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At least 631 records · Page 35Linked to original sources
PubMed1995

Clinical effects of preoperative oestradiol treatment before vaginal repair operation. A double-blind, randomized trial.

The objective of the study was to assess the effects of low-dose vaginal treatment with oestradiol before vaginal operation. In a double-blind randomized study including 43 postmenopausal women scheduled for vaginal repair operation for genital descensus, it was found that 7 patients suffered from concomitant urinary stress incontinence. Vagifem (25 micrograms oestradiol) or placebo was administered as vaginal pessaries daily, 3 weeks prior to surgery and the clinical effects evaluated. One month postoperatively the prevalence of bacteriuria (> 100,000 CFU/ml urine) was significantly lower when using oestradiol than in the placebo group. At follow-up 3 years later 40 women (93%) answered the questionnaires. None received hormone replacement therapy. Nineteen percent in the preoperative oestradiol group and 11% in the preoperative placebo group had had more than two episodes of cystitis treated with antibiotics. This difference is not statistically significant (p > 0.05). Recurrent cystitis was not correlated to bacteriuria postoperatively. Seventy-nine percent of the women with genital prolapse but only 29% of the women with concomitant urinary stress incontinence were cured (p < 0.05). Neither preoperative oestradiol treatment nor body weight had any influence on relapse. Preoperative low-dose vaginal oestradiol treatment may reduce the incidence of bacteriuria in the immediate postoperative period but no long-lasting effects on recurrent cystitis or relapse were seen. Longer-lasting hormone replacement therapy may be necessary to achieve lasting effects.

Aged↗
PubMed1993

Induction of abortion in early pregnancy with mifepristone in conjunction with gemeprost.

This study was performed to investigate the efficacy of oral mifepristone and vaginal gemeprost for termination of early pregnancy. Eighty women requesting first trimester abortion and with amenorrhea of less than 56 days were included. Gestational age was confirmed with ultrasonography. Mifepristone was administered as a single 600 mg dose followed after 48 hours by a vaginal pessary containing 1 mg gemeprost. One woman did not return for gemeprost and later had a vacuum aspiration performed. There was complete abortion in all remaining women. No serious side effects were registered and the number of women requiring opioid analgesia was low (8%). The conclusion is that this treatment is a genuine alternative to vacuum aspiration but medical supervision is necessary for some time after gemeprost administration.

Abortifacient Agents, Nonsteroidal↗
PubMed1991

Management of submucous uterine fibroid with buserelin, gemeprost and hysteroscopic resection.

A 19-year-old virgin presented with severe menorrhagia and a haemoglobin level of 76 g/L as a problem of management. A 5 cm diameter submucous fibroid was identified at hysteroscopy and biopsied but was unable to be removed. The luteinising hormone releasing hormone agonist, buserelin, was used in an attempt to produce symptomatic relief. One week after commencing buserelin therapy, severe menorrhagia occurred and the patient was admitted to hospital with a haemoglobin concentration of 24 g/L. Buserelin treatment was continued and no further menstruation occurred over the following year. As the patient was now well, hysteroscopic submucous fibroid resection was contemplated. Due to cervical rigidity in this teenager, a 1 mg gemeprost pessary was inserted into the posterior vaginal fornix three hours before surgery. This allowed an operative hysteroscope to be inserted into the uterus and a fibroid resection to be performed. Menstrual blood loss has been normal for six months after hysteroscopy. A combined medical and surgical approach may avoid hysterectomy in such problem patients.

Adult↗
PubMed2000

[Genital prolapse].

The prevalence of genital prolapse in women is unknown. The development of prolapse is dependent on the pelvic floor muscles and connective tissue. Risk factors are vaginal birth, obstipation, high abdominal pressure and surgical procedures. Preventive measures are discussed. The classification of prolapse is somewhat difficult. Conservative treatment with pessaries and pelvic floor muscle exercises and various surgical procedures are discussed.

Female↗
PubMedDate not supplied

Bilateral hydroureter and hydronephrosis causing renal failure due to a procidentia uteri: a case report.

We report a case of complete uterine prolapse that resulted in bilateral hydroureter, hydronephrosis, and renal dysfunction. The nonoperative reduction of the prolapse with a vaginal pessary reversed the obstructive uropathy and ameliorated renal function. The lower urinary tract should be imaged in patients with complete uterine prolapse. If present, obstructive uropathy should be relieved by the reduction of the prolapse before irreversible renal damage occurs.

Aged↗
PubMed2002

Concomitant urethral and uterovaginal prolapse in a postmenopausal woman. A case report.

