The effect of transvaginal prolapse surgery on anorectal function

Objective: Pelvic floor dysfunction can manifest as a spectrum including anorectal dysfunction, vaginal prolapse, and urinary incontinence. Sacrospinous fixation is a procedure performed by gynecologists to treat vaginal prolapse. The present study aims to evaluate the impact of transvaginal prolapse surgery on anorectal function. Materials and Methods: We conducted a retrospective review of patients undergoing sacrospinous fixation surgery for vaginal prolapse between 2014 to 2020. Those with anorectal dysfunction who had also been evaluated by the colorectal service preoperatively and postoperatively were included for analysis. These patients were assessed with symptom-specific validated questionnaires. The effect of surgery on constipation and fecal incontinence symptoms was analyzed. Results: A total of 22 patients were included for analysis. All patients underwent transvaginal sacrospinous fixation, and 95.4% also had posterior colporrhaphy for vaginal prolapse. There were a statistically significant improvements in the Fecal Incontinence Severity Index (FISI), the St. Mark's Incontinence Score (Vaizey), the embarrassment and lifestyle components of the Fecal Incontinence Quality of Life Score, the Constipation Scoring System, the Obstructed Defecation Score, and components of the Patient Assessment of Constipation Quality of Life score. Conclusion: Transvaginal prolapse surgery leads to a favorable effect on anorectal function, with improvements in both obstructed defecation and fecal incontinence scores in this small series. (AU)

Prolapsus muqueux de l'urêtre de la petite fille: diagnostic et traitement / Girl mucosal urethral prolapse: diagnosis and treatment

Defi ned as circumferential eversion of the epithelium of the distal urethra, mucosal prolapse of the urethra occurs in the girl child. The diagnosis is clinical but may be overlooked or confused with other conditions. Treatment remains controversial. The aim was to describe the anatomical and therapeutic aspects. Methods. This was a retrospective and descriptive study over 5 years. Age, time of admission and circumstances of occurrence were analysed. Clinical aspects were based on the length of the prolapse (small less than 1 cm, medium: between 1 and 2 cm, large more than 2 cm), the colour of the prolapse and the presence or absence of bleeding. The treatment was medical (hormonal) and surgical in case of failure of hormonal treatment. The evaluation of the results was based on the occurrence of recurrence and urinary incontinence. The average follow-up was 18 months. Results. Twenty-one patients were included in the study with a mean age of 6.5 years. The mean time to onset was 12.4 days. Vulvar bleeding was the reason for consultation in n=9 patients. The prolapse was large in 12 patients, medium in 9 patients and small in 3 patients. The prolapse was violaceous in 15 patients. Medical

Suspensión alta al ligamento uterosacro con suturas permanentes en el prolapso apical: seguimiento a 24 meses / High suspension to the uterosacral ligament with permanent sutures in the apical prolapse: 24-month follow-up

Introducción: El prolapso de órganos pélvico (POP) es una patología frecuente que afecta hasta el 60% de las mujeres. La fijación alta al ligamento uterosacro (FAUS) transvaginal es una alternativa para el tratamiento del prolapso apical con buenos resultados, tiempos operatorios y de recuperación acotados, además de bajas tasas de complicaciones. Objetivo: Evaluar la tasa de éxito anatómico y subjetivo en pacientes portadoras de un prolapso apical sometidas a FAUS en el Hospital de Quilpué a 24 meses de seguimiento. Materiales y método: Se realizó un estudio retrospectivo observacional descriptivo, seleccionando a todas las pacientes sintomáticas con un prolapso apical ≥ 2 de la clasificación de POP-Q, sometidas a una FAUS entre septiembre de 2014 y octubre de 2019. Los datos fueron obtenidos desde la base de datos de la unidad de uroginecología del Hospital de Quilpué, previa aprobación del comité de ética. El éxito objetivo se definió como un punto C a 1 centímetro sobre el himen y el éxito subjetivo con una escala de impresión de mejora global del paciente (PGI-I) mejor o mucho mejor y/o una escala visual analógica (EVA) mayor al 80%, a 24 meses de seguimiento. Resultados: Se incluyeron 46 pacientes. La tasa de éxito objetivo fue del 84% y de éxito subjetivo del 70%. Conclusiones: La FAUS transvaginal con suturas permanentes es una excelente alternativa para el tratamiento del prolapso apical con una tasa de éxito similar al gold standard a 24 meses de seguimiento.

Introduction: Pelvic organ prolapse (POP) is a frequent pathology that affects up to 60% of women. Transvaginal uterosacral ligament high fixation (USLs: utero-sacral ligaments) is an alternative for the treatment of apical prolapse with good results, limited operative and recovery times, as well as low rates of complications. Objective: To evaluate the anatomical and subjective success rate in patients with an apical prolapse undergoing STALUS at the Quilpué Hospital at 24 months of follow-up. Materials and method: A descriptive observational retrospective study was carried out, selecting all symptomatic patients with an apical prolapse ≥ 2 of the POP Q classification, submitted to a FAUS between September 2014 and October 2019. The data were obtained from the database of the Urogynecology Unit of the Quilpué Hospital, prior approval of the ethics committee. Objective success was defined as a C-point 1 centimeter above the hymen and subjective success with better or much better Patient Global Impression-Improvement (PGI-I) scale and/or a greater than 80% Visual Analogue Scale (VAS), at 24 months of follow-up. Results: 46 patients were included. The objective success rate was 84% and the subjective success rate was 70%. Conclusions: The transvaginal FAUS with permanent sutures is an excellent alternative for the treatment of apical prolapse with a success rate similar to the gold standard at 24 months of follow-up.

