Beruflich Dokumente
Kultur Dokumente
By
Amir Fauzi MD
Supervisor
Prof. DatoDrAsbi bin Ali
A THESIS PROPOSAL
SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR
THE DEGREE OF Ph. D
AT
MANAGEMENT AND SCIENCE UNIVERSITY
2015
LIST OF CONTENT
TITLE PAGE.......................................................................................................... i
LIST OF CONTENT.............................................................................................. ii
LIST OF TABLE.................................................................................................... iii
CHAPTER I INTRODUCTION........................................................................... 1
1.1................................................................................................................Bac
kground ................................................................................................ 1
1.2................................................................................................................Sco
pe of Research ...................................................................................... 2
1.3................................................................................................................Pro
blem Identification ............................................................................... 2
1.4................................................................................................................Aim
of Study ................................................................................................ 2
1.5................................................................................................................Ben
efit of Study .......................................................................................... 2
1.6................................................................................................................Hip
othesis................................................................................................... 2
CHAPTER II LITERATURE REVIEW ............................................................. 3
2.1. Pelvic Organ Prolapse ............................................................................3
2.1.1. Definition ..................................................................................... 3
2.1.2. Prevalence ................................................................................... 3
2.1.3. Etiology ....................................................................................... 3
2.1.4. Symptom ..................................................................................... 4
2.1.5. Patophysiology............................................................................. 5
2.1.6. Grading ........................................................................................ 6
2.1.7. Imaging ........................................................................................ 6
2.1.8. Differential Diagnosis ................................................................. 7
2.1.9. Treatment ..................................................................................... 7
2.1.10. Surgery ...................................................................................... 9
2.1.11. Prevetion..................................................................................... 11
2.2. Sacrospinous Fixation ............................................................................ 11
LIST OF TABLE
Table
Page
1.1 Research Plan ........................................................................................... 26
1.2 Research Budget ....................................................................................... 27
CHAPTER I
INTRODUCTION
1.1. Background
Pelvic organ prolapse is a common health problem affecting up to 40% women over
50 years old. It is defined as the descent of one or more of the pelvic organs. Anterior
vaginal wall prolapse concerns the bladder ancLor urethra (cystocele, urethrocele).
Apical prolapse entails either the uterus or post-hysterectomy vaginal cuff. Posterior
vaginal wall prolapse concerns the rectum but can also include the small or large
bowel (rectocele, enterocele). Women can present with prolapse of one or more
compartments.1
The life-time risk for women to undergo surgery for the management of POP
is about 11% and approximately 30% of these women will need additional surgery
because of prolapse recurrence.21n the US, the estimated lifetime risk of an 80-yearold woman undergoing surgical treatment for prolapse or urinary incontinence is
about l0%.3There are 43 cases of uterine prolapse in RSMH Palembang from 19992003.4The risk of uterovaginal prolapse increases with the number of vaginal births
and is higher in older and obese women.5The risk of prolapse repair after
