An Open Label Pre and Post Test Clinical Evaluation of Efficacy of Tila Taila Abhyanga and Massage of Yoni in Cystocele with Special Reference to Chyuta Avastha of Vasti

Prolapse or downward displacement of pelvic organs especially vagina, uterus and rectum is a common and disabling condition among women of menopausal age group. It affects their quality of life also. Displacement of vaginal anterior compartment results in cystocele. Quoting Acharya Susruta reference, the aim of this study is to find the efficacy of Tila taila yoni Abhya?ga in Cyuta avastha of Vasti with respect to first degree cystocele. 30 subjects were selected satisfying inclusion and exclusion criterias with the approval of Institutional ethical committee. Clinical evaluation is done with the help of relevant subjective and objective parameters. The subjective parameters were assessed before and after the treatment for a period of one month with UDI questionnaire and objective parameter with Baden-Walker system of grading Pelvic Organ Prolapse. Three months follow-up evaluation was also done with same parameters. The Wilcoxon Signed Rank Test is used to statically decompose the clinical data. Subjective parameters showed improvement of the condition viz frequency and urgency of urination, urine leakage with and without any activity, cough, sneeze, small amount of urine leakage, difficult and incomplete bladder emptying, bulging in vagina However, leakage not related to urgency, lower abdominal pressure, painful urination and lower abdomen or genital area, pelvic area heaviness or dullness, pelvic discomfort and burning micturition showed only a little reduction with the treatment. Objective parameter is also highly statistically significant at p value < 0.001.

Clinical application of the full-stack smart pelvic floor ultrasound to acquire and measure the minimal levator hiatus plane / 中华超声影像学杂志

Objective:To evaluate the feasibility of Full-stack Smart Pelvic Floor Ultrasound (FSPFU) software in the acquisition and measurement of the minimal levator hiatus (LH).Methods:Transperineal pelvic floor ultrasonography was performed in 119 women of 6-month postpartum from Nov.2020 to Jan.2021 of Shenzhen Second People′s Hospital. Mid-sagittal plane of pelvic floor was set as the initial plane, and the three-dimensional volume data was acquired. The dataset was stored in the machine. The offline volume data was manually adjusted to obtain the minimal LH images and measured by four physicians (two junior physicians as the D1 group and two senior physicians as the D2 group). For comparison, the results were also obtained using the fully automated method—the FSPFU software by a junior physician (the D3 group). The obtained parameters of minimal LH included area, circumference, anterioposterior diameter, transverse diameter, left and right levator-urethral gap distance. Analysis time was recorded for each group. The contours of minimal LH were outlined by three groups and the overlapping rate was calculated. The quality of the resulted images was evaluated and scored by another two senior physicians(A and B) independently.Results:The D3 group had a significant shorter analysis time compared with the other two groups, and the D1 group took a longer time than the D2 group, regardless of the cystocele severity (D1: 82.97 s, D2: 62.51 s, D3: 2.71 s, all P<0.05). The intergroup agreements and correlations of the minimum LH area were good (all ICC>0.85, rs>0.70, P<0.001) and the outlined contours were largely overlapped (>92%). There was no significant difference in image quality among the three groups(all P>0.05). Conclusions:FSPFU software can automatically obtain and measure the minimum LH in an efficient and accurate way, which can improve the effectiveness of the present pelvic floor examination. FSPFU software can be an useful tool in the diagnosis of pelvic floor dysfunctional diseases.

Various Approaches and Treatments for Pelvic Organ Prolapse in Women

Pelvic organ prolapse (POP) is bulging of one or more of the pelvic organs into the vagina and triggered by multiple causes. It is a very common disorder, especially among older women. POP is characterized by protrusion of the presentation part visible by the naked eye, and problems with urination or bowel movements. POP can be diagnosed based on the onset of symptoms and a pelvic exam, and management options include medical and surgical treatment. Although medical treatment cannot correct the abnormal herniation of the pelvic structures, this can help alleviate symptoms. One of the disadvantages of surgical interventions is recurrence, and advances in surgical techniques have decreased recurrence rates of POP. Therefore, author will explain the gynecology and urology approach and treatment.

