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[PMID]:27778256
[Au] Autor:Youssef M; Emile SH; Thabet W; Elfeki HA; Magdy A; Omar W; Khafagy W; Farid M
[Ad] Endereço:General Surgery Department, Colorectal Surgery Unit, Mansoura Faculty of Medicine, Mansoura University Hospitals, El Gomhuoria Street, Mansoura City, Dakahlia Providence, Egypt.
[Ti] Título:Comparative Study Between Trans-perineal Repair With or Without Limited Internal Sphincterotomy in the Treatment of Type I Anterior Rectocele: a Randomized Controlled Trial.
[So] Source:J Gastrointest Surg;21(2):380-388, 2017 02.
[Is] ISSN:1873-4626
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND AIM: Two types of rectocele exist; type I is characterized by relatively high resting anal pressures, whereas type II has lower resting anal pressures with associated pelvic organ prolapse. We compared trans-perineal repair (TPR) of rectocele with or without limited internal sphincterotomy (LIS) in the treatment of type I anterior rectocele. PATIENTS AND INTERVENTIONS: Consecutive patients with anterior rectocele were evaluated for inclusion. Sixty-two female patients with type I anterior rectocele were randomized and equally allocated to receive TPR alone (group I) or TPR with LIS (group II). The primary outcome was the clinical improvement of constipation. Secondary outcomes were recurrence of rectocele, operative time, and postoperative complications including fecal incontinence (FI). RESULTS: Clinical improvement of constipation and patients' satisfaction were significantly higher in group II at 1 year of follow-up (93.3 versus 70 %). Constipation scores significantly decreased in both groups postoperatively with more reduction being observed in group II (11.1 ± 2.1 in group I versus 8 ± 1.97 in group II). Significant reduction in the resting anal pressure was noticed in group II. Recurrence was recorded in three (10 %) patients of group I and one patient of group II. No significant differences between the two groups regarding the operative time and hospital stay were noted. CONCLUSION: Adding LIS to TPR of type I rectocele achieved better clinical improvement than TPR alone. The only drawback of LIS was the development of a minor degree of FI, which was temporary in duration.
[Mh] Termos MeSH primário: Esfincterotomia Lateral Interna
Períneo/cirurgia
Retocele/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Constipação Intestinal/etiologia
Constipação Intestinal/prevenção & controle
Incontinência Fecal/etiologia
Incontinência Fecal/prevenção & controle
Feminino
Seres Humanos
Tempo de Internação
Meia-Idade
Duração da Cirurgia
Satisfação do Paciente
Complicações Pós-Operatórias/prevenção & controle
Retocele/complicações
Recidiva
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180102
[Lr] Data última revisão:
180102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1007/s11605-016-3299-4


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[PMID]:28582460
[Au] Autor:Giri A; Hartmann KE; Aldrich MC; Ward RM; Wu JM; Park AJ; Graff M; Qi L; Nassir R; Wallace RB; O'Sullivan MJ; North KE; Velez Edwards DR; Edwards TL
[Ad] Endereço:Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
[Ti] Título:Admixture mapping of pelvic organ prolapse in African Americans from the Women's Health Initiative Hormone Therapy trial.
