Difference between revisions of "Vaginal prolapse"

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==<big>Pathophysiology</big>==
 
==<big>Pathophysiology</big>==
The pathogenesis of [[Pelvic]] organ prolapse like [[vaginal prolapse]] is  not fully understood. It is thought that vaginal prolapse  is characterized by  two main theories predominate: either the [[Fibromuscular Dysplasia|fibromuscular]] layer of the vagina develops a defect/tears away from its supports, or its tissues are stretched and attenuated weakness of , Pelvic organ prolapse is a [[hernia]] of the vaginal wall. Elements of vaginal hanging and perineum support undergo mechanical strains that lead to this [[pelvic floor]] disorder. The [[utero-sacral ligaments]] and the arcus tendineus of the [[pelvic fascia]] lose their elasticity. Atrophic levator anii muscles do not play their trempoline, active support anymore. That is related to the aging of these structures but also to excessive mechanical strains -[[pregnancy]], delivery, dyschesia, physical practices-. Moreover, postural disorders lead to a direct orientation of these strains on the genital slit.<ref name="pmid31626487">Mezzadri M (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=31626487 [Pelvic organ prolapse physiopathology].] ''Rev Prat'' 69 (4):385-386. PMID: [https://pubmed.gov/pmid: 31626487 pmid: 31626487]</ref>
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The pathogenesis of [[Pelvic]] organ prolapse like [[vaginal prolapse]] is  not fully understood. It is thought that vaginal prolapse  is characterized by  two main theories predominate: either the [[Fibromuscular Dysplasia|fibromuscular]] layer of the vagina develops a defect/tears away from its supports, or its tissues are stretched and attenuated, Pelvic organ prolapse is a [[hernia]] of the vaginal wall. The [[utero-sacral ligaments]] and the arcus tendineus of the [[pelvic fascia]] lose their elasticity. Atrophic levator anii muscles do not play their trempoline, active support anymore To the pelvic floor. That is related to the aging of these structures but also to excessive mechanical strains -[[pregnancy]], delivery, dyschesia, physical practices-. Moreover, postural disorders lead to a direct orientation of these strains on the genital slit.<ref name="pmid31626487">Mezzadri M (2019) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=31626487 [Pelvic organ prolapse physiopathology].] ''Rev Prat'' 69 (4):385-386. PMID: [https://pubmed.gov/pmid: 31626487 pmid: 31626487]</ref>
  
 
Prolapse and urinary incontinence often occur concomitantly and [[cystocele]], [[rectocele]], [[enterocele]], uterine descent or vaginal vault prolapse may also be present. The pathophysiology of prolapse encompasses direct and indirect injury, metabolic abnormalities and chronic high intra-abdominal pressure. Anterior vaginal wall prolapse may present as stress incontinence<ref name="pmid14767263">Marinkovic SP, Stanton SL (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14767263 Incontinence and voiding difficulties associated with prolapse.] ''J Urol'' 171 (3):1021-8. [http://dx.doi.org/10.1097/01.ju.0000111782.37383.e2 DOI:10.1097/01.ju.0000111782.37383.e2] PMID: [https://pubmed.gov/pmid: 14767263 pmid: 14767263]</ref>
 
Prolapse and urinary incontinence often occur concomitantly and [[cystocele]], [[rectocele]], [[enterocele]], uterine descent or vaginal vault prolapse may also be present. The pathophysiology of prolapse encompasses direct and indirect injury, metabolic abnormalities and chronic high intra-abdominal pressure. Anterior vaginal wall prolapse may present as stress incontinence<ref name="pmid14767263">Marinkovic SP, Stanton SL (2004) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14767263 Incontinence and voiding difficulties associated with prolapse.] ''J Urol'' 171 (3):1021-8. [http://dx.doi.org/10.1097/01.ju.0000111782.37383.e2 DOI:10.1097/01.ju.0000111782.37383.e2] PMID: [https://pubmed.gov/pmid: 14767263 pmid: 14767263]</ref>

Revision as of 13:25, 2 August 2020

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List of terms related to Vaginal prolapse

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Eman Alademi, M.D.[2]

Synonyms and Keywords: Female genital prolapse, procidentia and ptosis.

Overview

Vaginal prolapse is characterized by a portion of the vaginal canal protruding from the opening of the vagina. The condition usually occurs when the pelvic floor collapses as a result of childbirth and is inherent among tall Caucasian women.