hysterectomy was 4.7 times higher in women whose initial hysterectomy was
indicated for pelvic rgan prolapse and 8 times higher if preoperative prolapse grade 2
or more was present.6
Surgical procedures for treatment of vaginal vault prolapse are generally
categorized as either obliterative or reconstructive, and can performed either
abdominally or vaginally.7 More than 40 different operations have been described,
and all reconstructive techniques have in common the use of healthy structures for
cranial fixation of the vaginal vault.81n the last decades, many studies showed that
sacrospinous ligament fixation is an effective surgical procedure to correct
posthysterectomy vaginal vault prolapse.9Sacrospinous fixation was first described by
Sederl in 1958, and later popularized in Europe by Ritcher and Albright and in the
USby Randall and Nichols. 10Sacrospinouscolpopexy suspends the vaginal vault
towards the sacrospinous ligament, repositioning the upper vagina over the levator
plate. This procedure has been described in women who wanted to preserve the uterus
to retain fertility. 12Sacrospinoushysteropexy is anatomical efficient and safe and
most women are highly satisfied about the procedure.3The procedure can also be
used as an adjuvant technique to vaginal hysterectomy and anterior/posterior repair
for marked uterovaginal prolapse in the presence of poor cardinal and uterosacral
ligaments. One advantage of sacrospinous fixation is the possibility of concomitant
surgical repair of other vaginal defects.4,5
POP is associated with a few serious complications.It has significant negative
effects on a womans quality of life, ranging from physical discomfort, psychological
and sexual complaints to occupational and social limitations. It has been suggested
that hysterectomy may cause nerve supply damage and disrupt supportive structures
of the pelvic floor. Therefore women may be at increased risk for bladder dysfunction
and new-onset stress incontinence after vaginal hysterectomy. Buttock pain on the
side where the sacrospinous sutures have been passed occurs in approximately 1015% of the women but typically resolves in days to months.6,8
The anatomical outcome and complication rate of this operation was
described in few reports, but ncost authors do not focus on urogenital symptoms and
quality of life after sacrospinoushysteropexy.It was just mainly assessed in terms of
anatomical results)So, although anatomical outcome of the sacrospinoushysteropexy
appears to be good, we cannot conclude from current literature that this type of
in the support of the pelvic oor. The etiology of the fascial or ligament defects
that leads to prolapse is multifactorial.29
In severe prolapse, the woman can see or feel a bulge of tissue at or past the
vaginal opening. Most women have mild prolapse-the organs drop down only
slightly and do not protrude from the opening of the vaginaand do not have any
signs or symptoms. Some women with mild prolapse and women with severe
prolapse do have symptoms, which can include the following:27
incontinence
Bladder storage symptoms, such as frequency, urgency, or overactive bladder
syndrome
Voiding symptoms, such as hesitancy, slow stream, straining, incomplete
symptoms
are
lump.
local
discomfort.
backache.
Stage 0: No prolapse
Stage I: Most distal point is greater than 1 cm proximal to the hymen
Stage ll: Most distal point is between l cm proximal to the hymen and 1 cm
prolapse is the cervix. and careful examination can differentiate uterovaginal descent
from a long cervix. Third degree uterine prolapse is termed procidentia and is
usually accompanied by cystourethrocele and rectocele.26
II.1.7. Imaging
The role of medical imaging in evaluating women with pelvic organ prolapse
is not standardized. Abnormalities identied on history and physical examination or
on other ancillary tests teg. hematuria on urinalysis) may require further evaluation
with abdominal imaging. Empiric upper tract imaging is not mandated. However.an
overall 7.7% prevalence of hydronephrosis has been identied in women undergoing
prolapse surgery. The prevalence was higher in those with worsening prolapse. ln
patients with severe pelvic organ prolapse, a preoperative renal ultrasound may
identify patients who may require additional assessment or changes in management.36
Imaging modalities lune been studied for the diagnosis and quantication of
pelvic organ prolapse. Pelvic ultrasound can be used to diagnosis prolapse and
determine which compartment or organ is responsible for the symptomatic
prolapse. Three-dimensional ultrasound has been used to correlate the degree of
descent with symptoms. Dynamic magnetic resonance imaging has shown correlation
with clinical staging and allows for the measurement of the descent of pelvic organs.37
11.1.8. Differential diagnosis
urethral diverticulum.
Uterovaginal prolapse: large uterine polyp.
