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At least 253 records · Page 14Linked to original sources
PubMed1992

Urovaginal fistulas: experience with the management of 41 cases.

In a retrospective analysis the authors have evaluated their experience with the management of urovaginal fistulas in 41 patients. Of them 34 had vesicovaginal, 3 ureterovaginal, 2 urethrovaginal, 1 ureterovesicovaginal and 1 ileovasicorectovaginal fistula. Fistulas occurred most frequently after gynaecological operations for benign and malignant diseases and after radiotherapy. Reconstructive operations were performed in 37 patients, mostly from the vaginal approach. Primary repair of fistulas was successful in 35 patients. In 2 patients reoperation was required. Due to good experience the authors recommend the transvaginal approach, which in their opinion is suitable for repair of the prevailing part of vesicovaginal fistulas.

Adult↗
PubMed1996

[Clinical experience with a novel surgical technique: laparoscopy-assisted vaginal hysterectomy].

A new surgical technique, the laparoscopically assisted vaginal hysterectomy (LAVH) is evaluated through the clinical course of a group of patients operated for hysterectomy in the years 1993-1995. Although the groups of patients being operated for LAVH, vaginal or abdominal hysterectomy have not been randomized, we conclude that the laparoscopic assistance allows the vaginal approach of hysterectomies that should have been otherwise operated by laparotomy. Medical and financial advantages of this technique are discussed.

Adult↗
PubMed1996

Laparoscopy-assisted radical vaginal hysterectomy modified according to Schauta-Stoeckel.

In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is used to develop the paravesical and pararectal spaces. The cardinal ligament is isolated and cut after bipolar coagulation to the level of the deep uterine vein. By the vaginal approach, the ureters are identified before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visible. After incision of the vesicocervical reflection, the uterine fundus is grasped and developed (Döderlein maneuver). The lower cardinal and uterosacral ligaments are exposed by pulling the cervix and fundus uteri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined laparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 women with cervical cancer. The mean operating time was 80 minutes for the vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three patients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achieved at primary surgery for all intraoperative complications. No fistula was observed. The patients had fully recuperated after a mean of 28 days. The laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy.

Adult↗
PubMed1998

Surgery for the treatment of overactive bladder.

OBJECTIVES: To describe surgical options that may be indicated when conservative management of overactive bladder is unsuccessful. METHODS: The literature on current endoscopic and open surgical procedures is reviewed. RESULTS: The endoscopic approach of hydrodistention under anesthesia may be therapeutic, but normally offers only temporary relief of symptoms. Among open surgical procedures, cystolysis has not withstood the test of time and is no longer used. Partial rhizotomy can reduce reflex bladder contractility while preserving other important urogenital functions. Peripheral denervation via a vaginal approach appears effective in as many as 70% of patients with motor instability, but is not effective in interstitial cystitis or other sensory bladder disorders. Transvesical phenol injection is most effective for detrusor instability (DI) caused by multiple sclerosis. Enterocystoplasty is more helpful in intractable DI than in interstitial cystitis. Detrusor myomectomy has yielded excellent results in patients with neurogenic causes of DI. Urinary diversion is rarely required in DI, but may be preferable to enterocystoplasty when severe pelvic pain is present. CONCLUSIONS: When appropriately chosen, surgical procedures can substantially improve the quality of life of some individuals with overactive bladder.

Cystoscopy↗
PubMed2004

A comparison of abdominal and vaginal hysterectomy for the large uterus.

OBJECTIVE: To compare the perioperative outcomes of women with an enlarged uterus (>or=250 g) who had abdominal and vaginal hysterectomies. METHOD: Retrospective study of the perioperative outcomes of 288 consecutive women with an enlarged uterus, of whom 200 underwent an abdominal hysterectomy and 88 a vaginal hysterectomy, all for benign gynecological conditions. RESULTS: Among the perioperative complications, only the risk of ileus was significantly higher in the group that underwent abdominal hysterectomy. Although the need for blood transfusions was similar between the groups, mean perioperative hemoglobin change was significantly lower for women who had the abdominal approach. Vaginal hysterectomy shortened the length of hospitalization significantly but did not affect the operative time. All of these differences remained significant after adjusting for uterine weight (P<0.05). Baseline characteristics were similar between the groups, except for uterine weight. CONCLUSIONS: For women with a uterus weighing 250 g or more, vaginal hysterectomy shortens the hospital stay without significantly increasing perioperative morbidity when compared with the abdominal route.

