Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The ...Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The objective of this work was to evaluate the clinical aspects and functional disorders of patients with genital prolapse in Butembo in Democratic Republic of the Congo (DRC). Material and Methods: A descriptive study with analytical aims was conducted from January 1 to September 30, 2024 in Butembo/DRC. It involved 112 patients with symptomatic genital prolapse in whom an interview on functional disorders as well as clinical assessment according to the Baden and Walker classification were carried out. The data were entered into Microsoft Office LTSC 2021 Excel software and analysed using R software version 4.4.0. Results: Patients aged over 50 years were exposed to developing genital prolapse especially the mixed type (81.1%) compared to those aged under 50 years (p-value 0.014). Multi and large multiparous women had developed all types of prolapse especially the mixed type (100%) compared to primiparous and pauciparous women (p-value 0.027). Associated pathologies were more observed in case of mixed prolapse (51.4%) including vesicovaginal fistula (37.8%) (p-value Conclusion: Genital prolapse is common and functional urinary, sexual and anorectal signs are frequently observed in patients in Butembo/DRC.展开更多
Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can ...Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can be overlooked or confused with other pathologies. Treatment remains controversial. The aim of this work is to study the epidemiological, clinical and therapeutic data of urethral mucosal prolapse in young girls in our department. Materials and methods: Retrospective and descriptive study on urethral mucosal prolapse in little girls identified from the hospitalization records of the Sino-Guinean Friendship Hospital in Conakry. The study period was 5 years. Patients were selected randomly. Outcome assessment focused on the occurrence of recurrences and urinary incontinence. The mean follow-up duration was 24 months. The parameters studied were: Age, clinical and histological findings, therapeutic data and patient outcomes. Results: The incidence of urethral mucosal prolapse in girls in the urology department was 2.2 cases/year. The mean age of the patients was 6.7 years (with extremes of 5 months and 10 years). The age group of 7 to 10 years was the most represented, observed in 63.63% of patients. The most frequent reason for consultation was vulvar bleeding in 7 patients, or 63.63%. Malpighian hyperplasia with a congested chorion was the most observed histological type, in 4 patients. Surgical treatment consisting of complete excision of the prolapsed part had given excellent results. Conclusion: Urethral prolapse is a rare pathology, observed mainly in young black girls. Its diagnosis is based mainly on clinical examination. Surgical treatment gives satisfactory results, both clinically and aesthetically.展开更多
Objectives:Recently,pre-/post-operative Local Estrogen Therapy(LET)has shown effectiveness in alleviating Pelvic Organ Prolapse(POP)symptoms in clinical therapy.However,there is a lack of scientific evidence to suppor...Objectives:Recently,pre-/post-operative Local Estrogen Therapy(LET)has shown effectiveness in alleviating Pelvic Organ Prolapse(POP)symptoms in clinical therapy.However,there is a lack of scientific evidence to support these claims.Therefore,we aimed to explore the anti-senescence effects and mechanisms of 17β-estradiol(E2)on POP-derived fibroblasts.Methods:The primary fibroblast cells were isolated and cultured fromthe surgical samples of postmenopausal women clinically diagnosed with pelvic organ prolapse(POP)at stages III-IV(quantified using the POP-Q system)and without any other treatment within 6 months.(n=12,age 50–75).Colorimetric Cell Counting Kit(CCK-8)assay and Senescence-Associated-β-Galactosidase(SA-β-Gal)staining were used to test the cell proliferative capacity and the senescence rate.Western blotting(WB)was used to detect the expression of Collagen Type I(COL-I),Collagen Type III(COL-III),Cyclin-dependent kinase 4 inhibitor A(p16INK4a),Cyclin-dependent kinase inhibitor 1A(p21),Tumor Protein 53(p53),Sirtuin 1(SIRT-1)and Microtubule-associated protein 1A/1B-light chain 3-I/II(LC3-I/II)protein.A transmission ElectronMicroscope(TEM)was used to observe the ultrastructure of fibroblasts.Results:The results showed that E2 significantly promoted the proliferation of fibroblasts derived from POP and reduced the staining rate of SA-β-Gal.It markedly enhanced the extracellular matrix proteins COL-I and COL-III,accompanied by inhibition of the senescent maker p16INK4a.Additionally,our results improved the cells’autophagy and metabolic activity.Additionally,our results indicate the anti-senescence mechanism of E2 through the mediated SIRT-1/p53/p21 axis pathway.Conclusion:We provide preliminary evidence for the anti-aging effects and mechanisms of E2 on POP,hoping to provide a theoretical basis for estrogen against POP senescence and guide the clinical application and local administration of estrogen in POP treatment.展开更多
Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and th...Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.展开更多
BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many pat...BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.展开更多
BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with signifi...BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.展开更多
Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Method...Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.展开更多