11.1.9. Treatment
The choice of treatment depends on the patients wishes, level of fitness and
desire to preserve coital function. Prior to specific treatment, attempts should be made
to correct obesity, chronic cough or constipatIon. If the prolapse is ulcerated, a 7-day
course of topical oestrogen should be administered.26
If there is no any symptoms or if the symptoms are mild, it does not need any
special follow-up or treatment beyond having regular checkups. If there were
symptoms, prolapse may be treated with or without surgery.27
If a woman is found to have uterovaginal prolapse on examination but has no
symptoms, then it would be inappropriate to offer any surgical treatment and either
observation or conservative therapy would be best. If symptoms are mild, then pelvic
floor physiotherapy is offered but there are no randomized controlled trials examining
the effectiveness of physiotherapy on prolapse. Silicon rubber- based ring pessaries
are the most popular form of conservative therapy. they are inserted into the vagina in
much the same way as a contraceptive diaphragm and need replacement at annual
intervals. Shelf pessaries are rarely used but may be useful in women who cannot
retain a ring pessary. The use of pessaries can be complicated by vaginal ulceration
and infection. The vagina should therefore be carefully inspected at the time of
replacement. There are a whole range of newer pessaries that are undergoIng
evaluation and these may be more comfortable for the patient.Indications for pessary
treatment are patients wish, as a therapeutic test, childbearing not complete,
medically unfit, during and after pregnancy (awaiting involution), and while awaiting
surgery.26Kegel exercises may be recommended in addition to symptom-related
treatment to help strengthen the pelvic floor. Weight loss can decrease pressure in the
abdomen and help improve overall health. If the symptoms are severe and disrupt
life, and if nonsurgical treatment options have not helped, we may consider surgery.27
The aim of surgical repair is to restore anatomy and function. There are
vaginal and abdominal operations designed to correct prolapse, and choice often
depends on a womans desire to preserve coital function.
26
Age
If someone has surgery at a young age, there is a chance that prolapse will
recur and may possibly require additional treatment
Childbearing plans
Ideally, women who plan to have children (or more children) should postpone
surgery until their families are complete to avoid the risk of prolapse
condition that makes abdominal surgery risky, or whose own tissues are too weak to
repair without mesh.27
Recovery time varies depending on the type of surgery. You usually need to
take a few weeks off from work. For the first few weeks, you should avoid vigorous
exercise, lifting, and straining. You also should avoid sexual intercourse for several
weeks after surgery.27
If urinary symptoms are present, urine microscopy, cystometry and
cystoscopy should be considered. The relationship letween urinary symptoms and
prolapse is complex. Some women with cystourethrocele have concurrent
incontinence; as the prolapse increases in severity, urethral kinking may restore
continence but lead to voiding difficulty. Should renal failure be suspected, serum
urea and creatinine should be evaluated and renal ultrasound performed. For women
with symptoms of obstructed defaecation MR proctography can help diagnose a
rectocele.26
11.1.10. Surgery29
1. Cystourethrocele
Anterior repair (colporrhaphy) is the most commonly performed surgical
procedure but should be avoided if there is concurrent stress incontinence. An anterior
vaginal wall incision is made and the fascial defect allowing the bladder to herniate
through is identified and closed. With the bladder position restored, any redundant
vaginal epithelium is excised and the incision closed.
2. Rectocele
Posterior repair (colporrhaphy) is the most commonly performed procedure. A
posterior vaginal wall incision is made and the fascial defect allowing the rectum to
herniate through is identified and closed. With the rectal position restored, any
redundant vaginal epithelium is excised and the incision closed.
3. Enterocele
The surgical principles are similar to those of anterior and posterior repair, but
the peritoneal sac containing the small bowel should be excised. In addition, the
pouch of Douglas is closed by approximating the peritoneum andJor the uterosacral
ligaments.
4. Uterovaginal prolapse
Uterine preserving sucgery, procedures involving hysterectomy. These
procedures involve removal of the uterus:
Uterine preserving surgery is used largely when a woman still wants to have
further children and therefore the uterus has to be preserved. Occasionally, a woman
wishes to preserve her uterus and then may choose this option:
Hysterosacropexy
This involves accessing the uterus vaginally amputating the cervix and using the
uterosacral cardinal ligament complex to support the uterus. The operation is rarely
used now because of problems with complications to the cervix resulting in either
cervical stenosis or cervical incompetence and a risk of miscarriage.
Le Fort colpocleisis
This operation is used in very frail patients who are unfit for major surgery and are
not sexually active. It involves partial closure of the vagina while preserving the
uterus.
There is a range of mesh using devices that have been designed not only for anterior
and posterior vaginal prolapse but suggest they may be useful in uterovaginal
prolapse and can preserve the uterus. The data for this is scarce.
