Resultados funcionales en el tratamiento del prolapso rectal

Introducción: El prolapso rectal es una entidad clínica poco frecuente, habitualmente acompañada de otras alteraciones del piso pélvico, con un impacto negativo en la calidad de vida. Existen pocos modelos de calidad de vida adaptados a nuestra realidad. Uno de ellos es el EQ-D5, adaptada por Olivares-Tirado. Objetivos: evaluar la calidad de vida y los resultados funcionales de la cirugía de prolapso entre 2015 y 2021 y correlacionarlos con las distintas técnicas abdominales. Material y Métodos: Este es un estudio retrospectivo, observacional, transversal y de cohorte. Se pesquisaron 84 pacientes, se incluyeron 59. Para el análisis de la calidad de vida se utilizó la Encuesta EQ-D5. Para complementar el estudio se midió el Cleveland Clinic Incontinence Score y el Constipation Scoring System. Resultados: Hubo cambios significativos en todas las encuestas aplicadas a la mejoría en pre y postoperatorio, sin existir diferencias entre técnicas quirúrgicas, pero con menor índice de estadía postoperatoria en el grupo laparoscópico. Discusión: Existe una mejoría en la calidad de vida postoperatoria que se refleja en los índices obtenidos, independiente de la técnica quirúrgica, no obstante, esta se ve atenuada en pacientes recidivados, lo que se relaciona con la literatura, también sin encontrar diferencias entre las técnicas. Existe menos constipación postoperatoria en la técnica de rectopexia ventral. Conclusiones: Existe mejoría en la calidad de vida independiente de la técnica quirúrgica, sin cambios en pacientes recidivados. Ante ello, se debiera elegir la técnica más rápida y sencilla para el manejo, idealmente laparoscópica.

Background: Rectal prolapse is a rare clinical entity, usually accompanied by other pelvic floor disorders, with a negative impact on quality of life. There are few models of quality of life adapted to our reality. One of them is the EQ-D5, adapted by Olivares-Tirado. Objectives: To evaluate the quality of life and functional outcomes of rectal prolapse surgery between 2015 and 2021 and correlate them with the different abdominal techniques. Material and Methods: This is a retrospective, observational, cross-sectional and cohort study. A total of 84 patients were screened, 59 were included. The EQ-D5 Survey was used for the analysis of quality of life. To complement the study, the Cleveland Clinic Incontinence Score and the Constipation Scoring System were measured. Results: There were significant changes in all surveys applied to pre- and postoperative improvement, with no differences between surgical techniques, but with a lower rate of postoperative stay in the laparoscopic group. Discussion: There is an improvement in the postoperative quality of life that is reflected in the indices obtained, independent of the surgical technique, however, this is attenuated in recidivated patients, which is related to the literature, also without finding differences between the techniques. There is less postoperative constipation in the ventral rectopexy technique. Conclusions: There is improvement in the quality of life independent of the surgical technique, without changes in relapsed patients. Perhaps the fastest and easiest technique for handling should be chosen, ideally laparoscopic.

Experiencia de la histeropexia vaginal, usando prótesis de polipropileno / Experience of vaginal hysteropexy, using polypropylene prosthesis

Introducción: El prolapso de órganos pélvicos (POP) o distopia genital, es el descenso o desplazamiento de los órganos del suelo pélvico a través del canal vaginal o fuera de este. Objetivo: Evaluar los resultados de la histeropexia vaginal en la corrección quirúrgica del prolapso genital apical grado III o IV, usando prótesis de polipropileno; además describir la tasa de éxito, recurrencias y complicaciones. Método: Estudio de cohorte, en 42 mujeres sometidas a histeropexia vaginal (histero-cistopexia ortotópica) mediante prótesis de polipropileno (Splentis®), entre 2016 y 2021. Se realizaron tres evaluaciones postoperatorias (tres, seis y 12 meses). Se hizo muestreo no probabilístico. Se utilizó estadística descriptiva. Resultados: La edad media fue de 56,19 ± 9,27 años. El tiempo quirúrgico de 58,95 ± 13,74 minutos, el sangrado quirúrgico de 119,85 ± 68,73 ml. La tasa de éxito a los 12 meses fue del 90,47%. La recurrencia del prolapso apical fue del 4,76% a los seis meses y del 9,52% a los 12 meses; el de compartimento anterior a los seis meses arrojó un 7,14%, frente al 11,9% a los 12 meses. El 14,28% de las pacientes presentaron complicaciones menores. La incidencia de incontinencia urinaria de esfuerzo a los 12 meses fue del 16,66%. Conclusiones: la histeropexia vaginal es un procedimiento efectivo y seguro, con bajas tasas de recurrencias o complicaciones. Es importante que se sigan haciendo estudios con mejores diseños estadísticos.

Introduction: Pelvic organ prolapse (POP), or genital dystopia, is the descent or displacement of pelvic floor organs through the vaginal canal or outside of it. Objective: To evaluate the results of vaginal hysteropexy in the surgical correction of grade III or IV apical genital prolapse, using polypropylene prosthesis; also describe the success rate, recurrences and complications. Method: Cohort study in 42 women undergoing vaginal hysteropexy (orthotopic hystero-cystopexy) using a polypropylene prosthesis (Splentis®); between 2016 and 2021. Three postoperative evaluations were carried out (three, six and twelve months). Non-probabilistic sampling was done. Descriptive statistics were used. Results: The mean age was 56.19 ± 9.27 years. Surgical time of 58.95 ± 13.74 minutes, surgical bleeding of 119.85 ± 68.73 ml. The success rate after twelve months was 90.47%. Apical prolapse recurrence was 4.76% at six months and 9.52% at twelve months; that of the previous compartment, after six months it showed 7.14%, compared to 11.9% after twelve months; 14.28% of the patients presented minor complications. The incidence of stress urinary incontinence, at twelve months, was 16.66%. Conclusions: Vaginal hysteropexy is an effective and safe procedure, with low rates of recurrence or complications. It is important that studies continue to be carried out with better statistical designs.

