A novel bilateral anterior sacrospinous hysteropexy technique for apical pelvic organ prolapse repair via the vaginal route: a cohort study.

BACKGROUND: Uterine-preserving techniques are becoming increasingly popular in the last decade. This investigation evaluates a novel hysteropexy technique using a mesh in sling-alike configuration [Splentis (Promedon, Argentina)] which is attached anteriorly to the cervix and suspended to the sacrospinous ligaments bilaterally via the vaginal route in women undergoing surgery for uterine prolapse. METHODS: This was a single-center cohort study, evaluating women who underwent transvaginal hysteropexy with Splentis for primary uterine descent. Data have been collected prospectively as part of the quality assurance system. Primary endpoint was treatment success, defined as a combined endpoint including the absence of a vaginal bulge symptom and no retreatment of apical prolapse. A validated questionnaire to evaluate quality-of-life and prolapse symptoms was utilized. Descriptive analysis was applied. Wilcoxon signed-rank test was performed to compare paired samples. The significance level was set at 5%. RESULTS: A total of 103 women with a median age of 68.0 [IQR 11.5] years with a median apical POP-Q stage of 3 were included. The median surgery time was 22 [IQR 12] minutes and no intraoperative complication occurred. After a median follow-up time of 17 months, treatment success was achieved in 91 (89.2%) patients and quality of life and patient report outcomes improved significantly (p < 0.001). Mesh exposure occurred in 3 (2.9%) patients. Of these, two patients required surgical revision, and one patient was treated conservatively. One patient required partial mesh removal due to dyspareunia. CONCLUSION: Bilateral sacrospinous hysteropexy with Splentis offers an efficacious and safe alternative for apical compartment repair, incorporating the advantages of pelvic floor reconstruction via the vaginal route.

[Second national census and treatment of uterine prolapse and urinary fistula].

From 1977 to 1982, under the unified deployment of the Ministry of Health, census and treatment of uterine prolapse and urinary fistula were generally carried out in various places. Compared with the first census, the organizational collaboration is more effective, professional, and play a greater role. After that, surgical treatment can be applied to a wider range, and tens of thousands of critically patients can be treated and recovered.

Pre-operative guided imagery in female pelvic medicine and reconstructive surgery: a randomized trial.

INTRODUCTION AND HYPOTHESIS: The purpose was to determine if pre-operative guided imagery (GIM) would help women to feel more prepared, less anxious, and have higher satisfaction scores 6 weeks after surgery compared with routine care. METHODS: Eligible women planning to undergo pelvic floor surgery were enrolled and randomized. The GIM group received an institution-specific CD that uses GIM to detail day of surgery (DOS) events and expectations. Participants were asked to listen to the CD once daily during the week before surgery. At three time points (surgical consent visit, DOS, and 6-weeks post-operatively), we measured anxiety using the State and Trait Anxiety Inventory for Adults (STADI), in addition to preparedness for surgery and overall satisfaction (ten-point Likert scales). Data were analyzed in SPSS 23 using two-tailed t tests. RESULTS: A total of 38 out of 44 (86%) enrolled participants completed the study (GIM: 18, control: 20). The GIM self-reported compliance rate was 72%, with an average use of 4.8 times (range = 3-8 times). Women in the GIM group reported a significant increase from baseline in preparedness for surgery on both DOS and 6 weeks post-operatively (7.32 ± 1.81 vs 9.11 ± 1.13, p = 0.001) and (7.32 ± 1.81 vs 9.22 ± 0.81, p = 0.001) respectively; a change that was not seen in the control group. Satisfaction was high in both the GIM and the control group (9.55 ± 0.85 and 9.05 ± 1.70, p = 0.263). In all patients, anxiety increased from baseline to DOS and dropped at 6 weeks post-operatively, and was not significantly different in the two groups. CONCLUSIONS: Guided imagery improved patient preparedness for pelvic floor surgery with an overnight stay on their DOS and 6 weeks post-operatively.

[An introduction of the treatment of uterine prolapse and urinary fistula from 1966 to 1976].

During the period 1966 to 1976, a large number of retained patients of uterine prolapse and urinary fistula became a problem around the maternal and child health aspects not to be ignored. All traditional Chinese and Western medical practitioners under difficult condition had been trying their best to continue to carry out the treatment. For uterine prolapse, Chinese medicine therapy included decoction therapy, acupuncture therapy, comprehensive therapy, para-uterine injection of traditional Chinese medicine preparations; whereas Western medicine treatment included hysterophore and surgery. Guangxi and other places treated urinary fistula in an organized scale, and summed up the treatment experience continuously.