Vaginal hysterectomy
This is one of the oldest major operations with references dating from the time of
Hypocrates in the fifth century BC. The operation involves making an incision around
the cervix and entering the pentoneal cavity from the vaginal side ligating all the
major blood vessels and delivering the uterus through the vagina and suturing the
vault of the vagina. Obviously, there is lack of support of the vault and to try and
improve support, the standard procedure is to shorten the stretched uterosacral
cardinal ligament complex and then resuture into the vault of the vagina. Some
authors have used variations of this to try and attach the vault even higher in the
vagina with a higher uterosacral ligament fixation. A number of modifications have
been suggested to try and improve the support of the vagina. Some surgeons use
laparoscopically assisted techniques to perform a vaginal hysterectomy if there is
abdominal pathology, but this is not usual for prolapse.
This surgery offers support to the upper vagina minimizing risk of recurrent
prolapse at this site. The advantage of this surgery is that vaginal length is
maintained.29
11.2.3. Indication
Upper vaginal prolapse (uterine or vault prolapse, enteroceles). This
procedure can be used in reconstructive vaginal surgery where increased vaginal
length is required.29
11.2.4. Contraindication
Many of the general contraindications to sacral colpopexy are the same for
any surgical procedure. These may include the following:29
Anemia
Bleeding diathesis or the. need for anticoagulation
Significant cardiac or pulmonary comorbidities
Active infection such as cystitis, bacterial or fungal vaginal infection,
fistulas
Previous pelvic prolapse repairs with infected or exposed foreign material
and erosions
Pelvic irradiation
Previous pelvic surgery or prolapse repair, depending on the nature of the
operation and the subsequent pathology, side effects, or complications (the
existence of such may warrant additional diagnostic evaluation and may
require additional surgical intervention or change of approach to prolapse
repair)
Concomitant cystocele, rectocele, or urinary incontinence (the existence of
such pathology may require additional surgery, a vaginal approach, or a
combined approach)
11.2.5. Procedure
11.2.5.1 .Preparation before surgery
vagina
Using sharp dissection the vagina is freed from the underlying rectovaginal
fascia and rectum until the pelvic floor (puborectalis) muscle is seen.
Using sharp and blunt dissection the sacrospinous ligament running from the
ischial spine to the sacral bone is palpated and identified.
Two sutures are placed through the strong ligament and secured to the top of
the vagina. This results in increased support to the upper vagina. There is no
Surgery will be covered with antibiotics to decrease the risk of infection and blood
thinning agents (Clexanself injected for 5 days) will be used to decrease the risk of
clots forming in the postoperative phase.For the first 24 hours postoperatively a
vaginal pack is often inserted into the vagina to decrease the riskof bleeding and a
catheter is used to drain the bladder.
Vaginal sacrospinous ligament fixation has been compared to abdominal
sacral colpopexy in two randomized trials. Benson and colleagues randomized 88
women to receive either vaginal sacrospinous ligament fixation or abdominal
sacrocolpopexy and terminated the study at the interim analysis due to a disparity in
outcome favoring the abdominal approach. Reoperation for cystocele was necessary
in 29% of those in the vaginal group versus 10.5% of those in the abdominal group.
Vaginal vault prolapse recurred in 12% of the vaginal group versus 2.6% of the
abdominal group.38
In a study of 95 women randomized to either approach, Maher et al found a
subjective success rate of 94% in the abdominal group versus 91% in the vaginal
group after a median of 2 years. The objective success rate was 76% in the abdominal
group and 69% in the vaginal group. These differences, however, did not reach
statistical significance.39
In a Cochrane review of 22 randomized controlled trials, abdominal sacral
colpopexy was found to have a lower rate of recurrent vault prolapse and less
dyspareunia. The trend for a lower reoperation rate after abdominal sacral colpopexy
was not statistically significant. There was a longer operating time, longer recovery
period, and higher cost associated with the abdominal approach.40
11.2.5.6. Monitoring and Follow-up
Following surgery, the patient should be discharged with a comprehensive set
of postoperative care instructions. Any strenuous activity or heavy lifting should be
avoided in the immediate postoperative period, usually 6-8 weeks, to allow adequate
time for scar tissue formation. Activities that generate perinea] strain or trauma, such
as bicycle riding, should be prohibited. The patient must refrain from any sexual
intercourse during healing. Additionally, the patient should be instructed to not insert
tampons or applicators into the vagina. A course of antibiotics is often prescribed at
discharge, but level I evidence supporting its use is limited.
