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At least 307 records · Page 17Linked to original sources
PubMed2001

Results of anterior levatorplasty for rectocele.

OBJECTIVE: Transanal and transvaginal repair of rectocele have been advocated in the treatment of rectocele, with mixed results. The aim of this study was to assess our experience using anterior levatorplasty in the surgical management of rectocele. PATIENTS AND METHODS: Sixty of 90 women who had undergone anterior levatorplasty for rectocele over a seven year period were traced, and 44 (33 with rectocele only and 11 with rectocele and faecal incontinence) responded to a standardized questionnaire 6 months to 7 years (mean 3.5 years) after anterior levatorplasty. Results were expressed in general and specific improvement of symptoms and were classified as excellent, good, fair, or poor. The effects on social activities, sexual function, and employment were also assessed. RESULTS: General satisfaction with the operation was rated as good or excellent in 27 of 33 (82%) and 18 of 24 (75%) patients with rectocele only at 2 and 3.2 years follow-up, respectively, and in 7 of 11 (64%) and 5 of 11 (45%) patients with rectocele and faecal incontinence at 2 and 4 years follow-up, respectively. 31 (70%) and 34 (77%) of all patients reported an improvement in sensation and the ability to defaecate, respectively. An improvement in social activities, sexual satisfaction and employment was noted in 10 of 21 (48%), 10 of 23 (43%), and 7 of 12 (58%) patients, respectively. CONCLUSION: Anterior levatorplasty provides good short and long-term symptomatic improvement in patients with rectocele and avoids complications associated with rectal or vaginal approaches.

Journal Article↗
PubMedDate not supplied

Standing surgical repair of cystorrhexis in two mares.

Two surgical techniques were used to evert the bladder into the vagina for observation and repair of bladder tears that were associated with parturition. One technique involved an incision through the vaginal floor into the peritoneal cavity just caudal to the cervix, and prolapse of the bladder into the vagina. The second technique involved a 3-cm incision through the urethra, 5 cm cranial to the urethral orifice, and digital exploration of the tear and finger traction to evert the bladder through the urethral incision. In both mares, the bladder defects were repaired in two layers, with use of 2-0 polyglycolic acid in a simple continuous pattern. After repositioning, the vaginal and urethral incisions were closed in single layers using absorbable suture material. A standing vaginal approach eliminates the need for general anesthesia and allows excellent observation and repair of bladder tears in adult mares.

Animals↗
PubMed2003

[Does a Combined Fascial Sling - Burch Colposuspension Display Advantages over a Fascial Sling alone for Treatment of Urinary Stress Incontinence in Females?].

PURPOSE: Despite the development of new surgical techniques, the fascial sling procedure remains an important surgical technique for the treatment of female urinary stress incontinence. An advantage of combining it with an additional Burch colposuspension has been suggested. The objective of our study was to evaluate retrospectively selected patients who had undergone a fascial sling procedure with and without Burch colposuspension. MATERIALS AND METHODS: Of a total of 390 females who underwent an incontinence operation at our department between 1990 and 1999, 56 patients had had a fascial sling plasty. A total of 50 patients (89 %) were followed for a median of 59.5 months. The median age was 60 years. 56 % of the patients displayed recurrent stress incontinence. The previous operations had been performed via a vaginal approach in 42.9 % and an abdominal approach in 57.1 %. The sling procedure used was that of Narik and Palmrich. Of the 50 patients, 14 had an additional Burch colposuspension. RESULTS: The continence rates (no pads) were for patients with a fascial sling procedure alone 63.9 % and for the combination of both operations 64.4 %. An improvement (1-3 pads) was seen in 27.8 % and 21.4 %, respectively. No changes were seen in 5.6 % and 7.1 % and impairment was seen in 2.7 % and 7.1 %, respectively. After a five-year follow-up, the total patient satisfaction rate was 78 %. CONCLUSIONS: The fascial sling is effective operative technique for treating female urinary stress incontinence, especially in severe and type III incontinence and in patients who had undergone previous operations for incontinence. The operation is safe and is the only technique that offers controlled overcorrection in desperate cases. An advantage of adding a Burch colposuspension to the fascial sling procedure was not detected in our patient group.