Modified MR defecography without rectal filling in obstructed defecation syndrome: Initial experience.

OBJECTIVE: To evaluate the role of dynamic MR defecography before rectal filling in detecting occult anterior compartment prolapse in patients with obstructed defecation. METHODS: This prospective study was approved by the ethics committee. Seventy six females with obstructed defecation underwent dynamic MR defecography before and after rectal filling. Pre-rectal and post-rectal filling sequences were interpreted separately by two radiologists on two different settings with a time interval of one week. Statistical analysis was performed using Wilcoxon's-matched-pairs signed rank test and t-test for matched pairs; differences were considered statistically significant at p<0.05. RESULTS: Fifty eight females of 76 showed additional anterior compartment derangement, with 27 diagnosed only in pre-rectal filling sequence (27/58=46.55%). Following rectal filling detected cystocele in 27 patients was not identified in 14 cases and downgraded in 13. Similarly, detected uterine prolapse in 17 patients was not visualized in 14 patients and downgraded in 3. Furthermore, rectocele was identified in 7 cases before gel enema, additional 32 detected after rectal filling. Significant statistical difference in the detection of both cystocele (p=0.0001) and uterine prolapse (p=0.0013) was identified in the non-filled sequence. CONCLUSION: Pelvic floor imaging before rectal filling is significantly better for detection of anterior compartment prolapse.

[The first national general investigation and treatment of uterine prolapse: 1959-1966].

The first national general investigationon uterine prolapse is an important measure of strengthening the protection of working women. Under the guidance of the Ministry of Health, local governments are extensively carried out all rescuing works, including the adjustment of labor time by organizing traditional and western medicine practitioners to carry on the comprehensive survey and concentrated treatment, with certain effects. Across the full application of traditional Chinese medical therapies with its recipes and medicines, traditional Chinese medical practitioners were actively involved in rescuing. Restricted by the medical conditions with non-popular surgical treatment, medical practitioners continuously explored the surgical treatment suitable for rural areas, offering valuable experiences for the future treatment.

Efficacy observation of pelvic floor muscle training combined with traditional Chinese medicine in the treatment of mild-moderate pelvic organ prolapse / 中国医师杂志

Objective To explore the rehabilitation effect of pelvic floor muscle training combined with traditional Chinese medicine in the treatment of mild-moderate pelvic organ prolapse.Methods A prospective ease-control study,choosing 103 patients of mild-moderate pelvic organ prolapse from October 2012 to May 2014 in Maternal and Child Health Hospital Outpatient of Hunan Province,which were randomly divided into study group (52 cases) and control group (51 cases).All of the patients underwent two courses of pelvic floor muscle training,including Kegel exercise,biofeedback,electrical stimulation therapy,the study group combined with traditional Chinese medicine (Buzhongyiqitang) at the same time.The efficacy was analyzed before and after treatment of pelvic floor muscle strength,myoelectric potential and indexing of pelvic organ prolapse quantification (POP-Q) changes.Results There werent statistically significant differences in type Ⅰ and Ⅲ muscle fiber muscle strength and myoelectric potential of two groups before treatment,while the shrinkage index improved significantly after treatment,and the study group was significantly higher with statistically significant difference (P ＜ 0.05).The effective rates of POP-Q indexing changes in two groups were 71.2％ and 56.9％,respectively.The effective rate of the study group was significantly higher than the control group(P ＜ 0.05).Conclusions The clinical efficacy of pelvic floor muscle training combined with Buzhongyiqitang in the treatment of mild-moderate pelvic organ prolapse was significant,and it had a good clinical value.

Lajjalu treatment of uterine prolapse.

Mimosa pudica was found useful in cases of uterine prolapse with bleeding, consistent with my experience of working with the condition for more than 45 years, and treating hundreds of such cases of uterine prolapse. Hysterectomy has been avoided up to this date, and is not now expected to be recommended.