11.2.6. Complications
The most commonly reported complications for both open and laparoscopic
techniques include:
Pain(generally or during intercourse) in 2-3%
Exposure of the mesh in the vagina in 2-3%
Damage to bladder, bowel, or ureter in 1-2%
There are also general risks associated with surgery that include wound
infection, urinary tract infection, bleeding requiring a blood transfusion and deep vein
thrombosis (clots) in the legs, chest infection and heart problems. Your surgeon or
anesthetist will discuss any additional risks that may be relevant to you. 28The
sacrospinous fixation is highly effective at con trolling upper vaginal prolapse with a
failure rate of only 5-10%. Buttock pain on the side that the sacrospinous sutures have
been passed occurs in 5-10% women . This can be very painful but usually fully
subsides by 6 weeks.Bleeding requiring transfusion <1%. Damage to the surrounding
organs (bladder, rectum or ureter) occurs rarely and is usually repaired in
surgery.Small risk of clots forming in the legs or lungs after surgery (<1 %). Urinary
tract infection occurs in 1-5%. Painful intercourse can occur in 5% especially if a
posterior vaginal repair is performed. Confidence and comfort during coitus is likely
to be increased as a result of the prolapse being repaired.
Immediate perioperative complications include bowel obstruction, peritonitis,
urine leak from failed intraoperative recognition of a cystotomy, dehiscence, and
infection. Although most of these complications occur rarely, they must be included
in the differential when symptoms occur. Delayed bleeding is a rare complication but
should be entertained in a patient who is hemodinamically unstable.32
Postsurgical complications can be reduced by understanding the risks of the
surgical procedure, including the risks of anesthesia, positioning, surgical technique,
implants, and infection. Neurapraxia can be avoided by proper positioning and
padding of pressure points. In the modified lithotomy position for sacral colpopexy,
femoral nerve injury can occur by hyperextension at the hip and thus should be
avoided. Perineal nerve injury may result from compression against the stirrup if not
properly positioned and padded. Re ducing surgical time will reduce the length of
time the patient is in a position that increases risk for injury. Retractor placement for
exposure of the operative field can lead to nerve injury, most commonly the femoral
nerve as it traverses within the psoas muscle. Venous thromboembolism is another
complication that results from the hemodynamic state established by general
anesthesia, positioning, and surgical manipulation or retractor compression of great
11.2.7. Recovery
After the operation patient will have an IV drip in arm for fluids and pain
relief. They can expect to stay in hospital between 3-6 days. Tliw, iiagimatpay,k,
used, is removed on the first day and the bladder catheter after the first few days or
when your bladder empties appropriately. in the early postoperative period
patient should avoid situations where excessive pressure is placed on the
repair ie lifting, straining, coughing and constipation. Maximal fibrosis around the
repair occurs at 3 months and care needs to be taken during this time. If patient
develop urinary burning, frequency or urgency you should see your local doctor.