Types of vaginal prolapse


Historical Perspective:

Vaginal prolapse was first discovered in era of the pharaohs, about 1500 years before Christ. Then MRI/surgery was developed by Hippocrates to treat/diagnose vaginal prolapse over the centuries, different treatment modalities, some of which we can currently seem strange.[1]

Classification :

Vaginal prolapse may be classified according to Uterine cervical elongation that found in patients undergoing hysterectomy for pelvic organ prolapse, Cervical elongation grades and prolapse stages are correlated. Vaginal prolapse calssified as physiological uterine cervical elongation based on corpus/cervix ratio to (grade 0, CCR>1.5) grade I (CCR>1 and ≤1.5) grade II (CCR>0.5 and ≤1), and grade III (CCR≤0.5)[2][3]

Pathophysiology

The pathogenesis of Pelvic organ prolapse like vaginal prolapse is not fully understood. It is thought that vaginal prolapse is characterized by two main theories predominate: either the fibromuscular layer of the vagina develops a defect/tears away from its supports, or its tissues are stretched and attenuated, Pelvic organ prolapse is a hernia of the vaginal wall. The utero-sacral ligaments and the arcus tendineus of the pelvic fascia lose their elasticity. Atrophic levator anii muscles do not play their trempoline, active support anymore To the pelvic floor. That is related to the aging of these structures but also to excessive mechanical strains -pregnancy, delivery, dyschesia, physical practices-. Moreover, postural disorders lead to a direct orientation of these strains on the genital slit.[4]

Prolapse and urinary incontinence often occur concomitantly and cystocele, rectocele, enterocele, uterine descent or vaginal vault prolapse may also be present. The pathophysiology of prolapse encompasses direct and indirect injury, metabolic abnormalities and chronic high intra-abdominal pressure. Anterior vaginal wall prolapse may present as stress incontinence[5]


Differentiating vaginal prolapse from other Diseases


Epidemiology and Demographics

Age

Gender

Race


Risk Factors


Natural History, Complications and Prognosis

  • The majority of patients with vaginal prolapse remain asymptomatic .
  • Common complications of vaginal prolapse include [bladder incarceration[20]], [consecutive irreducible rectal prolapse[21]],
  • Prognosis is generally [excellent], and No serious perioperative complications[22]


Diagnosis

Symptoms

Physical Examination

Laboratory Findings

  • There are no specific laboratory findings associated with vaginal prolapse.

Imaging Findings

  • Pelvic MRI is the imaging modality of choice for vaginal prolapse. has the ability to identify changes related to uterosacral ligament disruption and to document the corrective changes after surgical repair of this ligament. In the future, pelvic MR imaging is help to document and advance knowledge of surgical repair methodology[31]. dynamic pelvic MRI (D-MRI ) provides an accurate diagnostic evaluation of the pelvis,Which seems an appropriate tool in pre-operative assessment of cases with vaginal prolapse. It will help in focusing our surgical strategy, especially in cases that present post-hysterectomy and in cases with residual or recurrent prolapse.[32]
  • On Pelvic MRI, vaginal prolapse is characterized by Defects of musculofascial component of the pelvic floor With Offten demonstrate combination of defects MLA( musculus levator ani ), EF ( sacrouterine ligaments  ) and SUL ( sacrouterine ligaments).[33]

Other Diagnostic Studies

Treatment

Vaginal prolapses must be treated according to the severity of symptoms.

Non-Surgical Therapy

  • With conservative measures (changes in diet and fitness, Kegel exercises, etc.)
  • With a pessary, to provide support to the weakened vaginal walls

Surgical Therapy

A new minimally invasive surgical procedure is effective in restoring a woman's anatomy to the condition it was before childbirth with a recovery time of only 2 weeks. It is performed vaginally using a laparoscope and surgical mesh to repair [35]the cystocele and rectocele and a laser to tighten the vaginal canal creating a natural support for the uterus.


