Assuntos
Obstrução Intestinal/etiologia , Pneumatose Cistoide Intestinal/etiologia , Doenças Vaginais/complicações , Doenças Vaginais/cirurgia , Prolapso Visceral/complicações , Prolapso Visceral/cirurgia , Idoso de 80 Anos ou mais , Feminino , Humanos , Histerectomia/efeitos adversos , Recidiva , Deiscência da Ferida Operatória/complicaçõesRESUMO
Visceroptosis is described in several heritable connective tissue disorders, including the hypermobility type of Ehlers-Danlos syndrome (hEDS), a.k.a. joint hypermobility syndrome (JHS). Clinical features of hEDS comprise joint hypermobility, mild skin hyperextensibility, joint instability complications, chronic joint/limb pain, and positive family history. Uterine and rectal prolapse has been reported in nulliparous women. We report on a family with two patients with hEDS. The proposita, a 38-year-old woman, present bilateral kidney prolapse requiring three nephropexies, gastric ptosis treated with gastropexy and Billroth I gastrectomy, and liver prolapse treated with a non-codified hepatopexy procedure. Radiological evaluation also showed ovarian and heart prolapse. To our knowledge this is the first case of multiple visceral ptoses in hEDS. Visceral prolapse may lead to severe morbidity, affecting quality of life and a high rate of relapses after surgical procedures. Further investigations are needed to understand the molecular basis of the disease and retrospective studies on surgical outcomes, presentation of case series can be effective in order to offer a better treatment and prevention for hEDS patients.
Assuntos
Síndrome de Ehlers-Danlos/complicações , Prolapso Visceral/complicações , Adulto , Idoso , Síndrome de Ehlers-Danlos/cirurgia , Feminino , Humanos , Masculino , Prognóstico , Recidiva , Resultado do Tratamento , Prolapso Visceral/cirurgiaRESUMO
Graft use in vaginal prolapse surgery has become more common secondary to high failure rates seen with traditional repairs. Mesh has been shown to be successful when suspending the upper portion of the vagina with sacralcolpopexy and its use vaginally isi n an attempt to reproduce those results seen from the more invasive abdominal approach. A recent Cochrane review has supported its use in the anterior compartment vaginally as lower failure rates have been shown. Vaginal mesh "kits" have been developed in an attempt to make these surgeries less invasive, more standardized, and easier to perform. One of the problems that does seem to be emerging is the thought that, just because these procedures are now being produced in "kits", they can be completed by any surgeon. This may not hold true, as these are still advanced techniques that require advanced pelvic surgery skills and, therefore, it is up to surgeons to also understand this and the limitations of these procedures. The current paper reviews the history of the development of mesh kits, the techniques utilized, and the data that have been published to date on results and complications, and recommendations on how to avoid these complications. Although initial studies are encouraging, more will need to be completed prior to the recommendations of general use of these kits in all prolapse patients. We need to have further investigation on proper patient selection, we must continue research on graft composition, and we must continue to develop techniques to minimize complications of needle passage or mesh placement. Even after we gain this knowledge, it will still require advanced surgical skills to complete these types of surgeries, and to help minimize complications and maximize results.
