Search PubMed⌕ Search

Biomedical subjects

H D Methfessel

Publications and source records attributed to H D Methfessel.

At least 19 recordsLinked to original sources
PubMed2001

Sacrospinous ligament fixation for vaginal vault prolapse.

INTRODUCTION: To assess intra- and postoperative complications and to look for long term follow-up results in women with sacrospinous ligament fixation. METHODS: Between 1988 and 1999, 200 women (mean age 59.8 years, range 33 to 83 years) underwent vaginal unilateral sacrospinous ligament fixation. 172 patients had had prior hysterectomy. In 28 patients concomitant hysterectomy and sacrospinous ligament fixation was performed. Sacrospinous ligament fixation was combined with the following procedures: 109 enterocele repairs (54.5%), 88 anterior colporrhaphies (44%), 57 reconstructions of urogenital diaphragma (28.5%) and 23 posterior colporrhaphies (11.5%). Additional Burch colposuspension and a Stamey procedure were carried out in 7 (3.5%) and 15 (7.5%) patients, respectively. RESULTS: All 200 patients were analysed for intra- and postoperative complications. Urinary tract infection (n = 16, 8.0%), temporary irritation of the sciatic nerve (n = 15, 7.5%), temporary partial ureteral obstruction (n = 11, 5.5%) and blood loss less than 400 ml (n = 7, 3.5%), occurred in the postoperative phase. Long-term data (range from 6 months to 9 years, mean 4.8 years) exist for 123 patients. 119 were completely cured without any signs of urinary incontinence and prolapse. At follow-up 4 patients (3.25%) showed recurrent vaginal vault prolapse. Recurrent cystoceles, rectoceles, enteroceles, were found in 10 cases (8.1%), one (0.8%) and one (0.8%), respectively. Two patients with complete recurrence of vaginal vault prolapse successfully underwent colpectomy and repeated sacrospinous ligament fixation, respectively. CONCLUSIONS. Sacrospinous ligament fixation is an effective and safe procedure with a low recurrence and complication rate.

Adult↗
PubMed2001

[Pelvic organ prolapse].

Pelvic organ prolapse of the female is a common disease with age dependent increase in incidence. The committee for standardisation of the International Continence Society recently suggested to avoid classical terms such as cystocele, rectocele or enterocele for the description of prolapse and to replace them by defined landmarks. The "Pelvic Organ Prolapse Quantification" (POPQ) was developed and five different grades of prolapse were defined. This is a true gain for scientific documentation but needs some effort to be implemented in routine practical work. Previous normal vaginal delivery is statistically highly correlated with prolapse, followed by climacteric involution, constitutional factors, physical work, chronic bronchitis, and overweight respectively. The diagnosis is confirmed by clinical examination. Defects of the supportive structures can be precisely assessed with dynamic magnetic resonance imaging. Time will show whether this costly method will become part of routine diagnostic procedures. A patient with moderate prolapse or few complaints may be treated conservatively with pelvic floor training or electrotherapy. Modern pessaries are tried as first line therapy or for patients unwilling to undergo surgery. Local estrogen application should routinely be prescribed for perimenopausal patients. In the last decade laparoscopic techniques have been established in addition to standard methods of pelvic floor reconstruction. These techniques do not follow a new surgical strategy but realise the minimal invasive approach to established methods of pelvic floor reconstruction. Of note, laparoscopic fixation is very convenient for young women who want to preserve their uterus. Long time follow up is not available for most techniques.

Female↗
PubMed1996

[Computer-assisted analysis of urethral pressure profiles in the woman].

The regular urethral stress profile which is applied for the diagnosis in urinary stress incontinence has been modified in two respects: Volley-like increasing pressure and a final spline-interpolation. With this method it is possible to analyze virtual standards for any variable of the profile. Measurements were carried out in 20 stress incontinent female patients compared with 10 healthy women. Urinary stress incontinence could not be verified through regular profiles (i.e. methods) in each of the 20 impaired patients. After the stress profile had been modified we proved that 11 Aases auf twenty definitely suffered from urethral insufficiency, 6 patients showed a deterioration of the profile and 3 had no change. It is possible to prove urinary stress incontinence by tracing the dynamics of the urethral pressure response which shows an irregular pattern in incontinent women.

Adult↗
PubMed1992

[Urinary fistula after radical hysterectomy with lymph node excision].