Related Chapters

References

  1. Ziouziou I, Zizi M, Bennani H, Karmouni T, El Khader K, Koutani A | display-authors=etal (2013) [History of pelvic prolapse.] Tunis Med 91 (4):227-9. PMID: : 23673698 pmid : 23673698
  2. Mothes AR, Mothes H, Fröber R, Radosa MP, Runnebaum IB (2016) Systematic classification of uterine cervical elongation in patients with pelvic organ prolapse. Eur J Obstet Gynecol Reprod Biol 200 ():40-4. DOI:10.1016/j.ejogrb.2016.02.029 PMID: 26967345 pmid: 26967345
  3. Schmoldt A, Benthe HF, Haberland G (1975) Digitoxin metabolism by rat liver microsomes. Biochem Pharmacol 24 (17):1639-41. PMID: 10 pmid: 10
  4. Mezzadri M (2019) [Pelvic organ prolapse physiopathology.] Rev Prat 69 (4):385-386. PMID: 31626487 pmid: 31626487
  5. Marinkovic SP, Stanton SL (2004) Incontinence and voiding difficulties associated with prolapse. J Urol 171 (3):1021-8. DOI:10.1097/01.ju.0000111782.37383.e2 PMID: 14767263 pmid: 14767263
  6. Schmoldt A, Benthe HF, Haberland G (1975) Digitoxin metabolism by rat liver microsomes. Biochem Pharmacol 24 (17):1639-41. PMID: 10 pmid: 10
  7. Schmoldt A, Benthe HF, Haberland G (1975) Digitoxin metabolism by rat liver microsomes. Biochem Pharmacol 24 (17):1639-41. PMID: 10 pmid: 10
  8. Chai TC, Davis R, Hawes LN, Twaddell WS (2014) Ectopic ureter presenting as anterior wall vaginal prolapse. Female Pelvic Med Reconstr Surg 20 (4):237-9. DOI:10.1097/SPV.0000000000000082 PMID: 24978091 pmid: 24978091
  9. Gyhagen M, Al-Mukhtar Othman J, Åkervall S, Nilsson I, Milsom I (2019) The symptom of vaginal bulging in nulliparous women aged 25-64 years: a national cohort study. Int Urogynecol J 30 (4):639-647. DOI:10.1007/s00192-018-3684-5 PMID: 29934770 pmid: 29934770
  10. Pahwa AK, Siegelman ES, Arya LA (2015) Physical examination of the female internal and external genitalia with and without pelvic organ prolapse: A review. Clin Anat 28 (3):305-13. DOI:10.1002/ca.22472 PMID: 25256076 pmid: 25256076
  11. Graham CA, Mallett VT (2001) Race as a predictor of urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol 185 (1):116-20. DOI:10.1067/mob.2001.114914 PMID: 11483914 pmid: 11483914
  12. Graham CA, Mallett VT (2001) Race as a predictor of urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol 185 (1):116-20. DOI:10.1067/mob.2001.114914 PMID: 11483914 pmid: 11483914
  13. Alperin M, Moalli PA (2006) Remodeling of vaginal connective tissue in patients with prolapse. Curr Opin Obstet Gynecol 18 (5):544-50. DOI:10.1097/01.gco.0000242958.25244.ff PMID: 16932050 pmid: 16932050
  14. Tsikouras P, Dafopoulos A, Vrachnis N, Iliodromiti Z, Bouchlariotou S, Pinidis P | display-authors=etal (2014) Uterine prolapse in pregnancy: risk factors, complications and management. J Matern Fetal Neonatal Med 27 (3):297-302. DOI:10.3109/14767058.2013.807235 PMID: 23692627 pmid: 23692627
  15. Vergeldt TF, Weemhoff M, IntHout J, Kluivers KB (2015) Risk factors for pelvic organ prolapse and its recurrence: a systematic review. Int Urogynecol J 26 (11):1559-73. DOI:10.1007/s00192-015-2695-8 PMID: 25966804 PMID: 25966804
  16. Nováčková M, Pastor Z, Brtnický T, Chmel R (Fall) [What is the risk of pelvic organ prolapse recurrence after vaginal hysterectomy with colporrhaphy?] Ceska Gynekol 82 (5):383-389. PMID: 29020786 PMID: 29020786
  17. Mirskaya M, Lindgren EC, Carlsson IM (2019) Online reported women's experiences of symptomatic pelvic organ prolapse after vaginal birth. BMC Womens Health 19 (1):129. DOI:10.1186/s12905-019-0830-2 PMID: 31664987 PMID: 31664987
