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At least 721 records · Page 40Linked to original sources
PubMed1997

Techniques of laparoscopic repair of total vault eversion after hysterectomy.

STUDY OBJECTIVE: To diagnose total pelvic vault eversion and develop surgical techniques for laparoscopic pelvic reconstruction in women after hysterectomy. DESIGN: Prospective study. SETTING: Regional hospital. PATIENTS: Nineteen women with total pelvic vault eversion and other pelvic defects after hysterectomy. INTERVENTIONS: All patients had a complete history and physical examination, and complete multichannel urodynamics. Cystocoele, rectocele, enterocele, and vault eversion were graded on a scale of 1 to 4. Posterior vaginal repair, sacral colpopexy, modified culdoplasty, paravaginal repair, and Burch urethropexy were performed laparoscopically according to the vault defects present. All patients had repeat transperineal ultrasound, cough stress test, urodynamic study, and vault examination 6 weeks and 1 year postoperatively. MEASUREMENTS AND MAIN RESULTS: Extensive diagnostic and grading criteria were used to determine which surgical repairs would result in the most anatomic outcome. Before surgery, 6 patients had complaints of urinary stress incontinence and 11 other were identified with the pessary test. All 19 patients underwent a sacral colpopexy, modified culdoplasty, and Burch urethropexy. Six paravaginal and 13 posterior vaginal repairs were performed. At 6 weeks, two women had detrusor instability that resolved spontaneously; no patients had stress incontinence or pelvic prolapse. At 1 year, one patient had mild genuine stress incontinence (93% cure rate) and none had vault eversion (100% cure rate). Two patients had grade 1 cystocele; one had grade 1 and two grade 2 rectoceles. CONCLUSION: Initial results of laparoscopic repair of total pelvic vault eversion are comparable to those of other surgical approaches. Careful anatomic evaluation of the different defects, together with urodynamic studies, are necessary in treating this difficult disorder.

Adult↗
PubMed1998

Transvaginal needle suspension with LeFort colpocleisis for stress incontinence and advanced uterovaginal prolapse in a high-risk patient.

Surgical therapy in high-risk patients with advanced symptomatic pelvic floor defects sometimes mandates a compromise in the extent of proposed and desired repairs in favor of procedures that can be performed more rapidly. An 80-year-old woman with disabling genuine stress urinary incontinence and stage IV uterovaginal prolapse who was unable to retain a pessary was at high surgical risk due to ischemic heart disease. Uterovaginal prolapse was treated by LeFort partial colpocleisis, and stress urinary incontinence by transvaginal needle suspension with symptomatic cure and without significant perioperative morbidity. Operating time was 29 minutes and estimated blood loss was 50 ml. The patient was discharged on the second postoperative day with adequate spontaneous voiding and without urinary retention. A combination of partial colpocleisis with transvaginal needle suspension worked well in this case and may represent an effective and rapid surgical option for similar women.

Age Factors↗
PubMedDate not supplied

Self-reported uterine prolapse in a resettlement colony of north India.

The aims of this study are to estimate the prevalence of self-reported uterine prolapse and to determine the treatment-seeking behavior of the respondents. Participants of this study are married women of Dadu Majra colony, Chandigarh, India, January-February, 1996. A house-to-house screening of the women was done by a nursing student utilizing a checklist of indicator symptoms of uterine prolapse. All women reporting such symptoms were interviewed further. Among the 2,990 women surveyed, 227 (7.6%) reported symptoms of uterine prolapse. Of the 227 women with self-reported uterine prolapse, 128 (57%) had not taken any treatment, 28 went to a traditional birth attendant (TBA), and 47 (21%) consulted a doctor. Thirty-eight women were advised to have an operation, but only eight complied. Other treatments used by small numbers of women included the use of a ring pessary or alcohol-soaked swab and heel pressure technique. Reasons for non-consultation included shyness (80; 63%), lack of cooperation by the husband, lack of time (80; 63%) and lack of money (74; 58%). The prevalence of prolapse was significantly higher in women with higher parity. More than 7% of the women reported symptoms of uterine prolapse.

Adolescent↗
PubMed2002

The effect of melatonin on the secretion of progesterone in sheep and on the development of ovine embryos in vitro.

Two experiments were carried out in order to determine whether melatonin can improve secretion of progesterone in vivo, and its effect on embryonic development in vitro. In the first experiment, blood samples were collected from 5 ewes at 15 min intervals for 2 h at 7 and 10 days after withdrawal of progestagen pessaries. The first hour constituted a control period, which ended with an intravenous administration of 3 microg/(kg bw)(0.75) melatonin. All the ewes on day 7 and three of the ewes on day 10 showed a progesterone response to melatonin challenge, defined as an increase in the plasma progesterone concentration in at least two consecutive samples during the post-treatment period above the mean+2SD of the values in the pre-treatment period. A paired t-test revealed a significant effect of melatonin on the overall plasma progesterone concentrations before and after the challenge, both on day 7 (pre, 0.61 +/- 0.11; post, 0.73 +/- 0.13 ng/ml; p<0.01) and day 10 (pre, 1.16 +/- 0.19; post, 1.30 +/- 0.20 ng/ml; p<0.05). Ninety-one thawed embryos (46 morulae and 45 blastocysts) were used in the second experiment, being cultured with or without 1 microg/ml melatonin. If the embryos were blastocysts when the culture started. melatonin increased the percentage that had hatched after 24 h of culture (p<0.01), and there was a lower percentage of degenerated embryos at the end of the incubation period (p<0.05). It may be concluded that melatonin treatment in sheep can increase both fertility and prolificacy by improving luteal function and embryonic survival.