[So] Source:PLoS One;12(6):e0178839, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Evidence suggests European American (EA) women have two- to five-fold increased odds of having pelvic organ prolapse (POP) when compared with African American (AA) women. However, the role of genetic ancestry in relation to POP risk is not clear. Here we evaluate the association between genetic ancestry and POP in AA women from the Women's Health Initiative Hormone Therapy trial. Women with grade 1 or higher classification, and grade 2 or higher classification for uterine prolapse, cystocele or rectocele at baseline or during follow-up were considered to have any POP (N = 805) and moderate/severe POP (N = 156), respectively. Women with at least two pelvic exams with no indication for POP served as controls (N = 344). We performed case-only, and case-control admixture-mapping analyses using multiple logistic regression while adjusting for age, BMI, parity and global ancestry. We evaluated the association between global ancestry and POP using multiple logistic regression. European ancestry at the individual level was not associated with POP risk. Case-only and case-control local ancestry analyses identified two ancestry-specific loci that may be associated with POP. One locus (Chromosome 15q26.2) achieved empirically-estimated statistical significance and was associated with decreased POP odds (considering grade ≥2 POP) with each unit increase in European ancestry (OR: 0.35; 95% CI: 0.30, 0.57; p-value = 1.48x10-5). This region includes RGMA, a potent regulator of the BMP family of genes. The second locus (Chromosome 1q42.1-q42.3) was associated with increased POP odds with each unit increase in European ancestry (Odds ratio [OR]: 1.69; 95% confidence interval [CI]: 1.28, 2.22; p-value = 1.93x10-4). Although this region did not reach statistical significance after considering multiple comparisons, it includes potentially relevant genes including TBCE, and ACTA1. Unique non-overlapping European and African ancestry-specific susceptibility loci may be associated with increased POP risk.
[Mh] Termos MeSH primário: Cistocele/genética
Locos de Características Quantitativas
Característica Quantitativa Herdável
Retocele/genética
Prolapso Uterino/genética
[Mh] Termos MeSH secundário: Actinas/genética
Afroamericanos
Idoso
Índice de Massa Corporal
Estudos de Casos e Controles
Cistocele/diagnóstico
Cistocele/patologia
Grupo com Ancestrais do Continente Europeu
Feminino
Proteínas Ligadas por GPI/genética
Expressão Gênica
Seres Humanos
Modelos Logísticos
Meia-Idade
Chaperonas Moleculares/genética
Proteínas do Tecido Nervoso/genética
Razão de Chances
Paridade
Retocele/diagnóstico
Retocele/patologia
Fatores de Risco
Índice de Gravidade de Doença
Estados Unidos
Prolapso Uterino/diagnóstico
Prolapso Uterino/patologia
Saúde da Mulher
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Actins); 0 (GPI-Linked Proteins); 0 (Molecular Chaperones); 0 (Nerve Tissue Proteins); 0 (RGMA protein, human); 0 (TBCE protein, human)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170606
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0178839


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[PMID]:28534327
[Au] Autor:Chen L; Meng F; Zhang T; Liu Y; Sha S; Chen S; Tai J
[Ti] Título:[Modified stapled transanal rectal resection combined with perioperative pelvic floor biofeedback therapy in the treatment of obstructed defecation syndrome].
[So] Source:Zhonghua Wei Chang Wai Ke Za Zhi;20(5):514-518, 2017 May 25.
[Is] ISSN:1671-0274
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:OBJECTIVE: To investigate the clinical efficacy and safety of modified stapled transanal rectal resection (STARR) combined with perioperative pelvic floor biofeedback therapy (POPFBFT) in treating obstructed defecation syndrome (ODS). METHODS: Thirty female ODS patients underwent modified STARR (resection and suture was performed in rectocele with one staple) combined with POPFBFT in Department of Colorectal and Anal Surgery, The First Hospital of Jilin university from October 2013 to March 2015. Before the modified STARR, patients received a course of POPFBFT (20 min/time, 2 times/d, 10 times as a course), and