  18. Girgis M, Shek KL, Dietz HP (2019) Total vaginal length: Does it matter for assessing uterine prolapse? Int Urogynecol J 30 (8):1279-1282. DOI:10.1007/s00192-018-3779-z PMID: 30357469 PMID: 30357469
  19. Schachar JS, Devakumar H, Martin L, Farag S, Hurtado EA, Davila GW (2018) Pelvic floor muscle weakness: a risk factor for anterior vaginal wall prolapse recurrence. Int Urogynecol J 29 (11):1661-1667. DOI:10.1007/s00192-018-3626-2 PMID: 29552738 PMID: 29552738
  20. Ober CA, Peștean CP, Bel LV, Taulescu M, Cătoi C, Bogdan S | display-authors=etal (2016) Vaginal prolapse with urinary bladder incarceration and consecutive irreducible rectal prolapse in a dog. Acta Vet Scand 58 (1):54. DOI:10.1186/s13028-016-0235-2 PMID: 27660054 PMID: 27660054
  21. Ober CA, Peștean CP, Bel LV, Taulescu M, Cătoi C, Bogdan S | display-authors=etal (2016) Vaginal prolapse with urinary bladder incarceration and consecutive irreducible rectal prolapse in a dog. Acta Vet Scand 58 (1):54. DOI:10.1186/s13028-016-0235-2 PMID: 27660054 PMID: 27660054
  22. Kavallaris A, Köhler C, Diebolder H, Vercellino F, Krause N, Schneider A (2005) Repair of prolapse with vaginal sacrocolporectopexy: technique and results. Eur J Obstet Gynecol Reprod Biol 122 (2):237-42. DOI:10.1016/j.ejogrb.2005.01.020 PMID: 15950362 PMID: 15950362
  23. Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V (2005) The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 112 (7):971-6. DOI:10.1111/j.1471-0528.2005.00568.x PMID: 15958002 PMID: 15958002
  24. Chai TC, Davis R, Hawes LN, Twaddell WS (2014) Ectopic ureter presenting as anterior wall vaginal prolapse. Female Pelvic Med Reconstr Surg 20 (4):237-9. DOI:10.1097/SPV.0000000000000082 PMID: 24978091 PMID: 24978091
  25. Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V (2005) The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 112 (7):971-6. DOI:10.1111/j.1471-0528.2005.00568.x PMID: 15958002 PMID: 15958002
  26. Digesu GA, Chaliha C, Salvatore S, Hutchings A, Khullar V (2005) The relationship of vaginal prolapse severity to symptoms and quality of life. BJOG 112 (7):971-6. DOI:10.1111/j.1471-0528.2005.00568.x PMID: 15958002 PMID: 15958002
  27. Ober CA, Peștean CP, Bel LV, Taulescu M, Cătoi C, Bogdan S | display-authors=etal (2016) Vaginal prolapse with urinary bladder incarceration and consecutive irreducible rectal prolapse in a dog. Acta Vet Scand 58 (1):54. DOI:10.1186/s13028-016-0235-2 PMID: 27660054 PMID: 27660054
  28. Chai TC, Davis R, Hawes LN, Twaddell WS (2014) Ectopic ureter presenting as anterior wall vaginal prolapse. Female Pelvic Med Reconstr Surg 20 (4):237-9. DOI:10.1097/SPV.0000000000000082 PMID: 24978091 PMID: 24978091
  29. Manothaiudom K, Johnston SD (1991) Clinical approach to vaginal/vestibular masses in the bitch. Vet Clin North Am Small Anim Pract 21 (3):509-21. DOI:10.1016/s0195-5616(91)50057-7 PMID: 1858246 PMID: 1858246
  30. Chai TC, Davis R, Hawes LN, Twaddell WS (2014) Ectopic ureter presenting as anterior wall vaginal prolapse. Female Pelvic Med Reconstr Surg 20 (4):237-9. DOI:10.1097/SPV.0000000000000082 PMID: 24978091 PMID: 24978091
  31. Martin DR, Salman K, Wilmot CC, Galloway NT (2006) MR imaging evaluation of the pelvic floor for the assessment of vaginal prolapse and urinary incontinence. Magn Reson Imaging Clin N Am 14 (4):523-35, vi. DOI:10.1016/j.mric.2007.01.004 PMID: 17433981 PMID: 17433981
  32. Obringer L, Roy C, Mouracade P, Lang H, Jacqmin D, Saussine C (2011) [Vaginal prolapse. What dynamic pelvic MRI adds to clinical examination?.] Prog Urol 21 (2):93-101. DOI:10.1016/j.purol.2010.07.011 PMID: 21296275 PMID: 21296275
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  35. <pmid>8934045</pmid>