Adult↗
PubMed1983

[Gynecologic endosonography: initial experiences].

Basing on our research work in hysteroscopy, we used recently developed small endosonographic sounds for intrauterine and later vaginal approach, for the first time in 1981. We call this method endosonography. The equipment used so far is described, the procedure explained, and the efficacy of this new technique demonstrated via several endosonograms. The advantage to transabdominal sonography is the close contact of the ultrasound transducer with the organ to be examined. This enables the use of high frequencies with correspondingly good resolution. Finally, our own experience is discussed.

Colposcopes↗
PubMed1994

[Tuboscopy--new developments for accurate tubal diagnosis].

A specially developed linear everting catheter (LEC) in combination with a microendoscope, enables for the first time the visualisation of the complete tubal mucosa from a vaginal approach. Preliminary results in using this technique are described. Physiological and pathological results of tubal mucosa can be presented, which will influence the diagnostic and therapeutic part of subsequent sterility treatment.

Adult↗
PubMed2000

Primary amenorrhea caused by crushing trauma of the pelvis.

An 18-year-old woman sought treatment for primary amenorrhea. Crushing trauma of the pelvis in her childhood had caused separation between the uterine corpus and the cervix. Through a combined abdominal and vaginal approach the continuity of the uterine outflow tract was restored. Years later, after in vitro fertilization, the patient was delivered of a healthy term baby in an elective cesarean procedure.

Adult↗
PubMed2001

Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation and subsequent pregnancy in the treatment of early invasive cervical cancer.

BACKGROUND: Recently, pregnancies in patients after radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy have been reported. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation has been previously described; however, subsequent outcome and pregnancy has not. METHODS: Three patients with cervical carcinoma, 1 with stage IA1 with lymph-vascular space invasion and 2 with stage IA2, were treated with radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation. RESULTS: All patients underwent the planned procedure with no significant intraoperative or postoperative complications. All patients had return to normal menstrual function. One patient had a successful pregnancy delivered at 39 weeks by cesarean section and is now subsequently pregnant with a second pregnancy. CONCLUSION: Radical abdominal trachelectomy is a technically feasible operation that uses operative techniques familiar to the American-trained gynecologic oncologist and results in wider parametrial resection than radical vaginal trachelectomy. In young patients desiring to retain fertility, successful pregnancies after radical abdominal trachelectomy are possible. Intraoperative and postoperative complications are likely to be lower with an abdominal versus a vaginal approach. Long-term survival of patients treated with radical trachelectomy for early invasive cervical cancer are yet to be determined.

Adenocarcinoma↗
PubMed1998

Vesico-vaginal and recto-vaginal fistulae.

In a series of 1138 patients with vesico-vaginal and/or recto-vaginal fistulae, the main cause in the developing world was obstructed labour, and in the developed world was surgery and/or malignancy. Most repairs were performed by a vaginal approach; there was dedicated nursing care; 85% were cured at the first attempt. In the developing world, prevention will require improved access to good obstetric care.

Journal Article↗
PubMed1986

Clinical evaluation of drugs used in fertility regulation.

The clinical evaluation of drugs used in fertility regulation is initially assessed in Phase I, II and III trials. The design of each phase and the investigative staff must be adequate. In Phase I, normal, healthy human volunteers meeting specific guidelines are usually studied. Numbers vary between 20 and 80 and the purpose is to determine the acute toxicity of the compound. In Phase II, efficacy and safety are examined in a clinical target population, and emphasis may be placed on pharmacological and mechanistic studies. Usually between 50 and 200 patients are involved. In Phase III, large-scale clinical studies for local registration and the introduction of drugs to various countries are included. This paper describes the evaluation of various drugs used in contraception, including NORPLANT implants, and considers the efficiency, safety and acceptability of such drugs. Phase IV studies are usually needed to reveal chronic toxicities or rare events.

