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At least 235 records · Page 13Linked to original sources
PubMed2002

Treatment of vaginal intraepithelial neoplasia with laser ablation and upper vaginectomy.

To assess the effectiveness of laser ablation and upper vaginectomy in the treatment of vaginal intraepithelial neoplasia (VAIN), we have reviewed the charts of 52 patients managed with laser ablation (28 patients) and upper colpectomy (24 patients). On the basis of our results, patient selection and operator skill have a significant influence on the outcome. In posthysterectomy patients with VAIN(3) at the vaginal apex, in the region of vaginal cuff scar, upper vaginectomy is the treatment of choice, while multifocal VAIN(2-3) or colposcopically well defined lesions, involving large areas of vaginal mucosa, could be successfully managed by CO(2) laser ablation.

Adult↗
PubMed2004

Comparison of outcomes between Burch colposuspension with and without concomitant abdominal hysterectomy.

A total abdominal hysterectomy may cause a postoperative vesicourethral dysfunction due to an injury to the pelvic nerves. However, many incontinent women with benign diseases of the uterus and its adnexae have undergone a Burch colposuspension with a concomitant abdominal hysterectomy. This study was undertaken to compare the outcomes of a Burch colposuspension performed alone with that of a Burch with a concomitant abdominal hysterectomy. This study included 132 women, who, were treated for primary urinary incontinence from February 1999 to February 2002 and were diagnosed with stress urinary incontinence by means of the urodynamic test at the Department of Obstetrics and Gynecology at Yonsei University Hospital. Forty-two women underwent a Burch colposuspension alone (Burch group) and 90 women underwent a Burch colposuspension with a concomitant abdominal hysterectomy (hysterectomy group). Between the Burch and hysterectomy groups, the mean age, parity, menopausal rate, Hormone Replacement Therapy (HRT) rate, 1 year follow-up outcomes and postoperative complications were compared using the subjective and objective stress tests according to the retrospective chart review. The mean age (54.6 +/- 0.5 vs 58.6 +/- 9.2 years, p=0.382), parity (3.3 +/- 1.2 vs 3.6 +/- 1.7), menopausal rate (71.4 vs 77.7%), or HRT rate (23.3 vs 11.2%) of the two groups were similar. Complications related to surgery were encountered in 5 patients (11.9%) in the Burch group and in 7 patients (7.8%) in the hysterectomy group (p=0.842). One year follow-up subjective symptoms were encountered in 2 patients in the Burch group and in 4 patients in the hysterectomy group (p=1.00). The stress test was positive in only one patient in the hysterectomy (p=1.00). No significant difference was observed in the 1 year follow-up outcomes, which were 91.4% (32/35 patients) in the Burch and 91.2% (73/80) in the hysterectomy groups. The results showed that there were no adverse effects on the 1 year follow-up outcomes or complications in patients who underwent a Burch colposuspension with an abdominal hysterectomy.

Abdomen↗
PubMedDate not supplied

[High colpocleisis in the treatment of postradiation vesicovaginal fistulas].

Surgical treatment with application of the modified technique of high colpocleisis according to Latsko was performed in 174 patients aged 26-72 with postradiation vesicovaginal fistulas. The latter developed 6 months to 26 years after radiotherapy. The operation resulted in restoration of the urinary bladder capacity and spontaneous urination.

Adult↗
PubMedDate not supplied

[Urinary stress incontinence in women: comparison of treatments].

A technique of surgical treatment of urinary stress incontinence (USI) in women is proposed. It consists of three stages. Stage 1 (intervaginal)--anterior colporaphy with plastic reconstruction of urogenital diaphragmatic muscles. Stage 2 (an original procedure)--fixation of the neck of the urinary bladder to musculus rectus abdominis and aponeurosis by means of three caprone ligatures by dissection of the anterior abdominal wall to the peritoneum. Stage 3--posterior colporaphy, perineolevatoroplasty. Stage 3 is conducted if the patient has marked rectocele simultaneously or 6 months after the initial operation. As shown by examination of 60 patients 1-20 years after the operation, good results were achieved in 91.2% of cases. The proposed method is simple, effective, involves all the pathogenetic links, corrects the changes in anatomofunctional condition of the lower urinary tracts restoring the "integral sphincter mechanism of the pelvis". It is recommended for treatment of females with moderate and severe USI or patients with enuresis type 2 and 3.