Reproductive diseases in captive Agoutis (Dasyprocta leporina) / Doenças reprodutivas em cutias em cativeiro (Dasyprocta leporina)

Reproductive diseases have been well documented in domestic livestock such as sheep, goat, cattle and pigs. However, there is very little information on these diseases in the agouti (Dasyprocta leporina). The agouti is used for its meat in South America and the Caribbean. More recently, intensive farming of this animal is being practiced in the Neotropics. There is dearth of information on dystocia and vaginal prolapses in the agouti. This document reports on three cases of reproductive diseases in captive reared agoutis in Trinidad and Tobago. The first case was a female agouti weighing approximately 3 kg that was in the last stage of pregnancy, which was found dead in its cage. The vulva of the mother had the protruding hind-limbs of the fetus. Necroscopic evaluation of carcass revealed little fat tissue and the mother had two fetuses in the right horn of the uterus. Each fetus weighed approximately 200 g. The fetuses were well formed with fur, teeth and eyes. The placenta was attached to each fetus. The pathological findings suggested that dystocia resulted from secondary uterine inertia which was the cause of death of the adult female agouti. The second case was that of an adult female agouti weighing 2.5 kg. This female had given birth to an offspring three weeks prior and was observed to have had a vaginal prolapse. Surgery was performed and the prolapsed vagina was placed back into the pelvic cavity. Further to this intervention, the vagina prolapsed twice. Subsequent to the re-insertion of the vaginal tissue the agouti was euthanized. The third case was also that of a dystocia. However, the fetuses weighed 235 g and 165 g respectively and were in normalpresentation, posture and positioning. The fetus however was unable to pass via the vagina and was trapped in the pelvic cavity. This caused secondary uterine inertia which was the cause of death. The causes of reproductive diseases in these cases are unknown but the feeding [...].

As doenças reprodutivas têm sido bem documentadas em rebanhos domésticos, como ovinos, caprinos, bovinos e suínos. Porém, há muito pouca informação sobre essas doenças na cutia (Dasyprocta leporina). A cutia é usada como carne na América do Sul e no Caribe. Mais recentemente, a criação intensiva desse animal está sendo praticada na região neotropical. Há escassez de informações sobre distocia e prolapsos vaginais na cutia. Este documento relata três casos de doenças reprodutivas em cutias criadas em cativeiro em Trinidad e Tobago. O primeiro caso foi de uma cutia de aproximadamente 3 kg que estava na última fase de gestação, encontrada morta em sua gaiola. A vulva da mãe tinha as patas traseiras salientes do feto. A avaliação necroscópica da carcaça revelou pouco tecido adiposo e a mãe tinha dois fetos no corno direito do útero. Cada feto pesava aproximadamente 200 g. Os fetos eram bem formados com pelos, dentes e olhos. A placenta foi presa a cada feto. Os achados patológicos sugeriram que a distocia resultou de inércia uterina secundária, que foi a causa da morte da cutia adulta. O segundo caso foi ode uma cutia adulta pesando 2,5 kg. Essa fêmea deu à luz uma cria três semanas antes e foi observado que tinha prolapso vaginal. A cirurgia foi realizada e a vagina prolapsada foi colocada de volta na cavidade pélvica. Após essa intervenção, a vagina prolapsou duas vezes. Após a reinserção do tecido vaginal, a cutia foi eutanasiada. O terceiro caso também foi de distocia. No entanto, os fetos pesavam 235 g e 165 g e estavam em apresentação, postura e posicionamento normais. O feto, entretanto, não conseguiu passar pela vagina e ficou preso na cavidade pélvica. Isso causou inércia uterina secundária, que foi a causa da morte. As causas das doenças reprodutivas nesses casos são desconhecidas, mas o manejo da alimentação e o espaço concedido à cutia no final da gestação podem ser fatores contribuintes.

Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature / Manejo conservador da espondilodiscite após colpopexia sacral laparoscópica: Relato de caso e revisão da literatura

Abstract Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication.We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of imageguided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.

Resumo A colpopexia sacral é um dos procedimentos padrão para tratar o prolapso de órgãos pélvicos apical. Na maioria dos casos, uma tela sintética é usada para facilitar a colposuspensão. A espondilodiscite é uma complicação rara, mas potencialmente grave, que deve ser prontamente diagnosticada e tratada, apesar da falta de consenso no manejo dessa complicação. Relatamos um caso de espondilodiscite após histerectomia supracervical laparoscópica e colpopexia sacral tratada conservadoramente. Também apresentamos uma revisão da literatura sobre essa complicação rara. Uma abordagem conservadora sem remoção da tela pode ser possível em pacientes selecionadas (estáveis, sem lesões vaginais, exposição da tela ou comprometimento neurológico grave). Hemoculturas e cultura de biópsias guiadas por imagem devemser realizadas para direcionar a antibioticoterapia. O tratamento conservador versus o cirúrgico deve ser avaliado regularmente, dependendo da progressão clínica e analítica. Uma equipe multidisciplinar é de suma importância no acompanhamento desses pacientes.