AIM:To analyze the clinical and pathological features of 89 patients presenting as lacrimal gland prolapse(LGP).METHODS:This retrospective study included 89 patients presenting as LGP.Magnetic resonance imaging(MRI)sc...AIM:To analyze the clinical and pathological features of 89 patients presenting as lacrimal gland prolapse(LGP).METHODS:This retrospective study included 89 patients presenting as LGP.Magnetic resonance imaging(MRI)scan was performed for all patients.Pathology and immunohistochemical staining of prolapsed tissue were performed during the surgery.The histopathological subtype was obtained,and the related clinical manifestations of different subtype were marked.RESULTS:Among the 89 patients involved,the histopathological subtype includes dacryoadenitis(43%;n=38),focal lymphocytes infiltration(20%;n=18),immunoglobulin G4(IgG4)-related lacrimal gland inflammatory disease(15%;n=13),lacrimal gland(13%;n=12),and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue(9%;n=8).As for manifestations of different subtypes,eyelid swelling was found the most frequent of lymphocytes infiltration(44%,n=8),and palpable lacrimal gland mass of dacryoadenitis(55%,n=21).All the IgG4-related lacrimal gland inflammatory disease(100%,n=13)and most dacryoadenitis(97%,n=37)presented as bilateral.CONCLUSION:LGP has the histopathological subtype most commonly as inflammation,followed by structural and lymphoproliferative changes.Most of patients present as eyelid swelling.Clinical manifestations can be significant to differentiate the diagnosis.展开更多
Pelvic organ prolapse(POP) occurs in a relatively big population of women which is continuously increasing and is associated with a variety of urinary bowel and sexual symptoms. As this problem magnifi es, the need fo...Pelvic organ prolapse(POP) occurs in a relatively big population of women which is continuously increasing and is associated with a variety of urinary bowel and sexual symptoms. As this problem magnifi es, the need for surgical repair is increasing relatively. The main goals of surgical repair for POP include: no anatomic prolapse, no functional symptoms, patient satisfaction and avoidance of complications, goals that cannot always be fully achieved. The decision for the type of surgery depends of various factors such as patient characteristics and prolapsed compartment but also by the surgeon expertise. The laparoscopic approach is already the gold standard procedure for many urologic procedures and can also be used for the treatment of POP and stress urinary incontinence. Herein, we review the literature about the available data concerning laparoscopic surgery techniques for treating POP.展开更多
Pelvic organ prolapsed is a common problem today, and it has been gradually increasing because of the longevity of women. Pelvic organ prolapse can result in negative psychological feelings that affect on women’s sex...Pelvic organ prolapsed is a common problem today, and it has been gradually increasing because of the longevity of women. Pelvic organ prolapse can result in negative psychological feelings that affect on women’s sexual activity. Methods: There is a cross-sectional study on sexual dysfunction in 296 women with pelvic organ prolapse grade II and III followed up at gynecological-pelvic floor unit of Hung Vuong hospital from 09/2017 to 06/2018. Results: The prevalence of female sexual dysfunction in PISQ-12 was 76.4% and 95% CI [71.6 - 81.2]. The rate of female sexual dysfunction in turn is: 1) Behavioral-Emotional: 93.6% 95% CI [90.8 - 96.4]. 2) Physiology: 62.2% CI 95% [56.7 - 67.7]. 3) Relationship to partner: 89.5% 95% CI [86.0 - 93.0]. Factor related to sexual dysfunction in women with pelvic organs (p < 0.05) is general sexual dysfunction: 1) Age group: women over age 55 increased generally the risk of sexual dysfunction, OR = 5.89, 95% CI [1.38 - 25.20]. 2) Diabetes mellitus increased the risk of sexual dysfunction with OR = 5.03, 95% CI [1.42 - 17.82]. 3) Patients with previous abortions reduced the risk of sexual dysfunction with OR = 0.49 95% CI [0.27 - 0.90]. Conclusion: Research on quality of life in pelvic organ prolapse should be considered more in the future.展开更多
Objective To observe the clinical efficacy of auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew on prolapse of lumbar intervertebral disc. Methods One hundred and three patie...Objective To observe the clinical efficacy of auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew on prolapse of lumbar intervertebral disc. Methods One hundred and three patients with prolapse of lumbar intervertebral disc were treated with a combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew. Results Of 103 patients, 46 cases were cured, 33 were markedly effective, 21 effective and 3 ineffective. The total effective rate was 97.1% （100/103）. Conclusion The combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew has a significant efficacy for the treatment of prolapse of lumbar intervertebral disc.展开更多
AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obs...AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.展开更多
Objective To observe the clinical effects of body acupuncture and wrist-ankle acupuncture on prolapse of lumbar intervertebral disc, Methods One hundred and eighty cases of prolapse of lumbar intervertebral disc were ...Objective To observe the clinical effects of body acupuncture and wrist-ankle acupuncture on prolapse of lumbar intervertebral disc, Methods One hundred and eighty cases of prolapse of lumbar intervertebral disc were randomly divided into body acupuncture and wrist-ankle acupuncture group （observation group） and simple body acupuncture group （control group）, 90 cases in each one. In observation group, body acupuncture was applied on Ahshi points of lumbar region, lumbar Jiájǐ （夹脊EX-B 2）, Dàchángshú（大肠俞 BL 25）, etc. and wrist-ankle acupuncture was applied on lower No. 4, 5 and 6 regions. In control group, simple body acupuncture was applied on the same points as observation group. Results The lumbar vertebral function and pain scale were improved in either group in comparison before and after treatment （P〈0.05）. Concerning pain improvement, the total effective rate was 95.6% in observation group, which was superior to that （86.7%） in control group （P〈0.05）. Concerning the improvement of lumbar vertebral function, the total effective rate was 90.0% in observation group and 93.3% in control group, without significant difference between two groups （P〉0.05）. Conclusion Combined therapy of body acupuncture and wrist-ankle acupuncture demonstrates apparent analgesia in prolapse of lumbar intervertebral disc.展开更多
External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal proced...External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.展开更多
Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January ...Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January 2008 and July 2014,transcatheter closure of VSD was attempted in 65 patients.Results:The total intermediate closure successful rate in all subjects was 96.9%.During the perioperative period,no death,major bleeding,pericardial tamponade,occluder dislodgement,residual shunt or hemolysis occurred.Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation,three cases of transient complete left bundle branch block occurred but did not sustain.At 1-year followup,no patients had residual shunts and complications.Furthermore,grade of residual AR were relieved in 61.9%(39/63)cases and degree of AVP were ameliorated in 36.5%(23/63)patients;Conclusions:Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective.Long term safety and efficacy needs to be assessed.展开更多
AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant data...AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant database were searched to identify studies.Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.RESULTS:Twelve non-randomized case series studies with 574 patients were included in the review.No surgical mortality was described.Conversion was needed in 17 cases(2.9%), most often due to difficult adhesiolysis.Twenty eight patients(4.8%) presented with major complications.Seven(1.2%) mesh-related complications were reported.Most frequent complications were urinary tract infection and urinary retention.Mean recurrence rate was 4.7% with a median follow-up of 23 mo.Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%.Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages.Evaluation of functional score was disparate between studies.CONCLUSION:Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.展开更多
Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of in...Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.展开更多
Pelvic organ prolapse(POP) occurs when the pelvic organs(bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman's quality...Pelvic organ prolapse(POP) occurs when the pelvic organs(bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman's quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells(MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.展开更多
AIM: To report our experience with perineal repair(Delorme's procedure) of rectal prolapse with particular focus on treatment of the recurrence.METHODS: Clinical records of 40 patients who underwent Delorme's ...AIM: To report our experience with perineal repair(Delorme's procedure) of rectal prolapse with particular focus on treatment of the recurrence.METHODS: Clinical records of 40 patients who underwent Delorme's procedure between 2003 and 2014 were reviewed to obtain the following data: Gender; duration of symptoms, length of prolapse, operation time, ASA grade, length of post-operative stay, procedure-related complications, development and treatment of recurrent prolapse. Analysis of post-operative complications, rate and time of recurrence and factors influencing the choice of the procedure for recurrent disease was conducted. Continuous variables were expressed as the median with interquartile range(IQR). Statistical analysis was carried out using the Fisher exact test.RESULTS: Median age at the time of surgery was 76 years(IQR: 71-81.5) and there were 38 females and 2 males. The median duration of symptoms was 6 mo(IQR: 3.5-12) and majority of patients presented electively whereas four patients presented in the emergency department with irreducible rectal prolapse. The median length of prolapse was 5 cm(IQR: 5-7), median operative time was 100 min(IQR: 85-120) and median post-operative stay was 4 d(IQR: 3-6). Approximately16% of the patients suffered minor complications such as- urinary retention, delayed defaecation and infected haematoma. One patient died constituting postoperative mortality of 2.5%. Median follow-up was 6.5 mo(IQR: 2.15-16). Overall recurrence rate was 28%(n = 12). Recurrence rate for patients undergoing an urgent Delorme's procedure who presented as an emergency was higher(75.0%) compared to those treated electively(20.5%), P value 0.034. Median time interval from surgery to the development of recurrence was 16 mo(IQR: 5-30). There were three patients who developed an early recurrence, within two weeks of the initial procedure. The management of the recurrent prolapse was as follows: No further intervention(n = 1), repeat Delorme's procedure(n = 3), Altemeier's procedure(n = 5) and rectopexy with faecal diversion(n = 3). One patient was lost during follow up.CONCLUSION: Delorme's procedure is a suitable treatment for rectal prolapse due to low morbidity and mortality and acceptable rate of recurrence. The management of the recurrent rectal prolapse is often restricted to the pelvic approach by the same patientrelated factors that influenced the choice of the initial operation, i.e., Delorme's procedure. Early recurrence developing within days or weeks often represents a technical failure and may require abdominal rectopexy with faecal diversion.展开更多
Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in...Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.展开更多
文摘Introduction: Genital prolapse is a health problem that gynaecologists are increasingly facing due to patients’ legitimate demands for care and the improvement in life expectancy without associated disabilities. The objective of this work was to evaluate the clinical aspects and functional disorders of patients with genital prolapse in Butembo in Democratic Republic of the Congo (DRC). Material and Methods: A descriptive study with analytical aims was conducted from January 1 to September 30, 2024 in Butembo/DRC. It involved 112 patients with symptomatic genital prolapse in whom an interview on functional disorders as well as clinical assessment according to the Baden and Walker classification were carried out. The data were entered into Microsoft Office LTSC 2021 Excel software and analysed using R software version 4.4.0. Results: Patients aged over 50 years were exposed to developing genital prolapse especially the mixed type (81.1%) compared to those aged under 50 years (p-value 0.014). Multi and large multiparous women had developed all types of prolapse especially the mixed type (100%) compared to primiparous and pauciparous women (p-value 0.027). Associated pathologies were more observed in case of mixed prolapse (51.4%) including vesicovaginal fistula (37.8%) (p-value Conclusion: Genital prolapse is common and functional urinary, sexual and anorectal signs are frequently observed in patients in Butembo/DRC.
