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At least 505 records · Page 28Linked to original sources
PubMed1995

Utero-vaginal prolapse: a rural disability of the young.

A study consisting of 156 and 195 patients admitted to Gondar College and Gandhi Memorial hospitals respectively, for surgical corrections of vaginouterine prolapses of second and third degrees was carried out from June 1989 to June 1993. At Gondar, uterovaginal prolapses accounted for 19.9% of all major gynaecological operations in comparison to 17.2% at Gandhi. The mean ages for Gondar and Gandhi subjects were 38.09 +/- 11.52 and 42.17 +/- 13.16 years, respectively. In both centres there is statistically significant (p < 0.05) sequestration of especially third degree prolapse with increase in age. Mean parity of 5.6 +/- 2.7 children and 5.4 +/- 2.6 children have been obtained for Gondar and Gandhi groups, respectively. There is statistically significant increase (p < 0.05) of the second and more so of the third degree genito- urinary prolapse with increase in parity. Of the 125 housewives from the Gondar group, 114 (92.2%) were from the rural areas. The results of Gandhi group revealed that 143 (90.5%) out of 158 subjects were rural housewives. There is significant association of prolapse and occupation particularly with the rural housewives of both centres. The symptoms and signs of both centres were variable and dependent on degrees of prolapse; and the mean durations were 2.8 years +/- 2.9 years for Gondar and 2.4 years +/- 2.4 years for Gandhi, respectively. As a vaginal problem, vaginal surgical approaches yielded better results despite shortcomings of short term follow up. This paper based on two hospital records with similar results illustrates that it is mainly a rural problem and relatively of a younger population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Laparoscopic hysterectomy. Supracervical vs. assisted vaginal.

Twenty cases of laparoscopic supracervical hysterectomy performed by operative laparoscopy without vaginal assistance were retrospectively compared to 232 cases of laparoscopically assisted vaginal hysterectomy reported in the literature. The specimens were morcellated intraabdominally and removed through the umbilicus. This is the first reported series of this technique with intraabdominal morcellation, which emphasizes cosmetic considerations and remains within the confines of the umbilicus. The postoperative hospitalization time ranged from 3.75 to 22.2 hours. On the second postoperative day, 10% of the patients returned to work, and 15% were able to drive. Patients resumed normal activity in an average of 5.6 days after surgery. As compared to laparoscopically assisted vaginal hysterectomy, there was a decrease in morbidity, blood loss and recovery time. Prolonged anesthesia from the longer operating time was clinically insignificant in terms of the patients' recovery. By decreasing the disability from hysterectomy from six weeks to one, the procedure provided financial savings through work time gained.

Activities of Daily Living↗
PubMed1998

[Treatment of effort stress incontinence using a mechanical procedure. Personal technique].

On March 14th 1992, a female patient (P.C.O.) with CR 167584, underwent surgery for urinary exertional incontinence. We followed an original technique as a first (worldwide?) experience, using a pneumatic stapler designed for the management of this condition. The approach is vaginal, the active end of the stapler is introduced into the cavity and propped up against the anterior side of this organ close to the urethra: from this point and once the position is secured, the devise is pressed against the internal side of the pubis and a staple is projected fastening the vagina's ceiling to the interior side of the pubis. A total of eight procedures were performed, but only the first patient maintains a steady continence as the staple stays in the same position it was planted. In all remaining cases, the staples fell off over the subsequent weeks and the patients returned to the early incontinence state. The reasons for the inefficacy of this first prototype are analyzed, providing an explanation for the rationale behind this report four years after the experience.

Female↗
PubMed1976

[Vaginal hysterectomy for therapeutic abortion and simultaneous sterilization (author's transl)].

Report about the experiences in termination of 25 early pregnancies by vaginal hysterectomy in cases final infertilisation was necessary. Advantages of the method are seen in avoiding dilatation of the cervix and in the calculable blood loss as compared to suction or curettage for abortion and simultaneous sterilization. In contrast to many apprehensions the risks do not seem to rise when performing vaginal hysterectomy of the pregnant uterus up to the 12th week. Advantages and criteria of the method are discussed.

Abortion, Therapeutic↗
PubMed1999

A new technique for performing Syed template interstitial implants for anterior vaginal tumors using an open retropubic approach.

