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Editorial Structuring reconstruction surgery in pelvic organ prolapse surgeryby Andri Nieuwoudt

Cover pelviperineologyThe two groups of patients most neglected in prolapse surgery are the very young women with prolapse and the patient who had a suboptimal result after prolapse surgery. The reason why any gynecologist is not keen to operate on the young woman with symptomatic prolapse is the awareness that the repair gives not only poor long term results, but also results in tissue damage. The patient who had had previous surgery, with a suboptimal result, creates a dilemma for the surgeon: the footprint of the previous surgery makes assessing difficult, and the re-do surgery is difficult due to tissue scarring and removal of tissue with the primary surgery. Success in addressing the prolapse is also less guaranteed with repetitive surgery. The use of synthetic materials in the vaginal wall of a young patient is for obvious reasons not an option, and in a patient with suboptimal result a challenge for repeat surgery. [More]

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Original Article What Is the Correlation Between Pelvic Organ Prolapse and Quality of Life? Clinical Validation of the Pelvic Organ Prolapse Quantification Index (Pop-Q-I)by Nucélio Luiz De Barros Moreira Lemos, Ana Luiza Antunes Faria, Jacqueline Leme Lunardelli, Silvia Da Silva Carramão, Gil Kamergorodsky, Jeffrey E. Korte

CorrelationStandardization of pelvic organ prolapse (POP) classification has been a major issue in the literature during recent decades. Much of these efforts were based on the need for a uniform method to assess anatomical outcomes in POP research. Taking part on these efforts, we have proposed the Pelvic Organ Prolapse Quantification Index (POP-Q-I), which quantifies the prolapse as a standardized continuous variable, in which 0 means completely absent prolapse, while 1 reflects complete vaginal eversion. This standardized quantification makes anatomical outcomes variables statistically more powerful and optimizes research. The POP-Q-I was validated at our center in a blinded prospective randomized study, showing good inter-observer correlation.  [More]

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Original Article Bilateral Iliococcygeus Fixation Technicque for Enterocele and Vaginal Vault Prolapse Repairby Haim Krissi, Stuart L Stanton

Bilateral IliococcygeusThe exact incidence of post-hysterectomy vaginal vault prolapse is unknown, with rates ranging from 0.2% to 43%. Many abdominal, vaginal and laparoscopic techniques have been described to correct this condition.The vaginal approach has a swifter and less painful recovery. The most common vaginal techniques are sacrospinous fixation (SSF) and uterosacral suspension (USS). Iliococcygeus fixation (ICF) is an alternative vaginal technique for vault prolapse and enterocele repair first described by Inmon in 1963. The aim of this study was to describe our experience with iliococcygeus fixation (ICF) technique. [More]

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Case Report What’S Falling Down?by Marco Soligo, Antonello Corbo, Claudio Beati, Sarah Montefusco, Maria Cristina Cesana, Carla Raviolo

Vaginal eviscerationVaginal evisceration is a rare condition, mainly reported after previous hysterectomy in postmenopausal women even though it is sporadically reported in women without previous pelvic surgery. It is commonly considered that the cornerstone in the management of this rare and potentially life threatening condition is a quick diagnosis and prompt surgical intervention. Some debate can be reserved for the most appropriate surgical approach. [More]

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Original ArticleThe Presence and Location of Estrogen And Progesterone Receptors in the Human Pelvic Cardinal Ligamentsby Haim Krissi, Reuvit Halperin, Rumelia Koren, Yoav Peled

Complex pelvic problemsPelvic organ prolapse and urinary stress incontinence are major problems affecting quality of life in a vast number of women. The etiology is most probably multifactorial, with a major contribution of muscular denervation during vaginal delivery, genetic factors, and the aging process. The higher prevalence of pelvic organ prolapse and urine incontinence in the postmenopausal period suggests that the hypo-estrogenic state might play an important role in their appearance. To prove a role for sex hormones in pelvic support, one of the first steps would be to find evidence of sex hormone receptors in these tissues. The presence of estrogen and progesterone receptors has been already established in the sacrouterine ligaments and levator-ani muscles. However, a thorough search of the English literature yielded no such studies about the cardinal ligaments, which are the most important ligaments that support the uterus. The aim of this study was to assess the presence and location of estrogen and progesterone receptors in the cardinal ligaments.  [More]

