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Management of recto-vaginal fistulas after prosthetic reinforcement treatment for pelvic organ prolapse

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World Journal of Gastroenterology 2010年第24期16卷 3011-3015页

作者： Mehdi Ouassi Silvia Cresti Urs Giger Igor Sielezneff Nicolas Pirrò Bruno Berthet Philippe Grandval Bernard Consentino Bernard Sastre Department of Visceraland Oncological Surgery Timone Hospital Department of Surgery Kantonsspital Bruderholz Department of gastroenterology Timone Hospital

AIM: To communicate our findings on successful treat-ment of recto-vaginal fistulas (RVFs) after prosthetic reinforcement surgery of pelvic organ prolapse (POP). METHODS: A retrospective single center study between 1998 and 2008 was performed. A total of 80 patients with RVF were identified, of which five patients (6%), with a mean age of 65 years (range: 52-73), had undergone previous surgery for POP with pros-thetic reinforcement. RESULTS: All patients complained about ongoing vaginal infections and febrile episodes. These symptomswere reported after a mean period of 18 mo after POP repair. As a first intervention, three patients underwent ablation of the prosthetic material (PM). As a second intervention, open proctectomy with a primary anas-tomosis, an omental patch, and a protective ileostomy were performed in two patients. One patient required a terminal colostomy due to complete destruction of the anal sphincters. In two other patients, ablation of the PM and proctectomy was performed as a one-step procedure. The postoperative course in all patients was uneventful, with a mean length of hospitalization of 20 d (range: 15-30). Closure of the ileostomy was achieved in all four patients within four months. After a mean period of 35 mo (range: 4-60) of follow-up, no recurrence was observed with normal continence in four ***: In our experience, the definitive treat-ment of high RVFs after PM repair for POP necessitates ablation of the PM, proctectomy with a primary colo-rectal anastomosis, an omental patch interposition, and a temporary ileostomy.

关键词： pelvic organ prolapse Recto-vaginal fistula Prosthetic treatment

Role of different childbirth strategies on pelvic organ prolapse and stress urinary incontinence： a prospective study

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Chinese Medical Journal 2008年第3期121卷 213-215页

作者： ZHU Lan BIAN Xu-ming LONG Yan LANG Jing-he Department of Obstetrics and Gynecology Peking Union MedicalCollege Hospital Beijing 100730 China

Background Traumatic damage to fascial and muscular support structures during childbirth may be a major factor of the development of stress urinary incontinence （SUI） and pelvic organ prolapse （POP）. The aim of this study was to prospectively investigate the role of different childbirth strategies on POP and SUI. Methods A total of 120 selected pregnant women were recruited and divided into two groups： vaginal delivery group （n=72） and selective cesarean delivery group （n=48）. The women were questioned with SUI sheet and estimated with POP quantification （POP-Q） within 6-8 weeks after delivery. The correlations of SUI and results of POP-Q with the strategies of delivery were analyzed, ttest, X2 test, and the Mann-Witney test were used for statistical analysis. Results Among the 120 women, SUI was developed during 29-30 gestational weeks in 20 patients （16.6%）, of whom 14 （70%） had symptoms of SUI till 6 weeks postpartum. Totally 20 （16.6%） women had SUI symptoms after delivery. The prevalence of postpartum SUI was positively correlated with the occurrence of SUI during 29-30 gestational weeks （P〈0.001）. In the vaginal delivery group, 100% of the women suffered form urinary prolapse 6 weeks postpartum, while 87.5% of those in the selective cesarean delivery group developed POP （P〈0.01）. The percentages of the first- and second-degree urinary prolapse in the vaginal delivery group were 20.8% and 79.2% respectively, which were significantly different from those in the selective cesarean delivery group （64.6% and 22.9%; both P=0.000）. Conclusions Pregnancy and delivery play an etiologic role in the development of SUI and POP. The onset of SUI during late pregnancy implies a significant risk of postpartum SUI symptoms. The prevalence of POP is significantly higher after vaginal delivery than after cesarean delivery.

关键词： natural childbirth cesarean section urinary incontinence pelvic organ prolapse

New native tissue repair for pelvic organ prolapse:Medium-term outcomes of laparoscopic vaginal stump-round ligament fixation

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World Journal of Clinical Cases 2023年第15期11卷 3457-3463页

作者： Toshiyuki Kakinuma Ayaka Kaneko Kaoru Kakinuma Ken Imai Nobuhiro Takeshima Michitaka Ohwada Department of Obstetrics and Gynecology International University of Health and WelfareNasushiobara 329-2763Japan