BACKGROUND: Urethral prolapse is frequently encountered in girls. Although its occurrence in elderly women is not rare, little published information exists regarding this clinical condition or its management. CASE: A 90-year-old woman (gravida 1, para 1) with a four-year history of intermittent vaginal bleeding had both urethral and uterovaginal prolapse. The condition was initially managed conservatively with estrogen and a pessary. Ultimately, surgical intervention was required for complete resolution. CONCLUSION: Urethral prolapse can occur in elderly women and may present concomitantly with other forms of pelvic floor dysfunction such as uterovaginal prolapse. Conservative treatment with estrogen is partially effective in reducing the size of the urethral prolapse and may point to hypoestrogenism as one potential cause of this condition in elderly women. However, surgical management may ultimately be required for complete resolution of these problems, even in medically compromised patients.

Aged↗
PubMed2003

Approach to urinary incontinence in women. Diagnosis and management by family physicians.

UNLABELLED: OBJECTIVE; To outline an approach to diagnosis and management of the types of urinary incontinence seen by family physicians. SOURCES OF INFORMATION: Recommendations for diagnosis are based on consensus guidelines. Treatment recommendations are based on level I and II evidence. Guidelines for referral are based on the authors' opinions and experience. MAIN MESSAGE: Diagnoses of stress, urge, or mixed urinary incontinence are easily established in family physicians' offices by history and gynecologic examination and sometimes a urinary stress test. There is little need for formal diagnostic testing. Management by family physicians (without need for specialist referral) includes lifestyle modification, pelvic floor muscle strengthening, bladder retraining, and pharmacotherapy with muscarinic receptor antagonists. Patients with pelvic organ prolapse might require specialist referral for consideration of pessaries or surgery, but family physicians can provide follow-up care. Women with more complex problems, such as severe prolapse or failed continence surgery, require referral. CONCLUSION: Urinary incontinence is a common condition in women. In most cases, it can be diagnosed and managed effectively by family physicians.

Aged↗
PubMedDate not supplied

Stress incontinence: alternatives to surgery.

Although surgery is commonly performed to alleviate or cure stress incontinence, there are non-surgical options that might well be explored and tried before a woman undergoes surgery, for which many are poor candidates. The least drastic treatments are behavioral therapies, chiefly pelvic floor muscle training (Kegel exercises), alone or with biofeedback. This method is effective but has the drawback of poor patient compliance. Another therapy, almost noninvasive, is electrical stimulation via needle or surface electrodes of the pudendal nerve and the pelvic plexus in order to treat detrusor instability. Some studies show good results for many patients; and there is no need for long-term compliance. Medical management has included hormone replacement therapy and alpha-adrenergic agonists, but questionable results and intolerable risks have shifted this mode to serotonin-norepinephrine reuptake inhibitors, which have CNS action. Finally, there are urethral occlusive devices, which have poor acceptance owing to side effects and difficulty of use, and vaginal pessaries, theoretically attractive but inexplicably poor performers in the marketplace.

Adrenergic alpha-Agonists↗
PubMed1991

[Management of cervico-vaginal dystrophies].

Fifty-nine outpatients affected by cervico-vaginal dystrophy with manifest symptoms were included in the study. Following initial tests (colposcopy with Schiller's test, colpocytological test, analysis of symptoms), a cycle of treatment was commenced using the insertion of a vaginal pessary of Polydeoxy-ribonucleotide (PDRN) in the evening for 20 days. A control on day 28 revealed a marked improvement of the symptoms together with a positive evolution of objective tests. During the 10th week after the end of therapy, both subjective and objective findings tended to confirm the relapse towards pre-treatment conditions.

Administration, Topical↗
PubMedDate not supplied

[Computerized evaluation of reparative processes of the cervix uteri].

This study was aimed to evaluate the effect of polydeoxyribonucleotide (PDRN), as reported in relevant literature, on cervical epithelia dynamics. Particularly, the interactions taking place between columnar epithelium and the squamous one have been examined. For the purposes of the study, the following computerized techniques, already widely known, have been used: The colposcope is joined to a videocamera connected with a computer (AT compatible). The computer is equipped with a graphic card capable to record and to digit the image, i.e. to make it recognizable by the computer itself. Thereafter, many operations can be performed on the colposcopic images: reductions, enlargements, retouches, record, recall, analysis, etc. Moreover, irregular epithelial areas can be easily determined to a good approximation and, using pre-established enlargement ratios, their evolution can be evaluated. By means of this technique 12 out-patients with uterine cervix ectopias, with or without normal transformation zone (NTZ), have been examined. The monthly therapy was 12 pessaries, each containing 5 mg polydeoxyribonucleotide (POLIDES 5--Farmigea), from the 7th to the 18th day of the cycle, repeated for 3 months. Since the first month of treatment a reduction of the ectopic columnar epithelium has been noted in most patients (9 on 12), with a squamous epithelium increase (peripheral reparative process). This process has kept on increasing during the following months in the 9 patients responding to the treatment, whose ectopic areas were covered by squamous epithelium (average 55% of the area; range 33%-78%). No response to the treatment has been shown in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The use of PGE2 for induction of labor in parturients with a previous cesarean section scar.

