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[Treatment of cancers limited to the uterine cervix with simple hysterectomy using a vaginal approach after brachytherapy].

PURPOSE: In patients with early cervix carcinoma, both radiotherapy and surgery or combined modalities provide effective therapies. In the two last modalities, recommended surgery is radical hysterectomy. The purpose of this prospective study was to assess the value of a limited vaginal hysterectomy after brachytherapy in patients without any unfavorable prognostic factor. PATIENTS AND METHODS: Twenty-two patients (stage Ia2 with vascular invasion: three patients, stage Ib 1:19 patients) with 1 cm median maximal tumor size and with previous negative laparoscopic lymphadenectomy (median number of lymph nodes: 12) underwent a limited vaginal hysterectomy 6 weeks after utero-vaginal brachytherapy. RESULTS: Two mild intra-operative complications were noted. Venous hemorrhage (100 mL) occurred in one patient during lymphadenectomy and another patient presented bladder injury during hysterectomy. These two complications were successfully controlled with no need for laparotomy. Only one late complication was observed: bladder grade G2 (b). With a 29 months follow-up (20-48 months), no recurrence was reported. CONCLUSION: These results appear promising in patients with very early cervix carcinoma but remain to be confirmed on a larger scale.

Adult↗

Abdominal versus vaginal approach for the management of genital prolapse and coexisting stress incontinence.

Patients who undergo surgery because of genital prolapse and coexisting stress incontinence can be treated by a combination of surgical procedures via a unified route. We performed a retrospective study among 47 patients to compare micturition, defecation and prolapse symptoms after surgery, as well as duration of hospital stay and complication rate between patients who underwent a unified vaginal or abdominal surgical correction. All patients were treated between January 1995 and December 1997 in the University Medical Center Utrecht or St Antonius Hospital Nieuwegein, The Netherlands. Abdominal surgery was associated with a higher prevalence of difficulty in bladder emptying (relative risk (RR) 2.3 (95% CI 1.4-8.4)), fecal incontinence (RR 3.4, CI 1.1-10.7) and soiling (OR 2.8, CI 1.2-6.2), as well as with a longer postoperative hospital stay (8.6 vs 7.3 days) and a higher complication rate (25.0% vs. 11.4%) than vaginal surgery. These results suggest that a unified vaginal surgical correction of genital prolapse and coexisting stress incontinence appears to be preferable to a unified abdominal surgical correction.

Aged↗

A vaginal approach to the treatment of genital prolapse.

The surgical treatment of 409 patients with genital prolapse is described. The procedure, which invariably included hysterectomy, concentrated upon one of the major complaints of these patients, i.e., their stress-incontinence. Special care was taken not to shorten the urethral length. Two hundred of these patients were available for a relatively long follow-up period ranging from 7 to 13 yr. Within the first post-operative year, stress-incontinence appeared to have been cured in 90% of the patients. The long-term results show that the percentage of continent women has diminished to 81, which is an important finding probably not attributable to the surgical technique. In the long term, the second most frequent complaint of low back pain has recurred in 29% of our patients.

Female↗

[Surgical treatment of anterior rectoceles in women. The perioneal-vaginal approach].

Rectoceles are best repaired via a perineal approach. The transperineovaginal approach provides access to the outer side of the rectocele: the rectal hernia is repaired with two or three purse-string sutures and suture of the rectal fascia. Levatorplasty, performed without narrowing of the vagina, reinforces the repair and strengthens the lax pelvic floor. Unilateral sacro-spinofixation of the vagina is a useful adjunct to restore normal anatomy. Rectocele repair via a perineovaginal approach has a low morbidity rate and achieves good functional results. Concomitant sphincteroplasty may be performed in the case of symptomatic rupture of the anal sphincter, treating as well urinary incontinence or prolapse of the uterus. Surgery is indicated in symptomatic rectocele when retraining the pelvic floor by biofeedback and medical therapy have failed to relieve symptoms. There are no clear predictive factors of outcome and the patient must be informed about the risk of persisting symptoms or failure.

Female↗

Combined abdominal and vaginal approach for bladder neck closure and permanent suprapubic tube: urinary diversion in the neurologically impaired woman.

Chronic indwelling Foley catheter placement in the neurologically impaired patient can lead to pressure necrosis of the urethra with incontinence. We report on 2 series of patients who underwent bladder neck closure and insertion of a suprapubic catheter for this problem. Our initial group includes 4 patients who underwent 5 transvaginal procedures, of which 2 (40%) were successful. Subsequently, we modified our approach, and used a combined abdominal and transvaginal repair, which was successful in 10 consecutive patients with a followup of 6 to 40 months (mean 15.6).

Abdomen↗