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PubMedDate not supplied

[Fetal thoracopagus. Echographic diagnosis at 26 weeks].

The authors report on one case of thoracopagus discovered by echography carried out after 26 weeks of amenorrhoea. The pregnancy was terminated therapeutically by hysterotomy when common viscera were identified (heart and liver). Echographic diagnosis during the first part of pregnancy allows evacuation to be carried out by the vaginal approach. The authors summarize the criteria for echographic diagnosis and also the epidemiological and embryological data required for assessing the prognosis.

Abnormalities, Severe Teratoid↗
PubMed1990

Obesity and vaginal hysterectomy.

A retrospective study was done of 471 consecutive vaginal hysterectomies done in a three-year period. Three groups of patients--239 normal to 9% overweight, 132 10-24% overweight and 100 greater than or equal to 25% overweight--were compared. Surgical difficulties were similar in all three groups. The more obese patient had a slightly greater incidence of febrile morbidity, stayed one day longer in the hospital and had a minimally greater loss of hemoglobin 48 hours postoperatively. However, obesity per se caused few problems during and after vaginal hysterectomy. The vaginal approach is the procedure of choice for hysterectomy in obese women.

Anemia↗
PubMed1990

[Diagnosis and treatment of women with urinary incontinence at Danish gynecologic departments].

The routine practice in the diagnosis and treatment of urinary incontinence was investigated by means of a questionnaire to which all 32 departments replied. Miction charts were employed routinely in 17 departments and for selected patients in eight departments. Weighing of diapers was employed in 13 departments for all patients investigated for incontinence, but only for selected patients in ten departments. Cystometry was employed in cases of stress-incontinence in 23 departments and in cases of urge-incontinence in 30 departments. As regards the choice of operative treatment, 22 departments stated that they would employ abdominal intervention in cases of anterior suspension defect and vaginal operation in posterior suspension defects. Other departments perferred an abdominal or vaginal approach without employment of guiding miction cysto-urethrography. It is concluded that there are great differences in the routine practices in Danish gynaecological departments in the diagnosis and treatment of utinary incontinence. This appears to be a suitable field for so called reference programmes.

Denmark↗
PubMedDate not supplied

[Surgical treatment of rectoceles].

Rectocele is a posterior colpocele inhabited by an expansion of the anterior wall of the rectum. Its physiopathology is similar to that of other vaginal prolapse and is essentially dependent on the opening of the vulva secondary to a damage of the pelvi-perineal musculature. Its specific symptomatology is poor except for dyschesis. A colpocystogram may be helpful when there is a need to differentiate between rectocele and elytrocele. The surgical treatment of rectocele requires, most of the time, a vaginal approach with posterior colpo-perineomyorraphy. More rarely, when the rectocele is isolated, small and associated with another anorectal pathology, the endo ano-rectal approach may be used to perform the rectorraphy.

Female↗
PubMed1979

Triplet pregnancy. A 10-year review of cases at Baragwanath Hospital.

A series of 61 triplet pregnancies delivered in the Baragwanath Hospital for the 10 years 1967 - 1976 is analysed, the incidence being 1 : 2 789 deliveries. The average maternal age was 29,6 years, and average parity 3,7; 60% had had adequate antenatal care, a figure significantly higher than that for the local normal pregnant population. The vast majority of the patients had vaginal deliveries, although the proportion of manipulative procedures was high. The duration of labour was strikingly short in most instances. The fetal outcome was impressively good, although somewhat better with the second triplet than with the other two. This indicates that, in spite of the recent tendency towards liberal use of caesarean sections in these patients, a careful and appropriate vaginal approach has its merits.

Adolescent↗
PubMed1980

Treatment of carcinoma in situ: evaluation of 1609 cases.

In 1609 cases of carcinoma in situ, various methods of treatment were adopted: primary irradiation (22 cases), radical hysterectomy (11), simple hysterectomy (418), cervical amputation (83), ring biopsy with cervical curettage (63), and conization alone (1012). The outcome was related far less to the method of treatment than to the reliability of the primary diagnosis. If the latter was based only on colposcopically directed punch biopsies or cervical curettage, even with ring biopsy, 2.1% of patients died of cancer. In patients treated by hysterectomy, the vaginal approach resulted in 4 times fewer recurrences than did the abdominal approach, because of visualization of the extent of the lesions. Best results were obtained after conization with serial step-sectioning of specimens. Among 634 cases treated by conization with total removal of the lesion, there were no recurrences.

