High Grade Uterine and Rectal Prolapse

Abstract Introduction: Pelvic floor hernias are encountered especially in elderly women. A combined genital, bladder, and rectal prolapse poses treatment challenges in aged women. Case presentation: We present the case of an 88 year-old patient, complaining of an intravaginal mass protruding for the last 3 months, rectal prolapse that occurred two weeks before admittance, accompanied by stress incontinence of urine and chronic constipation. Examination revealed a uterine prolapse with cystocele and a fourth grade rectal prolapse. We decided on a perianal and transvaginal approach, performing preliminary dilatation and curettage, cervix amputation, anterior colporrhaphy and colpoperineorrhaphy (Manchester procedure) with perineal rectosigmoidectomy using the LigaSure™ device, and coloanal manual anastomosis. Postoperatively the patient had no symptoms of stress urinary incontinence, bowel movement resumed in the fourth postoperative day, and the patient was discharged after seven days. One month after surgery the patient has both urinary and fecal continence, with no relapse in pelvic organ prolapse. Conclusions: Encountering genital, bladder, and rectal prolapse in the same patient is quite rare, and its treatment can be difficult in aged women. Therefore, a less invasive surgical procedure, using the transvaginal approach, and a genital sparing surgery could be the key in cases like this.

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Endometrial cancer after the Manchester procedure: a nationwide cohort study

10.22541/au.164003622.29403076/v1 ◽

2021 ◽

Author(s):

Karen Husby ◽

Kim Gradel ◽

Niels Klarskov

Keyword(s):

Endometrial Cancer ◽

Cox Regression ◽

Reference Group ◽

Uterine Prolapse ◽

Pelvic Organ ◽

Anterior Colporrhaphy ◽

Historical Cohort ◽

Manchester Procedure ◽

Overall Mortality

Objectives To investigate whether the Manchester procedure affects the risk and prognosis of endometrial cancer. Design Nationwide historical cohort. Setting The nationwide Danish registers including all residents with lifelong follow-up. Population All Danish women born 1947–2000, living in Denmark at one point during 1977–2018 undergoing the Manchester procedure (N = 23,935) or anterior colporrhaphy (reference group N = 51,008) during 1977–2018. Methods We conducted a nationwide cohort with full follow-up. Chi-Square test for trend to compare the diagnostic stage for the two groups of women. Cox Regression to analyse the risk of endometrial cancer and mortality. The models were adjusted for age, calendar year, income level, and parity. Main outcome measures Number of women diagnosed with endometrial cancer, the stage of endometrial cancer at the time of diagnosis and the cancer specific and overall mortality. Results During the follow up (median 13 years), 271 (1.13%) women were diagnosed with endometrial cancer after the Manchester procedure and 520 (1.05%) after anterior colporrhaphy. The adjusted hazard ratio (HR) for endometrial cancer was 1.00 (95% confidence interval (CI) 0.86 to 1.16). No difference in stage of cancer was found (p=0.18), nor when stratifying for calendar year. The HR for cancer specific mortality and overall mortality after the Manchester procedure was 0.86 (95% CI 0.65 to 1.15) and 0.93 (95% CI 0.77 to 1.12) respectively. Conclusions The Manchester procedure does not affect the risk or prognosis of endometrial cancer. Keywords Epidemiology, endometrial cancer, Manchester procedure, uterine prolapse, pelvic organ prolapse, vaginal hysterectomy

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Obliterative le fort’s colpocleisis for acute kidney injury caused by pelvic organ prolapse in elderly woman

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194386 ◽

2019 ◽

Vol 8 (10) ◽

pp. 4083

Author(s):

Rohini E. ◽

Hiremath P. B. ◽

Urmi Sanyal ◽

Indu N. R. ◽

Shilpa Ghosh ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Elderly Women ◽

Uterine Prolapse ◽

Obstructive Uropathy ◽

Kidney Injury ◽

Conservative Surgery ◽

Pelvic Organ ◽

Fourth Degree ◽

Renal Functions ◽

The Family

Pelvic organ prolapse (POP) is the descent of pelvic organs through the vagina, which sometimes causes hydronephrosis. Here authors report a case of an eighty five year old woman with a fourth degree uterine prolapse with obstructive uropathy. She was treated with a conservative surgery Le Fort’s colpocleisis. Following which the patient’s renal functions and symptoms improved. Hence authors conclude that colpocleisis can be considered as the option for elderly women who have completed the family with no desire to preserve the sexual function especially in women with co morbities where pelvic reconstructive surgeries pose a challenge.