Adult↗
PubMedDate not supplied

Vesical fistulae--an experience from a developing country.

This study analyses patients with vesical fistulae presenting at a teaching, referral hospital over the last ten years. There were 62 cases of vesical fistulae of which 60 were obstetric in origin (44 home and 16 hospital deliveries) and 2 were following gynaecological surgery. Of the hospital deliveries which culminated in fistula formation, 8 were vaginal and 7 forceps deliveries. In one patient, lower segment caesarean section was carried out. After a thorough urological work-up, patients were subjected to standard technique of layered closure (61 by vaginal approach and one by abdominal). Repair was successful in 53 (87.09%) patients. Of the 9 failures, 4 were repeat repairs.

Adolescent↗
PubMed2006

Sensory nerve injury after uterosacral ligament suspension.

OBJECTIVE: Uterosacral ligament suspension is a technique that is performed commonly to suspend the prolapsed vaginal apex. This case series describes our experience with the clinical evaluation and management of lower extremity sensory nerve symptoms after uterosacral ligament suspension. STUDY DESIGN: Hospital and office medical records from our 2 institutions were reviewed from January 2002 to August 2005, and all women who underwent uterosacral ligament suspension through a vaginal approach were identified. Women with symptoms of buttock and posterior thigh pain during the 6-week postoperative period were identified, and detailed clinical information was abstracted from the charts. RESULTS: From 182 uterosacral ligament suspension procedures, 7 women were identified. The age range was 42 to 70 years. Concurrent procedures included 6 vaginal hysterectomies, 5 anterior repairs, 4 posterior repairs, 2 slings, and 1 bilateral salpingo-oophorectomy. Within 24 hours of the surgical procedure, all the women experienced similar, substantial sharp buttock pain and numbness that radiated down the center of the posterior thigh to the popliteal fossa in 1 or both lower extremities. The ipsilateral uterosacral ligament suture was removed within 2 days of the procedure in 3 women who had immediate subjective reduction in their pain and complete resolution of pain by 6 weeks. The remaining 4 women were treated with gabapentin and narcotics. Three women had resolution of the pain by 12 to 14 weeks after the operation, and the last woman's pain resolved gradually by 6 months. CONCLUSION: Women who undergo uterosacral ligament suspension are at risk of postoperative pain and numbness in a S2-4 distribution. These symptoms appear to be related to the placement of uterosacral ligament sutures and may be relieved either by prompt removal of the ipsilateral uterosacral ligament suture or with prolonged medical therapy.

Adnexa Uteri↗
PubMed1987

Antibiotics and suction drainage as prophylaxis in vaginal and abdominal hysterectomy.

A randomized prospective study compared the efficacy of a three-dose perioperative course of intravenously administered cefuroxime and metronidazole versus suction drainage of the vaginal vault for preventing postoperative infection in abdominal and vaginal hysterectomies. In vaginally operated patients, a significant difference in the rate of vaginal cuff abscess formation was found between the drain group and the antibiotic group (33 versus 0%). In the abdominally operated patients, no significant difference was found (7 versus 0%). The rate of cystitis was not influenced by the prophylactic method. A positive correlation was found between Bacteroides sp isolated from the vaginal fluid and vaginal cuff abscesses in the vaginally operated women. The complications of infection are explained by the decrease in host defense, occurring more frequently in patients treated with the vaginal approach than with the abdominal technique.

Abscess↗
PubMed1995

Frequency and cause of aborted laparoscopic-assisted vaginal hysterectomy.

