Experience of conservative treatment of genital prolapse with urogynecological pessaries

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 24-26
Author(s):  
Gennady Y Yarin ◽  
Inna A Vilgelmi ◽  
Evgeny V Liuft

Background. Pelvic organ prolapse is one of the most common women's diseases worldwide. Genital prolapse incidence among women over 50 is on average 41%. There are variety methods for genital prolapse treatment; they are divided into surgical and non-surgical ones. One of the conservative treatment methods is a use of pessaries. According to different studies an efficacy of pessary therapy is approximately 60%. Aim to estimate a safety and efficacy of genital prolapse conservative treatment with a cube pessary on the basis on standardized questionnaires. Outcomes and methods. In ANO “NRITO Clinic” Urology and Gynecology Center 26 women with various degree genital prolapse were treated with pessary within the period from August 2015 to March 2016. Efficacy of pessaries use, patient satisfaction with this treatment method and complications rate were estimated. Results. Urogynecological cube pessary use in a treatment of various types of genital prolapse is quite an effective method (p

Author(s):  
Zhi-jing Sun ◽  
Tao Guo ◽  
Xiu-qi Wang ◽  
Jing-he Lang ◽  
Tao Xu ◽  
...  

Abstract Introduction and hypothesis This study aimed to investigate the evaluation and management of complications after pelvic floor reconstructive surgery for pelvic organ prolapse in China. Methods Complications of pelvic floor reconstructive surgery for pelvic organ prolapses from 27 institutions were reported from November 2017 to October 2019. All complications were coded according to the category-time-site system proposed by the International Urogynecological Association (IUGA) and the International Continence Society (ICS). The severity of the complications was graded by the Clavien-Dindo grading system. Four scales were used to evaluate patient satisfaction and quality of life after management of the complications: the Patient Global Impression of Improvement (PGI-I), the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7), the Pelvic Organ Prolapse Symptom Score (POP-SS), and a 5-point Likert-type scale that evaluated the patient’s choice of surgery. Results Totally, 256 cases were reported. The occurrence of complications related to transvaginal mesh (TVM) and laparoscopic sacrocolpopexy (LSC) had a significantly longer post-surgery delay than those of native tissue repair surgery (p < 0.001 and p = 0.010, respectively). Both PFIQ-7 and POP-SS score were lower after management of complications (p < 0.001). Most respondents (81.67%) selected very much better, much better, or a little better on the PGI-I scale. Only 13.3% respondents selected unlikely or highly unlikely on the 5-point Likert-type scale. Conclusions The occurrence of complications related to TVM surgery and LSC had a longer post-surgery delay than native tissue repair surgery. Long-term regular follow-up was vital in complication management. Patient satisfaction with the management of TVM complications was acceptable.


2020 ◽  
Vol 28 (2) ◽  
pp. 119-133
Author(s):  
Nicola Davies ◽  
Teresa Burdett

PurposeIntegrated healthcare is a central tenant of the NHS Long Term Plan (NHS, 2019). NICE in 2019 published guidelines; advising the integration of multidisciplinary professionals which may lead to an improvement in conservative treatment methods of pelvic organ prolapse. Therefore, current literature on the conservative treatments for pelvic organ prolapse needs to be reviewed to ascertain if an integrated approach would improve the symptoms and quality of life for women.Design/methodology/approachA systematic review of the literature between 2013 and 2018 was implemented. Papers included were written in English, peer-reviewed and consisted of treatments of pelvic organ prolapse in women. Papers containing surgical interventions, postpartum participants, reviews, evaluations, guidelines, follow-up studies, focusing on cost effectiveness, sexual function were excluded.FindingsSeven studies in total were included, and two overarching themes were identified: quality of life after treatment and the effect of conservative treatment on pelvic organ prolapse symptoms. The literature suggested that integrating care had a more positive outcome on pelvic organ symptoms and quality of life.Research limitations/implicationsTo develop a robust enhanced model of care for conservative treatment of pelvic organ prolapse through more mixed method or qualitative research, that incorporates integrative treatment methods with collaboration from multidisciplinary professionals.Practical implicationsThe practical implications of integrating the conservative management of pelvic organ prolapse is the communication between the multidisciplinary team must be exceptional to ensure everyone understands and agrees the treatment that is being provided to patient. Also, effective teamwork is important to ensure the patient receives the best care with input from the correct disciplines. The multi-professional team will need to have regular meetings to discuss and implement care plans for patients that might prove difficult to schedule due to differing commitments and priorities. This must be overcome to insure a successful and effective integrated approach to pelvic organ prolapse is delivered.Social implicationsThe social implications of integrating the professional approach to women's care of pelvic organ prolapse involves reducing the severity of the symptoms therefore, increasing the quality of life. This may result in the reduction of surgical intervention due to the patient being satisfied with the conservative management. Through integrating the management of the prolapse the patient will receive an accessible individualised care plan pathway that focuses on treating or reducing the impact of the symptoms that are bothersome to the patient whilst managing patient expectations. Patients will also, be reassured by the number of multi-disciplinary professionals involved in their care.Originality/valueGlobal integration of conservative treatments and multidisciplinary-professionals specialising in pelvic organ prolapse and pelvic floor dysfunction is needed.