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Perineal Rectosigmoidectomy Associated with Low Colorectal Anastomosis for Complete Rectal Prolapse Correction – Altemeier’s Procedure

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i1030518 ◽

2020 ◽

pp. 45-49

Author(s):

Marcel Gutierrez ◽

Anne Martinez ◽

Sandra Di Felice Boratto

Keyword(s):

Rectal Prolapse ◽

Elderly Women ◽

Colorectal Anastomosis ◽

Life Quality ◽

Complete Rectal Prolapse ◽

Social Relevance ◽

Surgical Interventions ◽

Perineal Rectosigmoidectomy ◽

Complications Rate

Introduction: Rectal prolapse constitutes in rectal protrusion through anal orifice. It’s more frequent in elderly women and the correction is exclusively surgical and fundamental, given the condition’s social relevance. We intend to describe a perineal rectosigmoidectomy (Altemeier) for correction of prolapse in multi-morbidity elder patient. Case Report: Female patient, 78 years old, evaluated by proctology ward of CHSBC. She Came in with complaint of anal region bulge for past 2 years. Proctological examination showed 15 cm rectal procidentia Rectal prolapse’s diagnosis came from colonoscopy. A perineal rectosigmoidectomy associated with colorectal anastomosis was done (Altemeier’s Procedure). There was appropriate postoperative evolution, discharge with good wound healing and ambulatorial follow up with good general healing. Discussion: Rectal prolapse is a result of anatomical alterations due to factors such as age and multiparity. Clinical presentation: abdominal discomfort, constipation, feces and gases release. It leads to life quality loss, thus surgical interventions become essential. Corrective surgeries seek to give back fecal continence. Currently, procedures branch out into abdominal and perineal. Altemeier consists in complete rectal removal via perineum. It’s appropriate for high surgical risk elders, since it has the lowest complications rate.

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Anatomical and Symptomatic Outcomes in Patients With Le Fort Colpocleisis

10.21203/rs.3.rs-1005385/v1 ◽

2021 ◽

Author(s):

Mehmet Ferdi KINCI ◽

Burak SEZGİN ◽

Mehmet Onur ARSLANER ◽

Deniz AKIN GÖKBEL ◽

İsmail GÖKBEL ◽

...

Keyword(s):

Elderly Women ◽

Uterine Prolapse ◽

Pelvic Organ ◽

Long Term Results ◽

Le Fort ◽

Case Evaluation ◽

Post Operative Period ◽

Pain Symptoms ◽

Anatomical Success

Abstract Background: We aimed to evaluate the short term anatomical and symptomatic results of elderly patients on whom Le Fort colpocleisis operation was performed due to pelvic organ prolapse (POP) in our clinic. Methods: Medical records of fifty-nine sexually inactive and ≥65 aged women with stage 2 or higher vaginal or uterine prolapse who underwent Le Fort colpocleisis operation were prospectively analysed. Pre-operative and 12 months post-operative data were recorded. Turkish validated Global Pelvic Floor Bother Questionnaire (GPFBQ) were also evaluated at pre-operative and 12 months post-operative period in all patients. Anatomical success was determined as no prolapse of any POP-Q point at or below 1 cm above the hymen. Results: A total of 59 patients were conducted in this study. The average age of the patients was 71.67±7.01 (years). The mean BMI was 27.1±9.52 kg/m2. POP-Q point C as well as, Gh and TVL measurements were significantly higher after surgery than those at preoperative period (p<0.01, p<0.01, p<0.01, respectively). There was no recurrence in any case. Evaluation of complications at the pre-operative and post-operative 12th month revealed significant differences for SUI, urinary frequency, nocturia, and pelvic pain symptoms during post-operative period (p:0.007, p<0.001, p:0.01, p<0.001; respectively). Conclusions: Le Fort colpocleisis is a simple and effective procedure that has been found to provide successful anatomical and symptomatic outcomes in sexually inactive and elderly women for POP. However long-term results of this procedure needs further investigation.

