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Pelvic organ prolapse

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are poor surgical candidates, or who may not be able to attend physical therapy. Pessaries require a provider to fit the device, but most can be removed, cleaned, and replaced by the woman herself; however, others have this done for them by a clinician biannually. A trial compared the two approaches and found that, compared with clinic-based care, self-management was associated with a similar quality of life, fewer complications, and was more cost-effective. Pessaries should be offered as a non-surgical alternative for women considering surgery.
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device fitted to the patient is also a non-surgical option, it is inserted into the vagina and may be retained for up to several months. Vaginal pessaries can immediately relieve prolapse and prolapse-related symptoms. Pessaries are a good choice of treatment for women who wish to maintain fertility,
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Compared to native tissue repair, transvaginal permanent mesh likely reduces the perception of vaginal prolapse sensation, the risk of recurrent prolapse, and of having repeat surgery specifically only for prolapse. Transvaginal mesh (TVM) has a greater risk of bladder injury and of needing repeat
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compared with native tissue repair for anterior compartment prolapse owing to increased morbidity. For posterior vaginal repair, the use of mesh or graft material does not seem to provide any benefits.
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Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, Mowat A, Maher C (2024-03-13). "Transvaginal mesh or grafts or native tissue repair for vaginal prolapse".
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Tulikangas P, et al. (Committee on Practice Bulletins—Gynecology and the American Urogynecologic Society) (April 2017). "Practice Bulletin No. 176: Pelvic Organ Prolapse".
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For surgical treatment of apical vaginal prolapse, going through the abdomen (sacral colpopexy) may have better outcomes than a surgical approach that goes through the vagina.
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Hagen S, Kearney R, Goodman K, Best C, Elders A, Melone L, Dwyer L, Dembinsky M, Graham M, Agur W, Breeman S, Culverhouse J, Forrest A, Forrest M, Guerrero K (December 2023).
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collapses after gynecological cancer treatment, childbirth or heavy lifting. Injury incurred to fascia membranes and other connective structures can result in
986:"Clinical effectiveness of vaginal pessary self-management vs clinic-based care for pelvic organ prolapse (TOPSY): a randomised controlled superiority trial" 487:
surgery for stress urinary incontinence or mesh exposure. The use of a TVM in treating vaginal prolapses is associated with severe side effects including
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Pelvic organ prolapses are graded either via the Baden–Walker System, Shaw's System, or the Pelvic Organ Prolapse Quantification (POP-Q) System.
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The criteria for stage 0 are not met, and the most distal prolapse is more than 1 cm above the level of the hymen (less than −1 cm).
1169:"UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse: FDA Safety Communication" 1041: 100:) is characterized by descent of pelvic organs from their normal positions into the vagina. In women, the condition usually occurs when the 363: 67:
A 40 year old woman with uterine prolapse, which is visible only in standing position, with the cervix protruding through the vulva.
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The most distal prolapse is between 1 cm above and 1 cm below the hymen (at least one point is −1, 0, or +1).
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Investigation of sheep reproductive tract as an animal model for pelvic organ prolapse and urogyencological research
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Represents complete procidentia or vault eversion; the most distal prolapse protrudes to at least (TVL−2) cm.
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The most distal prolapse is more than 1 cm below the hymen but no further than 2 cm less than TVL.
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No prolapse anterior and posterior points are all −3 cm, and C or D is between −TVL and −(TVL−2) cm.
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To study POP, various animal models are employed: non-human primates, sheep, pigs, rats, and others.
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Genital prolapse occurs in about 316 million women worldwide as of 2010 (9.3% of all females).
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or both. Treatment can involve dietary and lifestyle changes, physical therapy, or surgery.
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Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. (December 2012).
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Baessler K, Christmann-Schmid C, Maher C, Haya N, Crawford TJ, Brown J (19 August 2018).
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Maher C, Yeung E, Haya N, Christmann-Schmid C, Mowat A, Chen Z, Baessler K (2023-07-26).
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Baden–Walker System for the Evaluation of Pelvic Organ Prolapse on Physical Examination
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Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J (November 2016).
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Mowat A, Maher D, Baessler K, Christmann-Schmid C, Haya N, Maher C (5 March 2018).
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Beckley I, Harris N (2013-03-26). "Pelvic organ prolapse: a urology perspective".
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prolapse (descent of the roof of vagina) – after surgical removal of the uterus
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Ramaseshan AS, Felton J, Roque D, Rao G, Shipper AG, Sanses TV (April 2018).
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have been filed and settled against several manufacturers of TVM devices.