The Syed template (Alpha-Omega Services, Bellflower, CA) has been established as an advance in interstitial gynecologic brachytherapy. Unfortunately, enthusiasm for the technique is often tempered by certain tumor geometries which require blind insertion of the interstitial needles, potentially risking inaccurate placement of the radioactive sources and viscus perforation. These concerns arise particularly in the management of anterior vaginal tumors where difficulties in negotiating the pubic arch can prevent optimal needle placement. In answer to this problem, a technique utilizing an open retropubic approach for Syed template interstitial implants in anterior vaginal tumors under direct visualization is described. To date, six procedures have been performed. The disease entities include advanced cervical squamous cell carcinoma, clear cell carcinoma of the vagina, recurrent vaginal carcinoma, recurrent endometrial carcinoma, and urethral adenocarcinoma. Complete response was noted in five of six patients but persistent local control of disease was achieved in only one of five complete responses over a relatively short follow-up interval. Complications included paravaginal abscess (n = 1), postoperative deep venous thrombosis (n = 1), abdominal incision cellulitis (n = 1), and radiation enteritis (n = 1). An open retropubic approach allows direct visualization of the bladder and urethra during interstitial implantation of anterior vaginal malignancies and facilitates negotiation of the pubic arch. In our experience, this technique results in improved needle positioning and is thus intuitively likely to aid in avoiding injury to surrounding normal tissues. Additional accrual of a larger cohort will be necessary to arrive at any meaningful objective conclusions regarding the technique's benefit over current modalities.

Adult↗
PubMedDate not supplied

[Surgical repair of vesico-vaginal fistulae with abdominal-transvesical approach. Comments on this technique and long-term results].

OBJECTIVES: We reviewed our series of vesicovaginal fistula that had been treated by the abdominal-transvesical approach, which we have also utilized in complex relapsed fistulas of the posterior aspect of the bladder in all but one case of triple fistula associated with lithiasis of the bladder. METHODS: 6 patients with vesicovaginal fistula secondary to pelviogynecological surgery were treated by the abdominal-transvesical approach. One patient had been referred to our hospital for a triple fistula that had relapsed for the fifth time. This patient was submitted to cystolithotomy during the same session. Another patient with urinary incontinence and cystocele prior to the fistula underwent unrethrocervicopexy following the Marshall-Marchetti-Krantz technique after fistula repair. All the cases were treated by the same surgeon without omental interposition. RESULTS: Excellent results were achieved in all 6 cases, with no fistula relapse. The urinary infection disappeared in those patients with this complication prior to fistula repair. Patient control evaluation was performed 6-12 months postoperatively and at 4 years. All 6 patients are currently urologically asymptomatic and continent. CONCLUSIONS: In our view, vesicovaginal fistula repair can be done via the vaginal, abdominal or combined approach. We do not believe that one technique is superior over the other. Although the 6 cases described herein are not significant statistically, the abdominal-transvecial approach has been successful in these 6 cases, despite the difficulty that is always encountered in some cases of vesicovaginal fistula, regardless of the technique utilized. Omental interposition may be useful in those cases with a large fistulous defect. Some advocate fistulectomy in all cases. The time to surgical correction following diagnosis was always more than three months. The crossed or x-shaped suture achieves minimal superpositioning. Postoperative bladder drainage should not lie on the suture of the bladder mucosa to prevent decubitus through placement of a cystostomy tube. The foregoing points are essential in this procedure.

Adult↗
PubMedDate not supplied

[Advantages of laparoscopically-assisted vaginal hysterectomy in comparison with the traditional approach].

The authors are discussing the advantages of the laparoscopically assisted vaginal hysterectomy over the traditional vaginal method, comparing two groups of patients operated in both techniques. In 30 patients from the first group the traditional vaginal hysterectomy have been performed as part of the operation needed in order to change their sex. 20 patients from the second group have been operated, due to different indications, by laparoscopically assisted vaginal hysterectomy. Comparing the indications, the operation itself and the results in postoperative treatment the authors concluded that, for the laparoscopically assisted vaginal hysterectomy the indications are more numerous, practically there are no contraindications, the operation itself is easier, because all abdominal organs are visible on the screen. As for the results after the operation, they are almost identical in both groups. The only advantage of the traditional method is that, sometimes, the operation itself does not last long. The greatest benefit of laparoscopic assisted vaginal hysterectomy is the potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy. The authors unanimously concluded that only experienced surgeons can perform both operations.

Female↗
PubMed2004

Cytologic assessment of the vaginal epithelium in the common marmoset (Callithrix jacchus): a preliminary new approach to reproductive screening.