Constipação com obstrução à saída e incontinência fecal: o tratamento de reabilitação é o caminho? Mito ou realidade / Outlet obstructed constipation and fecal incontinence: is rehabilitation treatment the way? myth or reality

ABSTRACT Pelvic floor rehabilitation aims to address perineal functional and anatomic alterations as well as thoraco-abdominal mechanic dysfunctions leading to procto-urologic diseases like constipation, fecal and urinary incontinence, and pelvic pain. They require a multidimensional approach, with a significant impact on patients quality of life. An exhaustive clinical and instrumental protocol to assess defecation disorders should include clinical and instrumental evaluation as well as several clinical/physiatric parameters. All these parameters must be considered in order to recognize and define any potential factor playing a role in the functional aspects of incontinence, constipation and pelvic pain. After such evaluation, having precisely identified any thoraco-abdomino-perineal anatomic and functional alterations, a pelvi-perineal rehabilitation program can be carried out to correct the abovementioned alterations and to obtain clinical improvement. The success of the rehabilitative process is linked to several factors such as a careful evaluation of the patient, aimed to select the most appropriate and specific targeted rehabilitative therapy, the therapist's scrupulous hard work, especially as regards the patient's emotional and psychic state, and finally the patient's compliance in undertaking the therapy itself, especially at home. These factors may deeply influence the overall outcomes of the rehabilitative therapies, ranging from "real" success to illusion "myth".

RESUMO A reabilitação do assoalho pélvico visa abordar alterações funcionais e anatômicas perineais, bem como disfunções mecânicas torácicas-abdominais que levam a doenças procto-urológicas como prisão de ventre, incontinência fecal e urinária e dor pélvica. Requerem uma abordagem multidimensional, com impacto significativo na qualidade de vida dos pacientes. Um protocolo clínico e instrumental exaustivo para avaliar os transtornos de defecação deve incluir avaliação clínica e instrumental, bem como diversos parâmetros clínicos/fisiátricos. Todos esses parâmetros devem ser considerados para reconhecer e definir qualquer fator potencial desempenhando um papel nos aspectos funcionais da incontinência, prisão de ventre e dor pélvica. Após tal avaliação, tendo identificado com precisão quaisquer alterações anatômicas e funcionais tóraco-abdomino-perineais, um programa de reabilitação pelvi-perineal pode ser realizado para corrigir as alterações acima mencionadas e obter melhora clínica. O sucesso do processo de reabilitação está ligado a diversos fatores, como uma avaliação cuidadosa do paciente, visando selecionar a terapia de reabilitação direcionada mais adequada e específica, além do trabalho árduo e escrupuloso do terapeuta, especialmente no que diz respeito ao estado emocional e psíquico do paciente e, finalmente, a conformidade do paciente em realizar a terapia em si, especialmente em casa. Esses fatores podem influenciar profundamente os resultados globais das terapias de reabilitação, que vão desde o sucesso "real" até o "mito" ilusório.

Conocimiento y cuidados de la mujer para la prevención de prolapso de órganos pelvicos / Knowledge and care of women for the prevention of pelvic organ prolapse

Las disfunciones del piso pélvico tienen unaelevada incidencia en la población femenina,dentrodeestassedestacanlospro-lapsos uterinos, de la cúpula vaginal, entero-cele, cistóceles, retóceles, la incontinencia uri-nariaylafecal.Seestimaquedel3%al6%de la población femenina desarrollará alguna de estas disfunciones en algún momento de sus vidas. Objetivo: Determinar los conocimientos y cuidados que tienen las mujeres en etapa reproductiva y no reproductiva para prevenir prolapsos de órganos pélvicos en el Centro de Salud Miguel Paz Barahona (CSMPB) de San Pedro Sula en el primer semestre del año 2018. Pacientes y métodos: Estudio cuantita-tivo, transversal, descriptivo, instrumento tipo cuestionario aplicado a mujeres en etapa re-productivaynoreproductivaenelCSMPB,du-rante el primer semestre del año 2018. Pobla-ción 1766, muestra probabilística 316mujeres. Resultados: El 55% de la población tenían en-tre20-35añosdeedad,58%norealizabaejer-cicio físico, más de 90% desconocían sobre el prolapso de órganos pélvicos y sus cuidados, 19.2%presentósignosysíntomasdeprolapso de órganos pélvicos. Conclusión: Los resul-tados señalan que la mayoría mujeres tienen poco conocimiento sobre el prolapso de órga-nospélvicosyunporcentajepresentósintoma-tología, por lo tanto, no realizan cuidados para prevenir algún tipo de prolapso en el trascurso de suvida...(AU)

Incidência de incontinência urinária DE NOVO em pacientes com prolapso em estádio avançado submetidas à correção cirúrgica via vaginal com uso de tela / Incidence of urinary incontinence AGAIN in patients with advanced prolapse undergoing vaginal surgical correction using a mesh