Correlation between the posterior vaginal wall and apex in pelvic organ prolapse

OBJECTIVE: The aim of our study is to reveal the correlation between the posterior vaginal wall and apex in pelvic organ prolapse. METHODS: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic between January 2013 and December 2015. RESULTS: Four hundred five cases were enrolled in our study. When all POP stages were included, the Bp (pelvic organ prolapse quantification point) had a moderate correlation with the C (Pearson's r=0.419; P < 0.001). Cases where Bp was stage 3 and above presented strong positive correlations with C (Spearman's ρ=0.783; P < 0.001). Cases where C was stage 3 and above presented also strong positive correlations with Bp (Spearman's ρ=0.718; P < 0.001). CONCLUSION: Posterior vaginal wall prolapse and apical prolapse were correlated with each other, and this correlation was more prominent as stage increased. Therefore, when admitting a patient suspected of posterior vaginal wall prolapse or apical prolapse, it is necessary to evaluate both conditions. Especially in cases more severe or equal to stage 3, it is a must to suspect both conditions as the 2 are strongly correlated.

The efficacy and safety of modified anterior vaginal wall repair for anterior vaginal prolapse and cystocele in elderly women / 中华老年医学杂志

Objective To investigate the efficacy and safety of modified anterior vaginal wall repair in the treatment of anterior vaginal prolapse and cystocele in elderly women.Methods We retrospectively analyzed the clinical value of modified anterior vaginal wall repair in 58 elderly women with stage Ⅱ-Ⅳ anterior vaginal prolapse and cystocele,which were evaluated by pelvic organ prolapse quantitation (POP-Q) system.The modified anterior vaginal wall repair was based on the paravaginal repair as an add-on to a reverse bridge repair and cross stitching of bilateral sutures stemmed from vaginal repair.According to the condition of each patient,other pelvic floor repair,perineal laceration repair,and paraurethral fascia reinforcement might be performed at the same time.The curative effectiveness was subjectively and objectively evaluated in the postoperative follow-up.Results A total of 58 operations were successfully finished.The follow-up time was 6-24 months with an average of (14±8) months.The subjective cure rate was 100％ and the rate of objective cure defined as the top of the vagina above the level of ischial spine was 100％ at 3 months follow-up (n=58).The subjective and objective cure rate was 100％ and 96.6％ (56/58) at 6 months follow-up (n=58),100％ and 94.1％ (32/34) at 12 months follow-up (n=34),91.7％ (11/12) and 91.7％ (11/12) at 24 months follow-up (n=12),respectively.Conclusions The modified anterior vaginal wall repair is safe and effective for anterior vaginal prolapse and cystocele in elderly women.

Treatment of Anterior Vaginal Wall Prolapse Using Transvaginal Anterior Mesh With Apical Fixation: A Prospective Multicenter Study With up to 2 Years of Follow-up / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach. METHODS: This was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months. RESULTS: Ninety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P < 0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%–90% for every time point (P < 0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%). CONCLUSIONS: This midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications.

Mesh Surgery for Anterior Vaginal Wall Prolapse: A Meta-analysis / Cirurgia com tela para correção de prolapso de parede anterior: metanálise

Abstract Purpose Pelvic organ prolapse (POP) is a major health issue worldwide, affecting 6- 8% of women. The most affected site is the anterior vaginal wall. Multiple procedures and surgical techniques have been used,with or without the use of vaginalmeshes, due to common treatment failure, reoperations, and complication rates in some studies. Methods Systematic review of the literature and meta-analysis regarding the use of vaginal mesh in anterior vaginal wall prolapse was performed. A total of 115 papers were retrieved after using the medical subject headings (MESH) terms: 'anterior pelvic organ prolapse OR cystocele AND surgery AND (mesh or colporrhaphy)' in the PubMed database. Exclusion criteria were: follow-up shorter than 1 year, use of biological or absorbable meshes, and inclusion of other vaginal wall prolapses. Studies were put in a data chart by two independent editors; results found in at least two studies were grouped for analysis. Results After the review of the titles by two independent editors, 70 studies were discarded, and after abstract assessment, 18 trials were eligible for full text screening. For final screening and meta-analysis, after applying the Jadad score (> 2), 12 studies were included. Objective cure was greater in the mesh surgery group (odds ratio [OR] = 1,28 [1,07-1,53]), which also had greater blood loss (mean deviation [MD] = 45,98 [9,72-82,25]), longer surgery time (MD = 15,08 [0,48-29,67]), but less prolapse recurrence (OR = 0,22 [01,3-0,38]). Dyspareunia, symptom resolution and reoperation rates were not statistically different between groups. Quality of life (QOL) assessment through the pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-12), the pelvic floor distress inventory (PFDI-20), the pelvic floor impact questionnaire (PFIQ-7), and the perceived quality of life scale (PQOL) was not significantly different. Conclusions Anterior vaginal prolapse mesh surgery has greater anatomic cure rates and less recurrence, although there were no differences regarding subjective cure, reoperation rates and quality of life. Furthermore, mesh surgery was associated with longer surgical time and greater blood loss. Mesh use should be individualized, considering prior history and risk factors for recurrence.