In 908 radical hysterectomies including dissection of pelvic lymph nodes, 13 (= 1.43%) urogenital fistulas were seen. They occurred postoperatively between the 7th and 15th day. In 12 cases it was a uretero-vaginal and once a vesico-vaginal fistula. The operation report of 7 cases with uretero-vaginal fistula reveals difficulties in separating the ureter in its prevesical part proceeding from tumour spread, endometriosis, scar or bleeding. Since 1985 a percutaneous nephrostomy has been performed (5 cases). 4 fistulas were cured spontaneously, one of them had a percutaneous nephrostomy. In all cases, urography was normal. In 7 cases, ureterocystoneostomy had to be performed. This was done once with fixation of the psoas muscle and 6 times according to Boari. All patients were cured without any complications and with an undisturbed drainage assessed 1 year later by urography. 1 patient, who refused any follow-up, died subsequently. The only vesico-vaginal fistula has been closed by Latzko's procedure. In recent years the problems concerning urogenital fistulas resulting from surgery of cervical cancer have receded. However, if patients adopt an offensive attitude against surgical therapy of stage T2b, the rate of incidence of this complication can be expected to increase.

Adult↗
PubMed1992

[Occlusion of a vesicovaginal fistula with Latzko-repair].

UNLABELLED: The Latzko procedure is a well-known method for the closure of small vesico-vaginal fistulas occurring in the vaginal dome after hysterectomy. This method is favoured by gynaecologists. In three Departments of gynaecology, a total of 104 patients were treated. 76% had been referred from other hospitals. 56.7% resulted from gynaecological operations. In 69.2% was a benign and in 28.8% a malignant disease. In only 2 cases, the primary disease remained unknown. RESULTS: In 97 of 104 (= 93.3%) cases, the procedure according to Latzko succeeded at the first attempt. 5 of 7 recurrences were resolved by the second attempt with the same operative technique according to Latzko, signifying a secondary success rate of 98%. There were only 2 notable complications: the one, where a postoperative bladder haemorrhage attributed to anticoagulants, and the second with a bladder stone noticed 11 years after the Latzko procedure. This technique can be performed in 95% of all vesico-vaginal fistulas occurring. The fundamental advantages of its use are: short duration of the procedure, high cure rate and few complications.

Female↗
PubMed1990

[Diagnosis of angiologic function in unilateral leg edema following combined treatment of cervix cancer].

For the clarification of the genesis of a unilateral dropsy of the legs which had appeared in 16 women after operative and radiologic therapy of a carcinoma of the cervix apparative angiological functional investigations were carried out. A slightly diminished plethysmographic drainage volume in a Doppler-sonographically unhandicapped deep venous flow off corresponded to the clinical picture of the secondary lymphatic oedema. The findings were compared with the behaviour of the parameters in thrombosis of the iliofemoral vein and test persons with healthy vessels. Only in two cases a venous component in form of a stenosis of the pelvic veins and a postthrombotic syndrome, respectively, could be objectified. Since the methodology renders possible a differentiation of lymphatic oedema and phleboedema, it is suitable for non-invasive controls of the course and has practical significance in the after-care of female patients with carcinoma of the cervix.

Combined Modality Therapy↗
PubMed1989

[Estrogen and progesterone receptors in mesenchymal structures of the female urogenital tract].

In 37 women being operated on gynecologically small portions of mesenchymatic tissue have been sampled and analysed with respect to the presence and concentration of estrogen and progesterone receptors within the cytosol fraction. The proofs were taken from: ligamentum cardinale, ligamentum sacrouterinum, pubo-vesico-cervical fascia, paracolpium, ligamentum teres uteri, levator muscle and serving as a comparison tissue from fornix vaginae posterior. In the proofs of pubo-vesico-cervical fascia and paracolpium there were no progesterone receptors. In all the other tissues there were as a matter of principle estrogen and progesterone receptors. However from sample to sample there were wide differences with reference to the existence and the concentration of hormone receptors. There was no correlation to the age of life. The results are discussed and compared with those to be found in literature. MeSH: D 12.776.543.750.830.630 Receptors, estrogen G 6.184.154.803.817.349 Receptors, estrogen G 12.803.817.349 Receptors, estrogen D 12.776.543.750.830.700 Receptors, progesterone G 6.184.154.803.817.777 Receptors, progesterone G 12.803.817.777 Receptors, progesterone A 5.360.319.114.170 Broad ligament A 5.360.319.114.803 Round ligament

Adult↗
PubMed1988

[Actinic bladder-rectal-vaginal fistulas].