STUDY OBJECTIVE: To evaluate the frequency and cause of aborted laparoscopic-assisted vaginal hysterectomies (LAVH) at two hospitals of a major obstetrics and gynecology training program. DESIGN: Retrospective cohort study. SETTING: A university hospital and a university-affiliated county hospital. PATIENTS: Seventy-eight consecutive women who underwent LAVH at our institutions between June 1992 and February 1995. INTERVENTIONS: Data on age, weight, indications for surgery, obstetric and surgical history, concomitant procedures performed, postoperative diagnosis, perioperative complications, operative time, estimated blood loss, uterine weight, and length of hospital stay were collected from patients' hospital records. Univariate analysis of variance to assess statistical significance was performed when appropriate. MEASUREMENTS AND MAIN RESULTS: Eight (11.1%) of 78 procedures were converted to abdominal hysterectomy. The most frequent reason for conversion (5 cases, 6%) was large uterine size with limited mobility and associated inability to visualize the pelvic sidewall structures adequately. The other three procedures were converted because of massive intraperitoneal adhesions (2) and intraoperative severe bleeding (1). The mean uterine weight of these eight women (575 g, range 387-1030 g) was significantly higher than that of patients undergoing successful LAVH (230 g, range 35-612; p <0.03). CONCLUSIONS: In our limited series of 78 patients, only one LAVH was converted to abdominal hysterectomy because of an intraoperative complication. A conversion rate of 11.1% may be appropriate so as to offer the potential benefits of the laparoscopic-assisted vaginal approach to the largest number of women who would otherwise undergo an abdominal hysterectomy.

Adult↗
PubMed2001

[Vaginal hysterectomy:apropos of a series of 1008 interventions].

STUDY AIM: The aim of this study was to analyse our vaginal hysterectomies performed for prolapsed uterus and non prolapsed uterus with benign disease. For the latter indication, a comparison was made with abdominal hysterectomy. PATIENTS AND METHODS: From february 1986 to december 1998, 1008 vaginal hysterectomies were performed in our department: 219 for prolapsed uterus and 789 for non prolapsed uterus with benign disease. During the same time, 217 abdominal hysterectomies were performed for non prolapsed uterus with benign disease. RESULTS: Intra-operative and post-operative complications had the same rates in the two groups. Owing to the low number of abdominal hysterectomies, we cannot draw a valuable conclusion. The study of the literature shows in this field an advantage for the vaginal hysterectomy; mean time hospitalization was shorter in the vaginal group. CONCLUSION: Advantages of vaginal hysterectomy are multiple: aesthetic, shorter hospitalization, quicker recovery. The low rate of vaginal hysterectomy on non prolapsed uterus with non malignant disease is linked with the lack in training of surgeons for the vaginal approach. In these cases, a rate of 70% is a realistic one in a well trained hospital center.

Adult↗
PubMed1992

The role of partial colpectomy in the management of persistent vaginal neoplasia after primary treatment.

OBJECTIVE: To describe and assess the technique of partial colpectomy for the treatment of persistent vaginal neoplasia. SETTING: Gynaecological oncology unit of a London teaching hospital. SUBJECTS: 12 women with persistent vaginal intraepithelial neoplasia (VAIN) following hysterectomy for cervical intraepithelial neoplasia (CIN) or for benign disease. TECHNIQUE: Partial colpectomy using a vaginal approach assisted by a Schuhardt incision to improve access. RESULTS: Assessment of patients between 9 and 99 (mean 55) months after partial colpectomy for VAIN showed no recurrence of disease in ten patients (83%). CONCLUSION: This technique of partial colpectomy is an effective procedure, associated with minimal morbidity which should be considered as primary treatment for patients suffering from persistent vaginal disease after hysterectomy or other procedures.

Adult↗
PubMed1995

Small bowel herniation after laparoscopically assisted vaginal hysterectomy.

Laparoscopically assisted vaginal hysterectomies have been done with increasing frequency in the United States. To date, minimal complications have been noted with this procedure. The authors review a series of 90 individuals and note a three percent small bowel obstruction rate. This complication is more common in this group of patients than in patients having a standard abdominal hysterectomy. Since this operation has been commonly performed, it is often possible to convert an abdominal hysterectomy to a vaginal approach, this increase in complications is exceedingly high. The authors recommend closure of lateral abdominal wall port sites under direct laparoscopic visualization to prevent this serious complication.

Anastomosis, Surgical↗
PubMed2000

Vaginal leiomyoma--an imitator of prolapse.