文摘Introduction: Urethral prolapse, a rare benign lesion of the female urethra, is considered unusual in children, but it is far from exceptional in girls aged 18 to 24. African origin. The diagnosis is clinical but can be overlooked or confused with other pathologies. Treatment remains controversial. The aim of this work is to study the epidemiological, clinical and therapeutic data of urethral mucosal prolapse in young girls in our department. Materials and methods: Retrospective and descriptive study on urethral mucosal prolapse in little girls identified from the hospitalization records of the Sino-Guinean Friendship Hospital in Conakry. The study period was 5 years. Patients were selected randomly. Outcome assessment focused on the occurrence of recurrences and urinary incontinence. The mean follow-up duration was 24 months. The parameters studied were: Age, clinical and histological findings, therapeutic data and patient outcomes. Results: The incidence of urethral mucosal prolapse in girls in the urology department was 2.2 cases/year. The mean age of the patients was 6.7 years (with extremes of 5 months and 10 years). The age group of 7 to 10 years was the most represented, observed in 63.63% of patients. The most frequent reason for consultation was vulvar bleeding in 7 patients, or 63.63%. Malpighian hyperplasia with a congested chorion was the most observed histological type, in 4 patients. Surgical treatment consisting of complete excision of the prolapsed part had given excellent results. Conclusion: Urethral prolapse is a rare pathology, observed mainly in young black girls. Its diagnosis is based mainly on clinical examination. Surgical treatment gives satisfactory results, both clinically and aesthetically.
基金supported by 1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(ZYJC21048)Foundation of Sichuan Provincial Science and Technology Program(2022JDR0091,2023NSFSC0004,2023NSFSC0639,2023NSFSC1742)+5 种基金Cooperation Project for Academician&Expert Workstation(HXYS20001)Sichuan University Education Foundation(0040206107011)National Natural Science Foundation of China(Nos.82371883,82402191)China Postdoctoral Science Foundation(2023M732456)Postdoctor Research Fund of West China Hospital(2024HXBH142)Sichuan University“From 0 to 1”Innovation Research Project(2023SCUH0056).
文摘Objectives:Recently,pre-/post-operative Local Estrogen Therapy(LET)has shown effectiveness in alleviating Pelvic Organ Prolapse(POP)symptoms in clinical therapy.However,there is a lack of scientific evidence to support these claims.Therefore,we aimed to explore the anti-senescence effects and mechanisms of 17β-estradiol(E2)on POP-derived fibroblasts.Methods:The primary fibroblast cells were isolated and cultured fromthe surgical samples of postmenopausal women clinically diagnosed with pelvic organ prolapse(POP)at stages III-IV(quantified using the POP-Q system)and without any other treatment within 6 months.(n=12,age 50–75).Colorimetric Cell Counting Kit(CCK-8)assay and Senescence-Associated-β-Galactosidase(SA-β-Gal)staining were used to test the cell proliferative capacity and the senescence rate.Western blotting(WB)was used to detect the expression of Collagen Type I(COL-I),Collagen Type III(COL-III),Cyclin-dependent kinase 4 inhibitor A(p16INK4a),Cyclin-dependent kinase inhibitor 1A(p21),Tumor Protein 53(p53),Sirtuin 1(SIRT-1)and Microtubule-associated protein 1A/1B-light chain 3-I/II(LC3-I/II)protein.A transmission ElectronMicroscope(TEM)was used to observe the ultrastructure of fibroblasts.Results:The results showed that E2 significantly promoted the proliferation of fibroblasts derived from POP and reduced the staining rate of SA-β-Gal.It markedly enhanced the extracellular matrix proteins COL-I and COL-III,accompanied by inhibition of the senescent maker p16INK4a.Additionally,our results improved the cells’autophagy and metabolic activity.Additionally,our results indicate the anti-senescence mechanism of E2 through the mediated SIRT-1/p53/p21 axis pathway.Conclusion:We provide preliminary evidence for the anti-aging effects and mechanisms of E2 on POP,hoping to provide a theoretical basis for estrogen against POP senescence and guide the clinical application and local administration of estrogen in POP treatment.
基金Supported by Science and Technology Fund Project of Guizhou Health Commission,No.gzwkj2023-042 and No.gzwkj2024-010National Natural Science Foundation of China,No.82060440+2 种基金Guizhou Provincial Science and Technology Projects,No.QKHJC ZK[2024]-210Cultivation Program for General Projects of the National Natural Science Foundation of China,No.gyfynsfc[2023]-01Cultivation Program for Regional Projects of the National Natural Science Foundation of China,No.gyfynsfc[2024]-19.
文摘Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.
基金Supported by 2023 Academy Level Research Start-up Fund,No.YK2023332024 Academy Level Research Start-up Fund,No.YK202430+1 种基金Wujiang District,Suzhou City,“Promoting Health through Science and Education”Project,No.WWK202201Xuzhou Medical University Affiliated Hospital Development Fund Support Project,No.XYFY202423.