Resumo Introdução Prolapso de órgãos pélvicos é problema de saúde públicas, sendo o mais comumo anterior. Para tratamento são utilizadas cirurgias, comou semtelas. O uso de telas é para diminuir recidivas, mas não h á consenso. Métodos Foi realizada revisão da literatura e metanálise, sobre uso de telas na correção do prolapso anterior. Base de dados foi PUBMED , com termos (MESH): "Anterior Pelvic Organ OR Cystocele AND Surgery AND (Mesh or Colporrhaphy)". Critérios de exclusão foram: seguimento menor que 1 ano, telas biológicas ou absorvíveis. Resultados: foram avaliados 115 artigos. Após revisão dos títulos, 70 estudos foram descartados e 18 após leitura de resumos. Após critérios de Jadad (>2), 12 estudos foram incluídos. Análise estatística foi razão de risco ou diferença entre médias dos grupos, e as análises com grande heterogeneidade foram avaliadas através de análise de efeito aleatório. Resultados Cura objetiva foi superior no grupo com tela - OR 1,28 (1,07-1,53, p 1 0,00001), maior perda sanguínea - diferença média (MD) 45,98 (9,72-82,25, p = 0,01), tempo cirúrgico mais longo - MD 15,08 (0,48-29,67, p = 0,04), porém menor recorrência - OR 0,22 (0,13-0,38, p = 0,00001), não apresentando maior resolução dos sintomas - OR 1,93 (0,83-4,51, p = 0,15). Dispareunia e taxa de reoperação também não foram diferentes entre grupos. Qualidade de vida não apresentou diferença. Conclusões Cirurgia com tela para prolapso vaginal anterior apresenta melhor taxa de cura anatômica e menor recorrência, sem diferenças cura subjetiva, reoperação e qualidade de vida. Há maior tempo cirúrgico e perda sanguínea. Uso de telas deve ser individualizado.

Colposuspensión anterior con fijación a malla transobturatriz: una nueva técnica para el tratamiento del colpocele anterior / Anterior colposuspension with transobturator mesh fixation: a new technique for the treatment of anterior colpocele

Introducción: la zona crítica de sostén apical de la fascia vesicovaginal es el anillo pericervical, el cual no existe en el caso de mujeres histerctomizadas. Por lo tanto, el análisis y el desarrollo de posibilidades terapéuticas para el cistocele con menores recidivas posteriores es un tema crítico en la cirugía uroginecológica. Objetivo: presentar una nueva técnica quirúrgica para el tratamiento del colpocele anterior. Material y método: se presentan los primeros diez casos de pacientes operadas con una nueva técnica quirúrgica en el tratamiento por vía vaginal del colpocele anterior. La técnica denominada CATO (C-colposuspensión, A-anterior, TO-transobturatriz) se basa en la reparación del defecto del colpocele anterior (sea este central, medial o pericervical) mediante tejido propio, el cual se fija a una neoestructura dada por el emplazamiento de una cinta de malla de prolene por vía obturatriz posterior. Resultados: no se registraron complicaciones intraoperatorias; hubo un hematoma vesicovaginal posoperatorio inmediato. En cuanto a los resultados funcionales, no se registraron disfunciones vesicales. En el seguimiento se destaca que todas las pacientes presentan puntos Aa y Ba normales. No se registran complicaciones de la malla utilizada. La técnica resulta segura, respeta la anatomía funcional y es reproducible para el ginecólogo vaginalista entrenado y con conocimiento del abordaje transobturatriz posterior. El seguimiento a largo plazo demostrará si esta nueva técnica desarrollada por nuestro equipo tiene un lugar que ocupar en el arsenal quirúrgico del tratamiento de la patología del piso pélvico.