2010 ◽  
Vol 1 (3) ◽  
pp. 32-37
Author(s):  
S A Levakov ◽  
N S Wanke ◽  
O R Shablovskiy ◽  
A G Kedrova ◽  
V N Shirshov ◽  
...  

The aim was to evaluated anatomical and symptom specific outcome measures of prolapse repair with PROLIFT ® (Gynecare). In this longitudinal prospective observational study we collected data on a total of 85 women with pelvic organ prolapse stage 2 or more. Objective success rate was 85.9% at 6 months respectively. Patients required a blood more 500 ml - 7,1% and need transfusion. The mesh erosion rate or the displacement of the mesh were 3,5%. Vaginal surgery with prolift mesh® is an effective and safe procedure to correct pelvic organ prolapse over one year follow up.


2019 ◽  
Vol 14 (2) ◽  
pp. 46-48
Author(s):  
Madhu Shrestha

Aims: To evaluate the use of pessaries for women with Pelvic Organ Prolapse irrespectivve POP-Q stages. Method: This is retrospective study conducted at Paropakar maternity and Women’s hospital from mid April to mid December 2018 on 114 women with pelvic organ prolapse. Result: Total of 114 women with prolapse evaluated. Age of presentation ranged from 36 to 85 years. Twenty cases (17.6%) underwent prolapsed surgery and 71 cases (62.2%) had ring pessary. Conclusion: Overall acceptance of vaginal ring pessary is very high. It can be used in the majority of women with patient satisfaction and without noteworthy complication.


2004 ◽  
Vol 190 (4) ◽  
pp. 1025-1029 ◽  
Author(s):  
Jeffrey L Clemons ◽  
Vivian C Aguilar ◽  
Tara A Tillinghast ◽  
Neil D Jackson ◽  
Deborah L Myers

2017 ◽  
Vol 28 (11) ◽  
pp. 1685-1693 ◽  
Author(s):  
Nikolaus Veit-Rubin ◽  
Jean-Bernard Dubuisson ◽  
Angèle Gayet-Ageron ◽  
Sören Lange ◽  
Isabelle Eperon ◽  
...  

2020 ◽  
Vol 69 (5) ◽  
pp. 87-97
Author(s):  
Andrey N. Plekhanov ◽  
Vitaly F. Bezhenar ◽  
Alexey M. Karachun ◽  
Fyodor V. Bezhenar ◽  
Anna A. Tsypurdeyeva ◽  
...  

In recent studies, it has been established that extralevator abdominoperineal extirpation (ELAPE) of the rectum can improve the oncological results of treatment of distal rectal cancer compared to standard abdominoperineal extirpation. As a result of extralevator dissection, a large defect of the perineum is formed, which requires plastic closure. While performing ELAPE, the structures that form the pelvic diaphragm are affected. This increases the risk of pelvic organ prolapse in women and significantly affects the quality of life of these patients, which requires subsequent surgical treatment. Despite the fact that pelvic organ prolapse develops as a consequence of previous surgical treatment by an oncologist, they do not consider it as a complication in the long-term postoperative period. Such patients are not referred to the operating gynecologist. Currently, this problem is poorly understood and there are no standardized approaches to the surgical treatment of pelvic prolapse in this category of patients.


2017 ◽  
Vol 11 (1) ◽  
Author(s):  
Sweety Shrestha

Aims: Pelvic organ prolapse is a common condition in our country which affects the quality of life of many women. After vaginal operations for genital prolapse, there is increased chance of urinary tract infections, retention of urine and re-catheterization.The objective of this study is to evaluate  women with cystocele  in terms of clinical profile, different modalities of treatment and the complication  following repair.Methods: It is a descriptive study carried out amongst 80 cases of cystocele irrespective of associated uterine descent and stress incontinence of urine in College Of Medical Sciences – Teaching Hospital, Nepal from 1/9/201l to 30/10/2013.Results: During the study, 80 women  with  cystocele  were enrolled. Majority of the women (66.3%, n =53) with cystocele were within 15 to 45 years and 53.8% (n=43) of them had parity beyond 5. Among these women, 51.4% (n=41) had second degree cystocele  and 23.8% (n=19) had stress urinary incontinence. Majority of the women (58.8%, n=40) underwent vaginal hysterectomy with pelvic floor repair. Following surgery, the most common complication was urinary tract infection (14.7%, n = 10).Conclusions: In this study, majority of the cases with cystocele were in the reproductive age with parity beyond 5 while maximum number of the women with cystocele had associated third degree uterocervical descent. Urinary tract infection was the commonest complication following surgical treatment followed by retention of urine. 


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