Vaginal leiomyoma is a rare tumor with a variable clinical presentation and broad differential diagnosis that can lead to preoperative misdiagnosis. We present a case of vaginal leiomyoma with a symptom complex of prolapse, urinary urgency and urge incontinence. A 50-year-old woman presented with a 4-year history of deteriorating sensation of prolapse, significant complex urinary complaints and prolonged vaginal bleeding. Clinical examination revealed a mobile 6 x 8 cm mass arising from the anterior vaginal wall. She underwent hysteroscopy, curettage, urethrocystoscopy (normal findings) and mass enucleation through a vertical incision. Histology showed a benign leiomyoma. Ultrasonography, MRI, positive-pressure urethrography and urethrocystoscopy should be considered in the evaluation of an anterior wall vaginal mass. Surgical enucleation via a vaginal approach is the treatment of choice. If this surgical procedure results in skeletonization of the urethral and bladder support, a colporrhaphy/pubourethral ligament plication is required.

Diagnosis, Differential↗
PubMed2000

Laparascopically assisted vaginal resection of rectovaginal endometriosis.

BACKGROUND: We wanted to establish a technique of laparoscopically assisted radical vaginal surgery for deep endometriosis of the rectovaginal septum with extensive rectal involvement. TECHNIQUE: The procedure is started by vaginally excising the involved area which is left on the rectum, followed by bilateral dissection of the pararectal and retrorectal spaces. Para- and retrosigmoido-rectal spaces are developed laparoscopically along the coccygeosacral bone and medially to the pelvic splanchnic nerves toward the para- and retrorectal openings that were made transvaginally. Rectal transection is done with a laparoscopic stapling device caudal to the endometriotic lesion. Using a suprapubic minilaparotomy, the bowel is transected cranial to the lesion and reintroduced into the abdomen, and a transanal circular stapler anastomosis is done. EXPERIENCE: Thirty-four women had this procedure. The mean distance of the anastomosis was 4 cm above the anus. None required ileostomy or colostomy and no major complications were noted. CONCLUSION: The combination of laparoscopic and vaginal approaches is useful for removing extensive endometriotic infiltration of the rectosigmoid; bladder and rectal function and fertility can be preserved.

Adult↗
PubMed1988

[Transvaginal echography. An application in the diagnosis of cervical incompetence].

It has already been demonstrated that abdominal ultrasound is an adequate method for measuring the cervix in pregnancy. The use of the vaginal route for such measurement is new. We have been using for the vaginal approach an ultrasound transducer of 5 mHZ with an angle of sweep of 240 degrees. The study was carried out on 23 pregnant women at the 28th week of pregnancy who had been admitted because of threatened premature labour with possible cervical incompetence; and on 20 cases of normal pregnancy also at the 28th week, which is the time when we do glucose estimations normally in our antenatal clinics. The result of our work shows that this ultrasonic method through the vagina gives us much more accurate measurements of the cervix than digital vaginal examination does. A mean difference of 12.3 mm in the length of the cervix was found in normal pregnancies (46.3 mm) and in cases where there was a question of cervical incompetence (34 mm). Furthermore the phenomena of shortening, dilatation of the cervix and a funnel-shape of the internal os are ultrasound signs of value in diagnosing incompetent cervix. Further advantages of the transvaginal approach are that there is no need for the bladder to be filled previously, and that the organs are nearer which improves the ultrasound picture. All the same, it is to be emphasized that transvaginal ultrasound can only be a factor to be added to clinical examination in the diagnosis of the incompetent cervix.

Cervix Uteri↗
PubMed1996

Vaginal radical hysterectomy versus abdominal radical hysterectomy in the treatment of early-stage cervical cancer.