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Patnaik SS, Brazile B, Dandolu V, Damaser M, van der Vaart CH, Liao J.
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Vaginal prolapses are treated according to the severity of symptoms.
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Couri BM, Lenis AT, Borazjani A, Paraiso MF, Damaser MS (May 2012).
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ACOG Committee on Practice Bulletins—Gynecology (September 2007).
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Safety and efficacy of many newer meshes is unknown. Thousands of
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With conservative measures, such as changes in diet and fitness,
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National Institute of Diabetes and Digestive and Kidney Diseases
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Boyd S, Propst K, O'Sullivan D, Tulikangas P (March 2019).
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Chapter Six - Pelvic Floor Biomechanics From Animal Models
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Descent of the pelvic organs from their normal positions
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protruding through the vagina in a 73 year old woman.
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Pelvic Organ Prolapse Quantification System (POP-Q)
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Posterior urethral descent, lowest part other sites
478:Evidence does not support the use of transvaginal 284:Grade 1 descent into vagina not reaching introitus 2351:Noninflammatory disorders of female genital tract 1171:. U.S. Food and Drug Administration. 13 July 2011 2342: 737:"Surgery for women with apical vaginal prolapse" 557: 555: 1532: 898:American Journal of Obstetrics and Gynecology 832: 1373:Expert Review of Obstetrics & Gynecology 552: 1244:The Cochrane Database of Systematic Reviews 1199:The Cochrane Database of Systematic Reviews 741:The Cochrane Database of Systematic Reviews 687:Health & physical assessment in nursing 364:Pelvic Organ Prolapse Quantification System 162:Cystourethrocele (both bladder and urethra) 1539: 1525: 940: 717:: CS1 maint: location missing publisher ( 58: 32:For prolapse of pelvic organs in men, see 1392: 1218: 1144: 1092: 1017: 909: 809: 768: 636: 587: 319:normal position for each respective site 475:, serious complications are "not rare." 213: 131: 119: 87:316 million women (9.3% as of 2010) 1415: 1349: 351:maximum possible descent for each site 14: 2343: 684: 1569: 1520: 1188: 1186: 1114: 1112: 290:Grade 3 descent outside the introitus 1420:. Academic Press. pp. 131–148. 1289:Michelle Llamas, BCPA (2022-11-11). 730: 728: 2326:Persistent genital arousal disorder 826: 617:International Urogynecology Journal 287:Grade 2 descent up to the introitus 24: 1426:10.1016/B978-0-12-803228-2.00006-4 1183: 1109: 811:10.1097/01.AOG.0000263925.97887.72 25: 2367: 2140:Hypoactive sexual desire disorder 1659:Ovarian hyperstimulation syndrome 1436: 725: 221:in a 71 year old woman, with the 241: 1409: 1360: 1356:. Mississippi State University. 