Introdução: O prolapso de órgão pélvico é uma condição com alta prevalência em mulheres de meia idade e com aumento gradativo da incidência conforme o envelhecimento populacional e aumento da expectativa de vida. 21,3% das mulheres irão apresentar incontinência urinária de esforço associado ao prolapso uterino. Objetivo: Avaliar a incidência de incontinência urinária DE NOVO nas pacientes submetidas a correção cirúrgica via vaginal de prolapso de órgão pélvico no Hospital Maternidade Escola Vila Nova Cachoeirinha. Métodos: Estudo Prospectivo com seguimento de 86 pacientes portadoras de prolapso de órgão pélvico em estadios III e IV submetidas a tratamento cirúrgico com uso de tela vaginal. As pacientes continentes na avaliação pré-operatória foram tratadas apenas para correção do prolapso com uso de duas telas comerciais. As pacientes com perda urinária aos esforços foram tratadas com sling de uretra média concomitante com à correção do prolapso. O seguimento foi realizado com 14 dias, 30 dias, 3 e 12 meses. A avaliação feita relaciona idade, medidas de quantificação do POP através do POP-Q, sintomas urinários e questionários de qualidade de vida relacionados a perda urinária e sintomas vaginais. Resultados:Das 86 pacientes abordadas, 56 eram continentes do pré operatório, dessas, 20,68% desenvolveram IUDN de esforço, com 66 % sendo submetidas a nova cirurgia para inserção de SLING transobturatório. No pós operatório foi encontrado redução significativa das queixas urinárias com p < 0,05, exceto para noctúria além de melhora na qualidade de vida em relação aos sintomas urinários e sintomas vaginais devido a presença de prolapso. Conclusão: No presente estudo foi observado, a partir dos dados estatísticos, que a incidência de incontinência urinária de novo em pacientes submetidas a correção cirúrgica via vaginal com tela devido a prolapso em estádio avançado foi de 20,68%.

Uterine intussusception in immediate postpartum in bitches: case report / Intussuscepção uterina no puerpério imediato em cadelas: relato de caso

Uterine intussusception is a rare condition in bitches. This study aimed to report an unusual case of prolapsed uterine intussusception in a female dog. A 2-year-old American Bully bitch was received with labor history of large fetus requiring manual traction. The animal presented mucosal prolapse through the vulva, unproductive contractions and abdominal discomfort. After partial correction of mucosal prolapse, the dog was referred to ovary-hysterectomy surgery to correct prolapsed mucosa. During the surgical procedure, surgeons observed that the uterine horns were invaginated into the uterine body, rotated, and the tissue was slightly devitalized and congested. As previously described, this condition occurred during the immediate postpartum period. Thus, we suggest that this period can be a facilitator for the establishment of uterine intussusception.(AU)

A intussuscepção uterina é uma condição rara em cadelas. Portanto, este estudo tem por objetivo relatar um caso incomum de intussuscepção uterina prolapsada em fêmea canina. Uma cadela American Bully de dois anos de idade com histórico de parto de feto absoluto grande no qual necessitou de auxílio por tração manual foi apresentada. O animal exibiu um prolapso de mucosa através da vulva, contrações improdutivas e dores abdominais. Após a retração parcial do prolapso de mucosa, a cadela foi encaminhada para a ovário-histerectomia que teve por objetivo, também, corrigir a mucosa prolapsada. Durante o procedimento cirúrgico, foram verificados os cornos uterinos invaginados no corpo uterino, rotacionados, com o tecido levemente desvitalizado e congesto. Assim, como poucos casos encontrados na literatura, esta condição ocorreu durante o puerpério imediato. Dessa forma, sugere-se que este período, embora não seja um fator determinante para o estabelecimento da intussuscepção uterina, pode ser um facilitador no estabelecimento dessa condição.(AU)

Long-term outcome (5-10 years) after non absorbable mesh insertion compared to partially absorbable mesh insertion for anterior vaginal wall prolapse repair

ABSTRACT Objective: To evaluate long-term (5-10 years) outcomes of Minimally Invasive Surgical (MIS) kit insertion with Prolift® (non-absorbable) mesh compared to the use of Prolift M® (partially absorbable), for anterior vaginal wall prolapse repair. Study design: In this retrospective study we compared women undergoing MIS kit Prolift® insertion (n=90) vs. Prolift M® insertion (n=79) for anterior vaginal wall prolapse repair between 2006 and 2012 at our Institution. A number of 169 women fulfilled the inclusion criteria and were included in the study. Results: During the study period 128 women (76%) completed full follow-up; of them 58 (73%) following MIS kit Prolift® insertion, and 70 (88%) following MIS kit ProliftM® insertion. There was no significant difference between the Prolift® and Prolift M® regarding parity (3.04 vs. 2.88, p=0.506), presence of hypertension (24.1% vs. 39.1%, p=0.088), diabetes mellitus (3.4% vs. 11.6%, p=0.109), or urinary stress incontinence (39.7% vs. 47.1%, p=0.475). All participants had been diagnosed with POP grade 3 or 4 before the procedure. No significant complications during the procedure or postoperative period were identified in the study groups. The follow-up period was at least five years in duration for both groups. Both groups were comparable according to questionnaires focused on function and satisfaction. Conclusion: Patients undergoing MIS kit Prolift® and Prolift M® insertion for anterior vaginal wall prolapse repair had comparable early and late postoperative outcomes. No differences in patient's function and satisfaction between the two groups were identified. According to our findings, there is no superiority to either of the two studied mesh devices.

