Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Vaginal Approach”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources
PubMed1999

A retrospective comparison of abdominal sacrocolpopexy with Burch colposuspension versus sacrospinous fixation with transvaginal needle suspension for the management of vaginal vault prolapse and coexisting stress incontinence.

The objective of this study was to compare the surgical outcome of abdominal sacrocolpopexy and Burch colposuspension with sacrospinous fixation and transvaginal needle suspension in the management of vaginal vault prolapse and coexisting stress incontinence. One hundred and seventeen women with vaginal vault prolapse and coexisting stress incontinence were surgically managed over a 7-year period. The first 61 consecutive women who underwent sacrospinous fixation and transvaginal needle suspension comprised the vaginal group, and the following 56 consecutive women who underwent abdominal sacrocolpopexy and Burch colposuspension comprised the abdominal group. Office records were reviewed to assess the presence of recurrent prolapse and urinary incontinence during postoperative follow-up. Objective follow-up was available for 101 women. Mean duration of follow-up was 24.0 +/- 15 months for the vaginal group, and 23.1 +/- 12.6 months for the abdominal group. The incidence of recurrent prolapse to or beyond the hymen (33% vs. 19%, P=0.0505) and lower urinary tract symptoms (26% vs. 13%, P = 0.0506) were significantly higher in the vaginal group than in the abdominal group. Our data suggest that the combined abdominal approach has a lower incidence of recurrent prolapse and lower urinary tract symptoms than the combined vaginal approach in managing vaginal vault prolapse and coexisting stress incontinence.

Adult↗
PubMed2004

Narrow pubic arch and increased risk of failure for vaginal hysterectomy.

OBJECTIVE: The purpose of this study was to evaluate the risk factors involved in failed vaginal hysterectomies. METHODS: Data on all vaginal hysterectomies performed by a single gynecologic surgeon were collected prospectively. Patients requiring pelvic floor repair were excluded. Any procedure converted to the abdominal approach was classified as a failed vaginal hysterectomy and comprised the study group. For every woman who had a failed vaginal hysterectomy, the next 2 women who had successful vaginal hysterectomies immediately after the failed vaginal hysterectomy were taken as controls. Risk factors such as age, parity, body weight, surgical indication, uterine size, presence of leiomyomata in the anterior lower uterine segment, previous pelvic surgeries, abdominopelvic adhesions, location and length of cervix, narrow pubic arch, intraoperative complications such as bleeding requiring transfusion, visceral injury, nulliparity, and adnexal removal were compared between groups. RESULTS: We compared 25 failed vaginal hysterectomies with 50 controls whose procedures were completed successfully through the vagina. Among all the factors gynecologists can assess preoperatively, only the presence of a narrow pubic arch increased the risk of failure for vaginal hysterectomy (odds ratio [OR] 4.1; 95% confidence interval 1.32-12.69). Intraoperative bleeding with transfusion was also found as an independent cause for conversion to laparotomy (OR 7.37; 95% confidence interval 1.75-31.06). CONCLUSION: Women with a narrow pubic arch are not good candidates for vaginal hysterectomy. The most common unpredictable cause for conversion to laparotomy from the vaginal approach is intraoperative bleeding requiring transfusion. LEVEL OF EVIDENCE: II-2

Adult↗
PubMed2005

Immunotherapeutic approaches to enhance protective immunity against Candida vaginitis.