another 2 courses were carried out in clinic after discharge. Efficacy evaluation included general conditions of patients, morbidity of postoperative complication, overall subjective satisfaction (excellent: without any symptoms; good: 1 to 2 times of laxatives per month and without the need of any other auxiliary defecation; fairly good: more than 3 times of laxatives per month ; poor: with no improvement; excellent, good, fairly good are defined as effective), Longo ODS score (range 0 to 40 points, the higher the score, the more severe the symptoms), gastrointestinal quality of life index(GIQLI)(range 0 to 144 points, the lower the score, the more severe the symptoms), anorectal manometry and defecography examination. The follow-up lasted 12 months after operation (ended at April 2016). RESULTS: Average age of 30 patients was 57(46 to 72) years and Longo ODS score of every patient was ≥9 before operation. The modified STARR was completed successfully in all the 30 patients with average operation time of 25 (18 to 34) min and average hospital stay of 6(4 to 9) d. Postoperative complications included pain(20%, 6/30), urinary retention (16.7%, 5/30), anorectal heaviness (6.7%, 2/30), and fecal urgency(26.7%, 8/30). Anaorectal heaviness and fecal urgency disappeared within 3 months. No severe complications, such as postoperative bleeding, infection, rectovaginal fistula, anastomotic dehiscence and anal incontinence were observed. The effective rate of overall subjective satisfaction was 93.3%(28/30) during the follow-up of 12 months. There was no significant difference in Longo ODS score between pre- POPFBFT and pre-operation (pre- POPFBFT: 32.95±3.22, pre-operation: 32.85±3.62, t=1.472, P=0.163). Compared with pre-POPFBFT, Longo ODS score at 1 week after operation decreased (t=4.306, P=0.000), moreover, score at 1 month after operation was lower than that at 1 week (13.05±7.49 vs. 15.00±7.17, t=7.322, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation (F=2.111, P=0.107). Likewise, there was no significant difference in GIQLI score between pre-POPFBFT and pre-operation (pre-POPFBFT: 79.39±17.14, pre-operation: 76.65±17.56, t=1.735, P=0.096). Compared with the pre-POPFBFT, GIQLI score at 1 week after operation increased (t=4.714, P=0.000), moreover, GIQLI score at 1 month after operation was higher than that at 1 week (102.26±19.24 vs 91.31±21.35, t=5.628, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation(F=1.211, P=0.313). In comparison with pre- POPFBFT, parameters of defecography examination at 12 months after operation showed obvious improvement: the rectocele decreased from (34.1±0.4) mm to (3.1±0.3) mm (t=6.847, P=0.000), anorectal angle during defecation increased from (123.8±6.7)degree to (134.7±8.5)degree, enlargement of anorectal angle during defecation increased from (29.1±3.5)degree to (37.1±5.3)degree, while no significant differences in descend of perineum, anorectal angles at rest as well as parameters of anorectal manometry were found (all P>0.05). CONCLUSION: Modified STARR combined with POPFBFT is safe and effective for ODS patients.
[Mh] Termos MeSH primário: Canal Anal/cirurgia
Biorretroalimentação Psicológica/fisiologia
Constipação Intestinal/reabilitação
Constipação Intestinal/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/métodos
[Mh] Termos MeSH secundário: Idoso
Defecação
Defecografia
Procedimentos Cirúrgicos do Sistema Digestório/reabilitação
Feminino
Seres Humanos
Tempo de Internação
Meia-Idade
Duração da Cirurgia
Dor Pós-Operatória/etiologia
Diafragma da Pelve/fisiologia
Complicações Pós-Operatórias
Qualidade de Vida
Retocele
Grampeamento Cirúrgico
Técnicas de Sutura
Resultado do Tratamento
Retenção Urinária/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170524
[St] Status:MEDLINE


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[PMID]:28364872
[Au] Autor:Cagnacci A; Palma F; Napolitano A; Xholli A
[Ad] Endereço:Department of Obstetrics, Gynaecology and Paediatrics, Azienda Policlinico of Modena, Modena, Italy. Electronic address: angelo.cagnacci@uniud.it.
[Ti] Título:Association between pelvic organ prolapse and climacteric symptoms in postmenopausal women.
[So] Source:Maturitas;99:73-78, 2017 May.