Vaginal spotting or discharge is not uncommon in the first 10 but should be reported
to your doctor if heavy or persistent. Patient will have a check up at 6 weeks for a
review and sexual activity can usually be safely resumed at this time. Patient can
return to work at approximately 4-6 weeks depending on the amount of strain that
will be placed on the repair at your work and on how they feel.Avoiding heavy lifting
(> 1 5kg), weight gain and smoking can minimize failure of the procedure in the long
term.28
CHAPTER III
RESEARCH METHOD
III.1. Research Design
This is an observational analytic research, that use bivariate design. The core
of analysis is to compare the symptomatic output between sacrospinous fixation and
non sacrospinous fixation in prolapse patient.While the bivariate correlation describes
the relationship between two variables. In the context of this study, as the independent
variable (independent) is the urinary symptom, defecation symptom, and buttock
pain, while the dependent variable (dependent) is the surgery method. While the
method used is survey method. According to Malhotra (2009), the survey method is
the structure of the questionnaire given to a sample of a population and is designed to
get specific information from the respondents. With data, facts or information
obtained through the surveys, then each study variable can be described and known
the influence of one variable to another variable.
111.2. Reasearch Time and Place
The study will conducted in the Hospital Mohammad Hoesin Palembang in January
2016 by visiting each patient house.
111.3. Population and Sample
According to Sugiyono (2012), the population is a generalization region
consisting of objects or subjects that have certain qualities and characteristics defined
by the researchers to be studied and then drawn conclusions. The population was
hospitalized patients during January to December 2014 in the department of Dr. M.
Hoesin Palembang. This research use a total sampling, so the population that fulfill
the inclusion criteria and exclude the exclusion criteria will be visited to answer the
questionnaire. The inclusion criteria was patient that stayed in South Sumatera, agree
to fill the questionnaire. The exclusion criteria is patient who has been moved to other
address or cannot be contacted.
111.4. Research Variable
111.4.1 . Dependent Variable
The dependent variable is affected or the result of the independent variables.
The dependent variable of this research is the surgery method, with or without
sacrospinous fixation. 111.4.2. Independent Variable The independent variable is the
cause of change or the emergence of the dependent variable. The independent
variable of this study was the urinary, defecation, and buttock pain symptom of the
patient who have done the surgery in Hospital Mohammad Hoesin Palembang.
111.5. Data Collection
The data used for the study came from the primary data by giving
questionnaires to patient who met the inclusion criteria with questions that describe
the urinary, defecation, and buttock pain after sacrospinous fixation and nonsacrospinous fixation. Results of this study in the form of frequency and percentage
(proportion) can be presented in tables and graphs .
Number
Activity
1.
Submission of
2.
proposals title
Preparation of
3.
proposals
Presentation
4.
of proposals
Improvement
5.
proposal
Data
6.
collection
Data
7.
Processing
Presentation
2015
Month
November
December
2016
Month
January
February
March
of results
Table 1. Research Plan
III.9 Research Budget
Number
Description
1
Stationary
2
Questionnaire
3
Transportation
4
Etc
Total
Table 2. Research Budget
Quantity
1 Packet
100 packet
Price
Rp. 50.000,Rp. 500.000,Rp. 1.500.000,Rp. 500.000,Rp. 2.550.000,-
REFERENCES
1. Slieker-ten Hove MC, Pool-Goudzwaard AL, Eijkemans MJ, StecgcrsTheunissen RP, Burger CW, Vierhout ME: The prevalence of pelvic organ
prolapse symptoms and signs and their relation with bladder and bowel
disorders in a general female population. IntUrogynecol J Pelvic Floor
Dysfunct 2009, 20: 1037-45.
2. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL: Epidemiology of
surgically managed pelvic organ prolapse and urinary incontinence.
ObstetGynecol 1997, 89:501-6.
3. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997)
Epidemiology of surgically managed pelvic organ pro- lapse and urinary
incontinence. ObstetGynecol 89:501506
April
15. Silva-Filho AL, Triginelli SA, Santos-Filho AS, Ca" ndido EB, Traiman P,
Cunha-Melo JR (2004) Sacrospinous fixation for treatment of vault prolapse
and at the time of vaginal hyster- ectomy for marked uterovaginal prolapse. J
Pelvic Med Surg 10:213218
16. Altman D, Granath F, Cnattingius S, Falconer C: Hysterectomy and risk of
stress-urinary-incontinence surgery: nationwide cohort study. Lancet 2007,
370:14949.