BACKGROUND Laparoscopic sacrocolpopexy for pelvic organ prolapse(POP)is a new and widely used approach;however,ever since the United States Food and Drug Administration warned against the use of surgical mesh,repairs performed using patients’tissues[*** tissue repair(NTR)]instead of mesh have attracted much *** our hospital,laparoscopic sacrocolpopexy(the Shull method)was introduced in ***,patients with more severe POP who have a long vaginal canal and overextended uterosacral ligaments may not be candidates for this *** To validate a new NTR treatment for POP,we examined patients undergoing laparoscopic vaginal stump–round ligament fixation(the Kakinuma method).METHODS The study patients were 30 individuals with POP who underwent surgery using the Kakinuma method between January 2020 and December 2021 and who were followed up for>12 mo after *** retrospectively examined surgical outcomes for surgery duration,blood loss,intraoperative complications,and incidence of *** Kakinuma method involves round ligament suturing and fixation on both sides,effectively lifting the vaginal stump after laparoscopic *** The patients’mean age was 66.5±9.1(45-82)years,gravidity was 3.1±1.4(2-7),parity was 2.5±0.6(2-4)times,and body mass index was 24.5±3.3(20.9-32.8)kg/*** to the POP quantification stage classification,there were 8 patients with stage Ⅱ,11 with stage Ⅲ,and 11 with stage Ⅳ.The mean surgery duration was 113.4±22.6(88-148)min,and the mean blood loss was 26.5±39.7(10-150)*** were no perioperative *** of the patients exhibited reduced activities of daily living or cognitive impairment after hospital *** cases of POP recurrence were observed 12 mo after the *** The Kakinuma method,similar to conventional NTR,may be an effective treatment for POP.

关键词： pelvic organ prolapse Native tissue repair Laparoscopic surgery Round ligament Kakinuma method

Current Situation of Transvaginal Mesh Repair for pelvic organ prolapse

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Chinese Medical Sciences Journal 2014年第3期29卷 188-190页

作者： Lan Zhu Lei Zhang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College

SURGICAL mesh is a metallic or polymeric screen intended to be implanted to reinforce soft tissue or bone where weakness exists. Surgical mesh has been used since the 1950s to repairabdominal hernias. In the using surgical mesh products 1970s, gynecologists began to indicate the repair of pelvic organ prolapse （POP）, and in the 1990s, gynecologists began using surgical mesh for POP. Then the U.S. Food andDrug Administration （FDA） approved the first surgical mesh product specifically for use in POP.

关键词： pelvic organ prolapse vaginal mesh complication

Medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with posterior approach for a pelvic organ prolapse:A retrospective study of 124 cases

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Laparoscopic, Endoscopic and Robotic Surgery 2023年第4期6卷 154-159页

作者： Yunshan Zhu Xiao Zhang Danxia Chen Guangxiao Li Shanliang Shang Jianqiong Li Jianhua Yang Department of Obstetrics and Gynecolbgy Sir Run Run Show Hospital Zhejlang University School of MedicineHangzhou 310016China Key Laborutory of Reproductive Dysfunction Management of Zhejiang Provinar Hangzhou 310016China

Objective:pelvic organ prolapse(POP)is a common gynecological disease in middle-aged and older women that seriously affects patients'physical health and quality of life,increases the financial burden for patients,and becomes a major public health *** aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe ***:Patients with severe POP quantitation stage III-IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this *** results and complications were *** were retrospectively ***:In total,124 patients were *** were followed up for 32.2712.90 *** objective cure rate for patients who underwent hysterectomy was 917%(100/109),with 7(6.4%)patients had anterior vaginal wall prolapse and 2(1.8%)patients had posterior vaginal wall *** objective cure rate for patients who retained uterus was 66.7%(10/15).All 5 patients with recurrence had uterine prolapse,and 3(20.0%)of them also had anterior vaginal wall ***:Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe,minimally invasive,and effective method for patients with severe ***-term follow-up is needed to confirm the clinical effects.

关键词： pelvic organ prolapse Laparoscopy Pubocervical fascia reconstruction Sacrospinous ligament fixation

Sensory threshold for defecation and its correlation with pelvic organ prolapse:An exploration of related factors

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Gynecology and Obstetrics Clinical Medicine 2023年第3期3卷 149-153页

作者： Yanhua Liu Man Tan Cheng Tan Xin Yang Department of Obstetrics and Gynecology Peking University People's HospitalBeijingChina Department of Gynecological pelvic Floor and Oncology Chongqing Health Center for Women and ChildrenChongqingChina

Objectives This research aimed to investigate changes in defecation sensory threshold and related factors in patients with posterior vaginal wall *** A total of 214 patients with pelvic organ prolapse were recruited between October 2019 to January *** patients underwent a defecation sensory threshold examination,physical examination,and pelvic floor ultrasound *** related to the defecation sensory threshold were ***(1)Among the participants,57 patients(26.6%)had a defecation sensory threshold of more than 90*** with a threshold>90ml showed higher scores of defecation dysfunction in the Constipation Scoring System(CSS)score(p=0.003)and higher scores of constipation in the Colorectal-anal Distress Inventory 8(CRADI-8)score(p=0.002).(2)The defecation sensation threshold positively correlated with the Ap point(r=0.448,ppelvic organ prolapse commonly experience an increased threshold of defecation *** thresholds were associated with more frequent constipation ***,the severity of posterior pelvic prolapse positively correlated with the defecation sensory threshold.