Abstract Introduction: the critical area of apical support for the vesicovaginal fascia is the peri-cervical ring, which does not exist in women who have undergone hysterectomies. Thus, the analysis and development of new therapies for colpocele with smaller posterior relapse is critical for urogynecologic surgery. Objective: to present a new surgical technique for treatment of anterior colpocele Method: the study presents the first ten cases of women who were operated with a new surgical technique in treatment for anterior colpocele through the vagina. The technique under the name CATO (following the Spanish words: CATO (C-colposuspension, A-anterior, TO-transobturator) is based on repairing the anterior colpocele defect (central, medium or peri-cervical) using her own tissue, which is fixed to a new structure created by placing a mesh ribbon through a posterior transobturator. Results: no intraoperative complications were recorded; there was one case of immediate postoperative vesicovaginal hematoma. As to functional results, no vesical dysfunctions were recorded. Upon follow up, it is worth pointing out all patients show normal Aa and Bb stitches. Nos complications arose for the mesh used. The technique is safe, it respects functional anatomy and may be replicated by trained gynecologists who are familiar with the posterior transobturator approach. Long term follow up will reveal whether this new technique developed by our team may become part of the surgical toolkit for treating pelvic floor pathology.

Resumo Introdução: a zona crítica do suporte apical da fáscia vesicovaginal é o anel pericervical, que não existe nas mulheres histerectomizadas. Portanto, a análise e o desenvolvimento de possibilidades terapêuticas para o cistocele com menores recidivas posteriores é uma tema crítico na cirurgia uroginecológica. Objetivo: apresentar uma nova técnica cirúrgica para o tratamento do colpocele anterior. Material e método: apresentam-se os dez primeiros casos de pacientes operadas com uma nova técnica cirúrgica para tratamento por via vaginal da colpocele anterior. A técnica denominada CATO (Colpossuspensão, A-anterior, TO-transobturatoria) está baseada na reparação do defeito do colpocele anterior (seja central, medial ou pericervical) utilizando tecido próprio, que se fixa a uma neoestrutura dada pela colocação de uma tira de malla de prolene por via obturatriz posterior. Resultados: não foram registradas complicações intra-operatórias ou hematoma vesicovaginal pós-operatório imediato. Com relação aos resultados funcionais, não foram registradas disfunções vesicais. No seguimento se destaca que todas as pacientes apresentam pontos Aa e Ba normais. Não foram registradas complicações da malha utilizada. A técnica é segura, respeita a anatomia funcional e é reproduzível por ginecologista vaginalista treinado e com conhecimento da abordagem transobturatoria posterior. O seguimento em longo prazo demonstrará se esta nova técnica desenvolvida por nosso grupo de trabalho tem um lugar no arsenal cirúrgico no tratamento da patologia do piso pélvico.

Ultrasonic imaging of female cystocele subtypes:a preliminary study / 中华超声影像学杂志

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.

Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh

PURPOSE: To evaluate the medium-term efficacy and safety of transobturator four-arm polypropylene mesh in the treatment of high-stage anterior vaginal wall prolapse and concomitant stress urinary incontinence (SUI). MATERIALS AND METHODS: Between September 2010 and August 2013, a prospective single-center trial was performed to evaluate women with stage> or =3 anterior vaginal wall prolapse with or without SUI who presented to Labbafinejad Hospital, Teheran, Iran, and underwent anterior vaginal wall repair with polypropylene mesh. Pre- and postoperative evaluation included history; physical examination using the Pelvic Organ Prolapse Quantification system and cough stress test, both before and after reduction of prolapsed structures; Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ); urinalysis and culture; and a postvoid residual assessment. Complications were reported at a mean of 2 years of follow-up. RESULTS: A total of 71 patients underwent cystocele repair with the transobturator four-arm polypropylene mesh. Seven of the patients were lost to follow-up. There were no perioperative complications. The anatomical success rate was 87.5%. The subjective success rate was 92.1%. The PFDI and PFIQ were significantly improved after surgery (p<0.001). Among those with the simultaneous complaint of SUI, 82% were cured without any additional procedure. Three patients (4.6%) experienced vaginal mesh extrusion. Two patients (3.1%) reported worsening of dyspareunia after surgery. CONCLUSIONS: The four arms polypropylene mesh is an effective device for simultaneous correction of anterior vaginal wall prolapse and SUI with a low complication rate at a medium-term follow-up. The majority of the subgroup with concomitant SUI were cured without a second simultaneous procedure.