[Is] ISSN:1873-4111
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate whether climacteric symptoms are related to pelvic organ prolapse (POP) in postmenopausal women. STUDY DESIGN: A cross-sectional investigation was performed on 1382 postmenopausal women attending an outpatient service for menopause at a university hospital. MAIN OUTCOME MEASURES: Data regarding climacteric symptoms, as captured by the Greene Climacteric Scale, and objective POP were retrieved from an electronic database. Additional data retrieved were age, anthropometric measures, personal and reproductive history, use of medication or drugs, coffee, smoking, state of anxiety (STAI scale score) and depression (Zung scale score). RESULTS: The score of Greene Climacteric Scale was higher (p=0.02) in women with (n=538) than in those without (n=844) POP (29.6±13.6 vs. 27.8±13.; p=0.02). In multiple logistic regression models, the score was independently related to POP as a whole (OR 1.012; 95%CI 1.003,1.022; p=0.009), and to bladder prolapse (OR 1.011; 95%CI 1.007,1.07; p=0.02) or to uterus prolapse (OR 1.003; 95%CI 0.99,1.016; p=0.63) or rectum prolapse (rectocele) (OR 1.004; 95%CI 0.988,1.02; p=0.62). CONCLUSIONS: In postmenopausal women, a higher burden of climacteric symptoms, is associated with POP. Underlying mechanisms were not assessed and deserve further investigation.
[Mh] Termos MeSH primário: Ansiedade/epidemiologia
Depressão/epidemiologia
Fogachos/epidemiologia
Menopausa
Prolapso de Órgão Pélvico/epidemiologia
Saúde Reprodutiva
[Mh] Termos MeSH secundário: Ansiedade/psicologia
Café
Estudos Transversais
Cistocele/epidemiologia
Depressão/psicologia
Escolaridade
Feminino
Fogachos/psicologia
Seres Humanos
Histerectomia
Modelos Logísticos
Meia-Idade
Análise Multivariada
Pós-Menopausa
Retocele/epidemiologia
Fatores de Risco
Fumar/epidemiologia
Prolapso Uterino/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Coffee)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170602
[Lr] Data última revisão:
170602
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170403
[St] Status:MEDLINE


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[PMID]:28155202
[Au] Autor:Houman J; Weinberger JM; Eilber KS
[Ad] Endereço:Urology Resident, Cedars-Sinai Health System, 8631 West 3rd Street, Suite 930E, Los Angeles, CA, 90048, USA.
[Ti] Título:Native Tissue Repairs for Pelvic Organ Prolapse.
[So] Source:Curr Urol Rep;18(1):6, 2017 Jan.
[Is] ISSN:1534-6285
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Pelvic organ prolapse (POP) is a generalized term that refers to prolapse of any of the three vaginal compartments: anterior (cystocele), posterior (rectocele), and apical (uterine and vault prolapse). POP may affect up to 50% of parous women, and as a result, one in nine women will undergo at least one surgery for POP in her lifetime. Native tissue repair is the cornerstone of prolapse surgery, especially in light of the scrutiny placed on the use of mesh for prolapse. Refinements in the procedures over time have been based on both basic anatomy and fundamentals of surgery, as well as the ongoing acquisition of new knowledge through clinical studies.
[Mh] Termos MeSH primário: Prolapso de Órgão Pélvico/cirurgia
[Mh] Termos MeSH secundário: Cistocele/cirurgia
Feminino
Procedimentos Cirúrgicos em Ginecologia/métodos
Seres Humanos
Retocele/cirurgia
Resultado do Tratamento
Vagina/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1702
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170204
[St] Status:MEDLINE
[do] DOI:10.1007/s11934-017-0648-0


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[PMID]:28146137
[Au] Autor:Shi Y; Yu Y; Zhang X; Li Y
[Ad] Endereço:Department of Colorectal Surgery, Tianjin Union Medicine Center, Tianjin, China (mainland).
[Ti] Título:Transvaginal Mesh and Transanal Resection to Treat Outlet Obstruction Constipation Caused by Rectocele.
[So] Source:Med Sci Monit;23:598-605, 2017 Feb 01.