Análisis de la la muerte súbita cardíaca por prolapso de la válvula mitral en una autopsia de una mujer sin antecedente de cardiopatía. Reporte de caso / Analysis of sudden cardiac death due to mitral valve prolapse in an autopsy of a woman with no history of heart disease. Case report

Resumen En Costa Rica, el Reglamento de la Autopsia Hospitalaria y Médico Legal establece que la autopsia médico legal es obligatoria para toda muerte súbita. La patología cardíaca es responsable aproximadamente del 80 % de las muertes súbitas que requieren una autopsia forense; el prolapso de la válvula mitral (degeneración mixomatosa de la válvula mitral) es una de las formas más comunes de valvulopatía cardíaca, es relativamente común (2%-3% de la población general), y a menudo se considera benigno, la tasa anual de muerte cardíaca súbita (MSC) en individuos con MVP (0,2%-0,4% /año) es aproximadamente el doble que el observado en la población general (0,1%-0,2% año).

Abstract In Costa Rica, the Hospital and Legal Autopsy Regulations establish that a legal medical autopsy is mandatory for all sudden deaths. Cardiac pathology is responsible for approximately 80% of sudden deaths requiring a forensic autopsy; Mitral valve prolapse (myxomatous mitral valve degeneration) is one of the most common forms of heart valve disease, is relatively common (2%-3% of the general population), and is often considered benign, the annual rate of Sudden cardiac death (SCD) in individuals with MVP (0.2%-0.4%/year) is approximately twice that observed in the general population (0.1%-0.2%/year).

As dimensões ósseas da pelve podem estar relacionadas à gênese dos prolapsos de órgãos pélvicos? Uma revisão sistemática de estudos observacionais para avaliação de risco e prognóstico / Can the bone dimensions of the pelvis be related to the genesis of pelvic organ prolapses? A systematic review of observational studies for risk assessment and prognosis

Objetivo: Averiguar qual o papel desempenhado pelas dimensões ósseas da pelve em relação à gênese do prolapso de órgãos pélvicos por meio de publicações dos últimos quinze anos. Métodos: Trata-se de uma revisão sistemática de estudos ob- servacionais para avaliação de risco e prognóstico por meio de um levantamento bibliográfico virtual de artigos científicos publicados em revistas digitais entre os anos 2007 e 2022, nas bases de dados PubMed, BVS e ScienceDirect. Resultados: Uma área pélvica anterior mais ampla e um maior diâmetro interespinhoso foram caracterizados como possíveis causas para prolapso de órgãos pélvicos. A maior parte dos estudos contou com mensurações ósseas diversificadas, nas quais as demais dimensões não apresentaram significância estatística. Conclusão: Os estu- dos avaliados nesta revisão sugerem uma nova medida do assoalho pélvico rela- cionada a mulheres com prolapso, com apresentação de uma maior área anterior, em grande parte influenciada pelo diâmetro interespinhoso, o qual leva a um au- mento da carga sobre o assoalho pélvico. Porém, ainda assim, urge a necessidade de mais estudos para corroborar nossos achados.

Objective: To investigate the role played by the bone dimensions of the pelvis in relation to the genesis of pelvic organ prolapses through publications from the last fifteen years. Methods: This is a systematic review of obser- vational studies for risk assessment and prognosis through a virtual bibliographic survey of scientific articles published in digital journals between 2007 and 2022, in PubMed, BVS and ScienceDirect databases. Results: A wider anterior pelvic area and a larger interspinous diameter were characterized as possible causes for pelvic organ prolapses. Most of the studies have diversified bone measurements, in which the other dimensions weren't statistically significant. Conclusion: The studies evaluated in this review suggest a new measure- ment of the pelvic floor related to women with prolapse, with a larger anterior area, largely influenced by the interspinous diameter, which leads to an increased load on the pelvic floor. However, even so, there is an urgent need for further studies to corroborate our findings.

A randomized clinical trial comparing internal and external pessaries in the treatment of pelvic organ prolapse in postmenopausal women: A pilot study

Abstract Introduction and hypothesis Internal vaginal pessary is among the leading treatments for pelvic organ prolapse (POP); however, it has a high adverse event rate. An external pessary was recently developed as an alternative. The study's objective was to compare the efficacy of external and internal pessaries in treating POP in postmenopausal women. Methods This parallel randomized (1:1 ratio) open-blind study included 40 symptomatic women with stage 2 or 3 POP. They were randomized into two groups: group 1 (internal pessary) and group 2 (external pessary) (n = 20 in each); and evaluated at the start of and 3 months after the treatment. Statistical analysis was performed to compare the results within and between the groups before and after the 3-month treatment. Results The groups were homogeneous, except for the variables previous pregnancies (p = 0.030) and POP-Q score of apical prolapse (p = 0.023) whose values were higher in group 2. A significant improvement in quality of life was observed in both groups after 3 months of follow-up; however, internal pessaries were found to be more effective (p < 0.001). In group 1 there were differences between the initial and final POP-Q scores of anterior (0.004) and apical prolapse (p = 0.005). The complication rate associated with internal pessary use was high (p = 0.044). Conclusions The present data suggested that external pessaries have a similar effect to internal ones for the treatment of POP and improvement of the quality of life of postmenopausal women.

