Vaginal Vault Prolapse with Enterocele and Stress Incontinence by elfphabet5

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									Case Report

Vaginal Vault Prolapse with Enterocele and Stress Incontinence after Vaginal Hysterectomy
Ming-Cheh  Ou, M.D.,PhD1 , 2 , 3 , Ching-Liang Feng, M.D.1 , 2 , Li-Wei Huang, M.D.1 , 2 , Ken-Jen Yu, M.D.,PhD1 , 2
Genitourinary prolapse occurs when faults develop in the mechanisms for vaginal and uterine support. The causes may be due to childbirth, connective tissue disease, increased intra-abdominal pressure or iatrogenic causes. Massive genital organ prolapse is usually corrected with surgical treatment while mild genital organ is first treated with conservative treatment. We reported a case of vaginal vault prolapse with enterocele and stress incontinence occurring in a short period after vaginal hysterectomy. This patient was treated with vaginal sacrospinous suspension, McCall operation and transobtutator tape surgery (TOT). Postoperative evaluation one month later showed all the clinical disorders were corrected and improved. It indicates that a mutiple pelvic structures reconstruction is necessary for supporting and allowing normal function of the pelvic organs while mutiple pelvic structural defects concomitantly exist. (Full Text in English)

Key words: sacrospinous ligament, vaginal prolapse, enterocele, stress incontinence Taipei City Med J 2006; 3(4):404-408

Introduction
Genitourinary prolapse occurs when faults develop in the mechanisms for vaginal and uterine support. The causes may be due to childbirth, connective tissue disease, increased intra-abdominal pressure or iatrogenic causes. Mild genital organ prolapse should be offered with conservative treatment as hormonal replacement therapy, pelvic floor exercise or amelioration of risk factors with
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obesity, chronic cough. Nonetheless, massive genital organ prolapse only can be corrected with surgical treatment.

Case report
A 77 years old female patient had received vaginal hysterectomy for third degree uterine prolapse in 2001. She found her vagina prolapsed from introitus a few months after the hysterectomy.

Department of Obstetrics and Gynecology, Taipei City Hospital; 2 Department of Obstetrics and Gynecology, National YangMing University; 3 Taipei Medical University Received: 1 February 2006; Accepted: 26 April 2006 Correspondence to: Ming-Cheh Ou, Department of Gynecology and Obstetrics, Taipei City Hospital, Zhongxiao Branch, No. 87, Tongde Road, Nangang District, Taipei 115, Taiwan.

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Taipei City Medical Journal Vol.3 No.4 2006

個案報告

陰道式全子宮切除後陰道脫垂併發 小腸脫出及尿失禁
歐名哲1,2,3、馮錦良1,2、黃禮偉1,2、余堅忍1,2
當陰道或子宮的支持組織發生缺陷時,可能就 會產生生殖器官的脫垂。陰道或子宮的支持組織發生 缺陷的原因可能是分娩、結締組織疾病、腹腔壓力提 高或其他醫療疾病引起。輕微的生殖器脫垂可予以保 守性治療,重度脫垂則須施行外科治療。我們報導一 位子宮切除後發生陰道脫垂、小腸脫出的病人及併有 壓力性尿失禁。她接受了陰道薦棘韌帶懸吊術及小腸 脫出修補術,並施行經閉鎖孔尿道懸吊術以治療壓力 性尿失禁及預防陰道薦棘韌帶懸吊術引起的尿失禁後 遺症。術後追蹤發現這些骨盤腔鬆弛的缺陷均獲矯正 及改善。當婦女骨盤腔鬆弛的原因有多種時,應需要 多種手術的矯正才可恢復正常功能,而不能只施行一 種。

關鍵詞:薦棘韌帶,陰道脫垂,腸脫出,壓力性尿失禁 北市醫學雜誌 2006; 3(4):404-408

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臺 北 市 立 聯 合 醫 院 婦 產 部 ; 2國 立 陽 明 大 學 醫 學 院 婦 產 科 學 系 ; 3臺 北 醫 學 大 學 婦 產 科 學 系 受 理 日 期 : 2006年 2月 1日 ; 接 受 日 期 : 2006年 4月 26日 通 信 作 者 : 歐 名 哲 , 臺 北 市 立 聯 合 醫 院 忠 孝 院 區 婦 產 科 , 臺 北 市 南 港 區 115同 德 路 87號

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第 4 期,2006

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