Search PubMed⌕ Search

Biomedical subjects

P von Theobald

Publications and source records attributed to P von Theobald.

At least 19 recordsLinked to original sources
PubMed2003

[Three-way prosthetic repair of the pelvic floor].

We describe the triple operation for prolapse with prosthesis in patients with pelvic organ prolapse using a vesicovaginal mesh for the cystocele, a rectovaginal mesh for the rectocele and a posterior retro-and trans levatory vault suspension sling. Preliminary results in a consecutive series of 92 patients who underwent surgery between June 2001 and December 2002 showed three cases of vaginal erosion in contact with the prosthetic material, and one hematoma of the pararectal fossa with secondary abscess formation requiring ablation of the implant. There was one immediate anatomic failure. Function was good with no reports of dyspareunia or dyschesia.

Abscess↗
PubMed2000

[Complications of vaginal hysterectomy on non-prolapsed uterus].

OBJECTIVE: To assess our rate of complications after vaginal hysterectomy and those described in the literature, particularly in high risk groups such as obese, nulliparous women with previous abdomino-pelvic surgery or after GnRH administration. METHOD: We retrospectively looked for complications in 490 patients who underwent vagina l hysterectomy between 1990 and 1998: infections, hemorrhage, intraoperative complications, thrombophlebitis or pulmonary embolism, postoperative complications up to one month. The chi-squared test, t test for equality of means and Fisher's exact test were used for statistical analysis. RESULTS: The complication rate observed in our series (20.7%) was similar to those reported in the literature. We found no difference in the obese group (n=109) the nulliparous women (n=34), after GnRH administration (n=24) or i women with previous abdomino-pelvic surgery (n=128). Heavy bleeding was not increased by morcellation. CONCLUSION: Vaginal hysterectomy is easy and safe. The vaginal route is the best way for obese subjects and can be carried out in most cases, especially in nulliparous women or after GnRH analogs, even when morcellation is necessary, without increasing morbidity.

Female↗
PubMed1999

[Feasibility of the laparoscopic sub-urethral sling procedure].

OBJECTIVE: To evaluate the feasibility of the laparoscopic sling procedure, 44 patients 26 to 66 years old (average 45) with sphincter incompetence were included in this prospective series between 1993 and 1999. PATIENTS AND METHODS: Patient selection for a sling procedure was based on urodynamic findings (average closure pressure was 34 cm of water). The operative procedure is described. RESULTS: The follow up ranged from two to 66 months (average 27.6). Seven conversions into laparotomy had to be performed. 35 slings could be set successfully. Four of these slings had to be removed during the year following the procedure; two because of bladder neck erosion and two because of chronic bladder distension. The success rate of the 35 slings is 88.6%. The overall complication rate is 27% including five bladder injuries, 2 urether injuries and one hemorrhage. Ten of the twelve complications occurred in the 12 first patients and the complication rate decreased to 9% in the 32 last patients. Average hospital stay was 4 days. CONCLUSION: The laparoscopic sling procedure seems to be promising in the management of refractory urinary incontinence due to sphincter incompetence. But it is an advanced laparoscopic procedure for experienced laparoscopic surgeons, needing a long learning curve.

Adult↗
PubMed1997

Laparoscopic douglasectomy in the treatment of painful uterine retroversion.

BACKGROUND: One of the etiologies of pelvic pain in women, often unrecognized, is the Masters-Allen syndrome, which was described in 1955 as the "universal joint cervix" syndrome. It has the following three elements: (1) etiology: obstetrics-related trauma; (2) clinical findings: uterine retroversion with hypermobile cervix following elongation or desinsertion of the uterosacral ligaments; (3) anatomy: visualization of a tearing of the posterior serosa and subperitoneal fascia of the ligamentum latum. METHODS: Forty-one laparoscopic Douglasectomies with uterosacral ligamentopexy were performed in the department of Gynecology at the University Hospital of Caen during the period between 1990 and 1995 in patients with painful retroverted uterus. The patient selection was made thanks to the "pessary test." The surgical endoscopic procedure, identical to the operation first promoted by Jamain and Letessier in 1976 by laparotomy, is described. RESULTS: Total pain relief was experienced by 31 patients (75%) and partial relief by five patients (5%). Two main complications occurred, requiring one laparotomy (bleeding from a pelvic varicose vein with a concomitantly occurring breakdown of the washing-aspiration system) and one second laparoscopy at day 15 (one case of hematoma below the peritonization revealed by pain). Twenty-three women became pregnant again, and had normal deliveries except for two cesareans, with no recurrence of pain. Douglasectomy is compared to alternative techniques in the literature. Other indications for Douglasectomy are discussed. CONCLUSION: Douglasectomy is the only definitive procedure for restoring normal anatomy of the pelvic floor in case of painful uterine retroversion occurring in a setting of Masters-Allen syndrome. Additionally, it provides for pathological analysis of the excised peritoneum. The results of this procedure are excellent when the indication is correctly set, particularly as concerns positive pessary testing.