Función sexual y calidad de vida relacionada con la salud en mujeres climatéricas con prolapso genital en Centros de Salud Familiar de la región de Ñuble / Sexual function and health related quality of life in climacteric women with genital prolapse in Family Health Centers of the Ñuble region

RESUMEN Introducción y objetivos: Los síntomas de climaterio junto con el prolapso genital en la mujer que envejece, afectan la función sexual y la calidad de vida relacionada con la salud. El objetivo de este estudio fue describir la función sexual y la calidad de vida relacionada con la salud en mujeres climatéricas con prolapso genital según características sociodemográficas y clínicas. Métodos: Diseño descriptivo de corte transversal, sobre una muestra consecutiva de 45 mujeres climatéricas inscritas en dos Centros de Salud Familiar de la región de Ñuble, se seleccionaron a todas aquellas entre 42 y 60 años de edad, con diagnóstico clínico o ecográfico de prolapso genital, con vida sexual activa los últimos 6 meses y sin terapia hormonal de reemplazo. Para evaluar la función sexual se aplicó el Índice de Función Sexual Femenina y para la calidad de vida relacionada con la salud el Menopause Rating Scale. Se utilizó estadística descriptiva, y para analizar la diferencia entre las variables se aplicaron las pruebas estadísticas Chi-cuadrado y Test Exacto de Fisher. En todos los casos se consideró un nivel de significancia p<0,05. Los datos fueron analizados con el software estadístico SPSS v. 23. Resultados: Se observó una diferencia estadísticamente significativa entre escolaridad y función sexual (p= 0,005) y el tipo de parto y la calidad de vida relacionada con la salud (p=0,034). Conclusiones: El nivel educacional se podría considerar como factor protector de la función sexual.

SUMMARY Introduction and objectives: The climacteric symptoms together with genital prolapse in the aging woman, affects the sexual function and the health related quality of life. The objective of this study was to describe sexual function and health related quality of life in climacteric women with genital prolapse according to sociodemographic and clinical characteristics. Methods: Descriptive cross-sectional design, on a consecutive sample of 45 climacteric women enrolled in two Family Health Centers of the Ñuble region, were selected all those between 42 and 60 years of age, with a clinical or ultrasound diagnosis of genital prolapse, with active sexual life the last 6 months and without hormone replacement therapy. To evaluate sexual function the Index of Feminine Sexual Function was applied and for the health related quality of life the Menopause Rating Scale was applied. Descriptive statistics were used, and to analyze the difference between the variables, the Chi-square and Fisher's Exact test were applied. In all cases a level of significance was considered p <0.05. The data was analyzed with the statistical software SPSS v. 23. Results: A statistically significant difference was observed between schooling and sexual function (p = 0.005) and type of delivery and health related quality of life (p = 0.034). Conclusions: The educational level could be considered as a protective factor of sexual function.

Anal position index; can it predict pelvic organ disorders in adults? / O índice de posição anal pode prever doenças de órgãos pélvicos em adultos?

ABSTRACT Introduction: Anal position index is calculated with a simple formula, which is used to determine the exact position of anus in perineum. This index is currently used only in neonates and infants. Anteriorly displacement of anus is a common cause of chronic constipation. Here we assessed the association between anal position index with patients' characteristics, chronic constipation, rectum prolapse uterine prolapse, and number of delivery. Material and methods: This was a cross-sectional study performed in 2018 on 63 adult admitted to colorectal surgery clinic. Anus-forchuette, coccyx-forchuette and coccyx-scrotum and anal-scrotum were measure by a simple meter tape. Statistical Package for the Social Sciences (SPSS for Windows, ver. 18) was used for data analysis. Independent Student's t-test, correlation coefficient and ANOVA were used. Results: Sixty-three patients within age range of 22-75 years old were recruited. 48 were male (76.2%) and 15 females (23.8%). Twenty-nine (46%) had chronic constipation. The mean ± SD of the index with confidence interval of 95% was 0.5325 ± 0.11861 in males and 0.4510 ± 0.16803 in females. Also the mean of the index was 0.4616 ± 0.14007 in patients with chronic constipation and 0.5570 ± 0.11559 in patients without constipation. Discussion: Anal position index can be a prognostic factor to predict chronic constipation and pelvic floor anatomy disturbance in adults as well as pediatrics.

RESUMO Introdução: O índice de posição anal é calculado com uma fórmula simples, usada para determinar a posição exata do ânus no períneo. Atualmente, esse índice é usado apenas em neonatos e bebês. O deslocamento anterior do ânus é uma causa comum de constipação crônica. No presente estudo, avaliou-se a associação entre o índice de posição anal e as características dos pacientes, constipação crônica, prolapso uterino, prolapso do reto e número de partos. Material e Métodos: Este estudo transversal, realizado em 2018, incluiu 63 adultos admitidos na clínica de cirurgia colorretal. As distâncias ânus-frênulo dos lábios, cóccix-frênulo, cóccix-escroto e ânus-escroto foram medidas com uma fita métrica simples. O SPSS for Windows (v. 18) foi usado para análise dos dados. O teste t de Student para variáveis independentes, o coeficiente de correlação e o teste ANOVA foram usados. Resultados: Sessenta e três pacientes com idade entre 22 a 75 anos foram recrutados; 48 eram do sexo masculino (76,2%) e 15 do sexo feminino (23,8%). Destes, 29 (46%) apresentavam constipação crônica. A média ± DP do índice, com intervalo de confiança de 95%, foi de 0,5325 ± 0,11861 no sexo masculino e 0,4510 ± 0,16803 no sexo feminino. Além disso, a média do índice foi de 0,4616 ± 0,14007 em pacientes com constipação crônica e 0,5570 ± 0,11559 em pacientes sem constipação. Discussão: O índice de posição anal pode ser um fator prognóstico para predizer constipação crônica e alterações da anatomia do assoalho pélvico em pacientes adultos e pediátricos.