Efficacy of Pelvisoft® Biomesh for cystocele repair: assessment of long-term results

Introduction and Hypothesis To our knowledge a study regarding the efficacy of Pelvisoft® Biomesh for cystocele repair has not previously been reported in the literature. The aim of our study was to assess the long-term efficacy, subjective outcomes and complications in the use of a non-synthetic porcine skin mesh graft (Pelvisoft® Biomesh) associated with transvaginal anterior colporrhaphy in the treatment of cystocele prolapse. Materials and Methods A retrospective study was performed at a single centre. Thirty-three women aged 35-77 years underwent cystocele repair using Pelvisoft® graft between December 2005 and June 2009. Twenty-nine women who underwent transvaginal cystocele repair with Pelvisoft® Biomesh for over a 2 years period were assessed. Four patients were lost to follow-up. Cystocele repair was performed via the vaginal route using Pelvisoft®Biomesh implant by inserting it in the anterior vaginal wall. The median follow-up time was 54.0 months. The rate of recurrence was 17.3%. A total of 6.9% of patients presented early mesh exposure treated by conservative treatment. The mean PFDI-20 score was 72.2. Among sexually active women, the mean PISQ 12 was 33.9 but 56.2% had dyspareunia. After surgery, 6 patients had de novo intercourse. Our results show that the use of Pelvisoft® biomaterial associated with anterior colporrhaphy for cystocele repair appears to be safe with acceptable failure and complication rates at long term. Nevertheless, an adverse impact on sexual function was reported by the majority of patients. .

Experiencia en la corrección quirúrgica del prolapso del compartimiento anterior usando malla multianclaje / Experience in the surgical correction of anterior compartment prolapse using mesh multianchorage

Objetivo: describir la frecuencia de éxito, recidivas y complicaciones, en mujeres con prolapso genital del compartimiento anterior a quienes se les realizó intervención quirúrgica usando malla multianclaje macroporosa monofilamento. Metodología: estudio observacional de una cohorte de 71 mujeres con prolapso del compartimiento anterior e intervenidas en la Clínica Universitaria Bolivariana y a quienes se les realizó corrección quirúrgica con malla multianclaje durante el periodo de 2008-2011. Se realizaron dos evaluaciones postquirúrgicas cuantificando el prolapso por medio de la clasificación internacional POP-Q (Pelvic Organ Prolapse Quantification System) a los seis meses y al año de la cirugía. Resultados: se encontró mejoría del prolapso genital pasando del grado POP-Q III y IV prequirírgico al grado I postquirúrgico en 90,5 % de las pacientes; se encontró 2,9 % de recaída del prolapso grado IV. Nueve pacientes presentaron complicaciones tempranas. Se observó un porcentaje de recidiva de prolapso del compartimiento anterior a los seis meses del 4,2 % y de 9,9% al año de evaluación. Conclusión: encontramos disminución en el porcentaje de recidivas del prolapso de compartimento anterior en las pacientes a quienes se les corrigió con malla multianclaje. Se requieren estudios posteriores con diseños más exigentes. Por ahora podemos sugerir que hay una tendencia a un mejor resultado con el uso de la malla multianclaje para la corrección del prolapso del compartimiento anterior.

ABSTRACT Objective: to describe the success rate, complications and recurrences in women with genital prolapse of the anterior compartment who underwent surgery using macroporous monofilament mesh multianchorage. Methods: observational study of a cohort of 71 women with anterior compartment prolapse who were seized in the Clinica Universitaria Bolivariana and who underwent surgical repair with mesh multianchorage during the period 2008- 2011. Two postoperative assessments were performed by quantifying prolapse by the POP-Q International Classification (Pelvic Organ Prolapse Quantification System) at six months and one year after surgery. Results: an improvement was found genital prolapse POP-Q passing grade III and grade IV preoperative to grade I postoperative in 90.5% of patients; 2.9% of grade IV prolapse relapse was found. Nine patients had early complications. A recurrence rate of prolapse prior to six months of 4.2% and 9.9% to year evaluation was observed. Conclusions: We found decrease in the recurrence rate of anterior compartment prolapse in patients who were corrected mesh multianchorage. Subsequent studies are needed with better designs. Nowadays we can suggest that there is a trend to a better outcome with the use of mesh multianchorage correction of anterior compartment prolapse.