Clinical effect and prognostic factor of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse / Efeito clínico e fator prognóstico da estimulação elétrica e terapia de biofeedback no prolapso de órgãos pélvicos pós-parto / Efecto clínico y factor pronóstico de la estimulación eléctrica y la terapia de biorretroalimentación en el prolapso posparto de órganos pélvicos

ABSTRACT Objective: To explore the effects of electric stimulation and biofeedback therapy in patients with postpartum pelvic organ prolapse and to identify factors that can affect therapeutic efficacy outcomes. Method: This retrospective study analysed clinical data about patients with postpartum pelvic organ prolapse. A total of 328 women with pelvic organ prolapse at 6 weeks postpartum were recruited from one tertiary hospitals in Sichuan province in China, between March 2019 and March 2022. The prognostic factors of therapeutic efficacy were analysed using logistic regression and decision tree model. Results: Overall, 259 women showed clinical benefits from the treatment. The logistic regression model showed that parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were independent prognostic factors. The decision tree model showed that the pelvic organ prolapse quantitation stage before treatment was the main prognostic factor, followed by parity. There was no significant difference in the area under the receiver operating characteristic curve between the two models. Conclusion: Parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were important prognostic factors of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse.

RESUMO Objetivo: Explorar o efeito da estimulação elétrica e da terapia de biofeedback em pacientes com prolapso de órgãos pélvicos pós-parto e identificar fatores que podem afetar os resultados da eficácia terapêutica. Método: Este estudo é uma análise retrospectiva de dados clínicos de pacientes com prolapso de órgãos pélvicos pós-parto. Um total de 328 mulheres com prolapso de órgãos pélvicos nas seis semanas pós-parto foram recrutadas em um hospital terciário na província de Sichuan, na China, entre março de 2019 e março de 2022. Os fatores prognósticos de eficácia terapêutica foram analisados por meio de regressão logística e modelo de árvore de decisão. Resultados: No geral, 259 mulheres apresentaram benefícios clínicos com o tratamento. O modelo de regressão logística mostrou que a paridade, o treinamento muscular do assoalho pélvico em casa e o estágio de quantificação do prolapso de órgãos pélvicos antes do tratamento foram fatores prognósticos independentes. O modelo de árvore de decisão mostrou que o estágio de quantificação do prolapso de órgãos pélvicos antes do tratamento foi o principal fator prognóstico, seguido pela paridade. Não houve diferença significativa na área sob a curva ROC entre os dois modelos. Conclusão: A paridade, o treinamento muscular do assoalho pélvico em casa e o estágio de quantificação do prolapso de órgãos pélvicos antes do tratamento foram importantes fatores prognósticos da estimulação elétrica e da terapia de biofeedback no prolapso de órgãos pélvicos pós-parto.

RESUMEN Objetivo: Explorar el efecto de la estimulación eléctrica y la terapia de biorretroalimentación en pacientes con prolapso posparto de órganos pélvicos e identificar los factores que pueden afectar los resultados de la eficacia terapéutica. Método: Este estudio es un análisis retrospectivo de los datos clínicos de pacientes con prolapso posparto de órganos pélvicos. Entre marzo de 2019 y marzo de 2022, se reclutaron un total de 328 mujeres con prolapso de órganos pélvicos en las seis semanas posteriores al parto en un hospital terciario de la provincia de Sichuan, China. Los factores pronósticos de eficacia terapéutica se analizaron mediante regresión logística y el modelo de árbol de decisión. Resultados: En total, 259 mujeres mostraron beneficios clínicos relacionados con el tratamiento. El modelo de regresión logística mostró que la paridad, el entrenamiento en casa de la musculatura del suelo pélvico y la etapa de cuantificación del prolapso de órganos pélvicos antes del tratamiento fueron factores pronósticos independientes. El modelo de árbol de decisión mostró que la etapa de cuantificación del prolapso de órganos pélvicos previa al tratamiento fue el principal factor pronóstico, seguido de la paridad. No hubo diferencias significativas en el área bajo la curva ROC entre los dos modelos. Conclusión: La paridad, el entrenamiento en casa de la musculatura del suelo pélvico y la etapa de cuantificación del prolapso de órganos pélvicos previa al tratamiento fueron factores pronósticos importantes de la estimulación eléctrica y la terapia de biorretroalimentación en el prolapso posparto de órganos pélvicos.

Clinical efficacy of Amplatzer duct occluder-Ⅱ device for the treatment of ventricular septal defect with aortic sinus prolapse in child patients / 介入放射学杂志

Objective To investigate the efficacy of Amplatzer duct occluder-Ⅱ device(ADO-Ⅱ)in treating ventricular septal detect(VSD)with aortic sinus prolapse(ASP)in child patients.Methods The clinical data of 94 child patients with VSD complicated by ASP,who were admitted to the Hunan Provincial Children's Hospital of China between January 2018 and September 2022,were retrospectively collected.The child patients included 60 males and 34 females with a mean age of(4.7±3.1)years.Mild-moderate ASP was seen in 83 child patients,with a mean(4.12±0.97)mm-sized VSD.Severe ASP was seen in 11 child patients,with a mean(4.95±0.51)mm-sized VSD.Perimembrane VSD was observed in 54 child patients and intracristal VSD in 40 child patients.The relationship of VSD size and degree of ASP to the selection of ADO-Ⅱ,postoperative middle period aortic valve regurgitation and residual leakage was analyzed,so as to clarify the applicability of ADO-Ⅱ to such child patients.Results In the postoperative middle period,6 child patients had mild aortic valve regurgitation,most seen in the child patients who received 4-4 mm or 5-4 mm ADO-occluder;and 10 child patients had residual leakage,mainly seen in the child patients who received 5-4 mm or 6-4 mm occluder.Conclusion In the condition when the ADO-Ⅱ occluder shows satisfactory placement pattern,this treatment is suitable for the child patient having＜6 mm VSD with ASP.Although there are some residual leakage and aortic valve regurgitation after surgery,this interventional therapy still meets the clinical requirements.(J Intervent Radiol,2024,32:17-21)