文摘BACKGROUND Pelvic organ prolapse(POP)can lead to urinary incontinence,fecal incontinence,and other symptoms,affecting the quality of life,which results in anxiety and depression and other negative emotions in many patients.Trans-vaginal sacrospinous ligament suspension(VSSLS)involves securing the apex of the prolapsed vagina to the sacrospinous ligament to maintain the physiological axis of the vagina,help in repairing pelvic floor defects,and maintain the normal function of the pelvic floor,thereby alleviating patients’anxiety and depression.AIM To explore the effect of VSSLS in the treatment of POP and its influence on anxiety and depression among patients.METHODS Sixty patients with moderate to severe POP who underwent surgical treatment between January 2023 and June 2024 in Suzhou Ninth Hospital Affiliated to Soochow University were retrospectively enrolled in the study.According to treatment methods,they were divided into the control group(n=30,treated with vaginal hysterectomy alone)and observation group(n=30,treated with VSSLS combined with vaginal hysterectomy).The two groups were compared by baseline data,perioperative indicators,and postoperative pain intensity,prolapse distance before and after surgery,sexual function,pelvic function,anxiety,and depression.RESULTS No significant differences in baseline data,preoperative POP Quantification measurement value,Pelvic Floor Dysfunction Inventory 20(PFDI-20),Pelvic Floor Impact Questionnaire 7(PFIQ-7),Self-Rating Anxiety Scale(SAS),and Self-Rating Depression Scale(SDS)scores were found between the two groups.The obser vation group had longer operation time and more intraoperative blood loss than the control group,the Visual Analog Scale score on postoperative day 1 was slightly higher in than in the control group.On the reexamination 3 months postoperatively,the POP Quantification measurement values in the observation group were lower than those in the control group(P<0.05).Evaluation 6 months after surgery,the FSFI score was higher in the observation group than in the control group,the PFDI-20,PFIQ-7,SAS and SDS score scored were lower in than in the control group(P<0.05).The PFDI-20,PFIQ-7 scores positively correlated with the SAS and SDS scores.CONCLUSION VSSLS demonstrated a significant effect on the treatment of moderate and severe POP,as it can reduce the prolapse distance and PFDI-20 and PFIQ-7 scores and improve anxiety and depression among patients.
基金Supported by Scientific Research Fund of China-Japan Friendship Hospital,No.2019-1-QN-53.
文摘BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.
基金supported by the National Natural Science Foundation of China(No.82260297)Yunnan Province Clinical Research Center for Chronic Kidney Disease(No.202102AA100060).
文摘Objective This is a self-controlled multicenter retrospective study based on the clinical efficacy and complications of physiological reconstruction in the treatment of moderate and severe pelvic organ prolapse.Methods From December 2014 to August 2021,517 women were included and registered for physiological reconstruction at four Chinese urogynecology institutions.We enrolled 364 women with POP-Q stage≥3.The degree of POP was quantified via a POP-Q system.The surgical purpose of physiological reconstruction is to repair the vagina,levator ani muscle,perineum,and urogenital hiatus and adopt a repair method in accordance with the axial direction of physiology.All 330 evaluable participants were followed for 2 years.The evaluation indices included the PFDI-20,PGI-I,PFIQ-7,PISQ-12,PGI-I,and PGI-S.All complications were coded according to the category-time-site system proposed by the International Urogynecological Association(IUGA)and International Continence Society(ICS).Results Compared with the preoperative POP-Q scores,statistically significant improvements were observed at the 6-month,1-year and 2-year time points(P<0.001).Statistically significant improvements in quality of life were observed across all time points.Conclusions Physiologic reconstructive surgical techniques combined with modified anterior pelvic floor mesh implantation could help restore the physiologic axis and vaginal shape,which may be the most important factors in maintaining the functional position of pelvic floor organs and is the most effective method for repairing the pelvic fascia tendon arch.This surgical method is safe,feasible,and effective in patients with severe prolapse.
基金Supported by National Natural Science Foundation of China(No.82201214,No.82201221)Ophthalmic New Technology Incubation Fund Project of China Primary Health Care Foundation(No.2022 No.005)Shaanxi Key Research and Development Program(No.2021SF-156).
文摘AIM:To analyze the clinical and pathological features of 89 patients presenting as lacrimal gland prolapse(LGP).METHODS:This retrospective study included 89 patients presenting as LGP.Magnetic resonance imaging(MRI)scan was performed for all patients.Pathology and immunohistochemical staining of prolapsed tissue were performed during the surgery.The histopathological subtype was obtained,and the related clinical manifestations of different subtype were marked.RESULTS:Among the 89 patients involved,the histopathological subtype includes dacryoadenitis(43%;n=38),focal lymphocytes infiltration(20%;n=18),immunoglobulin G4(IgG4)-related lacrimal gland inflammatory disease(15%;n=13),lacrimal gland(13%;n=12),and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue(9%;n=8).As for manifestations of different subtypes,eyelid swelling was found the most frequent of lymphocytes infiltration(44%,n=8),and palpable lacrimal gland mass of dacryoadenitis(55%,n=21).All the IgG4-related lacrimal gland inflammatory disease(100%,n=13)and most dacryoadenitis(97%,n=37)presented as bilateral.CONCLUSION:LGP has the histopathological subtype most commonly as inflammation,followed by structural and lymphoproliferative changes.Most of patients present as eyelid swelling.Clinical manifestations can be significant to differentiate the diagnosis.