Adult↗
PubMed2001

[Low rate of recurrence at a follow-up study of vaginal repair of enterocele].

OBJECTIVE: Evaluation of short and longterm follow-up after vaginal repair of enterocele. DESIGN: Retrospective medical record investigation, questionnaire investigation and outpatient clinic follow-up examination. METHODS: In the Department of Gynaecology, Ikazia and Haven Hospital, Rotterdam, the Netherlands, 66 patients were treated because of enterocele by vaginal repair in 1989-1998. Follow-up results were gathered from medical records, a written questionnaire and recent gynaecological examination. RESULTS: The questionnaire response was 49/66 (74%); of the 17 non-respondents 6 had died. Of the 29 patients who had been routinely examined gynaecologically more than one year before, 25 consented to an additional gynaecological examination. The median follow-up until the questionnaire or the outpatient clinic examination was 3 years and 7 months (range: 1 month to 9 years and 7 months). A recurrent enterocele had been found in 4 patients; 3 of them underwent a repeat repair. A serious short-term complication was one rectovaginal fistula with a temporary artificial outlet. No clear relation of dysfunction of voiding and defaecation with the operation was found. However, problems with coitus were new in 19% of the sexually active group. CONCLUSION: The vaginal repair of enterocele showed good results with a low recurrence rate of 6% in a complex group of patients.

Adult↗
PubMedDate not supplied

Laparoscopic-assisted vaginal myomectomy: a case report and literature review.

The purpose of this article is to present a case of laparoscopic myomectomy (LM) that led to the identification of a new minimally invasive technique [laparoscopic-assisted vaginal myomectomy (LAVM)] for removing multiple transmural uterine myomas and facilitating uterine suturing. In addition, we reviewed the literature to (1) describe the history leading up to LAVM, (2) relate the benefits of this technique to other more widely performed myomectomy procedures [LM and laparoscopic-assisted myomectomy (LAM)], and (3) identify criteria for LM and LAVM.

Adult↗
PubMed2001

Accidental vaginal incision during cesarean section. A report of four cases.

BACKGROUND: Transverse vaginal incision during cesarean section, also known as anterior vaginotomy, is a recognized entity, mostly made unintentionally. CASES: At our institution, four patients underwent a transverse vaginal incision during cesarean section over an eight-year period. In three of them, excessive bleeding required blood transfusion. In one case, only hypogastric artery ligation resulted in bleeding control. None of the patients had subsequent vaginal deliveries. CONCLUSION: The exact incidence of anterior vaginotomy is difficult to evaluate. Accidental vaginal incision occurs mostly following a prolonged second stage of labor but is possible during the first stage. Risk factors include prolonged second stage of labor and an emergency setup. Reported complications resulting from anterior vaginotomy include excessive hemorrhage, with a possible need for hysterectomy, difficult approximation, and bladder or ureter injury. Massive bleeding and multiple blood transfusions occurred in our series as well. Fetal outcome and future obstetric behavior do not seem to be compromised. A high index of suspicion is essential when trying to avoid accidental anterior vaginotomy. Meticulous hemostasis, a search for bladder injury and anatomic closure are mandatory when managing this complication.

Accidents↗
PubMed2002

[Cystocele repair by the vaginal route with a tension-free sub-bladder prosthesis].

OBJECTIVE: To describe a new vaginal approach for the repair of cystoceles, reinforced with a tension-free polypropylene mesh. METHODS: The vaginal procedure consisted of a complete dissection of the cystocele and a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space. The polypropylene mesh (GyneMesh(TM), Gynecare, Ethicon France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. RESULTS: Forty-eight consecutive women with grade 3-4 cystoceles underwent this procedure between October 1999 and September 2001. Mean age was 63.9 years (41-85). Mean follow-up is 18 months (8-32). The success rate was 97.9%. There were a total of four vaginal erosions of the mesh (8.3%). There were no postoperative infections of the mesh. CONCLUSION: The vaginal repair of severe cystocele reinforced with a tension-free polypropylene mesh is a simple and reproducible technique, with high success rate and low morbidity.

Adult↗