The purpose of this study is to compare the safety, efficacy, and potential benefits of vaginal radical hysterectomy (VRH) versus abdominal radical hysterectomy (ARH) in the treatment of early-stage cervical cancer. We reviewed the charts of our first 52 patients with cervical cancer. We reviewed the charts of our first 52 patients with cervical cancer who underwent a laparoscopic pelvic lymphadenectomy (LPL), followed either by a VRH (Schauta) in 25 cases or ARH in 27 cases. For the 52 patients, the mean lymph nodes count obtained by LPL was 27 (range 8-59), and the only complication was an external iliac vein trauma requiring laparotomy. Both VRH and ARH groups were comparable in terms of age, weight, parity, stage, histology, and tumor volume. The mean blood loss was 400 cc for VRH vs 450 cc for ARH, operating time was 270 min vs 280 min, blood transfusion in 5 vs 4 women, and postoperative stay was 7 days for both groups. The only intraoperative complication in addition to the vein trauma was a cystotomy which occurred in 2 VRH patients. Febrile morbidity was noted in 4 VRH patients vs 9 ARH patients. There were one preperitoneal abscess and one hematoma in the VRH group vs 4 wound infections and 1 hematoma after ARH. Ileus occurred in 1 VRH vs 4 ARH patients. The current mean follow-up time is 27 months (8-52) and there has been one recurrence so far in the ARH group. Even though this is a retrospective study, our data indicate that VRH and ARH are comparable, except for the absence of an abdominal scar and less febrile morbidity with the vaginal approach. However, in our opinion, the main advantage in learning the Schauta operation is that the experience gained allows one to offer radical trachelectomy to selected young patients who wish to preserve their fertility.

Adult↗
PubMed2006

Conservation of the prolapsed uterus is a valid option: medium term results of a prospective comparative study with the posterior intravaginal slingoplasty operation.

It has been reported that, by the age of 80, the risk of women to undergo surgery for the treatment of pelvic organ prolapse (POP) exceeds 10%, a percentage expected to increase with the rise in life expectancy. The vaginal approach for POP reconstructive operations is associated with fewer complications and results in a shorter rehabilitation period than the abdominal route, whereas hysterectomy is widely performed concomitantly whenever the uterus is significantly prolapsed. However, there is no clear evidence supporting the role of hysterectomy in improving surgery outcome. We present our experience with a new minimally invasive procedure--the posterior intravaginal slingplasty (PIVS) for correction of advanced uterine prolapse--at the same time, comparing additive vaginal hysterectomy to uterine preservation, to evaluate the therapeutic significance of hysterectomy when vaginal apical prolapse is reconstructed with PIVS. Seventy-nine women presenting with moderate to severe uterine prolapse were enrolled into the current PIVS study. Vaginal hysterectomy was concomitantly performed upon patient's request (44 patients), whereas those wishing to preserve their uterus underwent reconstructive surgery only (35 patients). No intraoperative or postoperative major complications were recorded during an average follow-up of 29.8 months: One patient (1.3%) presented with surgical failure, whereas 71 (89.9%) of the operated patients reported satisfaction with the therapeutic results. Bladder overactivity symptoms declined from three thirds of the patients preoperatively to below 10% postoperatively. Ten (12.7%) patients had vaginal tape protrusion; all underwent segmental tape resection at the out-patient clinic. Because the PIVS procedure does not require either laparotomy or deep transvaginal dissection, as previously required for operative intervention, the hospitalization period was relatively short: 4.2 days for the hysterectomy group and 1.5 for the non-hysterectomy group. Other statistically significant differences between the hysterectomy and non-hysterectomy groups were the average ages (63.5 vs 51.0 years, respectively) and concomitant surgery (87% vs 69%, respectively, the higher percentage due to additive amputation of elongated uterine cervices). No other significant differences were recorded. The current results support the previously reported efficacy, safety, and simplicity of the PIVS procedure as well as the legitimacy of uterine preservation. Moreover, unstable bladder symptoms were found to be improved after this operation. However, long-term data are required to be able to draw solid conclusions concerning the superiority of the discussed operation.

Adult↗
PubMedDate not supplied

Laparoscopy in surgical treatment of vaginal aplasia: laparoscopy-assisted colpopoiesis and perineal hysterectomy with colpopoiesis.

OBJECTIVE: To optimize methods of surgery in patients with malformations of the genitalia. METHODS: Comparative evaluation of effectiveness of reconstructive plastic operations for malformations of uterus and vagina, performed by conventional methods or via laparoscopy. RESULTS: Laparoscopy permits identification of the pelvic peritoneum plus opening it and using the most mobile portion to create the vaginal fornix. In patients with vaginal and cervical aplasia and non-communicating functional rudimentary uterus, laparoscopy assists hysterectomy performed by the vaginal approach, as well as the last step of colpopoiesis. CONCLUSIONS: Laparoscopy significantly facilitates the procedure, reduces operating time and risks, and makes the operation available to the wide range of surgeons skilled in laparoscopy.

Female↗