Protective host defense mechanisms against vaginal Candida infections are poorly understood. While cell-mediated immunity (CMI) is the predominant host-defense mechanism against most mucosal Candida infections, no protective role for systemic or local Candida-specific CMI or antibodies has been identified against vaginal candidiasis. Rather, evidence exists for immunoregulation in vaginal tissue, which may inhibit a more profound protective Th1-type response. This study evaluated immunotherapy and gene therapy approaches in the murine model to potentially overcome immunoregulation and promote enhanced protection against vaginal candidiasis. In the first set of studies, the intravaginal and systemic administration of Thl-type cytokines and anti-IL-10 and anti-TGF-beta antibodies failed to enhance protection against a vaginal Candida infection. In a second set of studies, the novel intravaginal administration of Adenoviruses encoding Th1-type cytokines (IFN-gamma and IL-12) and the chemokine, MCP-1, showed substantial, but transient (24 h) expression of each in vaginal tissue and draining lymph nodes, even with a second administration. Unfortunately, treatment with these Adenoviral vectors did not enhance protection against experimental vaginitis. Construction of a new vector encoding IFN-gamma with a stronger promoter produced substantial IFN-gamma in vitro, but lower amounts in vivo and no extended expression. Taken together, while gene therapy can be used to induce cytokine expression in vaginal tissue, there appear to be strong regulatory mechanisms that additional manipulations or alternative approaches will have to overcome if protection against vaginitis is to be enhanced.

Animals↗
PubMed2002

Bilateral pedicled myocutaneous vertical rectus abdominus muscle flaps to close vesicovaginal and pouch-vaginal fistulas with simultaneous vaginal and perineal reconstruction in irradiated pelvic wounds.

Chronic postoperative pouch-vaginal and vesicovaginal fistulas after hysterectomy and irradiation to treat advanced cervical cancer do not respond to conventional treatment because of the low vascularity in the irradiated area. We present the successful repair of these complications in a female patient, in whom several vaginal and abdominal approaches had been tried and had resulted not only in failure but also in tissue loss and fibrosis and persisting fistulas. First, a synchronous vaginoabdominal approach using a vertical myocutaneous distally based rectus abdominis myocutaneous flap was used successfully to close a pouch-vaginal fistula and simultaneously reconstruct the posterior vaginal wall. In a second approach, the persisting vesicovaginal fistula was closed by a right rectus abdominis myocutaneous flap while simultaneously reconstructing the anterior vaginal wall, closing the enterocutaneous stoma and performing an appendicovesicostomy as a continence channel for catheterization. Despite unfavorable local wound situations, including an enterocutaneous stoma through the rectus abdominis and various previous incision lines, the transfer of axially well-vascularized tissue can solve these problem wounds. Consecutive bilateral use of the rectus abdominis flap may be necessary to deal with extensive pelvic wounds. This technique should be considered as one repair modality in irradiated pelvic wounds with fistulas. Previous enterostomy is not a contraindication to the use of this flap.

Adult↗
PubMed2001

Topical application of vitamin A reverses metaplasia of rat vaginal epithelium: a rapid and efficient approach to improve mucosal barrier function.

Retinyl palmitate and its metabolites retinol and retinoic acid control growth and epithelial differentiation. Systemic or local vitamin A deficiency induced by malnutrition, continuous chemical irritation or locally induced by inflammation causes squamous metaplastic changes in the epithelium of mucous membranes. We demonstrate that in an animal model topically applied retinyl palmitate can be taken up by the mucosal cells independently from the systemic supply. Under in vivo conditions metabolic changes in vaginal epithelium of rats were shown to be reversed by treatment with topical retinyl palmitate. - After only two days treatment squamous metaplastic vaginal epithelium in rats shows a reversal of the epithelium into a normal phenotype which continues after cessation of the treatment for 7 to 11 days. Higher concentrations and longer retention times lead to a statistically significant (p = 0.025) increase in the protection time. These data demonstrate that squamous changes induced by vitamin A deficiency can be totally reversed with topically applied retinyl palmitate.

Administration, Topical↗
PubMed2006

Vaginal foreign body in childhood: A multidisciplinary approach.

A 5-year-old girl referred to our division for evaluation of persisting foul-smelling brown vaginal discharge with pruritus for over 2 years, not corresponding to antibiotic therapy. Transabdominal ultrasound identified a heterogeneous mass intensely fixed in the upper third of vaginal wall. Vaginography revealed a filling defect in the upper part of vagina, confirming the diagnosis of an intravaginal foreign body. The foreign body was grasped and removed by traction; it turned out to be a thin double-wrapped piece of sponge. Psychological assessment of the girl was undertaken, in order to illuminate the potential of an underlying emotional and behavioural problem and revealed the existence of psychological disturbances mostly affecting social competence and adaptiveness.