文摘Pelvic organ prolapse(POP) occurs in a relatively big population of women which is continuously increasing and is associated with a variety of urinary bowel and sexual symptoms. As this problem magnifi es, the need for surgical repair is increasing relatively. The main goals of surgical repair for POP include: no anatomic prolapse, no functional symptoms, patient satisfaction and avoidance of complications, goals that cannot always be fully achieved. The decision for the type of surgery depends of various factors such as patient characteristics and prolapsed compartment but also by the surgeon expertise. The laparoscopic approach is already the gold standard procedure for many urologic procedures and can also be used for the treatment of POP and stress urinary incontinence. Herein, we review the literature about the available data concerning laparoscopic surgery techniques for treating POP.
文摘Pelvic organ prolapsed is a common problem today, and it has been gradually increasing because of the longevity of women. Pelvic organ prolapse can result in negative psychological feelings that affect on women’s sexual activity. Methods: There is a cross-sectional study on sexual dysfunction in 296 women with pelvic organ prolapse grade II and III followed up at gynecological-pelvic floor unit of Hung Vuong hospital from 09/2017 to 06/2018. Results: The prevalence of female sexual dysfunction in PISQ-12 was 76.4% and 95% CI [71.6 - 81.2]. The rate of female sexual dysfunction in turn is: 1) Behavioral-Emotional: 93.6% 95% CI [90.8 - 96.4]. 2) Physiology: 62.2% CI 95% [56.7 - 67.7]. 3) Relationship to partner: 89.5% 95% CI [86.0 - 93.0]. Factor related to sexual dysfunction in women with pelvic organs (p < 0.05) is general sexual dysfunction: 1) Age group: women over age 55 increased generally the risk of sexual dysfunction, OR = 5.89, 95% CI [1.38 - 25.20]. 2) Diabetes mellitus increased the risk of sexual dysfunction with OR = 5.03, 95% CI [1.42 - 17.82]. 3) Patients with previous abortions reduced the risk of sexual dysfunction with OR = 0.49 95% CI [0.27 - 0.90]. Conclusion: Research on quality of life in pelvic organ prolapse should be considered more in the future.
文摘Objective To observe the clinical efficacy of auricular subcutaneous penetration needling combining with row acupuncture at meridian sinew on prolapse of lumbar intervertebral disc. Methods One hundred and three patients with prolapse of lumbar intervertebral disc were treated with a combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew. Results Of 103 patients, 46 cases were cured, 33 were markedly effective, 21 effective and 3 ineffective. The total effective rate was 97.1% （100/103）. Conclusion The combined treatment of auricular subcutaneous penetration needling and row acupuncture at meridian sinew has a significant efficacy for the treatment of prolapse of lumbar intervertebral disc.
文摘AIM: To compare the clinical efficacies of two surgical procedures for hemorrhoid rectal prolapse with outlet obstruction-induced constipation.METHODS: One hundred eight inpatients who underwent surgery for outlet obstructive constipation caused by internal rectal prolapse and circumferential hemorrhoids at the First Affiliated Hospital of Xinjiang Medical University from June 2012 to June 2013 were prospectively included in the study.The patients with rectal prolapse hemorrhoids with outlet obstructioninduced constipation were randomly divided into two groups to undergo either a procedure for prolapse and hemorrhoids(PPH)(n = 54) or conventional surgery(n = 54; control group).Short-term(operative time,postoperative hospital stay,postoperative urinary retention,postoperative perianal edema,and postoperative pain) and long-term(postoperative anal stenosis,postoperative sensory anal incontinence,postoperative recurrence,and postoperative difficulty in defecation) clinical effects were compared between the two groups.The short- and long-term efficacies of the two procedures were determined.RESULTS: In terms of short-term clinical effects,operative time and postoperative hospital stay were significantly shorter in the PPH group than in the control group(24.36 ± 5.16 min vs 44.27 ± 6.57 min,2.1 ± 1.4 d vs 3.6 ± 2.3 d,both P < 0.01).The incidence of postoperative urinary retention was higher in the PPH group than in the control group,but the difference was not statistically significant(48.15% vs 37.04%).Theincidence of perianal edema was significantly lower in the PPH group(11.11% vs 42.60%,P < 0.05).The visual analogue scale scores at 24 h after surgery,first defecation,and one week after surgery were significantly lower in the PPH group(2.9 ± 0.9 vs 8.3 ± 1.1,2.0 ± 0.5 vs 6.5 ± 0.8,and 1.7 ± 0.5 vs 5.0 ± 0.7,respectively,all P < 0.01).With regard to long-term clinical effects,the incidence of anal stenosis was lower in the PPH group than in the control group,but the difference was not significant(1.85% vs 5.56%).The incidence of sensory anal incontinence was significantly lower in the PPH group(3.70% vs 12.96%,P < 0.05).The incidences of recurrent internal rectal prolapse and difficulty in defecation were lower in the PPH group than in the control group,but the differences were not significant(11.11% vs 16.67% and 12.96% vs 24.07%,respectively).CONCLUSION: PPH is superior to the traditional surgery in the management of outlet obstructive constipation caused by internal rectal prolapse with circumferential hemorrhoids.