Clinical Efficacy of Hochuekkito on Uterine and Bladder Prolapse—Assessment with Numerical Rating Scale and Baden-Walker grading— / 日本東洋医学雑誌

Female organ ptosis, especially uterine prolapse, is a delibilitative, dysfunctional condition of the supporting pelvic floor system of ligaments, connective tissues and muscles which manifests during pregnancy, delivery, or post-menopause. The Japanese Kampo herbal formula “hochuekkito” has been reportedly applied to uterine prolapse based on its putative ability to rejuvenate body vitality (Qi) and raise declined Qi. We assessed the efficacy of hochuekkito for uterine prolapse based on observations of its effect on clinical and objective symptoms. We administered hochuekkito to 17 patients (62.6 ± 7.1years) diagnosed with modern techniques as having uterine prolapse. The results showed that it was very effective in 6 cases (35.7%), effective in 9 cases (52.9%), and ineffective in 2 cases (11.8%). 10 patients with pessaries were all found to have been treated effectively (very effective : 4, effective : 6). In 6 patients whose compliance was below 90%, the percentage of very effective cases was 75%. The effectiveness score of hochuekkito with pelvic exercise (1.5 ± 0.5) and with pessaries (1.4 ± 0.5) was significantly higher than that with hochuekkito alone (0.8 ± 0.8) (p < 0.05). Finally, for uterine prolapse and bladder prolapse, the addition of pelvic exercise and pessaries to hochuekkito brought about more prompt improvement than that with hochuekkito alone. The increased efficacy with the addition of pelvic exercise or a pessary also helped strengthen atonic pelvic muscles, thus synergistically working together with the effects of hochuekkito.

Comparison study of Le Fort colpocleisis and total vaginal hysterectomy for prolapses uteri / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate and compare the Le Fort colpocleisis and conventional total vaginal hysterectomy in the uterine prolapse patients in the medically compromised or elderly patients. METHODS: This study was to analyze the data from 16 patients with uterine prolapse undergone Le Fort colpocleisis at the department of obstetrics and gynecology, Chung-ang university hospital from January 1991 to December 2000, and 36 patients with uterine prolapse undergone total vaginal hysterectomy from January 1999 to December 2000. We compared the age of patients, operation time, type of anesthesia, estimated blood loss, changes in hemoglobin, duration of hospitalization, occurrence of febrile morbidity, and medical complications based on the medical records. RESULTS: The mean operation time of 16 patients undergone Le Fort colpocleisis with uterine prolapse was 51+/-18 minutes, the estimated blood loss was 175+/-134 cc, hemoglobin change was 1.72+/-1.14 mg/dl, the mean days of hospitalization was 7.2+/-2.8 days, and the febrile illness occurred in 2 patients. In this group, general anesthesia was used in 10 patients (75%), local anesthesia in 4 patients (25%), and spinal and epidural anesthesia in 1 case respectively. The mean operation time of 11 patients undergone total vaginal hysterectomy with uterine prolapse was 86+/-29 minutes, the estimated blood loss was 366+/-154 cc, hemoglobin change was 2.36+/-1.22 mg/dl, the mean days of hospitalization was 7.8+/-1.6 days, and the febrile illness occurred in 3 patients. General anesthesia was done in total vaginal hysterectomy group and vulva hematoma was developed in 1 case postoperatively. There are significant difference (p<0.01) between the Le Fort colpocleisis and total vaginal hysterectomy in operational time, estimated blood loss, and type of anesthesia, but no significant difference in days of hospitalization, febrile morbidity. CONCLUSION: The assessment of Le Fort colpoclesis in uterine prolapse offers signinficant benefits in elderly or compromised patients and the method is safe for operation.

The Effects of Hochu-ekki-to on Uterine Prolaps and Ptosis / 日本東洋医学雑誌

Uterine prolapse and ptosis are caused by pelvic muscle atony and elongation of the endopelvic fascia. Radical treatment for uterine prolapse and ptosis is surgery. However, as these conditions usually arise in relatively older women, complications are common. Conservative treatment methods such as vaginal rings and Kampo medicine (particularly Hochu-ekki-to) are often recommended.<br>The authors prescribed Hochu-ekki-to for 38 patients with uterine prolapse and ptosis. A decrease in subjective symptoms was reported by 15 patients (39%) within four months. Seventy-two percent of these patients had uterine ptosis. Six of the 38 patients (16%) reported a worsening of subjective symptoms. The objective symptom of the degree of descent of the uterus when pulled by cervical forcepts did not change with treatment. The authors concluded that Hochu-ekki-to is useful in the treatment of uterine ptosis.