[Is] ISSN:1643-3750
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND The aim of this study was to evaluate the curative effect of transvaginal mesh repair (TVMR) and stapled transanal rectal resection (STARR) in treating outlet obstruction constipation caused by rectocele. MATERIAL AND METHODS Patients who had outlet obstruction constipation caused by rectocele were retrospectively analyzed and 39 patients were enrolled the study. Patients were assigned to either the TVMR or STARR group. Postoperative factors such as complications, pain, recurrence rate, and operative time were compared between the 2 groups. RESULTS Total effective rate was 100% in both groups. No long-term chronic pain occurred and discomfort rate of tenesmus was higher in the STARR group than in the TVMR group. Postoperative defecography showed that the rectocele depth was significantly reduced, and the prolapse of the rectal mucosa and the lower rectal capacity was also decreased. Four cases had mesh exposure in the TVMR group and 2 cases in the STARR group had anastomotic bleeding after the surgery. CONCLUSIONS For outlet obstruction constipation caused by rectocele, TVMR and STARR both obtained satisfactory results. Although TVMR is complex with longer operative time and hospitalization period, its long-term effect is better than that of STARR.
[Mh] Termos MeSH primário: Constipação Intestinal/cirurgia
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Obstrução Intestinal/cirurgia
Retocele/fisiopatologia
Retocele/cirurgia
Telas Cirúrgicas
[Mh] Termos MeSH secundário: Idoso
Canal Anal/cirurgia
Constipação Intestinal/complicações
Defecografia
Feminino
Seres Humanos
Meia-Idade
Duração da Cirurgia
Complicações Pós-Operatórias
Estudos Prospectivos
Reto/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170601
[Lr] Data última revisão:
170601
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170202
[St] Status:MEDLINE


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[PMID]:28059914
[Au] Autor:Fu CW; Stevenson AR
[Ad] Endereço:1 Department of Colorectal Surgery, Singapore General Hospital, Singapore 2 Department of Colorectal Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia 3 Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia.
[Ti] Título:Risk Factors for Recurrence After Laparoscopic Ventral Rectopexy.
[So] Source:Dis Colon Rectum;60(2):178-186, 2017 Feb.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Laparoscopic ventral rectopexy effectively treats posterior compartment prolapse. However, recurrence after laparoscopic ventral rectopexy is poorly understood. OBJECTIVE: This study aimed to evaluate factors contributing to recurrence after laparoscopic ventral rectopexy. DESIGN: A retrospective cohort analysis was performed of patients who underwent laparoscopic ventral rectopexy between June 2008 and June 2014. Patients presenting with full-thickness rectal prolapse were compared against the rest. Cox proportional hazards regression was used to determine predictors for recurrence. Operative findings of redo cases were evaluated. SETTINGS: This study was conducted under the supervision of a single pelvic floor surgeon. PATIENTS: A total of 231 patients with a median follow-up of 47 months were included. MAIN OUTCOME MEASURES: Clinicopathological risk factors and technical failures contributing to recurrence were analyzed. RESULTS: The overall recurrence rate was 11.7% (n = 27). Twenty-five recurrences occurred in patients with full-thickness rectal prolapse, of which 16 were full-thickness recurrences (14.2% (16/113)). Multivariate analyses showed predictors for recurrence to be prolonged pudendal nerve terminal motor latency (HR = 5.57 (95% CI, 1.13 - 27.42); p = 0.04) and the use of synthetic mesh as compared with biologic grafts (HR = 4.24 (95% CI, 1.27-14.20); p = 0.02). Age >70 years and poorer preoperative continence were also associated with recurrence on univariate analysis. Technical failures contributing to recurrence included mesh detachment from the sacral promontory and inadequate midrectal mesh fixation. LIMITATIONS: Modifications to the operative technique were made throughout the study period. A postoperative defecating proctogram was not routinely performed. CONCLUSIONS: Recurrence after laparoscopic ventral rectopexy is multifactorial, and risk factors are both clinical and technical. The use of biologic grafts was associated with lower recurrence as compared with synthetic mesh. Patients with full-thickness rectal prolapse who are elderly, have poorer baseline continence, and have prolonged pudendal nerve terminal motor latency are at increased risk of recurrence.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos do Sistema Digestório
Intussuscepção/cirurgia
Prolapso Retal/cirurgia
Retocele/cirurgia
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Incontinência Fecal/fisiopatologia
Feminino
Seres Humanos
Laparoscopia
Meia-Idade
Análise Multivariada
Modelos de Riscos Proporcionais
Nervo Pudendo/fisiopatologia
Doenças Retais/cirurgia
Prolapso Retal/fisiopatologia
Recidiva
Reoperação
Estudos Retrospectivos
Fatores de Risco
Índice de Gravidade de Doença
Telas Cirúrgicas/utilização
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170107
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000710


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[PMID]:27886434
[Au] Autor:Hainsworth AJ; Solanki D; Hamad A; Morris SJ; Schizas AM; Williams AB
[Ad] Endereço:The Pelvic Floor Unit, Guy's and St Thomas' Hospital, London, UK.