Prolapso uterino neonatal: relato de dois casos clínicos em hospital universitário e uma breve revisão da literatura / Neonatal uterine prolapse: two cases reports in an university hospital and a brief review of the literature

O prolapso genital neonatal é uma condição clínica rara e na maioria das vezes associada a anomalias neurológicas. Nos últimos 50 anos, foram relatados menos de 10 casos na literatura de prolapso genital em recém-nascido sem espinha bífida ou meningomielocele (nenhum deles no Brasil), tornando tal entidade ainda mais rara em neonatos neurologicamente normais. Neste artigo relatamos dois casos clínicos de prolapso genital em neonatos prematuros neurologicamente normais. Em ambos os casos foi optado por manejo conservador com redução digital do prolapso. Foi realizada também uma breve revisão da literatura para melhor discussão sobre o tema (etiologia, diagnóstico e manejo).(AU)

Neonatal genital prolapse is a rare clinical condition and most often associated with neurological abnormalities. In the last 50 years, less than 10 cases of genital prolapse have been reported in literature in neonates without spina bifida or meningomyelocele (none of them in Brazil), making this entity even rarer in neurologically normal neonates. In this article we report two clinical cases of genital prolapse in neurologically normal preterm neonates. In both cases, conservative management with digital reduction was chosen. A brief review of the literature was also carried out to better discuss the topic (etiology, diagnosis and management).(AU)

Manchester Operation: An Effective Treatment for Uterine Prolapse Caused by True Cervical Elongation

PURPOSE: Descent of the uterus is a major etiology of uterine prolapse. However, true cervical elongation can cause uterine prolapse without uterine descent. The aim of study was to investigate the clinical outcomes of Manchester operation in patients with uterine prolapse caused by “true cervical elongation,” compared with vaginal hysterectomy (VH). MATERIALS AND METHODS: Medical records of patients who underwent Manchester operation or VH from 2006 to 2015 were reviewed. True cervical elongation was defined on the basis of C point of the Pelvic Organ Prolapse Quantification (POP-Q) system ≥0 and D point ≤−4, as well as estimated cervical length of ≥5 cm. The primary outcome was recurrence of pelvic organ prolapse (POP) evaluated by POP-Q system. The outcomes of two groups were compared after propensity score matching, for age, parity, and preoperative POP-Q stage. RESULTS: During the study period, 23 patients underwent Manchester operation and 374 patients underwent VH. The recurrence rate of POP (p=0.317) and complication rate were not statistically significant different between the two study groups. Manchester operation exhibited shorter operation time than VH (p=0.033). In subgroup analysis (POP-Q stage III), body mass index [odds ratio (OR)=1.74; 95% confidence interval (CI), 1.08–2.81] and not having concurrent anterior colporrhaphy (OR for concurrent anterior colporrhaphy, 0.06; 95% CI, 0.01–0.75) were identified as significant risk factors for recurrence of POP. CONCLUSION: The Manchester operation technique seems to be an effective and safe alternative procedure for the treatment of uterine prolapse caused by true cervical elongation, compared with VH.

Culdoplastía de Mayo o colposacropexia abdominal en la corrección del prolapso de la cúpula vaginal poshisterectomía / Mayo culdoplasty or abdominal colposacropexy in correction of post-hysterectomy vaginal vault prolapse

El objetivo de este estudio fue comparar los resultados de la culdoplastía de Mayo con la colposacropexia abdominal en la corrección del prolapso de la cúpula vaginal poshisterectomía. Se revisaron las historias clínicas de 155 pacientes con prolapso de cúpula vaginal poshisterectomía en las que se procedió a la corrección quirúrgica entre febrero 2013 y noviembre 2017. Se realizó seguimiento para evaluar la satisfacción del paciente y el resultado a largo plazo. La edad promedio de las pacientes al momento de la cirugía fue de 67,1 +/- 5,6 años y 69,0 % de las pacientes tenían antecedentes de haber sido sometidas a histerectomía abdominal. El tiempo medio entre la histerectomía y la cirugía de corrección fue de 16,9 +/- 3,6 años. Ciento diecinueve pacientes se sometieron a abordaje vaginal utilizando la técnica de culdoplastía de Mayo (grupo A) y 36 pacientes se sometieron a colposacropexia abdominal (grupo B). Durante la cirugía se produjeron tres casos (2,5 %) de lesión vesical inadvertida en el grupo A. En el grupo A se observaron 2 casos de recurrencia comparado con un solo caso en las pacientes del grupo B (p = ns). Al analizar la satisfacción de la cirugía, 84,9 % de las pacientes del grupo A y 77,7 % de las pacientes del grupo B se declararon satisfechas con los resultados quirúrgicos. Se concluye que la corrección del prolapso de la cúpula vaginal mediante colposacropexia abdominal y culdoplastía de Mayo son procedimientos seguros y efectivos.

