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Related Experiment Videos

Genital prolapse with and without urinary incontinence.

T A Harris1, A E Bent

  • 1Department of Obstetrics and Gynecology, Valley Medical Center, Fresno, California.

The Journal of Reproductive Medicine
|August 1, 1990
PubMed
Summary

Pelvic organ prolapse, like procidentia and cystocele, can mask urinary incontinence. Surgical repair may reveal this incontinence, highlighting the need for careful pre- and post-operative evaluation.

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Area of Science:

  • Urogynecology
  • Pelvic Floor Disorders
  • Female Pelvic Medicine

Background:

  • Pelvic organ prolapse (POP), including procidentia, vaginal vault prolapse, and severe cystocele, can be associated with potential urinary incontinence.
  • This incontinence often becomes apparent only after surgical correction of the genital prolapse.
  • The pelvic diaphragm, comprising the levator ani and coccygeus muscles, normally supports pelvic organs.

Purpose of the Study:

  • To emphasize the importance of evaluating both actual and potential urinary incontinence in patients with genital prolapse.
  • To highlight the need for careful surgical planning to address all urogenital defects.
  • To ensure restoration of normal vaginal axis and unimpaired urinary function post-surgery.

Main Methods:

  • Patient evaluation must encompass both existing and latent aspects of genital prolapse and incontinence.
  • Stress incontinence testing should be conducted both before and after the reduction of genital prolapse.
  • Surgical repair planning requires meticulous attention to all significant and potential defects within the urogenital tract.

Main Results:

  • Childbearing-related stretch injury to the pudendal nerve can lead to denervation and weakening of pelvic muscles.
  • Aging exacerbates these muscle changes, contributing to anogenital prolapse and stress incontinence.
  • Iatrogenic causes of prolapse and incontinence can arise from surgical alterations in tissue force direction or removal of incontinence barriers.

Conclusions:

  • Comprehensive pre-operative and post-operative assessment for urinary incontinence is crucial in patients undergoing genital prolapse repair.
  • Surgical interventions should aim to restore normal vaginal anatomy and preserve urinary function.
  • Understanding the mechanisms of pelvic floor dysfunction, including nerve injury and aging, is key to effective management.

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