Summary of the best evidence for the prevention and management of stoma prolapse in enterostomy patients / 中国实用护理杂志

Objective:To summarize the relevant evidence for prevention and management of stoma prolapse in patients with enterostomy, so as to provide reference for the clinical prevention and management of stoma prolapse measures.Methods:According to the evidence-based resource "6S" evidence pyramid model, systematically searched about the evidence of enterostomy patients prolapse prevention and management in UpToDate, BMJ best practice, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, CNKI, Wanfang database,VIP Database, SinoMed,etc. The search time limit was from 30 January 2017 to 30 May 2023, 2 researchers independently evaluated the quality of the literature, selected and extracted the evidence.Results:A total of ten articles were included, including one clinical decision, five guidelines, one expert consensus, one evidence, one systematic review, one position statement. Through analysis, 20 best evidences were identified, including perioperative evaluation, preoperative colostomy site marking, reducing abdominal pressure, enterostomy prolapse nursing, health education and the follow-up.Conclusions:Best evidence summary for the prevention and care of stoma prolapse in enterostomy patients provides evidence-based reference for clinical application. Nurses should carefully select and apply evidence in combination with clinical situations and patients′ wishes, so as to develop a personalised stoma prolapse prevention and management programme for patients with enterostomy.

Clinical efficacy of biofeedback and electrical stimulation on pelvic organ prolapse after laparoscopic uterine suspension / 局解手术学杂志

Objective To analyze the clinical efficacy of biofeedback and electrical stimulation on pelvic organ prolapse(POP)after laparoscopic uterine suspension.Methods A total of 102 cases of POP patients admitted to our hospital were selected and divided into the control group and the observation group according to the random number table method,with 51 cases in each group.The patients in the control group were treated with laparoscopic uterine suspension,and the patients in the observation group were treated with biofeedback and electrical stimulation on the basis of the control group.The total effective rate,pelvic floor distress inventory-20(PFDI-20)score,pelvic floor impact questionnaire-7(PFIQ-7)score,female sexual function index(FSFI)score,pelvic incontinence sexual questionnaire(PISQ)score,and recurrence rate of the patients in the two groups were compared.A neuromuscular electrical stimulation therapy instrument was used to detect the recovery of pelvic floor muscle for patients before and after treatment.Results Compared with the control group,the efficacy of patients in the observation group was superior(P<0.05).The PFDI-20 and PFIQ-7 scores after treatment of patients in the two groups were decreased compared with those before treatment(P<0.05),and the PFDI-20 and PFIQ-7 scores after treatment of patients in the observation group were lower than those in the control group(P<0.05).The pelvic floor muscle strength,maximal muscle contraction force and sustained contraction time after treatment of patients in the two groups were significantly stronger/longer than those before treatment(P<0.05),and the pelvic floor muscle strength,maximal muscle contraction force and sustained contraction time after treatment of patients in the observation group were stronger/longer than those in the control group(P<0.05).The FSFI and PISQ scores after treatment of patients in the two groups were significantly increased compared with those before treatment(P<0.05),and the FSFI and PISQ scores after treatment in the observation group were higher than those in the control group(P<0.05).The recurrence rate after treatment of patients in the observation group was significantly lower than that in the control group(P<0.05).Conclusion Biofeedback and electrical stimulation can enhance the clinical efficacy of laparoscopic uterine suspension in the treatment of POP,improve the pelvic floor muscle strength and POP of patients,and improve their quality of life.

Relationship Between the Anteroposterior Hiatal Diameter and Female Pelvic Organ Prolapse Assessed by Two-Dimensional Pelvic Floor Ultrasound / 中国医学影像学杂志

Purpose To explore the association between the anteroposterior hiatal diameter(AP)and pelvic organ prolapse(POP).Materials and Methods All clinical and transperineal ultrasound(TPUS)data of 262 women with lower urinary tract symptoms or POP who had presented to Second Xiangya Hospital of Central South University from July 2017 to May 2019 were retrospectively summarized and analyzed.AP was measured in the median sagittal section of the pelvic floor at maximum Valsalva motion.The degree of POP was obtained via international continence society(ICS)pelvic organ prolapse quantification(POP-Q)system and TPUS.The relationship between AP and POP degrees,and the predictive ability of AP on POP degrees were analyzed,respectively.Results A total of 237 patients were finally selected.There were 51(21.51％)women within ICS POP-Q stage 0,57(24.05％)within stage Ⅰ,49(20.67％)within stage Ⅱ,44(18.56％)within stage Ⅲ,36(15.18％)within stage Ⅳ.The mean AP on maximal Valsalva was(61.33±10.71)mm(range 37.10-97.90 mm).There was a significant difference in AP measurements based on TPUS or POP-Q(F=52.00,58.18,both P<0.01).A receiver operating characteristic curve analysis proposed a cutoff of 6.0 cm,and the sensitivity and specificity of prediction of obvious POP via TPUS was 81.0％and 75.5％,respectively;the sensitivity and specificity of prediction of POP-Q Ⅱ or high levels POP was 74.5％and 76.0％,respectively.AP was positively highly related to the POP stages.AP on Valsalva of less than 6.0 cm was related to POP stage 0-Ⅰ,6.0 to less than 6.5 cm was related to POP stage Ⅱ,6.5 to less than 7.0 cm to POP stage Ⅱ-Ⅲ,7.0 or more to POP stage Ⅳ(r=0.61,0.47,0.56,0.41,all P<0.05).Conclusion AP≥6.0 cm indicates an enlarged levator hiatus,with likelihood of POP.The larger the AP,the more severe the POP is.