1343: 1323:ASB 2015 Annual Conference 2015 1307: 1282: 1235: 1161: 1060: 1034: 977: 934: 512: 431: 343:descent halfway past the hymen 297: 168:Posterior vaginal wall prolapse 1754:Dysfunctional uterine bleeding 1256:10.1002/14651858.CD012079.pub2 1211:10.1002/14651858.CD004014.pub6 885: 861: 785: 753:10.1002/14651858.CD012376.pub2 678: 653: 604: 146:Anterior vaginal wall prolapse 13: 1: 580:10.1016/S0140-6736(12)61729-2 545: 442:pelvic floor physical therapy 423: 327:descent halfway to the hymen 175:(small intestine into vagina) 1850:Menorrhagia (hypermenorrhea) 1821:Polymenorrhea (epimenorrhea) 1291:"Transvaginal Mesh Lawsuits" 1002:10.1016/j.eclinm.2023.102326 955:10.1097/aog.0000000000002016 271:Lower 1/3 deficient perineum 7: 2267:Pelvic inflammatory disease 835:Journal of Clinical Urology 528: 520: 10: 2372: 2262:Pelvic congestion syndrome 1692:Fallopian tube obstruction 1125:Cochrane Database Syst Rev 1073:Cochrane Database Syst Rev 1054:10.3310/nihrevidence_62718 911:10.1016/j.ajog.2019.01.055 459: 361: 233: 31: 2311:Vestibular papillomatosis 2286: 2279: 2254: 2230: 2163: 2121: 2063: 2054: 2010: 1955: 1937: 1914: 1890: 1880:Metropathia haemorrhagica 1782: 1744: 1735: 1726: 1677: 1578: 1562: 1444: 1137:10.1002/14651858.CD012975 1085:10.1002/14651858.CD013108 943:Obstetrics and Gynecology 869:"Kegel Exercises | NIDDK" 798:Obstetrics and Gynecology 629:10.1007/s00192-017-3467-4 83: 71: 66: 57: 49: 44: 1647:Follicular cyst of ovary 847:10.1177/2051415812472675 357: 115: 2145:Sexual arousal disorder 2101:Candidal vulvovaginitis 1759:Endometrial hyperplasia 685:Donita D (2015-02-10). 661:"Pelvic organ prolapse" 281:Grade 0 Normal position 192:Apical vaginal prolapse 53:Female genital prolapse 1588:Endometriosis of ovary 230: 141: 129: 2032:Vesicouterine fistula 1975:Cervical incompetence 1900:Recurrent miscarriage 1838:Premenstrual syndrome 1699:Fallopian tube cancer 504:class action lawsuits 335:descent to the hymen 255:Lower 1/3 urethrocele 217: 159:(urethra into vagina) 153:(bladder into vagina) 135: 123: 94:Pelvic organ prolapse 45:Pelvic organ prolapse 2190:Rectovaginal fistula 1615:Poor ovarian reserve 268:Middle 1/3 rectocele 265:Upper 1/3 enterocele 199:(uterus into vagina) 181:(rectum into vagina) 2240:Postcoital bleeding 2168:Urogenital fistulas 2096:Bacterial vaginosis 1749:Asherman's syndrome 1416:Patnaik SS (2016). 1350:Patnaik SS (2015). 574:(9859): 2163–2196. 370: 304: 293:Grade 4 Procidentia 252:Upper 2/3 cystocele 2125:Sexual dysfunction 2091:Atrophic vaginitis 2027:Retroverted uterus 1990:Female infertility 1970:Cervical dysplasia 1895:Female infertility 1687:Female infertility 1642:Corpus luteum cyst 1598:Ovulatory disorder 1593:Female infertility 368: 302: 231: 142: 130: 2338: 2337: 2334: 2333: 2275: 2274: 2250: 2249: 2183:Obstetric fistula 2081:Vaginal discharge 2050: 2049: 1995:Cervical stenosis 1910: 1909: 1764:Endometrial polyp 1722: 1721: 1652:Theca lutein cyst 1514: 1513: 1385:10.1586/eog.12.24 1048:. 11 April 2024. 990:eClinicalMedicine 696:978-0-13-387640-6 489:organ perforation 421: 420: 355: 354: 91: 90: 39:Medical condition 16:(Redirected from 2363: 2306:Kraurosis vulvae 2301:Bartholin's cyst 2284: 2283: 2235:Vaginal bleeding 2128: 2061: 2060: 2037:Uterine prolapse 1865:Menometrorrhagia 1789: 1742: 1741: 1733: 1732: 1632:Ovarian apoplexy 1576: 1575: 1567: 1566: 1541: 1534: 1527: 1518: 1517: 1442: 1441: 1430: 1429: 1413: 1407: 1406: 1396: 1364: 1358: 1357: 1347: 1341: 1340: 1338: 1337: 1331: 1325:. Archived from 1320: 1311: 1305: 1304: 1302: 1301: 1286: 1280: 1279: 1270: 10936147. 1239: 1233: 1232: 1222: 1205:(11): CD004014. 