[Ti] Título:Integrated total pelvic floor ultrasound in pelvic floor defaecatory dysfunction.
[So] Source:Colorectal Dis;19(1):O54-O65, 2017 Jan.
[Is] ISSN:1463-1318
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: Imaging for pelvic floor defaecatory dysfunction includes defaecation proctography. Integrated total pelvic floor ultrasound (transvaginal, transperineal, endoanal) may be an alternative. This study assesses ultrasound accuracy for the detection of rectocele, intussusception, enterocele and dyssynergy compared with defaecation proctography, and determines if ultrasound can predict symptoms and findings on proctography. Treatment is examined. METHOD: Images of 323 women who underwent integrated total pelvic floor ultrasound and defaecation proctography between 2011 and 2014 were blindly reviewed. The size and grade of rectocele, enterocele, intussusception and dyssynergy were noted on both, using proctography as the gold standard. Barium trapping in a rectocele or a functionally significant enterocele was noted on proctography. Demographics and Obstructive Defaecation Symptom scores were collated. RESULTS: The positive predictive value of ultrasound was 73% for rectocele, 79% for intussusception and 91% for enterocele. The negative predictive value for dyssynergy was 99%. Agreement was moderate for rectocele and intussusception, good for enterocele and fair for dyssynergy. The majority of rectoceles that required surgery (59/61) and caused barium trapping (85/89) were detected on ultrasound. A rectocele seen on both transvaginal and transperineal scanning was more likely to require surgery than if seen with only one mode (P = 0.0001). If there was intussusception on ultrasound the patient was more likely to have surgery (P = 0.03). An enterocele visualized on ultrasound was likely to be functionally significant on proctography (P = 0.02). There was, however, no association between findings on imaging and symptoms. CONCLUSION: Integrated total pelvic floor ultrasound provides a useful screening tool for women with defaecatory dysfunction such that defaecatory imaging can avoided in some.
[Mh] Termos MeSH primário: Constipação Intestinal/diagnóstico por imagem
Defecografia/métodos
Endossonografia/métodos
Distúrbios do Assoalho Pélvico/diagnóstico por imagem
Diafragma da Pelve/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Ataxia/complicações
Ataxia/diagnóstico por imagem
Ataxia/fisiopatologia
Bário
Constipação Intestinal/etiologia
Constipação Intestinal/fisiopatologia
Meios de Contraste
Defecação/fisiologia
Feminino
Hérnia/complicações
Hérnia/diagnóstico por imagem
Hérnia/fisiopatologia
Seres Humanos
Intussuscepção/complicações
Intussuscepção/diagnóstico por imagem
Intussuscepção/fisiopatologia
Meia-Idade
Diafragma da Pelve/fisiopatologia
Distúrbios do Assoalho Pélvico/complicações
Distúrbios do Assoalho Pélvico/fisiopatologia
Valor Preditivo dos Testes
Retocele/complicações
Retocele/diagnóstico por imagem
Retocele/fisiopatologia
Índice de Gravidade de Doença
Método Simples-Cego
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media); 24GP945V5T (Barium)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161126
[St] Status:MEDLINE
[do] DOI:10.1111/codi.13568


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[PMID]:27870169
[Au] Autor:van Iersel JJ; Formijne Jonkers HA; Verheijen PM; Broeders IA; Heggelman BG; Sreetharan V; Fütterer JJ; Somers I; van der Leest M; Consten EC
[Ad] Endereço:Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
[Ti] Título:Comparison of dynamic magnetic resonance defaecography with rectal contrast and conventional defaecography for posterior pelvic floor compartment prolapse.