文摘Objective To observe the clinical effects of body acupuncture and wrist-ankle acupuncture on prolapse of lumbar intervertebral disc, Methods One hundred and eighty cases of prolapse of lumbar intervertebral disc were randomly divided into body acupuncture and wrist-ankle acupuncture group （observation group） and simple body acupuncture group （control group）, 90 cases in each one. In observation group, body acupuncture was applied on Ahshi points of lumbar region, lumbar Jiájǐ （夹脊EX-B 2）, Dàchángshú（大肠俞 BL 25）, etc. and wrist-ankle acupuncture was applied on lower No. 4, 5 and 6 regions. In control group, simple body acupuncture was applied on the same points as observation group. Results The lumbar vertebral function and pain scale were improved in either group in comparison before and after treatment （P〈0.05）. Concerning pain improvement, the total effective rate was 95.6% in observation group, which was superior to that （86.7%） in control group （P〈0.05）. Concerning the improvement of lumbar vertebral function, the total effective rate was 90.0% in observation group and 93.3% in control group, without significant difference between two groups （P〉0.05）. Conclusion Combined therapy of body acupuncture and wrist-ankle acupuncture demonstrates apparent analgesia in prolapse of lumbar intervertebral disc.
文摘External and internal rectal prolapse with their affiliated rectocele and enterocele, are associated with debilitating symptoms such as obstructed defecation, pelvic pain and faecal incontinence. Since perineal procedures are associated with a higher recurrence rate, an abdominal approach is commonly preferred. Despite the description of greater than three hundred different procedures, thus far no clear superiority of one surgical technique has been demonstrated. Ventral mesh rectopexy(VMR) is a relatively new and promising technique to correct rectal prolapse. In contrast to the abdominal procedures of past decades, VMR avoids posterolateral rectal mobilisation and thereby minimizes the risk of postoperative constipation. Because of a perceived acceptable recurrence rate, good functional results and low mesh-related morbidity in the short to medium term, VMR has been popularized in the past decade. Laparoscopic or robotic-assisted VMR is now being progressively performed internationally and several articles and guidelines propose the procedure as the treatment of choice for rectal prolapse. In this article, an outline of the current status of laparoscopic and robotic ventral mesh rectopexy for the treatment of internal and external rectal prolapse is presented.
基金supported by National Nature Science Foundation of China(NO.81260052)Science and Technology Planning Project of Hainan Province of China(NO.812147)
文摘Objective:To evaluate the feasibility,safety and efficacy of transcathcter closure of ventricular septal defect(VSD)in patients with aortic valve prolapse(AVP)and mild aortic regurgitation(AR).Methods:Between January 2008 and July 2014,transcatheter closure of VSD was attempted in 65 patients.Results:The total intermediate closure successful rate in all subjects was 96.9%.During the perioperative period,no death,major bleeding,pericardial tamponade,occluder dislodgement,residual shunt or hemolysis occurred.Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation,three cases of transient complete left bundle branch block occurred but did not sustain.At 1-year followup,no patients had residual shunts and complications.Furthermore,grade of residual AR were relieved in 61.9%(39/63)cases and degree of AVP were ameliorated in 36.5%(23/63)patients;Conclusions:Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective.Long term safety and efficacy needs to be assessed.
文摘AIM:To assess effectiveness, complications, recurrence rate, and recent improvements of the anterior rectopexy procedure for treatment of total rectal prolapse.METHODS:MEDLINE, Pub Med, EMBASE, and other relevant database were searched to identify studies.Randomized controlled trials, non-randomized studies and original articles in English language, with more than 10 patients who underwent laparoscopic ventral rectopexy for full-thickness rectal prolapse, with a follow-up over 3 mo were considered for the review.RESULTS:Twelve non-randomized case series studies with 574 patients were included in the review.No surgical mortality was described.Conversion was needed in 17 cases(2.9%), most often due to difficult adhesiolysis.Twenty eight patients(4.8%) presented with major complications.Seven(1.2%) mesh-related complications were reported.Most frequent complications were urinary tract infection and urinary retention.Mean recurrence rate was 4.7% with a median follow-up of 23 mo.Improvement of constipation ranged from 3%-72% of the patients and worsening or new onset occurred in 0%-20%.Incontinence improved in 31%-84% patients who presented fecal incontinence at various stages.Evaluation of functional score was disparate between studies.CONCLUSION:Based on the low long-term recurrence rate and favorable outcome data in terms of low de novo constipation rate, improvement of anal incontinence, and low complications rate, laparoscopic anterior rectopexy seems to emerge as an efficient procedure for the treatment of patients with total rectal prolapse.
文摘Incarceration rarely complicates the chronically progressive form of the full thickness rectal prolapse.Even more rarely,it becomes strangulated,necessitating emergency surgery.We describe an extremely rare case of incarcerated acute rectal prolapse,without a relevant previous history or symptoms of predisposing pathology.The patient underwent emergency perineal proctosigmoidectomy,the Altemeier operation,combined with diverting loop sigmoid colostomy.The postoperative course was quite uneventful with an excellent final result after colostomy closure.The successful treatment of this patient illustrates the value of the Altemeier procedure in the difficult and unusual case scenario of bowel incarceration.