1190: 1181: 1180: 1178: 1176: 1165: 1159: 1158: 1148: 1116: 1107: 1106: 1096: 1064: 1058: 1057: 1038: 1032: 1031: 1021: 981: 975: 974: 938: 932: 931: 913: 889: 883: 882: 880: 879: 865: 859: 858: 830: 824: 823: 813: 789: 783: 782: 772: 732: 723: 722: 716: 708: 682: 676: 675: 673: 672: 665:womenshealth.gov 657: 651: 650: 640: 608: 602: 601: 591: 559: 371: 367: 305: 301: 276:Uterine prolapse 219:Uterine prolapse 197:Uterine prolapse 62: 42: 41: 21: 18:Vaginal prolapse 2371: 2370: 2366: 2365: 2364: 2362: 2361: 2360: 2341: 2340: 2339: 2330: 2271: 2246: 2226: 2159: 2122: 2117: 2113:Vaginal atresia 2046: 2006: 1965:Cervical cancer 1951: 1933: 1929:Uterine fibroid 1906: 1886: 1870:Polymenorrhagia 1811:Oligoamenorrhea 1783: 1778: 1718: 1673: 1669:Ovarian torsion 1558: 1548:Female diseases 1545: 1515: 1510: 1509: 1453: 1439: 1434: 1433: 1414: 1410: 1365: 1361: 1348: 1344: 1335: 1333: 1329: 1318: 1312: 1308: 1299: 1297: 1287: 1283: 1250:(3): CD012079. 1240: 1236: 1191: 1184: 1174: 1172: 1167: 1166: 1162: 1131:(3): CD012975. 1117: 1110: 1079:(8): CD013108. 1065: 1061: 1040: 1039: 1035: 982: 978: 939: 935: 890: 886: 877: 875: 867: 866: 862: 831: 827: 790: 786: 747:(7): CD012376. 733: 726: 710: 709: 697: 683: 679: 670: 668: 659: 658: 654: 609: 605: 560: 553: 548: 531: 523: 515: 462: 453:silicone rubber 438:Kegel exercises 434: 426: 366: 360: 300: 244: 236: 225:visible in the 118: 40: 37: 34:Rectal prolapse 28: 23: 22: 15: 12: 11: 5: 2369: 2359: 2358: 2353: 2336: 2335: 2332: 2331: 2329: 2328: 2323: 2318: 2313: 2308: 2303: 2298: 2292: 2290: 2281: 2277: 2276: 2273: 2272: 2270: 2269: 2264: 2258: 2256: 2252: 2251: 2248: 2247: 2245: 2244: 2243: 2242: 2231: 2228: 2227: 2225: 2224: 2223: 2222: 2217: 2212: 2207: 2202: 2192: 2187: 2186: 2185: 2180: 2175: 2173:Ureterovaginal 2164: 2161: 2160: 2158: 2157: 2152: 2150:Vaginal cancer 2147: 2142: 2137: 2131: 2129: 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494: 490: 484: 481: 480:surgical mesh 476: 474: 470: 466: 457: 454: 450: 445: 443: 439: 429: 416: 413: 412: 408: 405: 404: 400: 397: 396: 392: 389: 388: 384: 381: 380: 376: 373: 372: 365: 350: 347: 346: 342: 339: 338: 334: 331: 330: 326: 323: 322: 318: 315: 314: 310: 307: 306: 292: 289: 286: 283: 280: 279: 278: 277: 270: 267: 264: 263: 262: 261: 254: 251: 250: 249: 248: 247:Anterior wall 242:Shaw's System 239: 228: 224: 220: 216: 208: 204: 203:Vaginal vault 201: 198: 195: 194: 193: 190: 186: 183: 180: 177: 174: 171: 170: 169: 166: 161: 158: 155: 152: 149: 148: 147: 144: 143: 139: 134: 127: 122: 113: 111: 107: 103: 99: 95: 86: 82: 79: 76: 74: 70: 65: 61: 56: 52: 48: 43: 35: 30: 19: 2215:Sigmoidocele 2123: 2068:Hematocolpos 1947:Parametritis 1855:Metrorrhagia 1833:Dysmenorrhea 1786:Menstruation 1784: 1774:Endometritis 1709:Hydrosalpinx 1637:Ovarian cyst 1498: 1487: 1472: 1457: 1417: 1411: 1376: 1372: 1362: 1352: 1345: 1334:. 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Retrieved 667:. 2017-05-03 664: 655: 620: 616: 606: 571: 567: 535:Perineometer 524: 516: 513:Epidemiology 508: 501: 485: 477: 469:colpocleisis 463: 446: 435: 432:Non-surgical 427: 377:Description 298:Baden–Walker 275: 274: 259: 258: 246: 245: 237: 207:hysterectomy 191: 185:Sigmoidocele 167: 145: 102:pelvic floor 97: 93: 92: 29: 2220:Urethrocele 2135:Dyspareunia 2108:Hydrocolpos 2072:Hydrocolpos 2018:Hematometra 1939:Parametrium 1924:Adenomyosis 1737:Endometrium 1714:Salpingitis 1603:Anovulation 904:(3): S723. 