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At least 397 records · Page 22Linked to original sources
PubMed1996

An anatomical approach to oophorectomy during vaginal hysterectomy.

Oophorectomy is not always performed at the time of vaginal hysterectomy because of technical difficulties encountered in visualizing the ovaries and clamping and ligating the infundibulopelvic ligament. After uterine removal, a method that simplifies the approach involves separating the round ligament along the avascular space from the fallopian tube and ovary, then ligating the infundibulopelvic ligament separately from the round ligament, rather than clamping and ligating the infundibulopelvic and round ligaments together.

Adnexa Uteri↗
PubMed2002

[Local investigation concerning psychic and sexual functioning a short time after hysterectomy].

UNLABELLED: Hysterectomy is one of the most common operations done throughout the world. Patients' concerns about sexual functioning after hysterectomy is great. OBJECTIVE: We wanted to evaluate, through a local investigation based on a questionnaire, the psychosexual impact of this operation and to compare our data to those available in the literature. PATIENTS AND METHODS: 534 patients operated between of 01.01.1997 and 31.12.1997 for a benign uterine pathology (prolapse excluded) were included. Questions were about sexual and psychological functioning after hysterectomy. The main outcome measures were changes in the sexual life, sexual desire, orgasm, dyspareunia, frequency of sexual relations. Abdominal and vaginal surgical approaches were compared for some items when possible. RESULTS: After the operation, 83.3% of the patients felt better, 30.4% of the patients mentioned changes in their sexual life, 32% of low libido rates was noticed (and there was a significant difference between abdominal and vaginal surgical approaches), 27.6% of the patients had less frequent orgasm and only 8.8% experienced orgasm more frequently, 15% suffer from dyspareunia, and 15% were more engaged in sexual intercourse. CONCLUSION: Psychosexual impact of hysterectomy is limited and is not more frequent when vaginal surgery is performed, but pre- and post-operative prevention can be useful.

Adult↗
PubMed1983

[Resorption of drugs through the vaginal wall].

Drug absorption during vaginal administration. A method is described (systems approach to vaginal delivery of drugs and development of in situ vaginal drug absorption procedure) and is able to show vaginal absorption of drugs. Some drugs are rapidly and largely absorbed through vaginal epithelium: Metronidazole (Flagyl), Prostaglandins, Estrogens, Polyvidone-iodine (Betadine), Chloroquinadol (Gynotherax), d-Methadone, Hexachlorophene (Phisohex et Ultralan), Insulin and Triclosan. Other drugs are poorly absorbed: Amphotericin B (Fungizone, Amphocycline), Econazole (Pevaryl) and Trimethoprim. At least, some drugs are not absorbed: Nystatine (Mycostatine) and Furazolidone (Tricofuron).

Absorption↗
PubMed1995

Vaginal reconstruction in children and adults.

There are many different approaches to vaginal reconstruction. Methods include simple dilation, skin graft techniques, amnion graft and use of intestinal segments for vaginal replacement. When dealing with vaginal aplasia, sigmoid vaginoplasty seems to have a clear advantage with an excellent surgical success rate and a low rate of complications.

Adult↗
PubMed2003

Vaginoplasty with Interceed absorbable adhesion barrier for complete squamous epithelialization in vaginal agenesis.

OBJECTIVE: The purpose of this study was to present our experiences of an innovative surgical approach for vaginal agenesis with the use of Interceed absorbable adhesion barrier (Ethicon) to achieve a satisfactory neovagina. STUDY DESIGN: The current study involved 10 subjects who were diagnosed with vaginal agenesis. After the creation of a vaginal tunnel, a mold that had been wrapped with Interceed was placed in the neovagina. RESULTS: No operative and postoperative complications were encountered. The duration of the operation was < or =30 minutes, and blood loss was minimal. The postoperative hospital stay was only 2 days. Epithelialization of the neovagina was achieved 1 to 4 months after the operation, and all patients were satisfied with the outcome. The neovagina that was created with this procedure was not much different from the normal adult vagina as far as histologic and physiologic conditions are concerned. CONCLUSION: This innovative surgical procedure may be a potential alternative approach for the therapy of vaginal agenesis with the use of the absorbable adhesion barrier Interceed with excellent results.

Adolescent↗
PubMed2004

Vaginal microbicides: a novel approach to preventing sexual transmission of HIV.

