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At least 379 records · Page 21Linked to original sources
PubMed2003

Purohit technique of vaginal hysterectomy: a new approach.

To ease intra-operative access to laterally at vaginal hysterectomy, we have developed the 'Purohit technique of vaginal hysterectomy' using a right angle forceps, electrocautery and 10 mm telescope with light source. A prospective study on consecutive 214 women with benign disease of the uterus without prolapse, including cases with relative contraindications (excluding endometriosis and uteri above 20 weeks size), demonstrated it to be easy, safe and effective. Vaginal hysterectomy was successfully completed in 213 (99.53%) cases, with one failure (0.46%) which needed laparoscopic assistance. Vaginal salpingo-oophorectomy was completed in all indicated cases. We believe that many abdominal and laparoscopic hysterectomies could be avoided by this technique. Details of the technique can be seen on the following website http://www.purohittechnique.com

Female↗
PubMedDate not supplied

New approaches in laparoscopically assisted radical vaginal hysterectomy.

BACKGROUND: To illuminate our new approaches in laparoscopically assisted radical vaginal hysterectomy. METHODS: Twenty-four women underwent laparoscopically assisted radical vaginal hysterectomies during the period from March 1994 to May 1995 in our institute. Indications for this surgery, including cervical carcinoma stage 1A to 2A, were the same as for abdominal radical hysterectomy. The procedure was performed under general endotracheal anesthesia through means of the technique of videolaparoscopy. Two new approaches were recruited in these procedures including using middle upper abdomen as the primary trocar site and using ureteral stent or illuminator as a ureter marker. RESULTS: All of these patients completed the procedures without exception. The mean hospital stay was 8.2 +/- 3.2 days. The average blood loss was 540 +/- 210 ml with a range from 100 to 1800 ml. Operating time was from 220 to 420 minutes with a mean time of 325 minutes. In all cases pelvic lymphadenectomy was performed without exception, yielding an average of 13.2 macroscopic nodes. Two of them metastatic lymph nodes were noted. No ureteral injury occurred after using the ureteral stent as a marker. CONCLUSIONS: In this preliminary result, using middle upper abdomen as the primary trocar site could provide the surgeon with a wider and familiar visual angle, thus making the pelvic or para-aortic lymphadenectomy much easier. Moreover, using the ureteral illuminator as a marker during unroofing the ureter laparoscopically is helpful to prevent the ureteral injury and facilitating the procedures in laparoscopically radical hysterectomy.

Adult↗
PubMed1986

The posterior sagittal approach to repair of vaginal atresia and imperforate anus.

In 1982 deVries and Peña reintroduced the posterior sagittal approach for the repair of high imperforate anus, and it is already being utilized by many pediatric surgeons worldwide. This approach, the so-called "Kraske approach," has been used in the past for access to difficult rectal lesions, and has been applied to cloacal anomalies, again by Peña and deVries. We have recently applied this technique to repair a mid-vaginal atresia in a 12-year-old girl who also had chronic constipation and fecal incontinence following neonatal imperforate anus repair. The posterior sagittal approach allowed simultaneous reconstruction of the anus and vagina and may have application to the primary repair of ano-vaginal anomalies in infancy. The case history and a discussion of the technique form the basis of this report.

Abnormalities, Multiple↗
PubMed1989

Immunological findings in patients with chronically recurrent vaginal candidosis and new therapeutic approaches.

Eighteen patients with chronically recurrent vaginal candidosis showed low T-lymphocyte counts twice as frequent as a control group of 55 women. The patients were treated with azoles locally and lymphocyte stimulating pentapeptide thymopentin. The prolongation of disease-free intervals and a cure was mainly seen in the patients with low T-cell values before therapy. In vitro-proliferation assays upon stimulation with Candida albicans bore no correlation with the course of the disease. We suspect a failure in the co-operation of the immune cells, caused by differing strong responses to the Candida albicans stimulation.

Adjuvants, Immunologic↗
PubMed2001

Transabdominal approach to repair of vaginal vault prolapse.