Assuntos
Telas Cirúrgicas , Vagina/cirurgia , Prolapso Visceral/cirurgia , Dispareunia/cirurgia , Dispareunia/terapia , Feminino , Seguimentos , Humanos , Dor/tratamento farmacológico , Vagina/patologia , Prolapso Visceral/complicações , Prolapso Visceral/patologiaRESUMO
OBJECTIVE: To review the effectiveness of preoperative urodynamic study made with correction of the severe genital prolapse by Bresky valve in the diagnosis of urinary occult incontinence, in order to plan a correction with a prophylactic sub-mid urethral mesh in the prolapse surgery. PATIENTS AND METHOD: Patients of the Urogynecology and Vaginal Surgery Unit of Las Condes Clinic, between January 2006 and December 2007, with grade III or IV cystocele. A condition was patients without previous prolapse and/or incontinence surgeries. A non multichannel urodynamics test was made with prolapse correction by a Bresky valve. The urethra retro resistance measurement and cystometry was made. In the women in whom the occult urinary incontinence was discards the prolapse surgery was made with Prolift mesh. In the women with occult incontinence a prophylactic sub-mid urethral tape was applied in the prolapse surgery, to avoid the appearance of incontinence after surgery. RESULTS: Thirty eight women fulfilled the criterion to enter in this study, 14 (36.8%) of them did not register occult urinary incontinence in the urodynamic test. In the 24 (63.2%) with occult incontinence: Type I in 1: type II in 2: type III in 1 and type II+III in 10. During the cystometry 3 of them registered an asymptomatic hyperactive detrusor. In 1 (4.2%) of the 24 patients with prophylactic incontinence surgery, in the immediate postoperative time a failure was observed. The rest 23 women did not present incontinence during the observation period between 4 to 24 months. In the 14 women only with prolapse surgery incontinence was not registered. CONCLUSIONS: The preoperative urodynamic test with correction of severe genital prolapse by Bresky valve is an efficient method to detect the occult urinary incontinence. This allows planning a prophylactic incontinence surgery. According to our experience this method is safe and effective to avoid that the occult incontinence appears after a severe cystocele surgery repair and allows to given an integral solution to the pelvic floor problems that frequently sees associate, because they risk factors are the same to these conditions and both cause a high degree of deterioration of quality of life.
Assuntos
Incontinência Urinária por Estresse/diagnóstico , Prolapso Visceral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Técnicas de Diagnóstico Urológico/instrumentação , Desenho de Equipamento , Humanos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Prospectivos , Índice de Gravidade de Doença , Incontinência Urinária por Estresse/etiologia , Prolapso Visceral/cirurgiaRESUMO
OBJECTIVE: To discuss indications and therapeutic effects of concomitant surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) through a retrospective clinical review. METHOD: A retrospective review of the data of 16 women undergoing concomitant surgery for SUI and POP was available for analysis. In these cases, 12 patients presented with SUI symptoms associated with moderate or severe anterior vaginal wall prolapse; 4 patients had moderate or severe uterine prolapse associated with dysuria. All cases were confirmed to have type II stress urinary incontinence by preoperative physical examination, urodynamic study and cystography. The surgical procedures for pelvic floor repair included the placement of Gynemesh mesh implant, anterior or total Prolift mesh implant. The tension-free vaginal tape (TVT) or transvaginal tension free vaginal tape-obturator (TVT-O) was used for the anti-incontinence procedure. During the concurrent surgical procedures, pelvic floor repair was performed first. RESULTS: Followed up from 6 to 30 months, all cases got satisfactory results. After the procedure, the patients achieved complete continence without occurrence of dysuria or recurrence of POP. CONCLUSIONS: Stress incontinence and pelvic organ prolapse share common pathophysiologic etiologies and often coexist with one another. In SUI patients with symptomatic or moderate to severe POP, concurrent POP surgery should be performed actively at the time of incontinence surgery to prevent POP exacerbation and the occurrence of dysuria; while in patients with sole POP, occult SUI should be considered, and concomitant prophylactic incontinence measures should be taken at the time of POP repair to prevent the postoperative unmasking of SUI.
Assuntos
Incontinência Urinária por Estresse/cirurgia , Prolapso Visceral/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/cirurgia , Estudos Retrospectivos , Slings Suburetrais , Incontinência Urinária por Estresse/complicações , Prolapso Visceral/complicaçõesRESUMO
Vaginal evisceration can be defined as a defect in the vaginal wall resulting in prolapse of the intraperitoneal contents. This is a rare complication of hysterectomy, but may result in severe morbidity. We report the case of a postmenopausal woman with transvaginal evisceration of the sigmoid colon 1â year after an abdominal hysterectomy. An exploratory laparotomy was undertaken to reduce the prolapsed sigmoid colon through a combined vaginal-abdominal route. Repair of the defect of the vaginal vault was made using an absorbable running suture. Two years later, the patient presented at the emergency department with a transvaginal evisceration of the omentum. An exclusively vaginal approach was then chosen to repair the smaller vaginal defect and vaginal cuff was closed using non-absorbable sutures. As two different surgical approaches were used in this patient, a discussion of the different treatment options and also of the principles of prevention of vaginal cuff dehiscence is provided.