Child, Preschool↗
PubMed1981

Prostaglandin vaginal suppositories: a simple and safe approach to the induction of labor.

The results of 1000 consecutive unselected cases of induction of labor for medical or obstetric reasons using prostaglandin E2 suppositories are presented. The overall rate of failed induction resulting in a cesarean section in those patients with an unfavorable cervix has fallen from 42 to 2.5%. Only 27% of the entire series required augmentation of labor with intravenous oxytocin, the range being from 9.9% of multigravidas with a favorable cervix to 42.4% of primigravidas with an unfavorable cervix. Both low- and high-risk pregnancies are suitable for induction by this method and trials of vaginal breech delivery and of uterine scars have been safely and successfully carried out. This method has now become routine for the induction of labor at the authors' institution. It has proved to be simple, safe, and highly acceptable to patients and obstetricians alike in all cases in which a simple amniotomy would not suffice.

Delivery, Obstetric↗
PubMed1994

Prolapse of the sigmoid neovagina: report of three cases.

BACKGROUND: Prolapse of a sigmoid neovagina, created in patients with congenital vaginal aplasia or male transsexualism, is rare. In correcting this condition, preservation of coital function and restoration of the vaginal axis should be of primary interest. CASES: One patient with Mayer-Rokitansky-Küster syndrome developed a protrusion of the sigmoid neovagina almost 4 years after the initial operation. The prolapse was treated successfully using an abdominal approach to suspend the neovagina to a Cooper ligament. The second patient is a male-to-female transsexual who developed a prolapse 3 years after the creation of a sigmoid neovagina. After suspension of the neovagina to a Cooper ligament, the prolapse recurred; in a repeat approach, the neovagina was successfully suspended to the sacral promontory. The third patient, with Mayer-Rokitansky-Küster syndrome, complained of a protrusion immediately after creation of the neovagina. Initially, the redundant sigmoid was resected vaginally. However, the prolapse recurred, and an abdominal suspension to a Cooper ligament was performed. Finally, after 1 year, another recurrence was treated successfully with a vaginal approach. CONCLUSION: Prolapse of an artificially created vagina is a rare occurrence, without a standard treatment. Both abdominal and vaginal approaches may be needed to restore the neovagina without compromising its function.

Adolescent↗
PubMed2001

A colposcopic approach to an endometriotic nodule in the recto vaginal septum under laparoscopic control.

The surgical treatment of endometriotic nodules in the recto vaginal septum is aimed at removing the deeply infiltrating fibro muscular and abnormal glandular tissue, in order to relieve pelvic pain. The laparoscopic approach to the recto vaginal septum is difficult and potentially dangerous. We describe a new mode of access using a combination of laparoscopy and colposcopy. A 20-year-old woman presented with dyspareunia and dyschezia. Vaginal examination revealed a tender nodule, measuring 1.5 &#50 2 cm, in the posterior vagina wall. The endometriotic deposit was positioned at the top of the recto vaginal septum, extending into the posterior vaginal fornix. An air-contrast barium enema and vaginogran (lateral view) excluded a lesion that had penetrated the full thickness of the rectal wall. We carried out colposcopic CO 2 laser ablation of the nodule under laparoscopic control. 'Chocolate fluid' spilled from the lesion and the entire nodule was vaporised until normal tissue was reached. The patient was reviewed 3 and 6 months following the operation, and her symptoms had resolved. The colposcope allows an approach into an area of the pelvis that is usually difficult to access.

Journal Article↗
PubMed1990

Sonoembryology: an organ-oriented approach using a high-frequency vaginal probe.

First trimester gestations of 95 patients were studied by high-frequency transvaginal sonography, which permits the imaging of organs shortly after their development. This new technique has great potential for clinical implementation in such cases as accurate gestational dating and malformation workup.

Cerebral Ventricles↗
PubMed2007

Temperature and pH sensitive hydrogels: an approach towards smart semen-triggered vaginal microbicidal vehicles.

