Cespedes R D, Cross C A, McGuire E J
Department of Urology, Wilford Hall Medical Center, Lackland AFB, San Antonio, Texas, USA.
Medscape Womens Health. 1998 Jul;3(4):4.
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.
当代女性正保持着更健康、更积极的生活方式步入老年。诸如压力性尿失禁和盆腔器官脱垂等可治疗的疾病会影响这种积极的生活方式。在许多情况下，通过相对较小的外科手术治疗盆腔器官脱垂疾病，可以维持生活质量的改善。最佳治疗需要了解盆底解剖结构，理解各种盆底缺陷，并具备选择合适手术的经验。盆腔器官脱垂疾病的明确诊断只能通过体格检查做出。必须分别检查和评估阴道的每个部分——前壁、后壁、侧壁和顶端——以确定脱垂的真实性质和程度。检查应在膀胱中有适量尿液时进行，并且患者在检查过程中必须用力屏气。在某些情况下，这要求患者在部分检查过程中站立或坐直，以使所有脱垂区域显现出来。当采取适当的手术步骤时，可以预期获得良好的长期效果。膀胱膨出的成功治疗需要评估外侧和中央缺陷，因为对任何一个缺陷治疗不充分都会导致复发。直肠膨出的治疗更具争议性：大多数临床医生会修复有症状的直肠膨出，但许多人选择不治疗无症状的直肠膨出，因为几乎没有文献证明其益处足以证明术后性交困难风险的合理性。小的无症状小肠膨出可以用子宫托治疗；然而，大的有症状小肠膨出通常需要手术。