Assuntos
Histerectomia/efeitos adversos , Doenças Peritoneais/diagnóstico , Vagina/cirurgia , Prolapso Visceral/etiologia , Idoso , Feminino , Humanos , Laparotomia/métodos , Omento/patologia , Doenças Peritoneais/cirurgia , Recidiva , Resultado do Tratamento , Vagina/anormalidades , Vagina/anatomia & histologia , Prolapso Visceral/complicações , Prolapso Visceral/cirurgiaRESUMO
Renal diseases have been recognized as both a cause and a consequence of hypertension. Orthostatic renal hypertension is caused by ischemia resulting from elongation, twisting and angulation of renal vessels when a hypermobile kidney is present. Recent observation of a 22-year-old woman in whom orthostatic renal hypertension was cured by nephropexy prompted this report. Clinical manifestations, diagnosis and therapy of this condition are also discussed.
Assuntos
Hipertensão Renovascular/cirurgia , Nefropatias/cirurgia , Prolapso Visceral/cirurgia , Adulto , Angiografia Digital , Feminino , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/etiologia , Rim/cirurgia , Nefropatias/complicações , Nefropatias/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Técnicas de Sutura , Urografia , Prolapso Visceral/complicações , Prolapso Visceral/diagnóstico por imagemAssuntos
Esplenopatias/etiologia , Prolapso Visceral/complicações , Adulto , Feminino , Humanos , Recidiva , Anormalidade TorcionalAssuntos
Incontinência Urinária por Estresse/etiologia , Adulto , Cistoscopia , Feminino , Humanos , Pessoa de Meia-Idade , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinaria Neurogênica/etiologia , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária por Estresse/terapia , Sistema Urogenital , Prolapso Visceral/complicaçõesRESUMO
A case of jejunal intussusception caused by a multiple polypoid mucosal prolapse of jejunum in a 10-year-old girl is reported. The rarity of the lesion, its location, symptoms, and diagnosis are discussed.
Assuntos
Pólipos Intestinais/complicações , Intussuscepção/etiologia , Doenças do Jejuno/etiologia , Prolapso Visceral/complicações , Criança , Feminino , Humanos , Mucosa Intestinal/patologia , Pólipos Intestinais/cirurgia , Intussuscepção/cirurgia , Doenças do Jejuno/cirurgia , Prolapso Visceral/cirurgiaRESUMO
Forty three patients with nephroptosis, complicated by hypertension were examined (4 males and 39 females), aged from 18 to 60. Permanent hypertension was found in nine of them (21%), and renovasographically--organic renal-arterial stenosis at the nephroptosis side was established. After the failure of the conservative treatment, those patients had all the indications for operation. Seven of the patients underwent the operation and only in one woman patient--nephrectomy was performed, and in all the rest six patients--reconstructive revascularization and nephropexy. The follow-up of the operated patients so far reveals a very favourable effect upon the hypertension syndrome after the operation.
Assuntos
Hipertensão Renal/etiologia , Nefropatias/complicações , Prolapso Visceral/complicações , Adolescente , Adulto , Doença Crônica , Feminino , Humanos , Hipertensão Renal/cirurgia , Nefropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Prolapso Visceral/cirurgiaRESUMO
Abnormalities of hepatic fixation resulting in excessive mobility in a transverse plane are uncommonly encountered. The unusual incidental finding of a freely mobile liver and spleen in a patient presenting with sigmoid volvulus is reported. At laparotomy, the inferior aspect of the right hemidiaphragm was smoothly peritonealized, without evidence of coronary or triangular ligaments. It is postulated that this abnormal hepatic mobility reflects persistence of the primitive ventral mesogastrium. To the authors' knowledge, this unusual condition has not previously been recognized. The literature relating to wandering liver is reviewed and four other cases are presented. An invariable association of persisting ventral mesogastrium with abnormalities in colonic anatomy (hepatocolonic vagrancy) is described.