Massive Eversion of the Vagina: Pathogenesis, Diagnosis, and Therapy of the ???True??? Prolapse of the Vaginal Stump

Richter, K

doi:10.1097/00003081-198212000-00024

Cited by 73 publications

(33 citation statements)

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“…18,19 Moreover, prolapse can occur even when the uterine ligaments are spared (ie, supracervical hysterectomy). 20 Rather, our data suggest that the indication for hysterectomy (ie, pelvic organ prolapse) is a more important risk factor for a subsequent PFR.…”

Section: Commentmentioning

confidence: 99%

Incidence of pelvic floor repair after hysterectomy: A population-based cohort study

Blandon

Bharucha

Melton

et al. 2007

American Journal of Obstetrics and Gynecology

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OBJECTIVE-The objective of the study was to assess the incidence of and risk factors for pelvic floor repair (PFR) procedures after hysterectomy. RESULTS-The cumulative incidence of PFR after hysterectomy was 5.1% by 30 years. This risk was not influenced by age at hysterectomy or calendar period. Future PFR was more frequently required in women who had prolapse, whether they underwent a hysterectomy alone (eg, vaginal [hazard ratio (HR) 4.3; 95% confidence interval (CI) 2.5 to 7.3], abdominal [HR 3.9; 95% CI 1.9 to 8.0]) or a hysterectomy and PFR (ie, vaginal [HR 1.9; 95% CI 1.3 to 2.7] or abdominal [HR 2.9; 95% CI 1.5 to 5.5]). STUDY DESIGN-UsingCONCLUSION-Compared with women without prolapse, women who had a hysterectomy for prolapse were at increased risk for subsequent PFR. Keywords epidemiology; posthysterectomy; prolapse; risk factors Pelvic organ prolapse is common and a major indication for gynecologic surgery in the United States. It is estimated that United States women have an 11% lifetime risk of surgery for prolapse or incontinence. 1 Indeed, approximately 200,000 operations for prolapse are performed annually in this country, with a cost exceeding $1 billion. 2,3 Consequently, it is important to identify the factors that contribute to this problem to improve on both its prevention and treatment. Several risk factors have been proposed to initiate, aggravate, or contribute to decompensation in pelvic organ prolapse. 4 These include increasing age, higher gravidity and parity, obesity, conditions associated with increased intraabdominal pressure (eg, constipation), and prior hysterectomy. 1,5,6 The latter is particularly important because hysterectomy is second only to cesarean section as the most frequently performed major operation among women in this country 7 and because it has been estimated that up to one-third of operations for pelvic organ prolapse are repeat procedures. 1

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Section: Commentmentioning

confidence: 99%

Incidence of pelvic floor repair after hysterectomy: A population-based cohort study

Blandon

Bharucha

Melton

et al. 2007

American Journal of Obstetrics and Gynecology

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“…These severe complications were reported as being rare in large series published [10,11]. Postoperative intussusception and massive evisceration have been reported [2,12].…”

Section: Discussionmentioning

confidence: 99%

Sacrospinous Fixation for the Prolapsed Vaginal Vault

Özcan

Güngör²,

Ekin³

et al. 1999

Gynecol Obstet Invest

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In 54 patients, transvaginal sacrospinous ligament fixation procedures were reviewed retrospectively. The mean operation time was 15 (12–45) min. The mean blood loss was 126 (110–175) cm³. The only intraoperative complication was a rectal laceration that was repaired primarily. The mean duration of follow-up was 28 (4–54) months. There were only 2 recurrent vaginal vault prolapses. There were 3 cases of cystocele (5.5%), 1 case of rectocele (1.8%), 5 cases of enterocele (9.2%), 3 cases of stress incontinence (5.5%), and 5 cases of dysparonia (9.2%). Sacrospinous ligament fixation can be used as an alternative treatment to vaginal hysterectomy in aged women with medical problems and young women suffering from genital descent with infertility. The procedure has the advantage of avoiding laparatomy, facilitating other vaginal repairs needed during the same operation, preserving vaginal function and shortening the time necessary for anesthesia and surgery.

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“…The incidence of vaginal vault prolapse after hysterectomy has been estimated to be 2.0-3.6/1000 women years [3,4]. This risk increases from 1% at 3 years to 5% at 15 years after surgery [5].…”

Section: Hysterectomymentioning

confidence: 99%