Adult↗
PubMed1997

Feasibility of and interest in laparoscopic assessment in recurrent urinary stress incontinence after Burch procedure performed by laparotomy.

BACKGROUND: The Burch colposuspension, performed by laparotomy or laparoscopy, remains one of the most popular operations for the treatment of genuine stress incontinence. The average failure rate is 10% in patients followed up for 5 years or more in the literature. The etiology of the failure is difficult to assess by clinical or urodynamic investigations; the failure may be due to weak sutures on the Cooper's ligaments or on the vagina, to excessive or insufficient elevation of the cervical neck, or to an incompetent urethral sphincter. METHODS: The authors performed five preperitoneal laparoscopies for recurrent urinary stress incontinence in women after a colposuspension performed by laparotomy in order to determine the etiology of the recurrence (between 1992 and 1995 at the Department of Gynecology of the University Hospital of Caen, France). RESULTS: Laparoscopic preperitoneal access was possible in all patients. No laparotomy had to be performed. One small bladder injury occurred during the dissection. It was sutured by laparoscopy. There were no postoperative complications. In one patient, both of the sutures had escaped. In two other patients both sutures were found in place, but urodynamics showed a decrease in closure pressure. In two other patients, complaining of dysuria (painful voiding and acute bladder distension) associated with urinary leakage, only the colposuspension on one side had failed, involving a lateral torsion of the bladder neck. CONCLUSION: Preperitoneal laparoscopy is feasible after a laparotomic colposuspension and gives a very interesting etiologic contribution to the recurrence of incontinence. It helps to choose the most appropriate procedure to treat these recurrent incontinent patients: a new colposuspension if the previous one has failed anatomically and a sling operation if it hasn't and if the sphincter is incompetent.

Adult↗
PubMed1995

Laparoscopic preperitoneal colposuspension for stress incontinence in women. Technique and results of 37 procedures.

We present an original laparoscopic technique for treatment of stress urinary incontinence in women equivalent to the classical open approach described by Burch. This technique is particularly interesting because a wide pneumoretzius allows adequate access without being hindered by intestinal loops or the free border of the bladder. Suspension is achieved with nonabsorbable mesh bands stapled to the vagina and Cooper's ligaments. Seventy nine operations were performed at the Department of Gynecology of the University Hospital of Caen, France, between 1992 and 1995. The cure rate of the first 37 procedures (with a 18-42-month-long follow-up) is 86%. Of the patients, 22% had low closure pressure and 19% had an unstable bladder. No laparotomy had to be performed.

Adult↗
PubMed1994

[Laparoscopic colpo-suspension by the Burch technique].

The Burch technique is the reference method for the treatment of exertion incontinence related to cervicocystoptosis. We present an original laparoscopic technique equivalent to the classical open approach. This technique is particularly interesting because a wide pneumoretzius allows adequate access for instruments without being hindered by intestinal loops and the free border of the bladder. Suspension is achieved with non-absorbable mesh bands which are attached to the vagina and Cooper ligaments with staples. The anchoring point is thus larger and the space remains blood free. Fifty nine operations were performed with this technique at the Department of Gynaecology of the University Hospital at Caen, France. No failures have been observed.

Female↗
PubMed1994

[Surgical laparoscopy and pregnancy. Eight cases].