Laparoscopic ventral mesh rectopexy and anal sphincter plasty for complete rectal prolapse / 中华普通外科杂志

Objective:To evaluate the safety and effectiveness of laparoscopic ventral mesh rectopexy (LVMR) +anal sphincter plasty for complete rectal prolapse.Methods:From Jan 1, 2018 to Dec 31, 2022, 45 patients with complete rectal prolapse diagnosed in Beijing Erlong Road Hospital received laparoscopic ventral mesh rectopexy +anal sphincter plasty were included in this study.Result:There was no mortality rate associated with LVMR in this study cohort. The follow-up period was 8-76 months, with a median follow-up period of 59 months. There were 2 cases of recurrence, with a recurrence rate of 4%. Patients with concomitant fecal incontinence symptoms had a preoperative Jorge Wexner fecal incontinence score of 13.8±2.0, and postoperative Jorge Wexner fecal incontinence scores of 7.5±1.5, 5.3±1.3, 4.3±1.1, 2.8±1.0, and 1.8±0.5 at 3, 6, 12, 36, and 60 months, respectively, all P<0.001. Patients with concomitant constipation had a preoperative Wexner constipation score of 15.7 ± 1.5, and a postoperative Wexner constipation score of 9.0±1.8, 6.8±1.5, 5.2±1.4, 4.1±0.7, 2.0±0.0 at 3, 6, 12, 36, and 60 months, respectively, all P<0.001. Conclusions:LVMR +anal Sphincter plasty is safe and effective for the treatment of complete rectal prolapse, and there are few complications related to biological patches. Anal sphincter plasty can effectively improve anal function.

Clinical efficacy study of transvaginal ischia spinous fascia fixation in the treatment of pelvic organ prolapse / 安徽医科大学学报

Objective @#To explore the safety and effectiveness of transvaginal ischia spinous fascia fixation for pelvic organ prolapse.@*Methods @#The retrospective analysis of 124 patients who underwent surgical treatment for stage III - IV pelvic organ prolapse was conducted. Among them , 53 cases of transvaginal ischia spinous fascia fixation (IS⁃ FF) were performed as a study group (ISFF group) while 71 cases of transvaginal sacrospinous ligament fixation (SSLF) were performed as a control group (SSLF group) . The operation time , postoperative hospitalization days , preoperative and postoperative hemoglobin values , indwelling urinary catheter time , postoperative pain scores , and the occurrence of complications were compared between the two groups , and the efficacy of the operation was objectively evaluated by using the staging method of pelvic organ prolapse (POP⁃Q) . Also the scores of the pelvic floor impact questionnaire⁃7 (PFIQ⁃7) , the pelvic floor dysfunction questionnaire⁃20 (PFDI⁃20) , and the questionnaire of quality of life 12 (PISQ⁃12) were used to evaluate the patients ′ postoperative quality of life.@*Results @#The operation time and postoperative hospitalization days of patients in the ISFF group were less than those in the SSLF group , and the differences were statistically significant (P < 0. 05) . The preoperative and postoperative hemoglobin values , retention time of urinary catheter, postoperative pain scores , and hospitalization costs of patients in the two groups were compared , and the differences were not statistically significant. At the 3 ⁃month postoperative outpatient follow⁃up , the objective success rate was 100% in two groups. The median follow⁃up time of patients in both groups was 24 months ( 12 - 41 months) , and there were 2 cases of recurrence in the ISFF group , with a recurrence rate of 3. 77% and a subjective success rate of 96. 23% . While there were 3 cases of recurrence in the SSLF group and 2 cases of loss of visit , with a recurrence rate of 4. 34% and a subjective success rate of 95. 65% . 1 patient in the SSLF group presented with a pelvic hematoma with a diameter of about 5 cm after surgery. The hematoma disappeared after hemostasis and other symptomatic treatment. There was no organ injury or blood transfusion in both groups.@*Conclusion @#Transvaginal ischia spinous fascia fixation is a safe and effective treatment for pelvic organ prolapse , and it has the advantages of short operation time , fast postoperative recovery , fewer complications , and improvement of patients ′ quality of life.

Bioinformatics analysis based on pelvic organ prolapse related aging genes of GEO Database and LASSO regression algorithm / 吉林大学学报(医学版)