The AIDS epidemic continues its unrelentless expansion. According to the Joint United Nations Programme on HIV/AIDS, there are more than 40 million people living with HIV, and more than 15,000 new infections occur every day. One approach to curbing HIV is the development of topical microbicidal agents or microbicides. These are compounds designed to protect the body's mucosal surfaces from infection by sexually transmitted disease-causing pathogens, including HIV. Several candidates are in preclinical stages; however, only a handful have been tested in humans for safety, and even fewer are ready for clinical efficacy trials. In this update, we describe microbicide research and development, including preclinical screening algorithms, ideal properties, compounds in the pipeline, and future prospects. This review is based on a previous work, which has been updated to contain new information, especially regarding microbicide candidates in preclinical and clinical stages of development.

Administration, Intravaginal↗
PubMed1998

Rapid and inexpensive approaches to managing abnormal vaginal discharge or lower abdominal pain: an evaluation in women attending gynaecology and family planning clinics in Peru.

OBJECTIVES: To assess low abdominal pain, yellow vaginal discharge, other symptoms and signs, and demographic and behavioural variables as predictors for cervical or vaginal infection. METHODS: A cross sectional study of women attending gynaecology and family planning clinics in Lima, Peru was undertaken. 630 consecutive eligible female patients with chief or elicited complaints of yellow vaginal discharge, low abdominal pain, or both were interviewed and examined, together with a comparable reference group without these complaints. Vaginal specimens were tested for trichomoniasis and bacterial vaginosis. Endocervical specimens were tested for Neisseria gonorrhoeae and Chlamydia trachomatis using the ligase chain reaction. RESULTS: Infections found included chlamydial infection in 69 women (10.9%), gonorrhoea in 10 (1.6%), and either infection in 77 (12.2%); trichomoniasis in 46 (7.3%), bacterial vaginosis in 189 (30%), and either infection in 209 (33.2%). Cervical infection with C trachomatis and/or N gonorrhoeae was independently associated with history of a new sex partner within the last 3 months, more than one sex partner within the last year, use of condoms never or in less than 50% of sex acts, history of sex partner with STD within the last year; with symptoms of persistent low abdominal pain and of yellow vaginal discharge; and with signs of profuse and yellow vaginal discharge, cervical ectopy, easily induced endocervical bleeding, or brown cervical secretion. Using these findings, an algorithm was created that had a positive predictive value (PPV) of 36% for cervical infection among women reporting chief or elicited complaint of this abnormal vaginal discharge and a PPV of 25% among those without a complaint. A chief complaint of yellow vaginal discharge had a PPV of 50% for trichomoniasis or bacterial vaginosis. Among women without a chief complaint of yellow vaginal discharge, clinical findings of yellow vaginal discharge had a PPV of 55%. CONCLUSIONS: Where economic and technical constraints preclude testing, clinical findings and risk assessment are helpful in detecting vaginal and cervical infections. Several demographic, behavioural, clinical, and laboratory variables were predictive of infection in this population.

Abdominal Pain↗
PubMedDate not supplied

[Vaginal reconstruction in girls and young adults].

OBJECTIVE: There are many different approaches to vaginal reconstruction. Methods include simple dilatation, skin grafts techniques, amnion grafts and the use of bowel segments for vaginal replacement. METHOD: We herein discuss the most common surgical techniques and present our series of 15 patients who underwent intestinal vaginoplasty with either sigmoid colon or cecum. RESULTS: The complication rate was low, with two patients requiring revision for prolapse. Ten patients are sexually active with only one describing any degree of dyspareunia. CONCLUSION: When dealing with vaginal aplasia, intestinal vaginoplasty seems to have clear advantages with an excellent surgical success rate and low incidence of complications.

Adolescent↗
PubMed2004

Transvaginal hysterectomy: rationale and surgical approach.

Abdominal hysterectomy is performed in the United States at a 3:1 ratio over vaginal hysterectomy, despite evidence that vaginal hysterectomy offers advantages over abdominal hysterectomy with regard to operative time, complication rates, recovery, return to daily activities, and overall costs of treatment. In fact, the predominance of the abdominal approach may be based on factors other than clinical considerations, including resident training, use of limited or obsolete guidelines, greater third-party compensation for abdominal procedures, a presumption rather than a confirmation that pathology exists that contraindicates a vaginal approach, and misconceptions about the safety and cost of vaginal hysterectomy. A number of studies spanning several years demonstrate that the use of more systematic guidelines for selecting the route of hysterectomy results in a major shift toward the vaginal approach. Evidence also shows that transvaginal hysterectomy is both feasible and optimum for types of patients who have long been considered inappropriate candidates for the vaginal route. New instrumentation facilitates the vaginal approach and contributes to improved hemostasis and decreased operative time. Included here is a step-by-step approach to determining appropriate candidates for the vaginal approach via assessment of access, uterus size, and extent of pathology.