[So] Source:Colorectal Dis;19(1):O46-O53, 2017 Jan.
[Is] ISSN:1463-1318
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: This study compared the diagnostic capabilities of dynamic magnetic resonance defaecography (D-MRI) with conventional defaecography (CD, reference standard) in patients with symptoms of prolapse of the posterior compartment of the pelvic floor. METHOD: Forty-five consecutive patients underwent CD and D-MRI. Outcome measures were the presence or absence of rectocele, enterocele, intussusception, rectal prolapse and the descent of the anorectal junction on straining, measured in millimetres. Cohen's Kappa, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and the positive and negative likelihood ratio of D-MRI were compared with CD. Cohen's Kappa and Pearson's correlation coefficient were calculated and regression analysis was performed to determine inter-observer agreement. RESULTS: Forty-one patients were available for analysis. D-MRI underreported rectocele formation with a difference in prevalence (CD 77.8% vs D-MRI 55.6%), mean protrusion (26.4 vs 22.7 mm, P = 0.039) and 11 false negative results, giving a low sensitivity of 0.62 and a NPV of 0.31. For the diagnosis of enterocele, D-MRI was inferior to CD, with five false negative results, giving a low sensitivity of 0.17 and high specificity (1.0) and PPV (1.0). Nine false positive intussusceptions were seen on D-MRI with only two missed. CONCLUSION: The accuracy of D-MRI for diagnosing rectocele and enterocele is less than that of CD. D-MRI, however, appears superior to CD in identifying intussusception. D-MRI and CD are complementary imaging techniques in the evaluation of patients with symptoms of prolapse of the posterior compartment.
[Mh] Termos MeSH primário: Defecografia/métodos
Erros de Diagnóstico/estatística & dados numéricos
Imagem por Ressonância Magnética/métodos
Distúrbios do Assoalho Pélvico/diagnóstico por imagem
Prolapso de Órgão Pélvico/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Meios de Contraste
Feminino
Hérnia/complicações
Hérnia/diagnóstico por imagem
Hérnia/fisiopatologia
Seres Humanos
Intussuscepção/complicações
Intussuscepção/diagnóstico por imagem
Intussuscepção/fisiopatologia
Funções Verossimilhança
Masculino
Meia-Idade
Distúrbios do Assoalho Pélvico/complicações
Distúrbios do Assoalho Pélvico/fisiopatologia
Prolapso de Órgão Pélvico/complicações
Prolapso de Órgão Pélvico/fisiopatologia
Valor Preditivo dos Testes
Retocele/complicações
Retocele/diagnóstico por imagem
Retocele/fisiopatologia
Reto/diagnóstico por imagem
Análise de Regressão
Sensibilidade e Especificidade
Estatísticas não Paramétricas
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161122
[St] Status:MEDLINE
[do] DOI:10.1111/codi.13563


  10 / 599 MEDLINE  
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[PMID]:27615439
[Au] Autor:Swenson CW; Smith TM; Luo J; Kolenic GE; Ashton-Miller JA; DeLancey JO
[Ad] Endereço:Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI. Electronic address: scarolyn@med.umich.edu.
[Ti] Título:Intraoperative cervix location and apical support stiffness in women with and without pelvic organ prolapse.