The aim of this study was to compare the results of the Mayo culdoplasty with abdominal colposacropexy in the correction of post-hysterectomy vaginal vault prolapse. Medical records of 155 patients with post-hysterectomy vaginal vault prolapse were reviewed in which the surgical correction was carried out between February 2013 and November 2017. Follow-up was performed to evaluate the patient's satisfaction and the long-term result. The average age of the patients at the time of surgery was 67.1 +/- 5.6 years and 69.0% of the patients had a history of having undergone an abdominal hysterectomy. The mean time between hysterectomy and correction surgery was 16.9 +/- 3.6 years. One hundred and nineteen patients underwent vaginal access using the Mayo culdoplasty technique (group A) and 36 patients underwent abdominal colposacropexy (group B). During surgery there were three cases (2,5 %) of inadvertent bladder injury in group A. In group A, 2 cases of recurrence were observed compared with a single case in patients in group B (p = ns). When analyzing the satisfaction of the surgery, 84,9 % of the patients of group A and 77,7 % of the patients of group B declared themselves satisfied with the surgical results. It is concluded that the correction of vaginal vault prolapse by abdominal colposacropexy and Mayo culdoplasty are safe and effective procedures.

Correlation between the posterior vaginal wall and apex in pelvic organ prolapse

OBJECTIVE: The aim of our study is to reveal the correlation between the posterior vaginal wall and apex in pelvic organ prolapse. METHODS: We retrospectively reviewed the records of all new patient visits to a urogynecology clinic between January 2013 and December 2015. RESULTS: Four hundred five cases were enrolled in our study. When all POP stages were included, the Bp (pelvic organ prolapse quantification point) had a moderate correlation with the C (Pearson's r=0.419; P < 0.001). Cases where Bp was stage 3 and above presented strong positive correlations with C (Spearman's ρ=0.783; P < 0.001). Cases where C was stage 3 and above presented also strong positive correlations with Bp (Spearman's ρ=0.718; P < 0.001). CONCLUSION: Posterior vaginal wall prolapse and apical prolapse were correlated with each other, and this correlation was more prominent as stage increased. Therefore, when admitting a patient suspected of posterior vaginal wall prolapse or apical prolapse, it is necessary to evaluate both conditions. Especially in cases more severe or equal to stage 3, it is a must to suspect both conditions as the 2 are strongly correlated.

Colpocleisis para el tratamiento del prolapso de cúpula vaginal grave / Colpocleisis for the treatment ofadvanced vaginal vault prolapse

INTRODUCCIÓN: El prolapso de los órganos pélvicos (POP) es una condición cuya prevalencia aumenta con la edad. Es necesario que los cirujanos comprendan las indicaciones, riesgos, limitaciones y resultados de las varias técnicas quirúrgicas disponibles. En este artículo se aborda el tratamiento quirúrgico obliterativo del POP (colpocleisis y colpectomia) en base a la revisión de estudios. TÉCNICA: En la literatura son descritas muchas variaciones de las técnicas obliterativas. Con el objetivo de reglamentar la técnica para futuros estudios, describimos la técnica de LeFort modificada, realizada por los autores. Los métodos obliterativos tienen un tiempo operatório, morbilidad perioperatoria reducida y una tasa baja de recurrencia del prolapso. El índice de calidad de vida y satisfacción de la paciente son altos. CONCLUSIÓN: La literatura existente respecto a la colpocleisis es limitada por la calidad metodológica. Por tanto, no hay nivel de evidencia I o II, en lo que se refiere a la colpocleisis. Sin embargo, esta técnica debe hacer parte del arsenal terapéutico del cirujano en el abordaje de los prolapsos severos en mujeres mayores.

INTRODUCTION. The pelvic organ prolapse (POP) is a condition whose prevalence increases with age. Surgeons need to understand the indications, risks, constraints and results of various surgical techniques. This article is about obliterative surgical treatment of POP (colpocleisis and colpectomia) and it is based on the review of studies is discussed. TECHNICAL. In the literature are many variations of the techniques obliterative. In order to regulate the art for future study, we describe the technique of LeFort modified by the authors. The obliterative methods have operatory time, reduced perioperative morbidity and a low rate of recurrence of prolapse. The index ofquality oflife and patient satisfaction are high. CONCLUSION. The literature regarding the colpocleisis is limited by methodological quality. Therefore no evidence level I or II, in what concerns the colpocleisis. However, this technique should be part of the armamentarium of the surgeon in addressing severe prolapse in elderly women.