PURPOSE: To review the preoperative evaluation of women with vaginal vault prolapse and describe the surgical methods of treatment using a transabdominal approach. METHODS: Abdominal sacral colpopexy is the most widely performed method of transabdominal correction of vaginal vault prolapse. The procedure is completed by securing the apex to the vagina to the periosteum of the sacrum with mesh. This procedure is demonstrated in great detail. Successful repair can be achieved by other transabdominal approaches and by laparoscopic approaches. RESULTS: Twenty women (mean age 67.9 years) were evaluated for complex pelvic floor prolapse. Six (30.0%) patients had failed transvaginal sacrospinus ligament fixation. Abdominal sacrocolpopexy utilizing Marlex mesh, Halban culdeplasty, and paravaginal repair was performed on all patients. Five posterior repairs and one anterior repair was done. The average operating time for the colpopexy and enterocele repair alone is approximately 90 minutes. The average blood loss was 284 cc. The average hospital stay was 3.7 days. The mean follow-up is 11.3 months (6-27 months). The vaginal vault is well supported in all patients with no recurrent enterocele or vault prolapse. Three patients have asymptomatic grade II cystoceles, and three patients have asymptomatic grade II rectoceles. There were few complications. No mesh complications have been encountered. CONCLUSIONS: Vaginal vault prolapse can be a difficult problem to diagnose and treat. Successful treatment requires thorough knowledge of the anatomy, methods of diagnosis, and treatment options. The abdominal sacrocolpopexy achieves excellent correction of vaginal vault prolapse with minimal morbidity.

Abdomen↗
PubMed2004

Voiding dysfunction after tension-free vaginal tape: a conservative approach is often successful.

The published literature has focused mainly on the efficacy of tension-free vaginal tape (TVT) in correcting stress incontinence with few reports of complications. We report our experience with the first 52 cases of TVT, specifically assessing voiding dysfunction after the procedure. We carried out a retrospective study of patients undergoing TVT surgery for stress urinary incontinence (SUI) between April 2001 and July 2003. Data were collected on period of catheterization, voiding and storage symptoms, their duration and management. Fifty-two women with a mean age 54 years (36-77) were included. Postoperatively, the urethral catheter was removed routinely within 12 h. Twelve patients (23%) failed to void spontaneously and needed recatheterization. Ten of them (83%) were able to resume spontaneous voiding within 3 months. Twenty patients (38%) complained of storage symptoms postoperatively. Sixteen (80%) responded to conservative treatment. Transient urinary symptoms after TVT sling for SUI are common but can usually be managed conservatively.

Adult↗
PubMed1995

Vaginismus and outcome of treatment.

Vaginismus is a condition of involuntary spasm of the muscles surrounding the outer third of the vagina that is brought about by real, imagined or anticipated attempts at vaginal penetration and often leads to non-consummation of marriage. It is a classic psychosomatic disorder where phobia of vaginal penetration often stems from sexual ignorance, previous traumatic experiences or religious orthodoxy. Management of vaginismus aims at helping the woman to regain voluntary control of her pelvic floor muscles. The treatment utilises a behavioural method aimed at teaching relaxation of pelvic floor muscles together with a systematic desensitization of the fear of vaginal penetration. There are two approaches to vaginal desensitization. The first is gradual desensitization using vaginal self-dilatation, and the second method utilises rapid desensitization brought about by vaginal mould insertion. Of these, the rapid method is preferred at our institution. Surgical correction is almost never required and may be detrimental to achieving success. Management of these conditions requires a warm, empathetic attitude and demands great patience and understanding on the part of the physician. Between 1985 and 1991, 19 patients with vaginismus were treated at the National University Hospital, with a rapid desensitization programme using vaginal moulds. All 19 women could achieve satisfactory vaginal intercourse within 2 to 6 weeks of commencement of therapy.

Adolescent↗
PubMed2005

Laparoscopic-assisted vaginal subtotal hysterectomy.

BACKGROUND: A novel approach in combined laparoscopic and vaginal procedures through the posterior cul-de-sac for subtotal hysterectomy is introduced. PATIENTS AND METHODS: Twenty-one women with menometrorrhagia, symptomatic adenomyosis, or uterine myomas were enrolled in this study. After laparoscopic dissection of bilateral round ligaments and adnexa, a guiding suture brought the uterine fundus down through the posterior cul-desac into the vagina via a posterior colpotomy. Subtotal hysterectomy and hemostasis of the cervical stump were then performed transvaginally by conventional techniques and equipment. RESULTS: Mean operative time, blood loss, and length of hospital stay were 111.2 +/- 28.8 minutes, 252.4 +/- 147.9 mL, and 3.2 +/- 0.9 days, respectively. No patients developed serious complications, but 1 patient had a postoperative stump infection and was treated with 2 combined antibiotics, uneventfully. CONCLUSION: A combined laparoscopic and vaginal approach in performing subtotal hysterectomy through the posterior cul-de-sac is an alternative to a purely laparoscopic approach.