Microbicides are drug delivery systems (DDSs) for the prevention of sexual transmission of HIV and other STDs. A topically applied vaginal microbicidal gel should provide uniform coating of vaginal tissue, retention of this gel layer prior to intercourse, and controlled release kinetics of antivirals to inactivate the viral load potentially introduced during sexual activity. Here, we describe the microbicide-oriented characterization of a DDS made with a dual pH sensitive and thermosensitive smart polymer gel composed of a random terpolymer of N-isopropyl acrylamide, butyl methacrylate, and acrylic acid. The system was engineered to coat vaginal tissue with a stable gel layer and to release entrapped model agents in a burst release profile in response to the presence of the infecting agent: semen. The gel rheology, layer erosion properties, model drug release kinetics, and cytocompatibility of the terpolymer system were studied. Negligible erosion of the gel in the presence of vaginal fluid simulant suggests prolonged retention. Burst release of molecular and macromolecular model compounds was observed when the system's pH changed from the vaginal pH to the pH of semen, and cytotoxicity studies showed that the terpolymer is equally cytocompatible as a commonly used polymeric vaginal carrier.

Administration, Intravaginal↗
PubMed2000

[Radical vaginal trachelectomy for invasive cervical cancer].

The use of operative laparoscopy in gynecologic oncology has paved the way to a more conservative approach in radical treatments of some cancers, particularly cervical cancer. After the vaginal approach which shortens the hospital stay and the morbidity of a radical hysterectomy, a new fertility-preserving radical treatment has been proposed : the Radical Vaginal Trachelectomy (RVT). This technique has been used since 1991 in our institution. Until July 1999, 37 patients with early-stage cervical cancer desiring to retain their fertility were treated by a laparoscopic pelvic lymphadenectomy (LPL) and RVT. The median age was 32 (22-42), and 25 were nulliparous. Twelve were FIGO stage Ia2, 22 Ib1, 2 IIa and one Ia1 (VSI+). Most of the tumors were squamous (23), grade I (21), and the lesion was 2cms or less in 35 patients. Median operating time was 275 minutes ( 200 for the last 10 cases), and blood loss 200cc. Complications were mainly due to the LPL (3 arterial injuries) rather than the RVT (one iatrogenic cystotomy and one parametrial bleeding). The mean follow-up is 42 months. Two patients recurred including one who had a small-cell neuroendocrine tumor. Ten patients had a total of 13 pregnancies with 7 live births. One newborn died of E.coli-septicemia. Two patients had early miscarriages and 2 second trimester abortions (17 and 20 weeks). Two patients are still pregnant. LPL-RVT seems to be a good treatment modality for early-stage cervical cancer. It preserves fertility without lowering the chances of survival.

Adult↗
PubMed2006

Methods and results of urethrolysis.

Although occurring with somewhat less frequency now than historically reported, outlet obstruction after incontinence surgery continues to be a source of postoperative patient dissatisfaction and therapeutic dilemma. Several techniques have been described that fall under the rubric of urethrolysis, including sling incision, sling lysis with explantation, and formal vaginal or retropubic urethrolysis (incision and disruption of bladder neck and urethral fibrosis). Surgical approaches have included vaginal, retropubic, or combined techniques with or without the use of adjunctive steps such as graft interposition. However, evidence emanating from reports of these varied techniques has been incomplete due to variability in outcomes presentation, lack of longevity of follow-up, or problematic study design. Nonetheless, the bulk of clinical evidence supports the efficacy of urethrolysis as an intervention for outlet obstruction after stress incontinence surgery. However, persistent irritative bladder symptoms remain bothersome for some women and, in addition, the recurrence of stress incontinence also may complicate the technique of urethrolysis. Management of these potential adverse outcomes also has been inconsistent, with some authorities routinely performing repeat incontinence surgery at the time of urethrolysis and others preferring to assess continence status after convalescence from urethrolysis. The differences among the types of urethrolysis and the results of each type are reviewed in this article in light of evolving definitions of outlet obstruction, diagnosis, and definition in women.

Female↗