Eight cases of abdominopelvic surgery including 7 conducted uniquely by laparoscopy point out certain questions concerning diagnosis and management with this technique. These 8 cases included 6 cysts of the ovary, 1 appendectomy and 1 myomectomy. The consequences related to the operation or the anaesthesia and the foetal consequences were evaluated retrospectively. In particular, laparoscopic surgery induces certain pathophysiological modifications which remain to be studied.

Adult↗
PubMed1992

[Management of the scarred uterus].

On the basis of 899 cases of uterine scarring following cesarean section, the authors carried out a prophylactic cesarean in 42% of cases. Labor ended in childbirth by the genital tract in 44% of cases. The very low incidence of uterine rupture since segmental hysterotomy has become widespread and the improved fetal and maternal prognosis are all reasons to prefer delivery by the genital tract. One of the factors in choosing the method of childbirth is radiopelvimetry and estimation of the fetal weight; however, the suspicion of a threshold pelvis is not a contraindication to the labor test which was successful in 70% of the authors cases. On condition that strict obstetrical monitoring is possible, oxytocic drugs can be used to induce labor or correct hypokinesia and to administer a peridural analgesic. Routine extraction is no longer necessary during the expulsion phase but the authors remain faithful to uterine revision. In general, the labor test should be suggested as often as possible and should receive the same monitoring and treatment methods as for an intact uterus.

Birth Weight↗
PubMed1991

[Course of metrorrhagia after biopsy curettage of the endometrium in women in reproductive age ].

Authors working in the department of gynaecology and obstetrics in the university hospital of Caen with non-pregnant, non-menopausal women who were followed-up for at least 2 years after curettage have been able to carry out a retrospective study of 102 curettage and biopsies carried out either for diagnosis or to lessen bleeding in cases of metrorrhagia, menorrhagia or menometrorrhagia. Histology of the endometrium showed 40 cases of hyperplasia, 17 cases of polyps in the cavity of the uterus, 19 cases of atrophy, 6 cases of endometritis, 3 cases of atypical hyperplasia and 17 cases of normal endometrium. Hysterectomy was carried out in 22 cases because of recurrence of metrorrhagia. Anatomopathological examination of the operation specimens had shown iatrogenic atrophy of the mucosa in 13 cases (59%). The authors believe that this hypoplasia can be responsible for some recurrences and suggest that the state of the endometrium should be reassessed when metrorrhagia reappears in spite of well controlled treatment with progestagens. In the case of atrophy a cycle of oestrogens and progestagens should be started as it should be immediately after the curettage. The authors hope in this way to lessen the number of hysterectomies that have to be carried out because of failure of medical treatment.

Adult↗
PubMed1990

[The outcome of continuing pregnancies in patients with intrauterine devices. A retrospective study from the Maternity Unit of the University Hospital Center at Caen during the period 1985-1988].

This study has been carried out to investigate whether the presence of an intra-uterine contraceptive device in pregnancy is a risk factor for the pregnancy, for the fetus and for the mother. We have concerned ourselves with pregnancies that led to a viable fetus. We wanted to know whether early removal of the device altered the bad effects of the device. The same types of pathology such as bleeding, threatened premature labour, premature rupture of the membranes and premature delivery occurred whether the device was removed or not; but the incidence of the various complications was increased if the device remained in place the whole pregnancy. It seems absolutely necessary for every woman who becomes pregnant with an intra-uterine device to have the pregnancy diagnosed as early as possible and for the device to be removed to lessen the risk of complications. When this is not done the pregnancy should be considered a high risk pregnancy.

Amnion↗
PubMed1987

A new technique to protect ovarian function before pelvic irradiation. Heterotopic ovarian autotransplantation.

The authors describe a new technique for the subcutaneous heterotopic transplantation of the ovary before pelvic irradiation to treat Hodgkin's disease. Creation of a cavity to receive the transplant and the use of two surgical teams and the surgical microscope during the operation ensured its successful outcome. The transplanted ovary was followed up clinically and by ultrasound monitoring: ovarian cycles remained regular despite radiotherapy, and follicle growth occurred normally. In comparison to other types of oophoropexy described in the literature, the advantages of this technique included total protection of the ovary from irradiation, and conservation of ovarian function and fertility. One year after the procedure, puncture of the ovarian compartment produced a mature oocyte specimen.

Adolescent↗