157:Urethrocele 50:Other names 2345:Categories 2321:Vulvodynia 2205:Enterocele 2155:Vaginismus 2077:Leukorrhea 1985:Cervicitis 1916:Myometrium 1801:Amenorrhea 1627:Oophoritis 1500:DiseasesDB 1336:2019-03-26 1300:2023-01-16 996:: 102326. 878:2017-12-02 671:2017-12-29 546:References 424:Management 173:Enterocele 78:Gynecology 2210:Rectocele 2200:Cystocele 2086:Vaginitis 1295:drugwatch 1264:1469-493X 1010:2589-5370 920:0002-9378 761:1469-493X 713:cite book 705:894626609 493:infection 179:Rectocele 151:Cystocele 138:rectocele 126:cystocele 110:rectocele 106:cystocele 84:Frequency 73:Specialty 2316:Vulvitis 2280:External 2195:Prolapse 2022:Pyometra 1563:Internal 1556:genitals 1403:22707980 1276:38477494 1229:27901278 1155:29502352 1103:30121956 1028:38078194 1019:10701109 971:46882949 963:28333818 928:86740242 855:75886698 820:17766624 779:37493538 770:10370901 647:28929201 598:23245607 529:See also 521:Research 229:orifice. 2011:General 1550:of the 1494:D014596 1394:3374602 1220:6464975 1175:23 June 1146:6494287 1094:6513383 638:7329191 589:6350784 540:Pessary 465:Surgery 460:Surgery 449:pessary 234:Grading 227:vaginal 2356:Vagina 2056:Vagina 1957:Cervix 1876:Other 1861:Mixed 1845:Timing 1728:Uterus 1571:Adnexa 1552:pelvis 1401:  1391:  1274:  1262:  1227:  1217:  1153:  1143:  1101:  1091:  1026:  1016:  1008:  969:  961:  926:  918:  853:  818:  777:  767:  759:  703:  693:  645:  635:  596:  586:  568:Lancet 495:, and 440:, and 223:cervix 136:Large 2288:Vulva 2255:Other 1580:Ovary 1505:25265 1330:(PDF) 1319:(PDF) 967:S2CID 924:S2CID 851:S2CID 374:Stage 358:POP-Q 308:Grade 116:Types 1828:Pain 1796:Flow 1554:and 1489:MeSH 1478:9-CM 1399:PMID 1272:PMID 1260:ISSN 1248:2024 1225:PMID 1203:2017 1177:2015 1151:PMID 1129:2018 1099:PMID 1077:2018 1024:PMID 1006:ISSN 959:PMID 916:ISSN 816:PMID 775:PMID 757:ISSN 745:2023 719:link 701:OCLC 691:ISBN 643:PMID 594:PMID 497:pain 1483:618 1474:ICD 1468:N81 1459:ICD 1422:doi 1389:PMC 1381:doi 1268:PMC 1252:doi 1215:PMC 1207:doi 1141:PMC 1133:doi 1089:PMC 1081:doi 1050:doi 1014:PMC 998:doi 951:doi 947:129 906:doi 902:220 843:doi 806:doi 802:110 765:PMC 749:doi 633:PMC 625:doi 584:PMC 576:doi 572:380 473:FDA 98:POP 2347:: 2079:/ 2070:/ 2020:/ 1503:: 1492:: 1481:: 1466:: 1463:10 1397:. 1387:. 1375:. 1371:. 1321:. 1293:. 1266:. 1258:. 1246:. 1223:. 1213:. 1201:. 1197:. 1185:^ 1149:. 1139:. 1127:. 1123:. 1111:^ 1097:. 1087:. 1075:. 1071:. 1044:. 1022:. 1012:. 1004:. 994:66 992:. 988:. 965:. 957:. 945:. 922:. 914:. 900:. 896:. 871:. 849:. 837:. 814:. 800:. 796:. 773:. 763:. 755:. 743:. 739:. 727:^ 715:}} 711:{{ 699:. 663:. 641:. 631:. 621:29 619:. 615:. 592:. 582:. 570:. 566:. 554:^ 499:. 491:, 447:A 444:. 124:A 108:, 1540:e 1533:t 1526:v 1476:- 1461:- 1451:D 1428:. 1424:: 1405:. 1383:: 1377:7 1339:. 1303:. 1278:. 1254:: 1231:. 1209:: 1179:. 1157:. 1135:: 1105:. 1083:: 1056:. 1052:: 1030:. 1000:: 973:. 953:: 930:. 908:: 881:. 857:. 845:: 839:6 822:. 808:: 781:. 751:: 721:) 707:. 674:. 649:. 627:: 600:. 578:: 414:4 406:3 398:2 390:1 382:0 348:4 340:3 332:2 324:1 316:0 140:. 96:( 36:. 20:)

Index

Vaginal prolapse
Rectal prolapse

Specialty
Gynecology
pelvic floor
cystocele
rectocele

cystocele

rectocele
Cystocele
Urethrocele
Enterocele
Rectocele
Sigmoidocele
Uterine prolapse
Vaginal vault
hysterectomy

Uterine prolapse
cervix
vaginal
Pelvic Organ Prolapse Quantification System
Kegel exercises
pelvic floor physical therapy
pessary
silicone rubber
Surgery

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