Evaluación de la calidad de vida en mujeres climatéricas con prolapso genital luego del uso del pesario / Evaluation of the quality of life in climacteric women with genital prolapse after the use of the pessary

Resumen Objetivo. Evaluar la efectividad del pesario sobre la calidad de vida y la función sexual en mujeres climatéricas con prolapso genital grado II o mayor. Material y método. Estudio analítico, observacional, de corte transversal. Se eligieron mujeres en climaterio que asistieron a consulta por prolapso genital, en la Clínica la Sagrada Familia, Armenia, Quindío, entre enero de 2009 y diciembre de 2016. Se les aplicó dos escalas para medir el grado de satisfacción con el uso del pesario: la escala Menopause Rating Scale, y el Índice de Función Sexual Femenina. Ambos cuestionarios fueron realizados antes de la inserción del pesario y luego de tres meses de uso. Resultados. La muestra la constituyeron 57 mujeres con prolapso genital de 33.177 que consultaron en ginecología, para un 0,17% de mujeres tratadas con pesario. El 36,84% presentaron prolapso grado II; 47,36%, grado III, y 15,78%, grado IV. La edad media fue 52,8±5,4 años (rango entre 48 y 78 años); la edad media de la menopausia fue 48,3±4,2 años (rango entre 45 y 51 años), destacándose la menopausia natural en la mayoría (89%). El mayor porcentaje de mujeres usuarias del pesario pertenece al grupo de edad de más de 65 años (84,21%). La puntuación media global de la escala Menopause Rating Scale, antes de la inserción del pesario fue de 18,8±4,3 puntos (rango entre 6,9±3,3 y 19,5±9,6), y 10,2±5,4 puntos (rango entre 2,7±1,2 y 7,5±4,2) después de tres meses de uso. La puntuación media total del Índice de Función Sexual Femenina, antes de la inserción del pesario, fue 16,3 ± 8,3 puntos (rango entre 8,7 y 27,9); después de tres meses de uso del pesario la puntuación media total fue 21,7± 8 puntos (rango entre 9,9 y 29,7). Los trastornos sexuales más frecuentes fueron disminución del deseo (85,2%), anorgasmia (74,7%) y dolor (65,7%), con una prevalencia global de dificultades sexuales del 81,3%. Conclusión. El uso de pesarios en mujeres con prolapso genital grado II o mayor es una terapia eficaz en la disminución de los síntomas vaginales con mejoría en la calidad de vida y la sexualidad.

Abstract Objective. To evaluate the effectiveness of the pessary on quality of life and sexual function in climacteric women with genital prolapse grade II or higher. Material and methods. Analytical, observational, cross-sectional study. Women in climacteric who attended consultation for genital prolapse were elected at the Sagrada Familia Clinic, Armenia, Quindío, between January 2009 and December 2016. Two scales were applied to measure the degree of satisfaction with the use of the pessary: the «Menopause Rating Scale¼ Scale, and the Female Sexual Function Index. Both questionnaires were carried out, before the insertion of the pessary and after three months of use. Results. The sample consisted of 57 women with genital prolapse of 33,177 who consulted in gynecology, for a 0.17% of women treated with pessary. 36.84% had prolapse grade II, 47.36% grade III and 15.78% grade IV. The mean age was 52.8 ± 5.4 years (range between 48 and 78 years); The mean age of the menopause was 48.3 ± 4.2 years (range between 45 and 51 years), with natural menopause standing out in the majority (89%). The highest percentage of women using the pessary belongs to the age group over 65 years old (84.21%). The overall average score of the «Menopause Rating Scale¼ before the insertion of the pessary was 18.8 ± 4.3 points (range between 6.9 ± 3.3 and 19.5 ± 9.6), and 10.2 ± 5.4 points (range between 2.7 ± 1.2 and 7.5 ± 4.2) after three months of use. The total mean score of the Feminine Sexual Function Index, before the insertion of the pessary was 16.3 ± 8.3 points (range between 8.7 and 27.9), after three months of use of the pessary the total average score it was 21.7 ± 8 points (range between 9.9 and 29.7). The most frequent sexual disorders were desire decrease (85.2%), anorgasmia (74.7%) and pain (65.7%), with an overall prevalence of sexual difficulties of 81.3%. Conclusion. The use of pessaries in women with genital prolapse grade II or greater is an effective therapy in the reduction of vaginal symptoms with improvement in quality of life and sexuality.

Treatment of Anterior Vaginal Wall Prolapse Using Transvaginal Anterior Mesh With Apical Fixation: A Prospective Multicenter Study With up to 2 Years of Follow-up / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the safety and efficacy of a surgical polypropylene mesh for correction of anterior vaginal prolapse, with or without apical defects, by providing simultaneous reinforcement at the anterior and apical aspects of the vagina with a single-incision approach. METHODS: This was a prospective, multicenter, single-arm study involving women with baseline stage ≥2 anterior and/or apical vaginal wall prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system. The primary endpoint was defined as achievement of POP-Q stage ≤1 status. Additionally, patient-reported outcomes were assessed using the International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS). The device under evaluation was Calistar A, which is fixed posteriorly to the sacrospinous ligaments with a novel tissue-anchoring system (TAS) and anteriorly to the obturator internus muscles. Postoperative follow-ups were scheduled at 7 days and at 6, 12, and 24 months. RESULTS: Ninety-seven women were treated and assessed for the primary outcome. They were followed for up to 2 years (n=43), with a median of 12 months. Objective cure was achieved in 86 of the 97 patients (88.7%) (P < 0.0005). The mean reduction in the ICIQ-VS scores was in the range of 70%–90% for every time point (P < 0.05). No bleeding or surgical revision was reported. Mesh exposure occurred in 7 patients (7.2%), urinary retention in 5 (5.2%), de novo dyspareunia in 3 (3.1%), and urinary tract infections in 7 (7.2%). CONCLUSIONS: This midterm follow-up showed that apical and anterior vaginal reinforcement with a polypropylene implant fixed with a TAS provided good anatomical correction, with no major complications.