Clinical Trials as Topic↗
PubMed2004

Lateral excision of tension-free vaginal tape for the treatment of iatrogenic urethral obstruction.

OBJECTIVE: To report our experience on lateral excision of tape in women with iatrogenic urethral obstruction after the tension-free vaginal tape (TVT) procedure. METHODS: Seven women had iatrogenic urethral obstruction based on their clinical and urodynamic findings. All underwent lateral excision of the tape using the vaginal approach. Lower urinary tract symptoms, postvoid residual volume and urodynamic data were evaluated before and after excision. RESULTS: Before excision, all subjects had either irritative symptoms or increased postvoid residual volume (more than 100 mL), and 6 (85.7%) voided with strain. The mean time from initial surgery to tape excision was 28 days (range 4 to 108), with an average follow-up of 32 months (range 24-39). After the excision, voiding dysfunction was resolved in 6 of 7 patients. The remaining patient had significant improvement with only occasional symptoms of irritation. Two (28.6%) women reported recurrent stress incontinence and 1 (14.3%) required surgical treatment. The intervals for the 2 recurrent patients from TVT to excision were 4 days. The intervals for the 5 continent women were 15 to 108 days. CONCLUSION: Urethral obstruction after TVT is a relatively uncommon condition. It can be effectively treated with transvaginal lateral excision of the tape. Recurrent stress incontinence seems to be less likely to occur when the takedown procedure occurs beyond 14 days after the initial TVT operation.

Female↗
PubMed2005

Urinary control after the definitive reconstruction of cloacal anomaly.

PURPOSE: Urinary control after definitive repair of a cloacal anomaly is difficult to achieve. The present report aims to describe the clinical course of urinary control, and the need for the management of bladder dysfunction after reconstruction. METHODS: The present consecutive series consisted of 11 girls who underwent definitive repair of cloacal anomalies over a period of 11 years. Eight patients were associated with hydrocolpos. Radiological examination included a plain X-ray radiograph of the lumbosacral spine and a voiding cystourethrography with or without a urodynamic study. RESULTS: Reconstruction of the cloaca was performed on patients aged between 1 and 3 years using a posterior sagittal approach. Vaginal reconstruction was carried out 13 times in 11 patients using tubularized vaginal flap, distal rectal segment, perineal skin flap, or total urogenital sinus mobilization. Cystostomy or vesicostomy was carried out in four newborns/infants. Another seven patients could void spontaneously but incompletely with residual urine. Occult spinal dysraphism was found in five patients and hemisacrum in two patients. After definitive reconstruction, most patients acquired an adequate to normal bladder volume for 1-year-olds. Normal detrusor-sphincter function was seen in three patients. Detrusor areflexia was seen in two patients who underwent in utero vesico-amniotic shunt. Detrusor underactivity was observed in six patients. Bladder compliance was good in all patients except for one. No patients in the present series showed persistent urinary incontinence from the bladder neck or urethral dysfunction. CONCLUSION: It is postulated that wetting after definitive repair may be the result of overflow incontinence and poor bladder contractility rather than sphincter injury. The main clinical characteristic of bladder dysfunction was a failure to empty. We could not define the exact etiology, but iatrogenic injury from extensive dissection can lead to the higher risks of peripheral nerve damage. Accomplishment of definitive repair involves not only anatomical reconstruction, but also postoperative urinary control, including the initiation of clean intermittent catheterizations under repeated urodynamic evaluations.

Child, Preschool↗
PubMed1997

Puerperal inversion of the uterus in Nepal: case reports and review of literature.