Biopsy↗
PubMed1980

[Hysterosalpingectomy. A contribution to the prevention of primary tubal neoplasms].

Reporting on 5103 hysterectomies performed within a period of 8 years (1970-1977), with a persistent high frequency of the vaginal approach (93,0%) independent of the dignity of the disease, the importance of a simultaneous bilateral salpingectomy is emphasized. Age and parity of the patients as well as size of uterus and indication for surgery were of little influence on the mode of operation. 3 carcinomas of the uterine tube, i.e. 0,43% of all gynecological neoplasms in our collective and a total of 701 other genital carcinoma were treated. With reference to current literature the clinical problems of primary malignant tumors of the uterine tube are discussed and the 3 cases of preoperatively undetected carcinoma are presented to underline the diagnostic and prognostic complexity. As a prophylactic measure hysterosalpingectopmy is recommmended for every uterus extirpation.

Adult↗
PubMed1980

[The treatment of stress incontinence in women by aponeurotic "supporting" of the neck of the bladder. A new improved technique (author's transl)].

The authors describe a number of new technical details concerning surgery for stress incontinence in the woman using a sub-cervical strip. This involves the taking of a free aponeurotic strip from the upper lip of a Pfannensteil incision (which eliminates all possibility of incisional hernia), extensive pre-vesico-cervico-urethral dissection which is particularly important during reoperation (which allows the neck to rise up into its "normal" position in a patient placed in the Trendelenburg position), preparation of the sub- and latero-cervical course via a vaginal approach (avoiding tearing of the bladder and malposition of the strip), accurate placing along a straight line of the two "legs" of the U-shape given to the strip under visual control, without any tension (which avoids dysuria and should be adequate to ensure continence during stress) and finally attachments of the free ends of the aponeurotic strip to the medial end of the ligaments of Cooper using non-absorbable sutures (which leaves the strip at the desired length). Results : nine patients who had never undergone previous surgery, with nine cures ; ten patients operated upon after the failure of previous surgery for stress incontinence (8 successes and 2 failures including one reoperation with success using the same technique) ; finally, five patients operated upon for stress incontinence occurring after pelvic surgery of another type : 3 successes and 2 imperfect results. The authors briefly mention the 21 failures seen in a series of 26 cases of uplifting of the neck using a strip of skin and the 18 failures in a series of 30 reoperations for the treatment of stress incontinence in which there was no cervico-urethrolysis prior to passage of the strip.

Female↗
PubMed1995

Emergent obstetric management of uterine inversion.

Puerperal inversion of the uterus is an unusual and potentially life-threatening event occurring in the third stage of labor, but when managed promptly and aggressively inversion can result in minimal maternal morbidity and mortality. Once the diagnosis of inversion is made, measures should be undertaken to manage and correct acute blood loss and potential shock. In conjunction with anesthesia personnel, immediate uterine replacement should be considered. Uterine relaxants (MgSO4, terbutaline, or halothane) can be used if initial attempts fail; however, in the majority of patients successful immediate replacement without use of uterine relaxants is possible. The choice of anesthetic agent and uterine relaxants should be individualized based on the clinical scenario. Following manual replacement, massage and ecbolic agent(s) should be instituted immediately to prevent reinversion. Surgical repositioning via an abdominal or vaginal approach may be necessary in subacute or chronic inversions.

Anesthesia, Obstetrical↗
PubMed1995

[Laparoscopic interventions in gynecology].

Gynecological surgery is performed in a difficult anatomical area of vital organs close to the pelvic wall. It requires precise hemostasis to prevent blood loss and postoperative complications. Both blood loss and complications are reduced by pelviscopic operation techniques. Patients who undergo gynecological pelviscopic operations often experience in comparison to laparotomy less fever, require less postoperative analgesia and are able to tolerate a full diet within 24 hours of surgery. Very often they have a faster recovery and a shorter hospital stay than patients undergoing traditional abdominal or transvaginal operations. The endoscopic operative technique lays the foundation for minimal invasive surgery. The mainly organ-resecting gynecological laparotomy, aiming to avoid recurrence, is increasingly being replaced by pelviscopic organ preservative techniques. Meanwhile we tend to perform many hysterectomies laparoscopically assisted (LAVH). It avoids laparotomy in casesa of adhesions and high uterine tissue mass and seems to lower intraoperative risks such as infection by strong operative restriction of the vaginal approach. CISH (classic intrafascial S*E*M*M* hysterectomy, S*E*M*M denoting "serrated edge macro-morcellated") even leaves the pelvic floor intact. Furthermore, we perform pelviscopic operations in cases of endometriosis, benign tumors of the ovaries, ectopic pregnancies and genital malformations (i.e., Vecchietti genitoplasty in the MRK-syndrome).