Controversy still dominates the discussion of the correct method for delivering patients with a previous cesarean section (C/S) scar. Although many have abandoned the slogan of "once a cesarean, always a cesarean", repeat cesareans are still the rule in many institutions. We have abandoned this dogma, and are now advancing to new ideas and are promoting a new protocol. Nineteen post-one cesarean section patients were induced on various indications by means of PGE2 pessaries. Close surveillance revealed no complications and 16 were delivered vaginally. All neonates had good Apgar scores, and all scars were found to be intact upon examination. We recommend cautious use of prostaglandins for selected post-cesarean patients.

Cesarean Section↗
PubMed1984

Uterine prolapse complicating pregnancy. A case report.

A patient developed uterine prolapse during pregnancy. Conservative management consisted of bed rest and use of a pessary. A viable infant was delivered at 30 weeks' gestation following premature rupture of the membranes. A review of the literature suggests that maintaining conservative treatment of these patients throughout pregnancy can result in uneventful, normal, spontaneous delivery.

Adult↗
PubMed1980

[Genital prolapse and ureteropelvic distension].

In the last 110 cases of genital prolapse examined, IVU formed part of the prior urological investigation. 14 cases of ureteropelvic distension were thus discovered (13.6% of cases). In ten cases the prolapse was sufficiently largee as to exterioris the uterus or bring it to of the vulva. In 13 cases out of 15 a larg cystocoele was visible at the vulva with a full bladder. The precise urological consequences of these prolapses was greater than had been expected: 13 cases of incomplete vesical retention, 4 of unilateral ureteropelvic distension and 10 bilateral, including 3 only symmetrical. Bilateral high distension was in general associated with a large cystocoele. Severe renal insufficiency was seen in only one case, and 5 moderate elevations in blood urea, in 5 cases. The mechanism of such ureteropelvicalyceal distension is not clear, but the prolapse is directly responsible, since mechanical (insertion of a pessary) or surgical reduction of the prolapse restores the upper excretory tract to normal. Renal function recovered all the more rapidly when the prolapse had been present for a shorter time.

Aged↗
PubMedDate not supplied

Comparison of clotrimazole, fluconazole and itraconazole in vaginal candidiasis.

Women attending a genitourinary medicine clinic (n = 229) with mycologically confirmed acute vulvovaginal candidiasis were randomised to receive either clotrimazole (500 mg pessary and 1% cream), fluconazole (150 mg single oral dose) or itraconazole (200 mg bd oral dose for 1 day). Mycological cure rates were 96% in the itraconazole group, 95% in the clotrimazole group, and 83% in the fluconazole group (P = 0.008). The proportion of patients who were clinically cured showed a similar pattern (itraconazole 80%, clotrimazole 80%, fluconazole 62%). This suggests that itraconazole or clotrimazole are more effective than fluconazole in the treatment of acute vaginal candidiasis.

Administration, Oral↗
PubMed1994

[15-Methyl-PGF2 alpha vaginal suppository for induction of term labor].

The results of intravaginal 15-methyl PGF2 alpha (PG05) were compared with gemeprost (ONO-802, PGE1 analogue) pessary and oxytocin intravenous infusion for induction of labor at term. A total of 99 primipara with singleton pregnancy and cephalic presentation, accepted for induction, was randomly allocated into 3 groups: group 1, PG05 0.25 mg (n = 33), group 2, ONO-802 0.125 mg (n = 33), and group 3, oxytocin i.v. (n = 33). Among these, 30 cases had plasma PGs (PGE2 and PGF2 alpha) concentration determined before and after induction. Successful treatment was defined as active labor starting within 24 hours following induction or an increase of cervical Bishop score > 3. The success rates were not significantly different among the 3 groups (PG05 88%, ONO-802 100%, and oxytocin 79%), (P > 0.05). No significant difference existed in the plasma prostaglandin concentrations as well. It is suggested that PG05 may be used for induction of labor at term.

Adult↗
PubMed1996

Vaginal prolapse: management with nonsurgical techniques.

Obvious genital prolapse should not be ignored. Undoubtedly, it will progress, lead to worsening symptoms and alterations in pelvic function, and become more difficult to treat. Conservative management approaches include pelvic floor (Kegel) exercises for mild prolapse and use of vaginal pessaries to mechanically support prolapsed tissues. Comprehensive evaluation of bladder and urethral function should be done before any surgical repair is undertaken. Reconstructive surgery provides definitive therapy if all anatomic defects are addressed and the necessary lifestyle changes (eg, avoidance of exertional activities) are instituted.

Female↗
PubMed1997

Cervical prolapse complicating pregnancy.

Uterine cervical prolapse concurrent with pregnancy is rare. This article reports three cases of second-degree cervical prolapse during pregnancy. Two women developed prolapse in the late second trimester while one women had preexisting prolapse. Both women with prolapse developing during midpregnancy were treated unsuccessfully with a vaginal pessary to maintain cervical placement. Premature labor occurred in both of these women, resulting in one preterm birth. Although cervical prolapse is rarely encountered in pregnancy, the threat of preterm labor and delivery warrants close observation.

Adult↗