Anti-Bacterial Agents↗
PubMed1999

Evaluation of vaginal introital sampling as an alternative approach for the detection of genital Chlamydia trachomatis infection in women.

BACKGROUND: Genital Chlamydia trachomatis infections in women are traditionally detected by testing cervical and urethral samples. This sampling approach is not acceptable in some, e.g. screening situations. We evaluate an alternative approach, i.e. use of vaginal self-collected specimen for testing by polymerase chain reaction. METHODS: The sensitivity of self-collected vaginal (introital) samples to diagnose genital infections by Chlamydia trachomatis using Roche AMPLICOR CT/NG PCR was compared with the cervical- and first-voided urine samples from women consulting with- (Group 1; n=123) and without (Group 0; n=160) genital symptoms. Women were interviewed regarding genital hygiene. Genital symptoms and signs were noted. RESULTS: C. trachomatis DNA was detected in 13.0% of women from Group 1 and in 5.0% of women from Group 0, i.e. in urine of 6.5% vs. 1.9%, in the cervical swab in 9.8% vs. 5.0% and in vaginal swab in 11.4% vs. 3.8% of women, respectively. The vaginal sample was the most sensitive specimen for detecting C. trachomatis in the Group 1 women. It had sensitivity of 87.5% vs. 75% for cervical- and 50% for urine specimens. In Group 0, the cervical sample was 100% sensitive, while the vaginal introital sample and urine had a sensitivity of 75% and 37.5%, respectively. C. trachomatis was less often detected in urine of women who routinely practised genital washing. CONCLUSIONS: Vaginal sampling performed by the woman herself is a sensitive approach and might serve as an important stimulus for screening for C. trachomatis infections in young women at risk.

Adolescent↗
PubMed1998

High posttraumatic vaginal stricture combined with urethrovaginal fistula and urethral stricture in girls: reconstruction using a posterior sagittal pararectal approach.

PURPOSE: High vaginal stricture is a rare abnormality of traumatic origin, which in most cases is associated with urethral injury. Because to our knowledge there are no previous reports of surgical management of this condition, we describe our experience with plastic surgery performed via a posterior sagittal approach using local tissue in girls with posttraumatic vaginal stricture. MATERIALS AND METHODS: We performed vaginoplasty using a posterior sagittal pararectal approach in 6 girls 5 to 14 years old with posttraumatic high vaginal stricture. Five patients had urethral stricture and urethrovaginal fistula. In 5 cases bladder neck closure and the Mitrofanoff procedure were done. RESULTS: There were no complications in any patients during the immediate postoperative period. Followup studies 1 to 3 years later in all girls revealed a fully patent vaginal anastomosis. CONCLUSIONS: Principles of reconstruction that must be followed if a positive result is to be obtained include concurrent vaginoplasty and suture of the urethrovaginal fistula with separation of the suture line, complete excision of scars in the segments being joined, use of meeting flaps to lengthen the anastomotic line as much as possible, and prevention of ischemia and inflammation in the anastomotic region.

Adolescent↗
PubMed2002

Time course of VMN lesion effects on lordosis and proceptive behavior in female hamsters.

Previous studies suggest that ultrasound production by female hamsters is better able than other reproductive behaviors to recover from an initial drop caused by damage to the ventromedial hypothalamus (VMN). At the same time, few studies have examined the time course of such lesion effects. To remedy this, female hamsters were observed before and after control operations or VMN lesions. The behaviors considered were ultrasound production, lordosis, approach, and vaginal marking. Ultrasound production, lordosis, and approach were affected by lesions, permitting the description of the time course of each of these effects. Only ultrasound rates showed evidence of recovery, which culminated in rates significantly above those observed preoperatively in the same animals. This suggests that ultrasound production is unusual in its response to VMN damage and that the underlying mechanism could be of interest in studies of the processes that determine recovery from brain damage.

Animals↗