Female↗
PubMed1994

[Stress urinary incontinence. A comparison of of 4 methods of cystourethropexy. A 2-year follow-up].

All successful operations for relief of genuine stress urinary incontinence (SUI) have three objectives: elevation and retropubic maintenance during stress of the urethrovesical junction. The present study was realized at the Urogynecologic Service of the "Luis Castelazo Ayala" hospital IMSS to evaluate the results in a two years follow up of 597 patients that suffered from SUI treated by retropubic urethropexy, from February 1984 to May 1991. Patients were studied according to the service norms, previously published. We realized four types of procedures: Pereyra (379 cases), Burch (90 cases), Marchall-Marchetti-Kratz (60 cases) and Powell surgery (68 cases). Vaginal approach was realized in cases of pelvigenital statics disturbances like cysto- or rectocele; and abdominal approach was indicated in patients with enlarged uterus or pelvic masses. The complications rate was 15.3%. Success rate was 87.06% for all procedures and not statistic significance was found (p > or = 0.1 and X2 = 6.15), the best rate to the Burch and Pereyra procedures. We conclude the most important tip to successful rate in SUI surgery is correct choice of the procedure according to the patient.

Adult↗
PubMed1994

Laparoscopic repair of a vesicovaginal fistula: a case report.

BACKGROUND: Operative laparoscopy was performed for the management of ovarian remnant syndrome involving the bladder, bowel, vagina, and ureters, and requiring extensive dissection. A vesicovaginal fistula developed postoperatively. CASE: Because of the complexity and location of the fistula, a vaginal approach was not appropriate. Using techniques of videolaparoscopy, videocystoscopy, and operative laparoscopy, the fistula was repaired. CONCLUSION: In experienced hands, endoscopic management of complex vesicovaginal fistulas may be an alternative to the traditional abdominal approach.

Female↗
PubMed1977

[Early detection of postoperative deep-vein thrombosis in gynaecological patients by the 125I-Fibrinogen test (author's transl)].

Deep-vein thrombosis was detected by means of the 125I-fibrinogen test in 37.2% of patients undergoing gynaecological surgical procedures within the first six days postoperatively; 50% of the cases occurred within the first 48 hours. There was no difference in the incidence of thrombosis according to whether the abdominal or vaginal approach had been used. Varicose veins proved to be a high-risk factor in the development of deep-vein thrombosis. Prophylactic administration of horse-chestnut extract has to begin preoperatively in order to achieve a beneficial result.

Adult↗
PubMed1996

[Percutaneous needle colposuspension to Cooper's ligament: 63 cases].

OBJECTIVE: To evaluate the feasibility, safety and results of a new procedure of treatment of genuine urinary stress incontinence : needle percutaneous colposuspension to Cooper's ligament. STUDY DESIGN: From June 1994 to December 1995, 63 patients had a needle percutaneous Cooper's ligament colposuspension for stress urinary incontinence (USI). The mean age of the patients was 48 years (range : 32 to 80). Fourteen patients were menopausal (22,2 %). The mean parity was 2,7 (range 0 to 10). According to Blaivas and Olsson classification of USI, 6 patients had type 0, 32 type 1, 22 type 2 and 3 type 3. Fifty-eight patients had preoperative urodynamic control. RESULTS: The procedure was performed in 63 patients (100%). The mean operative time was 20 minutes (range 15 to 30). Peroperative complication: hemorrhagic in one case (1,5%). Postoperative complication rate was 12,7% including seven urinary infections. The mean follow-up of the patients was 8 months (range: 6 to 17). By subjective parameters, 55 patients were cured (87,3%). Only 38 patients had postoperative urodynamic control including the 8 patients with failure of the procedure. Among these 8 patients, 1 had clinical failure with normal urodynamic control, 2 had vesical instability and 5 had a persistence of USI confirmed by urodynamic control. CONCLUSION: Needle percutaneous colposuspension to Cooper's ligament appears as feasible and safe technique to cure USI. The interest of this new procedure of colposuspension is its fixation to the Cooper's ligament using the vaginal approach. Preliminary results are good, however longer follow-up is necessary to validate this new technique.