Objective:To screen the aging genes closely associated with pelvic organ prolapse(POP)by bioinformatics techniques,and to clarify the potential clinical significance and value of key genes.Methods:Gene Expression Omnibus(GEO)Database was used to download the datasets GSE53868 and GSE151188 for POP-related genes with the keyword"pelvic organ prolapse".The aging-related genes were obtained from Aging Atlas,CellAge,and the Human Ageing Genomic Resources(HAGR)Databases;the intersection of genes related with POP in two groups provided a list of differentially expressed genes(DEGs)associated with aging in POP;gene Set Enrichment Analysis(GSEA)was conducted with R software version 4.2.1;Gene Ontology(GO)functional enrichment analysis and Kyoto Encyclopedia of Genes and Genomes(KEGG)signaling pathway enrichment analysis of DEGs were conducted by the Database for Annotation,Visualization and Integrated Discovery(DAVID);the protein-protein interaction(PPI)network was constructed with Cytoscape 3.9.1 software;the top 10 Hub genes were selected by cytoHubba plugin;the infiltration of 22 types of immune cells in the patients in POP group and control group was analyzed by CIBERSORT deconvolution method using R software;the key genes were further screened by LASSO regression algorithm;the correlation and diagnostic efficacy between key genes and immune cell infiltration were analyzed.Results:From the Aging Atlas,CellAge,and HAGR Databases,724 aging-related genes were identified.Intersection with the POP expression profile yielded an aging gene expression matrix related to POP containing 624 genes,and 29 POP-related DEGs were identified after differential analysis,including 2 upregulated genes and 27 downregulated genes.The GSEA results showed that the upregulated pathways were mainly related to diabetes and cellular senescence,whereas the downregulated pathways included Alzheimer's disease and hypoxia-inducible factor-1(HIF-1)signaling pathways.The GO functional enrichment analysis mainly enriched in the biological processes such as the response of the cells to lipopolysaccharide,inflammatory response,and negative regulation of cell proliferation.The KEGG signaling pathway enrichment analysis mainly enriched in interleukin-17(IL-17),tumor necrosis factor(TNF),and nuclear factor-kappa B(NF-κB)signaling pathways.The PPI network analysis got 10 Hub genes including interleukin-6(IL-6),interleukin-1B(IL-1B),prostaglandin-endoperoxide synthase 2(PTGS2),and NF-kappa-B inhibitor alpha(NFKBIA).The CIBERSORT deconvolution method results showed a relatively higher infiltration proportion of neutrophils and activated mast cells in the patients in POP group,the activated mast cells had a positive correlation with most of the DEGs(r>0.5)and the macrophages had a significant positive correlation with IL-1B(r>0.6).The key genes Jun D proto-oncogene(JUND),Snail homolog 1(SNAI1),amphiregulin(AREG),Lamin A/C(LMNA),and superoxide dismutase 2(SOD2)selected by LASSO regression analysis had high diagnostic efficacies,and the area under receiver operating characteristic curve(ROC)(AUC)were all greater than 0.75.Conclusion:During the aging process,the genes such as JUND,SNAI1,AREG,LMNA,and SOD2 may participate in the pathophysiology of POP through various pathways,including inflammation-related pathways,transcription regulation,and affecting collagen secretion and metabolism,thereby influence the connective tissue support function and promote the occurrence and development of POP.

Study on application of modified anterior pelvic floor functional reconstruction operation in pelvic organ prolapse / 重庆医学

Objective To analyze the application value of modified anterior pelvic floor reconstruction operation in pelvic organ prolapse.Methods A retrospective analysis was adopted.A total of 141 patients with pelvic floor reconstruction surgery in the obstetrics and gynecology department of Chongqing Municipal Ma-ternal and Child Health Care Hospital from January 2020 to December 2021 were included.The patients were divided into the observation group(modified anterior pelvic floor reconstruction operation,n=78)and control group(classic anterior pelvic floor reconstruction operation,n=63)according to the operation methods.The perioperative indicators,pelvic organ prolapse quantitation(POP-Q)score before and after operation,objective cure rate after operation,recurrence situation and pelvic floor quality of life score before and after operation were compared between the two groups.Results There was no significant difference in the surgical time,bleeding volume,duration of antibacteriakl drug use,and length of hospital stay between the two groups(P＞0.05).The POP-Q scores after surgerynin the two groups were signbificantly increase compared with before operation,and the objective cure rate in postoperative 12 months in the observation group was significantly higher than that in the control group at 12 months after surgery(91％.0 vs.81.0％,P＜0.05).There was no recurrence in the observation group after one year follow-up,while there were two cases of recurrence in the control group.The scores of the pelvic floor distress inventory short form 20(PFDI-20),pelvic floor impact questionnake,short form 7(PFIQ-7),and pelvic organ prolapse/incontinence sexual function questionnaire-12(PISQ-12)in 1 month after surgery in the two groups had statisticallyu significant differences compared with those before surgery(P＜0.05).After one year of follow-up,the patient global impression of improvement(PGI-I)score in the observation group was significantly lower than that in the control group(P＜0.05).Con-clusion The modified anterior pelvic floor reconstruction operation can effectively improve the quality of life in the patients,moreover the patients are not easy to relapse,so which is a new type of operation worthy of promotion.

Surgical and functional outcome of laparoscopic vaginal suspension combined with suture rectopexy for management of pelvic organ prolapse

Purpose: Laparoscopic techniques to treat pelvic organ prolapse are gaining popularity around the globe due to their low recurrence rates and better functional results compared to perineal techniques. However, the optimum surgical procedures are not yet determined. In the current research, we suggest a novel surgical approach, laparoscopic vaginal suspension with suture rectopexy, to treat multiorgan pelvic prolapse. Methods: This prospective cohort trial was conducted from March 2018 to March 2022 and comprised 35 females with multiorgan pelvic organ prolapse with obstructed defecation symptoms. A residual rectal prolapse was still present despite the manual reduction of uterine prolapse. Patients' conditions before and after the operation were monitored regarding the obstructed defecation score, sexual function, need for laxatives, anorectal manometry pressures, anorectal sensations, and recurrence. The mean follow-up duration was one year. Results: Modified Longo score for obstructed defecation significantly decreased at six and twelve months after surgery. Additionally, a significant reduction was reported in the number of patients who needed laxatives at six and twelve months after surgery. Anorectal manometry pre- and post-surgery showed a significant elevation in the mean squeeze pressure and a decline in all rectal sensations. All parameters of the female sexual function scoring system increased postoperatively. No recurrence was reported during follow-up. Conclusion: For multiorgan pelvic prolapse, laparoscopic vaginal suspension combined with suture rectopexy has excellent functional outcomes, minimal morbidity, and low cost. (AU)