17. Mant J, Painter R, Vessey M: Epidemiology of genital prolapse: observations
from the Oxford Family Planning Association Study. Br J ObstetGynaecol
1997, 104:57985.
18. Blandon RE, Bharucha AE, Melton LJ, Schleck CD, Babalola E0, Zinsmeister
AR, Gebhart JB: Incidence of pelvic floor repair after hysterectomy: A
population-based cohort study. Am J ObstetGynecol 2007, 1971664.
19. Nieminen K, Huhtala H, Heinonen PH (2003) Anatomical and functional
assessment and risk factors of recurrent prolapse alter vaginal sacrospinous
fixation. ActaObstetGynecolScand 82:471478
20. Kovac SR, Cruikshank SH (1993) Successful pregnancies and vaginal
deliveries after sacrospinousuterosacral fixation in five of nineteen patients.
Am J ObstetGynecol 168:17781786
21. Rane A, Lim YN, Withey G, Muller R (2004) Magnetic resonance imaging
findings following three different vaginal vault prolapse repair procedures: a
randomised study. Aust NZ J ObstetGynaecol 44:135139
22. Sze EH, Meranus J, Kohli N, Miklos JR, Karram MM (2001) Vaginal
configuration on MRI after abdominal sacrocolpopexy and sacrospinous
ligament suspension. IntUrogynecol J Pelvic Floor Dysfunct 122375379
23. Hefiii MA, ElToukhy TA (2006) Long-term outcome of vaginal
sacrospinouscolpopexy for marked uterovaginal and vault prolapse. Eur J
ObstetGynecolReprodBiol 127:257263
24. Hefni
MA,
E1
Toukhy
TA,
Bhaumik
J,
Katsimanis
(2003)
25. Van Brummen HJ, Bruinse HW, van de Pol G, Heintz AP, van der Vaart CH
(2006) Defecatory symptoms during and after the first pregnancy: prevalences
and associated factors. IntUrogynecol J Pelvic Floor Dysfunctl 7(3):224230
26. Shaw R, Luesley D, Monga A (eds). Urogynaecology section. Gynaecology,
4th edn. London: Churchill Livingstone, 2010.
27. December 2013 by the American College of Obstetricians and Gynecologists,
Surgery for Pelvic Organ Prolapse
28. Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic
Organ Support Study (POSST): the distribution, clinical definition, and
epidemiologic condition of pelvic organ support defects. Am J Obstet
Gynecol. 2005 Mar. 192(3):795-806.
29. International urogynecological association 2011, sacrocolpoplexy, a guide for
women
30. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al.
An
International
Urogynecological
Association
(IUGA)/International
Continence Society (ICS) joint report on the terminology for female pelvic
floor dysfunction. NeurourolUrodyn. 2010. 29(1):420.
31. Swift SE. The distribution of pelvic organ support in a population of female
subjects seen for routine gynecologic health care. Am J Obstet Gynecol. 2000
Aug. 183(2):277-85.
32. Swift S, Woodman P, O'Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic
Organ Support Study (POSST): the distribution, clinical definition, and
epidemiologic condition of pelvic organ support defects. Am J Obstet
Gynecol. 2005 Mar. 192(3):795-806.
33. Anger JT, Weinberg AE, Gore JL, Wang Q, Pashos CL, Leonardi MJ, et al.
Thromboembolic complications of sling surgery for stress urinary
incontinence among female Medicare beneficiaries. Urology. 2009 Dec.
74(6): 1223-6.
34. Begley J S, Kupferman SP, Kuznetsov DD, Kobashi KC, Govier FE,
McGonigle KF, of abdominal sacrocolpopexy mesh erosions. Am J Obstet
Gynecol. 192(6): 1956-62.
35. Kohli N, Walsh PM, Roat TW, Karram MM. Mesh erosion after abdominal
sacrocolpopexy. Obstet Gynecol. 1998 Dec. 92(6):999-1004.
36. Haylen BT, Freeman RM, Swift SE, Cosson M, Davila GW, Deprest J, et al.
An
International
Urogynecological
Association
(IUGA)/International