Gynecology,
Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, OH
Until recently, most major gynecologic surgery
was performed either vaginally or by laparotomy. In the last decade,
surgeons have explored laparoscopic access for many gynecologic surgical
disorders. Pelvic reconstructive surgery can be performed laparoscopically
but demands a high skill level especially in suturing. Initial reports for
laparoscopic bladder neck suspension for genuine stress urinary
incontinence are encouraging but lack long term follow-up. The literature
contains only a few case studies addressing pelvic support procedures. In
this review we present our methods for laparoscopic management of
different types of pelvic floor support defects. We view laparoscopy as a
method of access rather than a procedure. We present laparoscopic
techniques that do not modify the surgical procedures that have been
validated by conventional surgery.
7: Medscape Womens Health
Vaginectomy: Profile of Success in Treating
Smale LE, Smale CL, Mundo NG, Rivera R.
Department of Obstetrics and Gynecology at Kern
Medical Center, Bakersfield, Calif.
Treatment of procidentia and vaginal inversion
in older women either with pessaries or surgery commonly brings poor
results. Women are unable to retain the pessary; they develop vaginitis
and vaginal ulcerations; and surgical "correction" fails due to
age-induced genital atrophy or previous obstetrical trauma. We performed a
retrospective chart review to assess results of our own technique of
vaginectomy/hysterectomy and pelvic floor closure for vaginal vault
prolapse and procidentia in 26 aged sexually inactive women seen in our
practice. The women ranged from 63 to 83 years of age and had borne 0 to 9
children. Where possible, an estrogen-containing medication was introduced
into the vagina preoperatively to stimulate thickening of the vaginal
mucosa. A standard Heaney or Doderlein vaginal hysterectomy was performed.
Operative time averaged 100 minutes, blood loss averaged 278mL, and 5
patients required a blood transfusion. All patients were discharged in
good condition after an average stay of 4.67 days, although 9 of the 24
patients had complications. Since body-cavity invasion was minimal,
postoperative care was simple, consisting of hydration with intravenous
fluids, urine drainage utilizing an indwelling catheter, (while preventing
bladder distension), early ambulation, and prophylaxis against infection
8: Pediatr Clin North Am
Common office problems in pediatric urology
Brown MR, Cartwright PC, Snow BW.
Department of Urology, University of Utah School
of Medicine, Salt Lake City, USA.
The number of genital problems that
pediatricians encounter is substantial. The most common ones have been
reviewed in this article. Perhaps the most important point to reinforce is
the appropriateness of nonintervention in uncircumcised boys whose
foreskins have not become retractile during early school years. Without
infections or pathologic phimosis, these boys do well, and most foreskins
become retractile as they approach puberty. Abnormalities beyond those
discussed or those not fitting the anticipated pattern probably warrant
9: Am Fam Physician 1997 Feb 15;55(3):827-34
Fam Physician 1997 Apr;55(5):1586
Fam Physician. 1997 Feb 15;55(3):774-6.
Fam Physician. 1997 Sep 15;56(4):1064, 1067-8.
indications, alternatives and predictors.
Kramer MG, Reiter RC.
University of Iowa College of Medicine, Iowa
Hysterectomy, the most common major nonobstetric
operation, is performed in more than 570,000 women in the United States
each year. Although the number of hysterectomies has decreased in recent
years, many authorities believe that hysterectomy is often unnecessary and
unjustified. There is no universally accepted set of criteria regarding
the appropriate indications for hysterectomy. The main indications for
hysterectomy include the following conditions: uterine leiomyomas,
dysfunctional uterine bleeding, endometriosis/adenomyosis, chronic pelvic
pain and genital prolapse. Current literature, however, routinely
recommends conservative management of most nonmalignant gynecologic
conditions, with hysterectomy reserved for refractory cases. Several
nonmedical factors, such as patient race, age, geographic location,
medical history and background, as well as health care provider
characteristics, such as time since completion of training, gender, and
affiliation with teaching hospitals, are also associated with hysterectomy
10: J Endourol
of genital prolapse.
Liu CY, Reich H.
Chattanooga Women's Laser Center, TN, USA.
Massive eversion of the vagina is one of the
most disturbing disorders confronting a woman. It is a complex disorder
that always coexists with other pelvic floor defects. The management is
almost always surgical, and all defects must be repaired concomitantly.
Current surgical practice relies primarily on the strength of the
endopelvic fascia and certain ligaments, which clearly is not ideal for
providing the kind of support needed. Current understanding of the
neurophysiology, neuroanatomy, and biophysics of the pelvic floor give us
hope that management will be more effective in the future. Laparoscopic
repair techniques are described.
11: Obstet Gynecol Surv
of genital prolapse in neonates and young women.
de Mola JR, Carpenter SE.
Department of Obstetrics and Gynecology,
University of Pennsylvania School of Medicine, Philadelphia, USA.
The presence of genital prolapse in neonates and
young women poses a challenging management problem to the gynecologist.
Neonatal uterine prolapse is associated with congenital spinal defects,
and successful correction has been achieved mainly with simple digital
reduction or the use of a small pessary. Uterine prolapse can also occur
in young or nulliparous woman who wish to preserve their fertility.
Operations using sling, sacral cervicopexy, or transvaginal sacrospinal
fixation techniques seem to provide excellent repair for these patients,
including the possibility of childbearing. A review of the pathophysiology
of genital prolapse in neonates and young women with emphasis on the
surgical and nonsurgical options for management is presented.