Prevalence of colorectal symptoms and anal incontinence in patients with pelvic organ prolapse attended at an outpatient urogynecology service

Abstract Objective: To analyze data of patients with symptomatic pelvic organ prolapse evaluated with PFDI20 and its subscales to report the prevalence of lower gastrointestinal symptoms and anal incontinence in the population of a public hospital and analyze its impact on quality of life. Methods: Cross-sectional study of patients with symptomatic POP. Patients were evaluated with demographic data, POP-Q, pelvic floor ultrasonography, urological parameters, and pelvic floor symptoms (PFDI-20), and quality of life (P-QoL) surveys. Patients were classified as CRADI-8 "positive" for colorectal symptoms, with responses "moderate" in at least 3 and/or "severe" in at least 2 of the items in the CRADI-8 questionnaires. Results: One hundred thirteen patients were included. 42.5% (48) were considered positive for colorectal symptoms on CRADI-8. 53.4% presented anal incontinence. No significant differences were found in sociodemographic variables, POP-Q stage, ultrasound parameters, or urological parameters. Positive patients had a significantly worse result in PFDI-20, POPDI (48 vs 28; p<0.001), UDI6 (51 vs 24; p<0.001), and in the areas of social limitation (44.4 vs 22.2; p = 0.045), sleep- energy (61.5 vs 44.4; p = 0.08), and severity (56.8 vs 43.7, p=0.015) according to P-QoL. Conclusion: Moderate or severe colorectal symptoms are seen in 40% of patients with symptomatic POP in our unit. Full evaluation of pelvic floor dysfunction symptoms should be performed routinely in urogynecology units. (FONIS SA12I2I53 - NCT02113969).

Síndrome genitourinario de la menopausia en mujeres del policlínico universitario Dr. Cosme Ordoñez EECarceller, Cuba / Genitourinary syndrome in women at the Dr. Cosme Ordoñez Carceller university polyclinic, Cuba

Resumen Objetivo: Determinar la frecuencia e intensidad del síndrome genitourinario de la menopausia en las mujeres atendidas en la consulta de climaterio y menopausia del Policlínico Universitario "Dr. Cosme Ordoñez Carceller. Materiales y métodos: Investigación tipo observacional, descriptiva y transversal, realizada en el período comprendido entre enero 2018 y diciembre de 2022. El universo de trabajo quedó constituido por 2962 mujeres de edad mediana del policlínico universitario Dr. Cosme Ordoñez Carceller. La muestra fue de 353 mujeres seleccionada mediante un muestreo estratificado simple. Para la recogida de los datos se empleó un modelo de Historia Clínica, de la cual se extrajeron los aspectos referidos a los datos sociodemográficos, la edad de inicio de los síntomas climatéricos y de la menopausia, las alteraciones genitourinarias y su intensidad en relación a la etapa del síndrome climatérico. Resultados: La edad promedio de las mujeres estudiadas fue de 49,4 +/- 5,18 años. La mayor cantidad de ellas se encontraban en la perimenopausia (60,1%), mientras que el porcentaje en las posmenopáusicas alcanzaba el 39,9%. La edad promedio de inicio de los síntomas fue de 45,8 +/- 6,2 años, la mayor frecuencia ocurrió entre los 45 y 49 años (61,5%). La edad promedio de aparición de la menopausia de 48,4+/- 3,7 años, lo que representa que más de dos tercios (81,6%) de las mujeres tuvieron su última menstruación por encima de los 45 años. Las alteraciones genitourinarias predominaron en la perimenopausia y la intensidad leve. Conclusiones: El síndrome genitourinario de la menopausia constituye un grupo de manifestaciones clínicas frecuentes en la mujer en etapa climatérica y afecta a más de dos tercios de las mujeres del policlínico, aparecen con mayor periodicidad entre los 45 y 49 años, en la perimenopausia y con intensidad leve.

Abstract Objective: To determine the frequency and intensity of genitourinary syndrome of menopause in womens treated in the climacteric and menopause consultation of the University Polyclinic 'Dr. Cosme Ordonez Carceller. Methods: Observational, descriptive and cross-sectional research, carried out in the period between January 2018 and December 2022. The universe of work was made up of 2962 middle-aged women from the Dr. Cosme Ordoñez Carceller university polyclinic. The sample consisted of 353 women selected by simple stratified sampling. For data collection, a Clinical History model was used, from which aspects related to sociodemographic data were extracted, the age of onset of climacteric symptoms and menopause, genitourinary disorders and their intensity in relation to the stage of climacteric syndrome. Results: The average age of the women studied was 49.4 +/- 5.18 years. The largest number of them were in perimenopause (60.1%), while the percentage in postmenopausal women reached 39.9%. The mean age of onset of symptoms was 45.8 +/- 6.2 years, the highest frequency occurring between 45 and 49 years (61.5%). The average age of onset of menopause of 48.4+/- 3.7 years, which represents that more than two thirds (81.6%) of the women had their last menstruation over 45 years of age. Genitourinary alterations predominated in perimenopause and mild intensity Conclusions: The genitourinary syndrome of menopause constitutes a group of frequent clinical manifestations in women in the climacteric stage and affect more than two thirds of the women al the policlinic, appearing more frequently between the ages of 45 and 49, in perimenopause and with mild intensity.