Adult↗
PubMed1996

[Sub-urethral diverticulum in women. Apropos of 12 cases].

The authors report a retrospective study of 12 cases of urethral diverticuli in women, observed over 17 years (1977-1994) at the department of urology in Casablanca. The mean age was 40 years. The reason of consultation was iterative cystitis (10 cases), the perception of the diverticulum by the patient in 50% of cases. The clinical examination permitted the diagnosis in all the cases. Intra-venous pyelography and retrograde cystogram led to a better analysis of the diverticulum. All our patients have been operated on by a vaginal approach, the resection of the diverticulum being made in 12 cases. During follow-up, one patient presented a recurrence, and another has been admitted for dilatation of a meatal stenosis.

Adult↗
PubMed1977

[Urological complications following gynecological surgery (author's transl)].

Lesions of the urinary tract occur in a constant percentage no matter what type of gynecological operation is performed. In the last 11 years we saw 150 immediately postoperative complications, 85 of which involved the ureter, 58 the bladder and 7 the urethra. 8 lesions of the ureter healed spontaneonsly. 15 ureters were mounted with a stent. Surgical treatment had to be performed on 62 ureters. 50 of which were ureteroplasties: 21 ureteroneocystostomies, 28 ureteroplasties with a bladder flap (Boari-Küss), 1 uretero-ureteral-anastomosis. The results were good in 80%. Therapy of vesical-fistulae consisted in operative closure 3 month after the primary lesion. (54 cases: 30 vaginal approaches, 7 transvesical approaches, 14 transvesical a. with a peritoneal flap and 3 transvesical a. with interposition of the omentum.) Continence was achieved in all but one cases. Two cases required a second intervention. 4. fistulas were treated only conservative, in 3 times successfull, one event of bladder abdominal-wall fistula. The 4th case was not closed because of the rejection of the operation from the patient. All urethral fistulae could be closed successfully.

Adult↗
PubMed1998

[Results of transrectal echography in the study of female urinary stress incontinence].

The development of echographic transducers allows now to study Female Urinary Exertional Incontinence (FUEI) using different approaches (vaginal, perineal and transrectal). A total of 122 transrectal echographies were performed. Based on the clinical symptoms: 14 patients are continent, 15 report micturition urgency, 11 micturition urgency plus FUEI, and 82 FUEI. All parameters Xrest, Yrest, AUVPrest, Xexertion, Yexertion, AUVPexertion, X', Y', AUVP' were measured. Three groups were defined: Group I, normal ultrasound diagnosis; Group II, vesical neck hypermobility; Group III, FUEI using Kolmogorov-Smirnov's test, the data fits a standard distribution curve and the results were analyzed through a variance analysis and Newman-Keul's test. During Valsalva's manoeuvre, patients with FUEI show greater caudal mobility of the vesical neck which becomes more significant as the degree of FUEI increases. Dorsal mobility is also greater in patients with FUEI although this parameter is of no use to quantify the degree of FUEI. Posterior urethro-vesical angle variability only discriminates patients with no FUEI from those with a higher degree of FUEI.

Female↗
PubMedDate not supplied

Hans Frangenheim--culdoscopy vs. laparoscopy, the first book on gynecological endoscopy, and "cold light".

In the United States, culdoscopy (a vaginal approach to view the abdomen) replaced laparoscopy for about 20 years, circa 1950-1970. In contrast to many of his colleagues, Hans Frangenheim of Wuppertal, Germany, was not satisfied with culdoscopy and turned to an abdominal approach. Frangenheim began publishing his experiences with gynecological laparoscopy in 1958 and stressed technical improvements. He constructed a CO2 insufflator, wrote the first book on gynecological endoscopy, and introduced "cold light" into laparoscopy. Frangenheim strongly stimulated the rise of gynecological laparoscopy in Europe in the 1960s and later.

Culdoscopy↗