Combined fistulas between urinary bladder, rectum and vagina are one of the most serious complications after radiation therapy of genital carcinoma in female patients. The prognosis quo ad restitutionem is poor also at the present time. In our material of 25 cases the restoration of complete faecal and urinary continence was achieved in only 5 patients, however with a loss of the ability of sexual intercourse. In 5 cases an ileum conduit combined with an anus praeter was the definitive solution and in 4 further cases the hygienic situation was improved by colpocleisis and vesico-rectal anastomosis, respectively. In the other patients only a palliative and symptomatical therapy was possible because of poor condition, advanced age and unfavourable local situation.

Adult↗
PubMed1988

[Choriocarcinoma of the uterine cervix].

Case report of a 18-year-old girl with choriocarcinoma of the uterine cervix. The patient underwent radical hysterectomy with pelvic lymphonodectomy followed by chemotherapy (Methotrexate, Actinomycin D). A malignant trophoblastic tumor of this localisation is very rare. Approximately 60 case has been described in the literature at present.

Adolescent↗
PubMed1987

[Rare foreign body fistulas of the female bladder].

Fistulae between kidney and vagina caused by foreign bodies are very rare nowadays. Two casuistics illustrate the curious anamnesis of such patients: in an 18-year-old girl a foreign body inserted during masturbation led to a perforation, in the case of a 66-year-old woman a pessary which had been forgotten since 35 years penetrated into the urinary bladder.

Adolescent↗
PubMed1986

[Latzko-plasty for closing vesicovaginal fistulas].

It is reported on 68 Latzko-grafts in vesicovaginal fistulae. In 63 cases (92.6%) the closure was successful in the first session; 4 of the 5 failures were corrected with the same technique in the second session. The method is technically simple and little stressing for the patient. It is to be recommended particularly for the treatment of the typical posthysterectomy fistula. The shortening of the vaginal canal is insignificant also in young women.

Female↗
PubMed1983

[Melanoma of the female urethra].

Case report of a 69-year-old woman with a melanoma of the urethra. Radical surgery was renounced in regard of the age. We performed local excision with inguinal lymphonodectomy only followed by chemotherapy with dacarbazine. A tumor of this localisation is rare. Approximately 45 cases have been described in the literature at present. The prognosis of the diseases is very poor.

Aged↗
PubMed1982

[Urometric studies before and after stress incontinence operations].

77 women with insufficiency of the urethral sphincter were urometrically examined before and 16 weeks after operations for urinary stress incontinence (38 vaginal plastic operations and 39 Zoedler plastic operations). The resting pressure in the urethra cannot be increased by either operation. On the contrary, the readings are lower after the operations. A slight increase in the functional length of the urethra is to be observed only in the case of Zoedler plastic operations. The so-called stress quotient shows the clearest change. This increases in both groups and corresponds to clinical healing. The results are compared with more recent, partly divergent findings.

Female↗
PubMed1982

[Anamnestic and urometric classification of 185 cases of urinary incontinence].

Standard interviews were obtained from 185 women with urinary incontinence over three years to collect information about their individual complaints. All probands then were urometrically examined. The selection had been by negative criteria, as 40.5 per cent of the women had undergone one or several unsuccessful operations earlier in the past. Information based on case histories was grouped by three categories of complaint; only stress symptoms (n = 66), stress and urge symptoms (n = 116), only urge symptoms (n = 3). The following findings were obtained, in terms of ICS classification, by urometric diagnosis: stress incontinence due to urethral insufficiency (n = 51), stress incontinence with accompanying urge component (n = 72), sensorial urge incontinence (n = 26), motor urge incontinence (n = 16), overflow incontinence (n = 7), no urometric findings (n = 13). Sizeable variation was found to exist by comparison between complaint groups on the basis of case history and groups based on urometric classification. Such discrepancy applied primarily to the grey area of combined stress-urge symptoms from which the majority of bladder-dependent incontinence forms was recorded. Yet, pure stress incontinence, too, signalized genuine urethral insufficiency only in 51 of 66 cases. Hence, even detailed case history can provide only limited information for proper diagnosis.

Female↗
PubMed1979

[Pregnancy and delivery after renal transplantation (author's transl)].

A case report is given on a 21-years-old woman who became pregnant 18 months after renal transplantation. In spite of relatively unfavourable conditions (match 0,25; hypertension) renal function showed a good adaptation throughout the gestation. In the 38. week of pregnancy the woman was successfully delivered of a 2440 g healthy female child by vacuum extraction. There were no effects of the immunsuppressive drugs on the newborn. It is the third case of a successful delivery after renal transplantation in the GDR.

Adult↗