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Outcomes and Postoperative Complications of Robot-Assisted Laparoscopic Hysterosacropexy: Initial Experience

Urologia Internationalis ◽

10.1159/000371726 ◽

2015 ◽

Vol 95 (1) ◽

pp. 44-49 ◽

Cited By ~ 1

Author(s):

Maria Angela Cerruto ◽

Carolina D'Elia ◽

Francesca Maria Cavicchioli ◽

Stefano Cavalleri ◽

Matteo Balzarro ◽

...

Keyword(s):

Uterine Prolapse ◽

Pelvic Organ ◽

Consecutive Series ◽

Complication Rates ◽

Early Complications ◽

Robot Assisted ◽

Female Patients ◽

The Mean ◽

Record Review

Background: Pelvic organ prolapse is a common condition, affecting about 50% of women with children. The aim of our study was to evaluate results and complication rates in a consecutive series of female patients undergoing robot-assisted laparoscopic hysterosacropexy (RALHSP). Materials and Methods: We performed a medical record review of female patients with uterine prolapse who had consecutively undergone RALHSP from February 2010 to 2013 at our department. Results: Fifteen patients were included in the analysis. All patients had uterine prolapse stage ≥II and urodynamic stress urinary incontinence. The mean age was 58.26 years. According to the Clavien-Dindo system, 4 out of 15 patients (26.6%) had grade 1 early complications and 1 patient had a grade 2 complication. At a median follow-up of 36 months, there was a significant prolapse relapse rate of 20% (3/15). Conclusion: In our hands RALHSP is easy to perform, with satisfying mid-term outcomes and a low complication rate.

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Perineal rectosigmoidectomy: An effective approach for the repair of complete rectal prolapse

Annals of the College of Surgeons Hong Kong ◽

10.1046/j.1442-2034.2000.00042.x ◽

2000 ◽

Vol 4 (1) ◽

pp. 13-16

Author(s):

KM Chiu ◽

AK AhChong ◽

AWC Yip

Keyword(s):

Rectal Prolapse ◽

Complete Rectal Prolapse ◽

Perineal Rectosigmoidectomy

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Abdominal resection rectopexy with pelvic floor repairversus perineal rectosigmoidectomy and pelvic floor repair for full-thickness rectal prolapse

British Journal of Surgery ◽

10.1002/bjs.1800810253 ◽

1994 ◽

Vol 81 (2) ◽

pp. 302-304 ◽

Cited By ~ 109

Author(s):

K. I. Deen ◽

E. Grant ◽

C. Billingham ◽

M. R. B. Keighley

Keyword(s):

Rectal Prolapse ◽

Pelvic Floor ◽

Full Thickness ◽

Resection Rectopexy ◽

Pelvic Floor Repair ◽

Perineal Rectosigmoidectomy ◽

Abdominal Resection

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Surgical treatment of rectal prolapse: experience and late results with 51 patients

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812004000400003 ◽

2004 ◽

Vol 59 (4) ◽

pp. 168-171 ◽

Cited By ~ 4

Author(s):

Carlos Walter Sobrado ◽

Desidério Roberto Kiss ◽

Sérgio C. Nahas ◽

Sérgio E. A. Araújo ◽

Victor E. Seid ◽

...

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Rectal Prolapse ◽

Late Results ◽

Long Term Results ◽

Complete Rectal Prolapse ◽

Presacral Space ◽

Perineal Rectosigmoidectomy ◽

Study Results ◽

Low Incidence

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

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