Female↗
PubMed1995

Trial of labor: a disciplined approach to labor management resulting in a high rate of vaginal delivery.

A disciplined approach to labor management has resulted in a low cesarean rate (9%) in our population. We wondered if this management scheme was applicable and safe applied to women with previous cesareans. Women with a previous cesarean delivering in a 5-year period were included. Labor management included encouragement of trial of labor, labor stimulation with oxytocin when indicated, epidural analgesia only after entering the active phase, and continuous monitoring. Demographic, labor and delivery, and neonatal data were electronically stored and analysis performed using SPSS release 4.1 for VAX/VMS. Statistical analysis was performed using chi-square and Fisher's exact test where appropriate. Multiple logistic regression was performed to control for potentially confounding variables. A previous cesarean had been performed in 713 (11%) gravidas who met the inclusion criteria. Vaginal delivery was attempted in 588 (82%) and 517 (88%) achieved vaginal birth. Older women (14 versus 1 versus 8%, p = 0.04), of higher parity (63 versus 35 versus 17%, p = 0.0001), requiring preterm delivery (14 versus 8 versus 4%) were more likely to have an elective repeat cesarean than a successful or failed trial of labor. Pregnancies requiring oxytocin (90 versus 53%, p = 0.02), receiving epidural analgesia (62 versus 49%, p = 0.05), developing chorioamnionitis (20 versus 4%, p < 0.0001) were more likely to fail a trial of labor. Four uterine ruptures occurred and only one patient was receiving oxytocin. There were no differences in umbilical artery blood acidemia among elective repeat cesarean sections and successful or failed trial of labor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Posthysterectomy rectal and vaginal prolapse, a commonly overlooked problem.

The existence of combined rectal and vaginal prolapse is more common than the literature would suggest. This paper outlines a further development in the operative management which has been applied to 24 patients with this problem. All had had a hysterectomy and most had had in addition one or more vaginal repairs. The common mode of presentation was one of pelvic pain (19 patients), sometimes severe, crippling and intractable and some form of protrusion (14 patients), difficult or unsatisfied defaecation and rectal incontinence (9 patients). The vaginal prolapse which always involved the vault and usually involved the lower vagina was usually found to be incomplete and the rectal prolapse complete (but occult). The operative procedure essentially consists of a Wells type rectopexy which has a new modification in which the sling is extended to anchor the vaginal vault after correction of the enterocele by the abdominal approach. A vaginal repair is subsequently performed at the same operation where anterior or posterior vaginal prolapse persists. Important points in the procedure are the avoidance of sepsis (the vaginal vault is not opened during the procedure) and protection of the ureters by careful assessment of the lateral margins of the vaginal vault which is illuminated by transvaginal vault endoscopy. At this early stage operative morbidity has been minimal, relief of the pelvic symptoms has been most encouraging, but the length of follow-up is short (range 6-30 months, average 15.6) and long-term evaluation will be necessary as with all surgery for prolapse.

Adult↗
PubMed1987

[Vaginal hysterectomy of the non-prolapsed uterus. Toward rehabilitation].

The main steps to be carried out in the operation of vaginal hysterectomy when the uterus is not prolapsed are overall the same as when vaginal hysterectomy is carried out for prolapse: separation of the bladder from the uterus, opening of the Pouch of Douglas, dividing the utero-sacral ligaments, opening the vesico-uterine pouch, dividing the cardinal ligaments, delivering the fundus of the uterus, freeing the uterine cornua and reperitonealisation. All the same, for each step there are numerous different details to be carried out. Careful attention to all these modifications make it easier to remove a non mobile uterus or one that is markedly enlarged. When the definite advantages of this technique, which is unfortunately insufficiently practised in France, are understood it is the operation of choice rather than the abdominal approach whenever a vaginal approach is possible, which it is in the large majority of cases.

Female↗