[So] Source:Am J Obstet Gynecol;216(2):155.e1-155.e8, 2017 Feb.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: It is unknown how initial cervix location and cervical support resistance to traction, which we term "apical support stiffness," compare in women with different patterns of pelvic organ support. Defining a normal range of apical support stiffness is important to better understand the pathophysiology of apical support loss. OBJECTIVE: The aims of our study were to determine whether: (1) women with normal apical support on clinic Pelvic Organ Prolapse Quantification, but with vaginal wall prolapse (cystocele and/or rectocele), have the same intraoperative cervix location and apical support stiffness as women with normal pelvic support; and (2) all women with apical prolapse have abnormal intraoperative cervix location and apical support stiffness. A third objective was to identify clinical and biomechanical factors independently associated with clinic Pelvic Organ Prolapse Quantification point C. STUDY DESIGN: We conducted an observational study of women with a full spectrum of pelvic organ support scheduled to undergo gynecologic surgery. All women underwent a preoperative clinic examination, including Pelvic Organ Prolapse Quantification. Cervix starting location and the resistance (stiffness) of its supports to being moved steadily in the direction of a traction force that increased from 0-18 N was measured intraoperatively using a computer-controlled servoactuator device. Women were divided into 3 groups for analysis according to their pelvic support as classified using the clinic Pelvic Organ Prolapse Quantification: (1) "normal/normal" was women with normal apical (C < -5 cm) and vaginal (Ba and Bp < 0 cm) support; (2) normal/prolapse had normal apical support (C < -5 cm) but prolapse of the anterior or posterior vaginal walls (Ba and/or Bp ≥ 0 cm); and (3) prolapse/prolapse had both apical and vaginal wall prolapse (C > -5 cm and Ba and/or Bp ≥ 0 cm). Demographics, intraoperative cervix locations, and apical support stiffness values were then compared. Normal range of cervix location during clinic examination and operative testing was defined by the total range of values observed in the normal/normal group. The proportion of women in each group with cervix locations within and outside the normal range was determined. Linear regression was performed to identify variables independently associated with clinic Pelvic Organ Prolapse Quantification point C. RESULTS: In all, 52 women were included: 14 in the normal/normal group, 11 in the normal/prolapse group, and 27 in the prolapse/prolapse group. At 1 N of traction force in the operating room, 50% of women in the normal/prolapse group had cervix locations outside the normal range while 10% had apical support stiffness outside the normal range. Of women in the prolapse/prolapse group, 81% had cervix locations outside the normal range and 8% had apical support stiffness outside the normal range. Similar results for cervix locations were observed at 18 N of traction force; however the proportion of women with apical support stiffness outside the normal range increased to 50% in the normal/prolapse group and 59% in the prolapse/prolapse group. The prolapse/prolapse group had statistically lower apical support stiffness compared to the normal/normal group with increased traction from 1-18 N (0.47 ± 0.18 N/mm vs 0.63 ± 0.20 N/mm, P = .006), but all other comparisons were nonsignificant. After controlling for age, parity, body mass index, and apical support stiffness, cervix location at 1 N traction force remained an independent predictor of clinic Pelvic Organ Prolapse Quantification point C, but only in the prolapse/prolapse group. CONCLUSION: Approximately 50% of women with cystocele and/or rectocele but normal apical support in the clinic had cervix locations outside the normal range under intraoperative traction, while 19% of women with uterine prolapse had normal apical support. Identifying women whose apical support falls outside a defined normal range may be a more accurate way to identify those who truly need a hysterectomy and/or an apical support procedure and to spare those who do not.
[Mh] Termos MeSH primário: Colo do Útero/fisiopatologia
Cistocele/fisiopatologia
Retocele/fisiopatologia
Prolapso Uterino/fisiopatologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Estudos de Casos e Controles
Colo do Útero/patologia
Feminino
Seres Humanos
Período Intraoperatório
Meia-Idade
Prolapso de Órgão Pélvico/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170531
[Lr] Data última revisão:
170531
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160913
[St] Status:MEDLINE



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