文摘Pelvic organ prolapse(POP) occurs when the pelvic organs(bladder, bowel or uterus) herniate into the vagina, causing incontinence, voiding, bowel and sexual dysfunction, negatively impacting upon a woman's quality of life. POP affects 25% of all women and results from childbirth injury. For 19% of all women, surgical reconstructive surgery is required for treatment, often augmented with surgical mesh. The surgical treatment fails in up to 30% of cases or results in adverse effects, such as pain and mesh erosion into the bladder, bowel or vagina. Due to these complications the Food and Drug Administration cautioned against the use of vaginal mesh and several major brands have been recently been withdrawn from market. In this review we will discuss new cell-based approaches being developed for the treatment of POP. Several cell types have been investigated in animal models, including a new source of mesenchymal stem/stromal cells(MSC) derived from human endometrium. The unique characteristics of endometrial MSC, methods for their isolation and purification and steps towards their development for good manufacturing practice production will be described. Animal models that could be used to examine the potential for this approach will also be discussed as will a rodent model showing promise in developing an endometrial MSC-based therapy for POP. The development of a preclinical large animal model for assessing tissue engineering constructs for treating POP will also be mentioned.
文摘AIM: To report our experience with perineal repair(Delorme's procedure) of rectal prolapse with particular focus on treatment of the recurrence.METHODS: Clinical records of 40 patients who underwent Delorme's procedure between 2003 and 2014 were reviewed to obtain the following data: Gender; duration of symptoms, length of prolapse, operation time, ASA grade, length of post-operative stay, procedure-related complications, development and treatment of recurrent prolapse. Analysis of post-operative complications, rate and time of recurrence and factors influencing the choice of the procedure for recurrent disease was conducted. Continuous variables were expressed as the median with interquartile range(IQR). Statistical analysis was carried out using the Fisher exact test.RESULTS: Median age at the time of surgery was 76 years(IQR: 71-81.5) and there were 38 females and 2 males. The median duration of symptoms was 6 mo(IQR: 3.5-12) and majority of patients presented electively whereas four patients presented in the emergency department with irreducible rectal prolapse. The median length of prolapse was 5 cm(IQR: 5-7), median operative time was 100 min(IQR: 85-120) and median post-operative stay was 4 d(IQR: 3-6). Approximately16% of the patients suffered minor complications such as- urinary retention, delayed defaecation and infected haematoma. One patient died constituting postoperative mortality of 2.5%. Median follow-up was 6.5 mo(IQR: 2.15-16). Overall recurrence rate was 28%(n = 12). Recurrence rate for patients undergoing an urgent Delorme's procedure who presented as an emergency was higher(75.0%) compared to those treated electively(20.5%), P value 0.034. Median time interval from surgery to the development of recurrence was 16 mo(IQR: 5-30). There were three patients who developed an early recurrence, within two weeks of the initial procedure. The management of the recurrent prolapse was as follows: No further intervention(n = 1), repeat Delorme's procedure(n = 3), Altemeier's procedure(n = 5) and rectopexy with faecal diversion(n = 3). One patient was lost during follow up.CONCLUSION: Delorme's procedure is a suitable treatment for rectal prolapse due to low morbidity and mortality and acceptable rate of recurrence. The management of the recurrent rectal prolapse is often restricted to the pelvic approach by the same patientrelated factors that influenced the choice of the initial operation, i.e., Delorme's procedure. Early recurrence developing within days or weeks often represents a technical failure and may require abdominal rectopexy with faecal diversion.
文摘Rectal prolapse associated with traumatic fecal incontinence is a rare clinical combination. This study was designed to assess Delorme＇s operation with sphincteroplasty as a surgical management of this combination in terms of recurrence and improvement of fecal incontinence. In this prospective study, we enrolled patients suffering from short, full-thickness rectal prolapse associated with traumatic fecal incontinence who had been admitted to Alexandria Main University Hospital during the period of May 2010-January 2013. Preoperative data including cause of trauma, duration of symptoms, results of anal manometry, and degree of fecal incontinence using Wexner score were collected from all patients. Delorme＇s procedure with overlap sphincteroplasty was done in all patients. Recurrence of prolapse and improvement of fecal incontinence were assessed after 1, 3, 6 and 12 months. The study included 13 patients aged （32±8.7） years, 9 females and 4 males. Cause of sphincteric injury included previous anal surgery in 7 patients and normal labor in 6 patients. Duration between sphinctefic injury and operation was （8.08±2.47） months. Preoperative Wexner＇s mean score was 16.07±3.4. Early postoperative complications included superficial wound infection （69.2%）, minor wound dehiscence （61.5%）, and postoperative bleeding （7.6%）. Recurrence was detected in 1 patient at 6 month follow-up. Wexner＇s score showed significant improvement for all patients after 6 months （4.00±2.04）. In conclusion, combination of Delorme＇s procedure and sphincteroplasty for treatment of patients with short complete rectal prolapse associated with traumatic fecal incontinence is a safe, effective surgical management with satisfactory results regarding anatomical and functional outcomes.
