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Biomedical subjects

Douglass S Hale

Publications and source records attributed to Douglass S Hale.

6 recordsLinked to original sources
PubMed2006

Abdominovaginal sacral colpoperineopexy: patient perceptions, anatomical outcomes, and graft erosions.

This is a retrospective analysis of 169 consecutive patients who underwent the abdominovaginal sacral colpoperineopexy. POP-Q measurements, patient willingness to have the same surgery again, and mesh erosions were recorded during follow-up visits. Patients whose erosion responded to office excision were defined as having minor mesh erosion. Patients with persistent erosions requiring outpatient surgical excisions were defined as having major mesh erosion. For the 122 patients with 12-month follow-up, all POP-Q points improved (p<0.005) compared with preoperative measurements. The response to the question "Would you go through the same surgery again?" was "yes" 77.3% of the time and "no" 4.9% of the time. Minor mesh erosion rate was 5.9% (10/169). Major erosion rate was 0.6% (1/169). In conclusion, when combined with paravaginal defect repair and Burch urethropexy, the abdominovaginal sacral colpoperineopexy effectively addresses all support defects in patients with advanced prolapse. The procedure is associated with a high level of patient willingness to have the same surgery again, and it is achieved with low erosion rate.

Collagen↗
PubMed2005

Factors which influence the short-term success of pessary management of pelvic organ prolapse.

OBJECTIVE: The purpose of this study was to identify patient criteria which may affect the outcome of a pessary trial. STUDY DESIGN: Records of 407 patients presenting with symptomatic pelvic organ prolapse who had a trial of pessary management were reviewed. Success was defined both by the initial fitting as well as by whether the patient was using the pessary at the 3-week follow-up visit. Outcomes were compared using chi-square test, 2-sample Student t test, or the Wilcoxon rank sum test, as appropriate. Statistical analysis was carried out at a significance of .05. RESULTS: One hundred sixty-eight patients (41%) were successfully fitted and continuing to use a pessary at the time of the 3-week follow-up visit. The likelihood of a successful pessary trial was significantly lower in subjects with a past history of hysterectomy (P<.001) or known reconstructive surgery for prolapse (P=.010). There was no association between the stage of prolapse and pessary trial outcome. There was no significance found in the relationship between the predominant location of support loss and the pessary trial outcome at the 3-week follow-up visit. CONCLUSION: The type and severity of pelvic organ prolapse do not influence the likelihood of a successful pessary fitting, and should not be used as a basis on which to select patients for pessary management.

Adult↗
PubMed2003

Total colpocleisis with high levator plication for the treatment of advanced pelvic organ prolapse.

OBJECTIVES: Our purpose was (1). to report long-term objective and subjective outcome data after total colpocleisis with high levator plication and (2). to compare operative morbidity of total colpocleisis in patients with prior versus concurrent hysterectomy. STUDY DESIGN: The medical records of patients who underwent total colpocleisis with high levator plication between August 1, 1988, and December 31, 2000, were retrospectively reviewed. Patient characteristics, operative data, and objective outcome measures including pelvic organ prolapse staging measurements were obtained from subject records. Subjective outcome measures were obtained by a standardized telephone survey. A t test was used to compare continuous variables between patients who underwent prior versus concurrent hysterectomy. The Fisher exact test was used to test for association between patient group and each categorical variable. RESULTS: During the 12-year study period, 92 subjects underwent total colpocleisis with high levator plication. Of the 92 subjects, 90 (97.8%) underwent concurrent operations and 37 (40.2%) underwent simultaneous hysterectomy. With objective cure defined as absence of prolapse to the hymen, 90 subjects (97.8%) were objectively cured after a median follow-up of 12 months (range, 0-64 months). Of 62 subjects available for telephone follow-up, 56 (90.3%) reported being satisfied or very satisfied with how the surgery cured their prolapse after a median follow-up of 24 months (range, 13-161 months). Concurrent hysterectomy was associated with statistically significant increases in absolute change in hematocrit (9.5% without vs 11.9% with hysterectomy) and transfusion requirement (12.7% without vs 35.1% with hysterectomy). There was no significant difference in surgical complications between groups. CONCLUSION: Total colpocleisis is an effective operation for the treatment of advanced pelvic organ prolapse. Concurrent hysterectomy is associated with higher blood loss and transfusion requirements.

Aged↗
PubMed2002

Transurethral bladder eversion concurrent with uterovaginal prolapse.

BACKGROUND: Transurethral bladder eversion is rare. A case of transurethral bladder eversion with concurrent uterovaginal prolapse is presented. CASE: The patient was postmenopausal, had a long history of uterovaginal prolapse, and developed bladder eversion. Examination under anesthesia revealed full-thickness transurethral bladder eversion and complete uterine procidentia. Temporary reduction of the prolapse was done initially because of her unstable medical condition. After medical stabilization, definitive surgical reconstruction was completed by a vaginal approach. CONCLUSION: Full-thickness, transurethral bladder eversion can be surgically treated by a vaginal approach.

Bladder Exstrophy↗