Defecography in symptomatic older women living at home.
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BACKGROUND: complaints of defecation disorders in older patients living at home is an emerging problem. Little is known about radiological examination of this population. OBJECTIVE: this study aimed to analyse the yield of defecography in women older than 75 years, living at home and complaining of defecation disorders. DESIGN AND SETTINGS: prospective study of patients referred to a radiology department in a tertiary-care medical centre in Rouen, France. SUBJECTS AND METHODS: 52 women (mean age: 78, range: 75-93) complaining of constipation, faecal incontinence or pelvic pain underwent defecography. Defecography was performed after intake of a barium meal and vaginal opacification. Radiographs were analysed accordingly with the established criteria. RESULTS: defecography showed perineal descent in 27 patients, rectocele in 29, intussusception in 33 and enterocele in 14. A combination of abnormalities was found in 40 women. Only 3 studies were normal. There was no significant association between symptoms and pelvic disorders revealed by defecography. CONCLUSIONS: defecography in symptomatic women aged 75 years and over did not raise any technical difficulty. It revealed a 77% rate of abnormalities, but there was no relationship between the symptoms and the detected abnormalities. (+info)
Incidence of pelvic organ prolapse in Nigerian women.
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OBJECTIVE: To establish the incidence and types of utero-vaginal prolapse. METHODS: Retrospective medical records analyses of women who were subjected to reconstructive pelvic surgery for various types of pelvic relaxation at the Nnamdi Azikiwe University Teaching Hospital, Nnewi and the University Of Nigeria Teaching Hospital, Enugu, Nigeria was carried out. The study was conducted from January 1996 to December 1999 during which there were 7515 surgical admissions. The inclusion criteria were those women who complained of feeling a mass in the vagina with demonAstrable descent of the anterior and/or posterior and/or apical vaginal walls and/or perineal descent. Excluded were patients who had other symptoms other than utero-vaginal prolapse and those whose grades and sites of prolapse were not determinable from the clinical or surgical notes. Also excluded were patients with nerve injury or disease, connective tissue disorders and neuromuscular diseases. The subjects were divided into two groups. Group I consisted of 54 women (age < or = 40 years), and group II included 105 women (age > or = 40 years). The findings between those two groups were compared with reference to sites, types and degree of prolapse. Also, coexistence of pelvic relaxation and underlying medical conditions were evaluated. RESULTS: A total of 159 subjects out of 492 charts studied met the inclusion criteria for the study. In group I, mean age was 32.839 with a standard deviation (SD) of +/- 6.012 years; and in group II the mean age was 56.543 with a SD of 8.094. Hypertrophic (elongated) cervix was determined in 15 (6.3%) subjects in group I for an incidence of 1.58% per year, cystocele (vaginal anterior wall descent) was present in 21 (8.9%) women for an incidence of 2.2% per year; rectocele (posterior vaginal wall descent) was identified in 15 (6.3%) women for an incidence of 1.58% per year; vaginal cough prolapse (apical descent) was present 21 (8.9%) women for an incidence of 2.2% per year. Perineal descent was absent in this group. In group II, there was no hypertrophic cervix; cystocele was present in 39 (16.5%) cases for an incidence of 4.13% per year; rectocele was identified in 27 (11.4%) women, amounting to an incidence of 2.85% per year; vaginal cough prolapse was present in 36 (15.%) women, an incidence of 3.75% per year; perineal descent was present in 63 (25.6%) women, for an incidence of 6.4% per year. CONCLUSION: (1) The incidence of hypertrophic cervix without any other abnormality amounted to 1.58% per year. This medical entity can present as uterine prolapse and was noted only in group I. (2) The annual incidence for hospital admission with a diagnosis of uterine prolapse was 2.1%. (3) The incidence of cystocele, and rectocele was not statistically different in the two groups; but the incidence of perineal descent and uterine prolapse were significantly more in group II than group I. (4) The etiology of hypertrophic cervix is not known, but it is of importance especially in the childbearing age when it may be related to prolonged pregnancy, cervical dystocia, etc. (+info)
Dynamic MR imaging of outlet obstruction.
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The outlet obstruction syndrome encompasses all pelvic floor abnormalities which are responsible for an incomplete evacuation of fecal contents from the rectum. It has been estimated that outlet obstruction may be observed in half of constipated patients. A detailed clinical examination still represents the cornerstone of the diagnosis of these patients. However, there is general agreement that a reliable evaluation of the different pelvic floor abnormalities and the treatment decision highly depend on the imaging assessment. Traditionally, conventional defecography has played an important role in the radiological assessment of these patients but the technique is limited by its projectional nature and its inability to detect soft-tissue structures. Dynamic pelvic MR imaging using either closed-configuration or open-configuration MR systems is a rapidly evolving technique which has been gaining increased interest over the last years. The free selection of imaging planes, the good temporal resolution, and the excellent soft-tissue contrast have transformed this method into the preferred imaging modality in the evaluation of patients with pelvic floor dysfunction including rectocele, enterocele, internal rectal prolapse, and anismus. (+info)
Management of disorders of the posterior pelvic floor.