The application of vaginal cytology in defining reproductive events is a widely accepted and applied diagnostic tool in many species. Here we present a preliminary approach to recognizing a correlation between changes in vaginal epithelial cytology and circulating plasma progesterone in the common marmoset, Callithrix jacchus, such that vaginal cytology could be diagnostically appropriate for reproductive management. We assessed six captive-born adult female common marmosets for the duration of one complete estrus cycle. Cytologic samples, collected by vaginal swab, and blood for plasma progesterone concentration were collected twice weekly. Cytologic samples were blindly assessed, and vaginal epithelial maturation was defined on the basis of the karyopyknotic index (KPI). In the three consistently cycling females (cj0328, cj0732, and cj0678), a marked increase in KPI corresponded with rising plasma progesterone levels, which subsequently decreased throughout the duration of follicular phase. The remaining three females who had previously irregular estrus cycles (cj0608, cj0680, cj0724) demonstrated irregularity in their progesterone profiles which correlated with inconsistent KPIs. Although KPI is not a very sensitive single sampling indicator of ovulation, evaluating changes in cytologic morphology over time aid in predicting the timing of an ovulatory event. Our results suggest that vaginal cytology can be an effective alternative to blood sampling for reproductive management of the common marmoset.

Animals↗
PubMed2001

Tension-free vaginal tape and percutaneous vaginal tape sling procedures.

PURPOSE: Midurethral synthetic sling procedures for treatment of stress urinary incontinence (SUI) are gaining increased attention from surgeons specializing in female pelvic reconstructive techniques seeking successful patient outcomes through reproducible simplicity. This report describes the procedural steps and methods used to maximize the potential for successful outcomes using techniques of midurethral synthetic sling placement. Reported complications and surgical outcomes are reviewed with respect to patient selection and minimizing the potential for morbidity and mortality as long-term clinical experience is accumulated. MATERIALS AND METHODS: Tension-free vaginal or transvaginal tape (TVT) and the recently introduced percutaneous vaginal tape (PVT) are two new procedural choices for placement of synthetic sling material at the midurethra. Both procedures use sling material composed of polypropylene mesh, a nonabsorbable synthetic material, placed at the level of the midurethra via an antegrade (PVT, using a percutaneous ligature carrier) suprapubic approach or retrograde (TVT, using vaginal trocars) vaginal approach. Patient selection, procedural techniques, and methods described are based on observations obtained or reported from clinical experience. Outcomes and complications for TVT are derived from a literature review of all published articles in Index Medicus from 1996 to 2000. RESULTS: The experience with TVT for the last 5 years is encouraging. At 3-year follow-up for TVT, reported cure rates for SUI range from 80% to 95%. A multitude of worldwide reports on PVT with shorter follow-up support the findings of the TVT experience. Reproducible findings with midurethral synthetic slings are the short operative times recorded for the sling procedure, ease of technical performance, minimal patient discomfort, and a high rate of early return of normal voiding function. The rate of complications such as obstructive voiding or de novo instability (0-15%) and urinary retention necessitating a secondary procedure (2-4%) appear to be equal to the rates of contemporary competing technologies and procedures for treatment of SUI. CONCLUSIONS: Preliminary reports and the experience at our institution suggest that the techniques of midurethral synthetic sling placement of TVT and PVT are reproducible, easy to master, and minimally invasive with respect to tissue handling. Although complications with all anti-incontinence procedures exist, understanding the anatomical considerations and methodology of these unique procedures should minimize patient morbidity, avoid patient mortality, and produce a high rate of durable success.

Female↗
PubMed2004

Clinical opinion: guidelines for hysterectomy.

OBJECTIVE: Abdominal hysterectomy remains the predominant method of uterine removal in the United States, despite evidence that vaginal hysterectomy offers advantages in regard to operative time, complication rates, return to normal activities, and overall cost of treatment. STUDY DESIGN: The predominance of the abdominal approach may be based on factors other than clinical considerations that include resident training, use of obsolete or limited guidelines, a perception rather than a confirmation that pathologic conditions exist that may suggest contraindications to the vaginal approach, misconceptions regarding the cost and safety of vaginal hysterectomy, and increased third-party reimbursement for the abdominal procedure. RESULTS: Evidence-based practice guidelines that were developed by the Society of Pelvic Reconstructive Surgeons and were adopted by the National Guidelines Clearinghouse have demonstrated that, in a number of studies that span several years, a dramatic shift toward the vaginal approach occurred when the guidelines were applied prospectively. CONCLUSION: The guidelines demonstrate that transvaginal hysterectomy is both feasible and optimal for many patients who long have been considered inappropriate candidates for vaginal hysterectomy. This clinical opinion attempts to address the reasons for the predominant use of the abdominal approach.

Algorithms↗