关键词： Anorectal function Defecation sensory threshold pelvic organ prolapse

Comparison of mood state in severe pelvic organ prolapse patients before and after surgery

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Gynecology and Obstetrics Clinical Medicine 2021年第4期1卷 220-224页

作者： Xicui Long Yong Hu Zhenghua Xiong Chen Li Wenjiao Jin Huiming Guo Juan Zhang Xuesong Han Department of Gynecology The First Affiliated Hospital of Kunming Medical UniversityKunmingYunnanChina

Objective:This study aimed to compare the mood state of patients with severe pelvic organ prolapse(POP)before and after ***:This prospective study enrolled 100 patients with severe POP who were surgically treated between October 2016 and February *** clinical severity of POP was evaluated using the POP Quantification(POPQ)*** state evaluation,using the Hamilton anxiety(HAMA)and the Hamilton depression(HAMD)scale,was performed preoperatively and at 3 and 6 months ***:The POP-Q stage was significantly improved postoperatively(Pprolapse surgery patients and mesh pelvic reconstruction patients preoperatively and at 3 and 6 months postoperatively(P>0.05).Conclusions:Patients with severe POP have different anxiety and depression symptoms *** individualized surgical treatment is effective for improving the clinical severity of severe POP and might alleviate or improve POP-related anxiety or depression symptoms.

关键词： pelvic organ prolapse Anxiety Depression Mood state Surgery

Using a needle for sacrospinous ligament fixation for pelvic organ prolapse based on the Miyazaki technique

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Gynecology and Obstetrics Clinical Medicine 2022年第2期2卷 82-85页

作者： Ilnur Irekovich Musin Alfiya Galimovna Yashchuk Valentin Nikolaevich Pavlov Jianliu Wang Xiuli Sun Raisa Arkadevna Naftulovich Elena Mikhailovna Popova Federal State Budgetary Educational Institution of Higher Education Bashkir State Medical University of the Ministry of Health of the Russian Federation Lenina 3UfaRepublic of Bashkortostan450008Russia Department of Obstetrics and Gynecology Peking University People's Hospital11th Xizhimen South StreetXicheng DistrictBeijing100044China

Background:Approximately 7%of all women will require surgery to correct pelvic organ prolapse during their *** these,approximately 10%-13%will require another operation within 5 years due to recurrence of the *** in life expectancy and elderly individuals with estrogen deficiencies will mean higher rates of pelvic organ prolapse,significantly reducing the quality of life for millions of *** study introduces technologies that can help treat pelvic prolapse while reducing the rate of ***:This paper outlines how to properly perform sacrospinous ligament fixation using the Miyazaki ***:A needle was used to successfully perform a sacrospinous ligament fixation using Miyazaki's ***:Considering the Food and Drug Administration’s 2019 decision to permit surgeries with native tissue,this method can be used with sacrospinous ligament fixation as the primary treatment option for pelvic organ prolapse.

关键词： pelvic organ prolapse Sacrospinous ligament fixation Sacrocolpopexy pelvic surgery

Plasma Levels of Transforming Growth Factor-Beta 1 in Women with pelvic organ prolapse

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Open Journal of Urology 2023年第5期13卷 133-142页

作者： Kimio Sugaya Katsumi Kadekawa Katsuhiro Ashitomi Saori Nishijima Seiji Matsumoto Department of Urology Kitakami Central Hospital Okinawa Japan Southern Knights’ Laboratory Okinawa Japan Department of Urology Okinawa Kyodo Hospital Okinawa Japan Ashitomi Urologic Clinic Okinawa Japan Center for Advanced Research and Education Asahikawa Medical University Asahikawa Japan

Objective: In women with pelvic organ prolapse (POP), decreased expression of transforming growth factor-beta 1 (TGF-β1) has been shown in POP tissues. However, no studies have evaluated plasma TGF-β1 levels in patients with POP, so it is unknown whether they are also changed or not. Therefore, we compared plasma TGF-β1 levels in women with and without POP. Methods: Participants were 49 women with POP and 23 healthy control women. All participants were postmenopausal. We measured plasma TGF-β1 and compared data between patients with POP and controls, and between patients with uterine prolapse (UP, n = 19) and those with a cystocele (CC, n = 30). In addition, in patients, we assessed the POP quantification system (POP-Q) stage. Results: Plasma TGF-β1 levels were significantly lower in patients than in healthy controls. POP-Q stage was not significantly different between the UP and CC subgroups, but POP-Q stage IV was diagnosed in 63% of patients with UP and 7% of those with CC. Plasma TGF-β1 levels were significantly lower in the CC subgroup than in the UP subgroup. Conclusion: Plasma TGF-β1 is decreased in POP. It remains unclear whether the lower levels indicate a reduction in systemic TGF-β1 activity, but they can be assumed to reflect reduced TGF-β1 expression in POP tissues.

关键词： Cystocele pelvic organ prolapse Transforming Growth Factor-Beta 1 (TGF-β1) Uterine prolapse