Prolapse of the Uterus and Vagina: A Review of 539 Cases

Abstract

This paper is concerned with a survey of the results of surgical treatment for uterine prolapse over a 10-year period, and an evaluation of recent therapeutic advances. Most of the patients were operated upon by the Manchester method, the remainder by the Le Fort-Neugebauer technique.The most frequently employed operation for prolapse is the Donald-Fothergill (Manchester) repair. The operation is seldom followed by recurrence. Thus S h a w (1933) found recurrence in 3.6 per cent of 529 patients; J a k o b s e n (1948)) in 6.8 per cent of 117; S t r o d e (1951)~ in 4 per cent of 272; V i b e r g (1955) in 0.6 per cent of 174; D a n i e l s s o n (1957j, in 9.4 per cent of 535. The operative mortality is also low. S h a w (1949) reported 0.4 per cent of 2,150 cases and A h l t o r p (1948) 0.5 per cent of 1,167 cases. In D a n i e l s s o n ' s series the mortality was 0.6 per cent of 535 cases.Closure of the vagina, according to the Le Fort-Neugebauer method, should be reserved mainly for elderly women and/or poor operative risks. K u h n e l (1951) of Denmark reported on 58 women, aged 44-77 years, who were operated upon by this method. In his series there were 2 deaths due to the operation, and 3 other patients had recurrences. This mortality appears strikingly high but it is not higher than that reported by K i i h n e l (1951) in his review of the cases published in the literature, namely 3.7 per cent of 254 cases.

Risk of Abortion After Amputation of Uterine Cervix

“…D a n i e 1 s so n (1957) found prolapse to recur in 19. 4 per cent of those cases in which the cervix was not amputated, as against 4.2 per cent of those in whom the cervix was amputated. I n 1958 S v e n n e r u d reported 17.2 per cent after incomplete Manchester method, i. e. without either amputation of the cervix or the anterior o r posterior plasty, as against 4.6 per cent after complete Manchester operation.…”

Influence of Abdominal and Vaginal Pressures on the Position of the Uterus, Especially During Pregnancy and the Puerperium

“…Hormonal factory were discussed by Svennerud ( 1958) who pointed out that in post-menopausal patients the administration of estrogen not only gives relief of symptoms but also produces anatomical improvement. Timonen, Nuoranne Pr Meyer (1968) found that late menarche was common in nulliparas with prolapse, and that in nulliparas the relative frequency of prolapse is increased after the menopause.…”