Rectopexia laparoscópica con técnica de Orr-Loygue para el tratamiento del prolapso rectal / Laparoscopic Orr-Loygue rectopexy with mesh for the treatment of rectal prolapse

Introducción: Existen múltiples alternativas para el tratamiento quirúrgico del prolapso rectal mediante procedimientos de fijación, resección o combinados. Si bien el abordaje perineal evita el acceso a la cavidad peritoneal, se acompaña de una tasa de recidiva mayor en relación al abordaje abdominal. Descripción: Se presenta una paciente de 66 años, histerectomizada por vía laparotómica, con un prolapso rectal externo y reductible de 1 año de evolución, sin incontinencia fecal ni constipación. La endoscopia preoperatoria descartó patología colónica asociada. Abordaje laparoscópico en posición de Trendelenburg lateralizado a la derecha. Como es habitual en estos casos se observa la presencia de dolicosigma y fondo de saco de Douglas profundo y se evidencia también la cicatriz de la cesárea. El procedimiento comienza con la apertura peritoneal a nivel del promontorio y la movilización de la unión rectosigmoidea, identificando el uréter izquierdo. Se continua la disección circunferencial tras la apertura de la reflexión peritoneal hasta la altura de la cúpula vaginal. La rectopexia se realiza según la técnica de Orr-Loygue mediante la fijación de la malla por una parte a ambas caras laterales del recto y por otra al promontorio sacro con puntos de polipropileno 2-0, cuidando de no lesionar los vasos ilíacos y los uréteres. Finalmente se cierra la reflexión peritoneal con poliglactina para aislar las mallas protésicas del contenido visceral. La paciente tuvo una buena evolución postoperatoria, otorgándose el alta a las 48 h. Tras 8 meses de seguimiento se encuentra asintomática, con tránsito digestivo y continencia fecal sin alteraciones. Conclusión: El abordaje laparoscópico para el tratamiento del prolapso rectal es seguro y ofrece las ventajas de la cirugía mini-invasiva. La rectopexia con malla protésica es un procedimiento técnicamente desafiante, aunque con mejores resultados alejados. (AU)

Introduction: There are multiple alternatives for the surgical treatment of rectal prolapse through fixation, resection or combined procedures. Although the perineal approach avoids access to the peritoneal cavity, it is associated with a higher recurrence rate than the abdominal approach. Description: The video shows a 66-year-old female patient, hysterectomized by laparotomy, with a 1-year history of reduciblefull-thickness rectal prolapse, without fecal incontinence or constipation. Preoperative endoscopy ruled out associated colonic pathology. The laparoscopic approach is done with the patient placed in Trendelenburg and tilted to the right. As usual in these cases, the presence of dolichosigma and deep Douglas pouch is observed, as well as the cesarean section scar. The procedure begins with the peritoneal opening at the level of the promontory and the mobilization of the rectosigmoid junction, identifying the left ureter. Circumferential dissection is continued after opening the peritoneal reflection up to the level of the vaginal vault. Rectopexy is performed according to the Orr-Loygue technique by fixing the mesh to both lateral aspects of the rectum on one side and to the sacral promontory on the other side with 2-0 polypropylene interrupted sutures, taking care not to injure the iliac vessels and ureters. Finally, the peritoneum is closed with a running suture with polyglactin to isolate the prosthetic mesh from the visceral content. The patient had a good postoperative outcome and was discharged at 48 h. After 8 months of follow-up, she is asymptomatic and has normal colonic transit and fecal continence. Conclusion: the laparoscopic approach for the treatment of rectal prolapse is safe and offers the advantages of minimally invasive surgery. Prosthetic mesh rectopexy is a technically challenging procedure, although has better distant results. (AU)

Prolapso rectal completo / Complete Rectal Prolapse

Introducción: El prolapso rectal completo es la invaginación de las capas del recto a través del canal anal y su protrusión fuera de este. Su incidencia es de 2,5 por 100 000 habitantes con predominio en mujeres de edad avanzada. Es una afección de curso crónico y benigno, cuya presentación clínica y endoscópica es tan variable que puede confundirse con otras entidades como con el cáncer colorrectal. Objetivo: Presentar el caso de una paciente femenina, operada de prolapso rectal completo en la provincia de Cienfuegos. Presentación de caso: Se presenta una paciente femenina de 76 años de edad, blanca, de procedencia rural que acude a la consulta y refiere que lleva 12 días sin defecar. Además, presenta dolor, sangramiento rectal no activo y una masa que protruía a través de la región anal sugestiva al examen físico de un prolapso rectal completo. El tacto rectal confirma el diagnóstico. Se realiza reducción quirúrgica del prolapso por técnica de Delorme. Actualmente lleva 6 meses de operada con evolución favorable. Por lo poco frecuente de esta entidad se considera de interés científico su publicación. Conclusión: Esta entidad es poco común en el entorno médico, el gran cambio que causa en el nivel de vida de aquellos que la portan y sus complicaciones hace que requiera un tratamiento rápido y oportuno(AU)

Introduction: Complete rectal prolapse is the invagination of the rectal layers through the anal canal and its protrusion out of it. Its incidence is 2.5 per 100,000 inhabitants, predominantly in elderly women. It is a chronic and benign condition, whose clinical and endoscopic presentation is so variable that it can be confused with other entities, such as colorectal cancer. Objective: To present the case of a female patient who underwent surgery for complete rectal prolapse in the province of Cienfuegos. Case presentation: A 76-year-old female patient, white, from a rural area, came to the clinic and reported that she had not defecated for 12 days. In addition, she presents pain, nonactive rectal bleeding and a mass protruding through the anal region suggestive, on physical examination, of a complete rectal prolapse. Digital rectal examination confirmed the diagnosis. Surgical reduction of the prolapse was performed using the Delorme technique. She has undergone surgery for 6 months now, with favorable evolution. Due to the rarity of this entity, its publication is considered as scientifically interesting. Conclusion: This entity is uncommon in the medical environment. The great change that it causes in the living standards of those who carry it and its complications make it require a quick and timely treatment(AU)