Pelvic prolapse: diagnosing and treating cystoceles, rectoceles, and enteroceles.

Published

Journal Article (Review)

The current generation of women is maintaining a healthier and more active lifestyle into an older age. Treatable conditions such as stress urinary incontinence and pelvic prolapse detract from this active lifestyle. In many cases, an improved quality of life can be maintained by treating pelvic prolapse conditions with relatively minor surgical procedures. Optimal treatment requires a knowledge of pelvic floor anatomy, an understanding of the various pelvic floor defects, and experience in selecting the appropriate procedure. The unequivocal diagnosis of pelvic prolapse conditions can only be made on physical examination. Each section of the vagina -- anterior, posterior, lateral, and apex -- must be inspected and evaluated separately to define the true nature and degree of prolapse. The examination should be performed with a moderate amount of urine in the bladder, and the patient must strain forcefully during the procedure. In some cases, this requires that the patient stand or sit upright during part of the examination to allow all areas of prolapse to become manifest. When the proper procedures are performed, excellent long-term results can be anticipated. The successful treatment of cystoceles requires an evaluation for both lateral and central defects, as inadequate treatment of either defect will lead to recurrences. The treatment of rectoceles is more controversial: Most clinicians would repair symptomatic rectoceles, but many choose not to treat asymptomatic rectoceles because there is little documented benefit to justify the risk of postoperative dyspareunia. Small asymptomatic enteroceles may be treated with a pessary; however, large symptomatic enteroceles usually require surgery.

Full Text

Duke Authors

Cited Authors

  • Cespedes, RD; Cross, CA; McGuire, EJ

Published Date

  • July 1998

Published In

Volume / Issue

  • 3 / 4

Start / End Page

  • 4 -

PubMed ID

  • 9732085

Pubmed Central ID

  • 9732085

Electronic International Standard Serial Number (EISSN)

  • 1521-2076

Language

  • eng

Conference Location

  • United States