Scrotal cystocele presenting with renal failure.

Extensive bladder herniation is rare. We hereby present a case of scrotal cystocele with chronic renal failure. It was managed successfully by initial nephrostomies and then definitive corrective surgery.

Application of transperineal ultrasound in female typing of cystocele / 中华超声影像学杂志

Objective To investigate the application value of transperineal ultrasound in female patients with cystocele.Methods Transperineal ultrasound were performed in 36 female patients with cystocele and the bladder neck movement degrees (BND),retrovesical angle and the degree of urethral rotation were observed at maximum Valsalva.The ultrasonic manifestation of 36 female patients with cystocele were summarized.Results On maximal Valsalva bladder neck mobility all increased in 36 patients,32 patients with open retrovesical angle (≥140°) and 30 female patients with urethral rotation ≥ 45°.There were 6 cases with type Ⅰ,bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation ＜45°.There were 26 cases with type Ⅱ,bladder neck was lower than inferoposterior margin of the symphysis pubis,cystocele with open retrovesical angle (≥140°) and urethral rotation ≥45°.There were 4 cases with type Ⅲ,bladder was lower than inferoposterior margin of the symphysis pubis,cystocele with intact retrovesical angle (＜ 140°) and urethral rotation ≥45°.Conclusions The transperineal ultrasound can be used for classification of cystocele in female patients and which may provide more reliable information for clinical diagnosis.

Management of Pelvic Organ Prolapse

Quality of life is adversely affected by pelvic organ prolapse, the prevalence of which is increasing because of the persistently growing older population. Today, the tension-free vaginal mesh kit has grown in popularity owing to its comparable cure rate to traditional reconstructive surgery and the feasibility of an early return to normal life. However, significant debate remains over the long-term cure rate and the safety of tension-free vaginal mesh in the United States. The U.S. Food and Drug Administration recommends obtaining informed consent about the safety and cure rate when the patient chooses surgery using the tension-free vaginal mesh kit or meshes before surgery. The goal of surgery for pelvic organ prolapse is the restoration of anatomic defects. This review article provides an overview of basic surgical techniques and the results, advantages, and disadvantages of surgery for pelvic organ prolapse.

The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

Introduction and Hypothesis We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP) Materials and Methods After Institutional Review Board (IRB) approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q) scoring system. Graft related complications were also recorded. Results Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48) months. Seventeen patients (25%) had previous AVWP repair and 32 (46%) had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%), stage III in 27 (39%) and stage IV in 33 (48%) patients. Anatomic success was found in 48 (69%) patients, with 23 (33%) having stage 0 and 25 (36%) stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. conclusions The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts. .

Conduta nos prolapsos genitais / Management of genital prolapse

O prolapso genital constitui afecção de grande importância social e econômica dada sua prevalência estimada em até 40% das mulheres, cujo aumento gradual coincide com o envelhecimento populacional. Estima-se que 30% das pacientes submetidas ao tratamento cirúrgico já foram operadas previamente pelo mesmo motivo. Fatos como esses e outras situações conflitantes, como a escolha entre tratamento conservador ou cirúrgico, a melhor técnica operatória para tratar as alterações anatômicas e funcionais do assoalho pélvico e o uso ou não de uma grande complexidade de materiais sintéticos e biológicos, têm sido objeto de constante investigação. O presente estudo teve por objetivo realizar uma revisão sistemática da literatura em relação ao manejo das pacientes portadoras de prolapso genital, considerando as evidências atuais referentes à utilização dos pessários vaginais, ao papel da fisioterapia, à melhor abordagem cirúrgica, às indicações do uso de telas e a concomitância, na vigência do prolapso, do tratamento cirúrgico da incontinência urinária

