Speciality
Spotlight

 




 

Obstetric & Gynaecology

 

 




Prolapse

   

  • LJ Romanzi, et al (New York Hosp-Cornell Med Ctr)

    The Effect of Genital Prolapse on Voiding,

     J Urol 161: 581-586, 1999.


        


    They found that women with grade 3 or 4 cystocele more commonly had urethral hypermobility and symptoms of voiding difficulty. Urodynamics showed bladder outlet obstruction in 4% with grade 1 or 2 cystocele and 58% with grade 3 or 4 cystocele.

        


    Ring pessary reduction of prolapse during urodynamics is useful in determining symptomatic and occult conditions in women with severe prolapse.

        


    Urinary incontinence may be masked by prolapsed bladder and kinked urethra and it is important to predict sphincter weakness, and “occult incontinence” before operations for pelvic
    relaxation.

         

  • N C. Lambrou, J L Buller, J R Thompson et al 

    Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery.

    Am J Obstet Gynecol, Dec.2000; 183: 1355-60

        


    Objective
    : The primary aim of this study was to report on the prevalence of perioperative complications associated with reconstructive pelvic surgery. A secondary aim was to identify risk factors predictive of perioperative complications in this population.

         


    Study Design
    : A retrospective chart review was performed of 100 consecutive cases of reconstructive pelvic surgery. Statistical analysis included descriptive statistics and logistic regression.

         

    Results : The prevalence of perioperative complications was 46%, including 13 intraoperative complications and 33 postoperative complications. The readmission rate for complications was 15%. The number of procedures per patient was an independent risk factor for intraoperative blood loss (P<. 0038). Intraoperative estimated blood loss in turn was an independent risk factor for perioperative complications (P<.0001).

        

    Conclusions : Perioperative complications associated with reconstructive pelvic surgery were increased relative to those associated with general gynecologic surgery. The number of procedures per patient and associated blood loss appeared to contribute to the increase in perioperative complications.

         

  • M.P. FitzGerald, N Kulkarni, and D Fenner

    Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse.

    Am J Obstet Gynecol, Dec. 2000; 183: 1361-4

         

    Objective : This study was undertaken to determine whether surgery for advanced pelvic organ prolapse corrects the voiding dysfunction commonly associated with this conditions and if so to evaluate the ability of preoperative voiding studies to predict such correction.

          

    Study Design : The records of all women who underwent surgery at the center between January 1996 and June 1999 for stage 3 or 4 pelvic organ prolapse were reviewed. Patients were included in this review if they had a postvoid residual volume of >100mL documented by catherization on at least 2 occasions, had no normal postvoid residual volumes documented, and had undergone preoperative multichannel urodynamic testing that included an instrumented voiding study. Demographic and urodynamic data were analyzed for the ability to predict whether the elevated postvoid residual volume would be resolved after surgery.

         

    Results : Thirty-five patients satisfied the criteria for inclusion in the review. Twenty-six had stage 3 pelvic organ prolapse and 9 had stage 4 pelvic organ prolapse. The mean preoperative postvoid residual volume was 226 mL (range, 105-600mL). Thirty-one patients (89%) had normal postvoid residual volumes after surgery. As a predictor of elevated postoperative postvoid residual volumes, the preoperative voiding study had a sensitivity of 66%, a specificity of 46%, a positive predictive value of 12%, and a negative predictive value of 93%.

         

    Conclusion : A preoperative voiding study performed with the pelvic organ prolapse reduced most accurately predicted postoperative voiding function when results of the voiding study were normal. Most patients with advanced pelvic organ prolapse and elevated postvoid residual volume had normalization of the postvoid residual volume after surgical correction of the pelvic organ prolapse.

         

      



 

 

Speciality Spotlight

 

 

Prolapse
   

  • LJ Romanzi, et al (New York Hosp-Cornell Med Ctr)
    The Effect of Genital Prolapse on Voiding,
     J Urol 161: 581-586, 1999.
        
    They found that women with grade 3 or 4 cystocele more commonly had urethral hypermobility and symptoms of voiding difficulty. Urodynamics showed bladder outlet obstruction in 4% with grade 1 or 2 cystocele and 58% with grade 3 or 4 cystocele.
        
    Ring pessary reduction of prolapse during urodynamics is useful in determining symptomatic and occult conditions in women with severe prolapse.
        
    Urinary incontinence may be masked by prolapsed bladder and kinked urethra and it is important to predict sphincter weakness, and “occult incontinence” before operations for pelvic relaxation.
         

  • N C. Lambrou, J L Buller, J R Thompson et al 
    Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery.
    Am J Obstet Gynecol, Dec.2000; 183: 1355-60
        
    Objective : The primary aim of this study was to report on the prevalence of perioperative complications associated with reconstructive pelvic surgery. A secondary aim was to identify risk factors predictive of perioperative complications in this population.
         
    Study Design : A retrospective chart review was performed of 100 consecutive cases of reconstructive pelvic surgery. Statistical analysis included descriptive statistics and logistic regression.
         
    Results : The prevalence of perioperative complications was 46%, including 13 intraoperative complications and 33 postoperative complications. The readmission rate for complications was 15%. The number of procedures per patient was an independent risk factor for intraoperative blood loss (P<. 0038). Intraoperative estimated blood loss in turn was an independent risk factor for perioperative complications (P<.0001).
        
    Conclusions : Perioperative complications associated with reconstructive pelvic surgery were increased relative to those associated with general gynecologic surgery. The number of procedures per patient and associated blood loss appeared to contribute to the increase in perioperative complications.
         

  • M.P. FitzGerald, N Kulkarni, and D Fenner
    Postoperative resolution of urinary retention in patients with advanced pelvic organ prolapse.
    Am J Obstet Gynecol, Dec. 2000; 183: 1361-4
         
    Objective : This study was undertaken to determine whether surgery for advanced pelvic organ prolapse corrects the voiding dysfunction commonly associated with this conditions and if so to evaluate the ability of preoperative voiding studies to predict such correction.
          
    Study Design : The records of all women who underwent surgery at the center between January 1996 and June 1999 for stage 3 or 4 pelvic organ prolapse were reviewed. Patients were included in this review if they had a postvoid residual volume of >100mL documented by catherization on at least 2 occasions, had no normal postvoid residual volumes documented, and had undergone preoperative multichannel urodynamic testing that included an instrumented voiding study. Demographic and urodynamic data were analyzed for the ability to predict whether the elevated postvoid residual volume would be resolved after surgery.
         
    Results : Thirty-five patients satisfied the criteria for inclusion in the review. Twenty-six had stage 3 pelvic organ prolapse and 9 had stage 4 pelvic organ prolapse. The mean preoperative postvoid residual volume was 226 mL (range, 105-600mL). Thirty-one patients (89%) had normal postvoid residual volumes after surgery. As a predictor of elevated postoperative postvoid residual volumes, the preoperative voiding study had a sensitivity of 66%, a specificity of 46%, a positive predictive value of 12%, and a negative predictive value of 93%.
         
    Conclusion : A preoperative voiding study performed with the pelvic organ prolapse reduced most accurately predicted postoperative voiding function when results of the voiding study were normal. Most patients with advanced pelvic organ prolapse and elevated postvoid residual volume had normalization of the postvoid residual volume after surgical correction of the pelvic organ prolapse.
         

      

 

By |2022-07-20T16:43:37+00:00July 20, 2022|Uncategorized|Comments Off on Prolapse

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