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INTRODUCTION: Constipation is a relatively common problem affecting 15 percent of adults in the Western world, and over half of these cases are related to pelvic floor disorders. This article reviews the clinical presentation and diagnostic approach to posterior pelvic floor disorders, including how to image and treat them. METHODS: A Pubmed search using keywords "rectal prolapse," "rectocele," "perineal hernia," and "anismus" was performed, and bibliographies of the revealed articles were cross-referenced to obtain a representative cross-section of the literature, both investigational studies and reviews, that are currently available on posterior pelvic floor disorders. DISCUSSION: Pelvic floor disorders can occur with or without concomitant physical anatomical defects, and there are a number of imaging modalities available to detect such abnormalities in order to decide on the appropriate course of treatment. Depending on the nature of the disorder, operative or non-operative therapy may be indicated. CONCLUSION: Correctly diagnosing pelvic floor disorders can be complex and challenging, and the various imaging modalities as well as clinical history and exam must be considered together in order to arrive at a diagnosis. (+info)
OBJECTIVES: To review intraoperative and postoperative complications associated to the correction of cystocele and rectocele with polypropylene mesh macropore monofilament (Gynemesh PS) using transvaginal free tension technique. MATERIALS AND METHODS: Prospective study of patients that have been submitted to correction of cystocele and/or rectocele between November 2004 and August 2005 in the Urogynecology and Vaginal Surgery Unit of Gynecology and Obstetrics Department, Las Condes Clinic. Mesh was used in 31 patients: 9 for cystocele, 11 for rectocele, and 11 for concomitant meshes. Total mesh used 42. Media age 55 years old, weight 64 kilograms. In 7 patients we used a third mesh for correction of urinary incontinence by TVT-O technique. RESULTS: They did not present intraoperative complications, neither in immediate or delayed postoperative time. We did not observe hematoma, infection, erosion or exposition mesh. Healing of cystocele and rectocele was obtained in 100% of patients, with a pursuit between 1 and 8 months. DISCUSSION: The use of prosthetic polypropylene monofilament macropore mesh in the correction of cystocele and/or rectocele, by transvaginal route with tension free technique seems to be a safe and effective surgery procedure. (+info)
Sonomorphological evaluation of polypropylene mesh implants after vaginal mesh repair in women with cystocele or rectocele.
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OBJECTIVE: To investigate whether the sonographically measured size of the mesh implant in women who had undergone vaginal polypropylene mesh repair 6 weeks previously correlates with the original size of the mesh and whether the mesh ensures complete support of the anterior or posterior compartment. METHODS: Forty postmenopausal women with anterior or posterior vaginal wall prolapse and sonographically proven cystocele (n = 20) or rectocele (n = 20) were evaluated preoperatively and 6 weeks after vaginal mesh repair. Introital ultrasound was performed to identify the polypropylene mesh and measure its distal to proximal length and configuration as well as its thickness. The initial mesh length was compared with that measured by ultrasound 6 weeks postoperatively. Vaginal length was measured pre- and postoperatively. RESULTS: The mean +/- SD age of the women was 68 +/- 7 years. The 20 women with cystocele underwent repair by means of anterior transobturator mesh implantation; the initial mesh length was 6.8 +/- 1.1 cm versus 2.9 +/- 0.6 cm postoperatively. The 20 women with rectocele underwent repair by posterior transischioanal mesh implantation; the initial mesh length was 9.9 +/- 0.8 cm versus 3.3 +/- 0.5 cm postoperatively. The mesh supported 43.4% of the length of the anterior vaginal wall and this value was 53.7% for the posterior wall (P = 0.016). CONCLUSION: Sonography is recommended for postoperative evaluation of the anterior and posterior mesh positions after prolapse surgery. There is a considerable discrepancy between the implanted mesh size and the length measured 6 weeks later by postoperative ultrasound. Published by John Wiley & Sons, Ltd. (+info)
Ultrasound assessment of pelvic organ prolapse: the relationship between prolapse severity and symptoms.
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OBJECTIVE: At present little information is available to help define whether a certain degree of pelvic organ prolapse is clinically relevant. We performed a retrospective study to define cut-offs for significant pelvic organ descent on the basis of prolapse symptoms. METHODS: At a tertiary urogynecological center, 735 women with symptoms of lower urinary tract dysfunction and prolapse were seen for interview, clinical examination, multi-channel urodynamics and ultrasound imaging, while supine and after voiding, for prolapse quantification. Women with multi-compartment prolapse, i.e. those in whom no compartment was clearly dominant were excluded. Receiver-operator statistics were used to test pelvic organ descent as a predictor of prolapse symptoms. RESULTS: Mean age was 55.1 years, mean parity 2.8 (range, 0-12). Symptoms of prolapse were reported by 188 women (25.6%). Seventy-four showed a symptomatic multi-compartment prolapse and were excluded, 56 symptomatic women had cystoceles and 48 had rectoceles. Symptomatic cystoceles descended on average to 23.8 mm below the symphysis pubis and symptomatic rectoceles to 21.4 mm below the symphysis pubis. Descent was strongly associated with symptoms of prolapse (both, P < 0.001). Receiver-operating characteristics (ROC) statistics suggested a cut-off of 10 mm below the symphysis pubis for cystocele, and 15 mm below the symphysis pubis for rectocele. ROC curves were similar for both compartments (area under the curve, 0.857 and 0.821, respectively). CONCLUSIONS: Descent of the bladder to > or = 10 mm and of the rectum to > or = 15 mm below the symphysis pubis are strongly associated with symptoms, and these values are proposed as cut-offs for the diagnosis of significant prolapse on the basis of ROC statistics. (+info)
Posterior compartment anatomy as seen in magnetic resonance imaging and 3-dimensional reconstruction from asymptomatic nulliparas.
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