Retrospective study of 6 cases of puerperal inversion of the uterus is being presented from 1975 to 1995 and a review of literature for 20 years of the period 1975-1995 has been summarised. In the present series, one case with acute puerperal inversion of uterus were treated by manual reposition, 2 cases of chronic puerperal inversion of uterus was treated surgically by Kustner's vaginal approach. Two cases with subacute puerperal inversion of uterus, 1 case of chronic puerperal inversion were treated by Haultain and Huntington method. Out of 241 cases of uterine inversion obtained from review of literature for last 20 years, 229 (95%) constituted puerperal and 12 (5%) were non puerperal inversions. Among puerperal inversions, 191 (83.4%) cases were of acute type and only 6 (2.62%) cases were of subacute variety. The chronic puerperal inversion constituted 32 (13.9%). Out of 63 cases of uterine inversions in India, maternal deaths were reported as 6 (9.5%) but there was no maternal death in the present series.

Adult↗
PubMed1976

Vaginal ureterolithotomy.

The vaginal approach to the low ureteric calculus may provide an easy, rapid and safe solution to a difficult surgical problem. It is important to select the case with care and, provided basic surgical principles are followed, the complications should be minimal. 3 recent successful cases are described and a further 2 in which the technique failed due to proximal displacement of the stone. The importance of adequately immobilising the calculus prior to ureterotomy is emphasised.

Adult↗
PubMed1980

Urethral diverticulum in females.

Thirteen cases of urethral diverticulum in females are reported. Symptoms were non-specific. Two cases presented with suppuration in previously undiagnosed diverticula. The most important physical sign was palpation of the sac on vaginal examination. Micturating cystourethrography was the most useful investigation. An association with carcinoma makes excision mandatory and in 10 cases this was performed by a vaginal approach. A laterally based flap incision is described which was used in 7 cases without complication. In one case the diverticulum recurred after 5 years and was removed in the same way. Two cases that presented with suppuration were treated by incision and drainage: in one the diverticulum re-formed and the other case was lost to follow-up. The aetiology of the condition is unknown but we believe, on histological evidence, that it is congenital.

Adolescent↗
PubMed2006

Didelphic uterus and obstructed hemivagina: recurrent hematometra in spite of appropriate classic surgical treatment.

We report the case of a young girl with uterus didelphys, obstructed vagina and ipsilateral renal agenesis treated by diagnostic laparoscopy and resection of the vaginal septum by a vaginal approach in order to drain the distended uterus. Despite classic surgery, the myometrium on the treated side never recovered its normal function, with subsequent persistence of recurrent hematometra. Laparoscopic subtotal hemihysterectomy had to be performed to avoid retention of hematometra and secondary pelvic inflammatory disease.

Abnormalities, Multiple↗
PubMed1988

The Mayer-Rokitansky syndrome. Report of 5 cases.

Five cases of uterus didelphys, unilateral imperforate vagina and ipsilateral renal agenesis are reported with a follow-up from 1 to 5 years. Diagnosis included typical revelation at puberty (2 cases) but also in the first months of life (2 cases). One case was only diagnosed at the age of 6 years, and the presence of an ectopic ureter was noted in the imperforate vagina. The authors point out the necessity of precise evaluation and careful management in order to maintain an intact reproductory tract. Simple excision of the septum is recommended which can most of the time be done by the vaginal approach.

Adolescent↗
PubMed1983

Colpotomy drainage of pelvic abscesses.

Retrospectively the records of 155 patients with an acute pelvic abscess who were treated by colpotomy drainage were studied. The more aggressive management, i.e. surgery, is to be preferred and the vaginal approach gives good results. The complications and morbidity in this series were very low and the mortality less than 1%. The procedure itself is simple and requires no special skill or great experience.

Abscess↗
PubMed2005

Vaginal vault prolapse: identification and surgical options.

Reconstructive surgeons should be familiar with the identification and treatment of vaginal vault prolapse. Most utilized techniques can be effective in terms of suspension of the vaginal apex. New technology has allowed for the performance of vaginal-approach techniques with increasingly physiologic anatomic and functional outcomes (Figure 8).

Female↗