The pelvic organ prolapse is an important social and economic problem with the estimated prevalence at up to 40% of women, increasing with the aging population. It is estimated that 30% of patients undergoing surgical treatment, have been operated previously for the same reason. Facts such as these and other situations of conflict as the choice between conservative or surgical treatment, the best surgical technique to treat the anatomical and functional changes of the pelvic floor and use or not of a great complexity of biological and synthetic materials, have been under constant investigation. This study aims to realize a systematical review regarding the management of patients with genital prolapse, considering the current evidence regarding the use of vaginal pessaries, the role of physiotherapy, the best surgical approach, the indications for the meshes use and the concomitant surgical treatment of urinary incontinence, in the presence of prolapse

Clinical application of transperineal ultrasonography in diagnosis of anterior compartment dysfunctional disease / 中国介入影像与治疗学

The rapid development of ultrasonographic technology,especially the three-dimensional ultrasonographic technology has brought new opportunities to pelvic imaging.The anatomy and related diseases of the anterior compartment of female pelvic floor,and the recent application and development of transperineal ultrasonography in the anterior compartment were reviewed in this article.

Incidentally Detected Inguinoscrotal Bladder Hernia

The bladder is involved in less than 4% of inguinal hernias. Inguinoscrotal bladder hernias are difficult to diagnose, and less than 7% are diagnosed preoperatively. Inguinoscrotal bladder hernias are usually asymptomatic. However, they can result in significant complications, such as bladder necrosis or acute renal failure. Accurate diagnosis is crucial to avoid bladder injury during surgery and other complications. Here we report the case of a 64-year-old man who presented with a scrotal mass. Ultrasonography of the scrotal mass showed a nonspecific cystic mass. During surgery, the mass was revealed to be a herniated bladder.

Colpopexia anterior con uretrosuspensión con monoprótesis sintética en el tratamiento simultáneo del cistocele y la incontinencia urinaria / Use of a synthetic monoprosthesis of monofilament, macropore, polypropylene mesh for the simultaneous cure of cystocele and the stress urinary incontinence

Objetivo: Describir la técnica quirúrgica y los resultados de la cura simultánea del cistocele e incontinencia urinariade esfuerzo (IUE) utilizando una monoprótesis de polipropileno monofilamento macroporosa, basado en el "Nazca TC POP Repair System". Material y Métodos: Estudio retrospectivo, descriptivo de tipo serie de casos. Se recolectaron los datos de 69 pacientes intervenidas en dos centros, uno público y otro privado, entre mayo 2007 y abril 2008 en Lima-Perú. Se recopilaron los datos de 56 pacientes hasta los tres meses post cirugía. Resultados: Las complicaciones más importantes fueron extrusión de malla en 4/69 (6%), recidiva del prolapso en 1/56 (2%), persistencia de la IUE 1/56 (2%, retención urinaria 11/69 (16%), infección urinaria en 16/69 (23%), infección de la cúpula en 9/69 (13%) y hematoma en 3/69 (4%). La curación del cistocele según el POP-Q a los tres meses fue de 53/56 (95%) y la satisfacción de las pacientes fue 96,42%. La cura subjetiva de la IUE fue: curada 48/56 (85,1%), mejorada 7/56 (12,5%) y no curada en 1/56 (1,78%). Conclusiones: El uso de esta monoprótesis puede significar un procedimiento seguro y eficaz para la corrección quirúrgica del cistocele y la IUE.

Objectives: To describe the technique for the simultaneous cure of cystocele and the stress urinary incontinence (SUI) using, polypropylene mesh, based on the "Nazca TC POP Repair System". Materials and methods: Retrospective, descriptive study, case series type. We included 69 patients, operated in two centres, a public and a private one, between May 2007 and April 2008 in Lima - Perú. We compiled the data of 56 patients until three months post surgery. Results: The most important complications were: mesh erosion 4/69 (5.7%), prolapse relapse 1/56 (1.7%), SUI persistence 1/56 (1.7%), urinary retention 11/69 (15.9%). We also had urinary tract infection 16/69 (23.18%), vaginal cupula infection 9/69 (13.04%) and hematoma 3/69 (4.34%). The cure rate with POP-Q system scores three months after surgery was 53/56 (94.64%) for cystocele and the patient satisfaction was 54/56 (96.42%). For SUI, the subjective efficacy for cure was 48/56 (85.71%), improvement in 7/56 (12.5%) and failure in 1/56 (1.78%). Conclusions: The use of monoprothesis can be an effective and sure procedure to repair the prolapse of anterior vaginal wall and SUI.