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ReviewRetropubic, Transobturator and Intraobturator Tape Procedures: How, When And Whyby Francesco Bernasconi

urinary incontinence on quality of lifeStress urinary incontinence (SUI) is a highly prevalent symptom that has been estimated to be among the top ten medical problems of adult women. Worldwide about 200 millions women suffer of urinary incontinence (UI) (2-3 millions in England, 10-12 in the USA and 3 millions in Italy). In Thelma Thomas’ epidemiological survey, one of the most frequently cited article in literature, prevalence of UI varies, based on population age, from 4.5% to 37%, with an average of 18%. These data are confirmed in subsequent epidemiological studies also at a national level. Although not life-threatening, SUI may seriously impair the physical, psychological, and social wellbeing of the affected patients. Several procedures have been proposed for the surgical treatment of SUI, both in the hypermobility associated kind (type I-II) and in the Intrinsic Sphinteric Deficiency kind (ISD type III), as described by Blaivas and Olsson in 1988. [More]

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Original ArticleReduction of External Anal Mucosal Prolapse with Circular Staplerby Christian Rushfeldt, Stig Norderval, Barthold Vonen

reduction external anal mucosal prolapseExternal anal mucosal prolapse (EAMP) is characterized by protrusion of the anal mucosa distal to the anal verge. The external component of the prolapse may be present only during defecation or straining, spontaneously or as a permanent, non-reducible condition. Common symptoms are bleeding, pain, itching, a feeling of obstructive defecation and secretion of mucus. A common treatment is rubber band ligations, but the Milligan-Morgan haemorrhoidectomy technique for excision of the redundant mucosa is by most considered the gold standard. Band ligation is associated with recurrences, pain and bleeding1 and Milligan- Morgans technique with significant postoperative pain, anal incontinence and other complications.  [More]

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Original ArticlePtq™ Bulking Agent Injection for the Treatment of Fecal Incontinence: Qol and Manometric Evaluationby Francesco Guerra, Francesco Velluti, Daniele Crocetti, Filippo La Torre

Complex pelvic problemsFecal incontinence (FI) is a distressing and socially debilitating symptom which causes the patient to gradually abandon all forms of social, family and working relationships. FI exists along a wide spectrum of variable complaints going from soiling of underclothes or flatus incontinence to complete loss of control of bowel emptying. In many cases, patients feel so inhibited and are so afflicted by this condition that they are reluctant to discuss the problem with a physician and FI is probably therefore an underestimated disease. The calculated prevalence of FI is between 0.5% and 18.4% in non-institutionalized adults, 32% in the geriatric population and 56% in elderly people with psychiatric disorders. Medical treatment should be offered in all cases. Conservative treatment, such as dietary changes and pelvic rehabilitation is reported to be effective in 65-70% of cases. In those patients who do not benefit from conservative treatment, a surgical approach must be proposed. Injection of bulking agents, already used in the treatment of urinary incontinence, has been proposed recently as a substitute for surgical treatment of anal incontinence.
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Original ArticleAggressive Angiomyxoma Mimicking Cervical Polypby Elisavet Paplomata, Asterios Fotas, Dimitrios Balaxis, Theodoros Filindris, Stavros Charalambous, Vasileios Rombis

angiomyxomaAggressive angiomyxoma is a mesenchymal tumor initially first described in 1983. It typically appears as a soft tissue mass of the pelvis and perineum in women of reproductive age. Its differential diagnosis includes myxoma, myxoid liposarcoma, sarcoma botryoides, and other soft tissue tumors with secondary myxoid changes. We present a rare case of aggressive angiomyxoma of the uterine cervix, clinically simulating a pedunculated cervical polyp.  [More]

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Pelvic Floor Digest March 2010 Issue Pelvic Floor Digest read_pdf [97kb]

pelvic floor digestThis section presents a small sample of the Pelvic Floor Digest (December 2009), an online publication (www.pelvicfloordigest.org) that reproduces titles and abstracts from over 200 journals. The goal is to increase interest in all the compartments of the pelvic floor and to develop an interdisciplinary culture in the reader. 

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