Animals↗
PubMed2002

[Prolapse operation--also of help in urinary tract infections?].

Pelvic support defects are frequently associated with chronic and recurrent urinary tract infections. This is due to common etiological factors (hormone-related atrophy, neurogenic diseases, metabolic disorders) and to direct mechanical effects exerted by the descensus on the urethra function (kinking that occurs with miction disorders and an increase in the residual urine with large cystoceles or stress incontinence and urgency with large urethroceles). The therapy should begin conservatively and address all possible etiological factors. Fundamentals of conservative therapy include estrogens, pelvic floor training, pessaries, drinking and micturition training and therapy and prevention of ascending infections [1]. When conservative therapy does not achieve either a cure or a satisfactory degree of improvement within a few months, surgical treatment should usually be recommended. In this case, modern surgical methods are preferred which seek to achieve both an anatomical as well as a functional restoration, i.e. continence, a good degree of bladder emptying and defecation as well as painless coitus.

Female↗
PubMed2003

[Conservative therapy of urinary incontinence and bladder complaints in the woman].

Urinary incontinence and urogenital disorders are increasing. This is bothersome and impinges on the patient's quality of life. Early recognition, allowing early diagnosis, effective therapy as well as long-term prophylaxis are important. For diagnosis that quickly leads to a therapeutic decision, the anamnesis should specifically cover this area. Additionally, clinical examination, urinalysis including residual urine determination and cystoscopy for evaluating the bladder wall and a coughing test with a full bladder should be performed-all investigations easily done in the gynecologists's office. After diagnosis, treatment planning takes place. Urinary incontinence and urogenital complaints often have several pathologic causes. To improve success, various treatment possibilities should be optimally combined. Conservative therapy basics include: drinking and miction training, pelvic floor training including training aids and electrostimulation, pessaries, pharmaceutical therapies, estrogen as well as a through prophylaxis and treatment of infection. The primary treatment must be followed up with long-term prophylaxis. The most important requirements for a successful conservative therapy include knowing the various treatment basics, their uses, understanding and having the patience to follow through with an involved and time-intensive treatment plan. This work provides an overview of the various conservative treatments and their successful combinations.

Diagnosis, Differential↗
PubMed1997

Plant immunomodulators for termination of unwanted pregnancy and for contraception and reproductive health.

Neem (Azadirachta indica) seed and leaf extracts have spermicidal, anti-microbial, anti-fungal and anti-viral properties. They are also immunomodulators that induce primarily a TH1 type response. These properties are being exploited to develop two different useful methods of fertility control. Neem extracts given orally at early post-implantation stage terminate pregnancy in rodents and primates. Treatment has no residual permanent effect and fertility is regained in subsequent cycles. The mechanism by which the action occurs is not fully clear. A transient increase in CD4 and more significantly in CD8 cells is noticed in mesenteric lymph nodes and spleen. A rise in immunoreactive and bioactive TNF-alpha and IFN-gamma in draining lymph nodes, serum and foetal-placental tissue is observed. A polyherbal cream and pessary have been developed containing three active ingredients of plant origin. These have synergistic spermicidal properties on human sperm as determined by the Sander Cramer test. Their use before mating has high contraceptive efficacy in rabbits and baboons. Another interesting property is their inhibitory action on a wide spectrum of micro-organisms, including Candida albicans, C. tropicalis, Neisseria gonorrhoeae, the multidrug-resistant Staphylococcus aureus and urinary tract Escherichia coli, Herpes simplex-2 and HIV-1. Phase I clinical trials have been completed in India, Egypt and the Dominican Republic, and indicate the safety of the formulation, its acceptability and beneficial action invaginosis due to infections.

Abortion, Induced↗
PubMed2000

Case report. Paraphimosis due to erotic dancing.

Paraphimosis usually develops when a tight foreskin is retracted over the glans penis for a prolonged period. Many esoteric aetiologies have been implicated in the development of paraphimosis including piercing the foreskin, Plasmodium falciparum infection, application of celadine juice to the foreskin, chancroid, pessaries and the implantation of pearls. We report the first two cases of paraphimosis developing during wining, an erotic dance native to Trinidad & Tobago.

Adolescent↗
PubMed2001

Differences in reproductive performance, embryo development, interferon-tau secretion by the conceptus and luteal function in ewe lambs synchronized in oestrus before or after the spontaneous onset of luteal activity preceding puberty.

In mid-September, 1 month before the insertion of intravaginal pessaries to induce sexual activity, blood samples were collected every 4 days from 16 ewe lambs aged 7 months, in order to determine the incidence of ovulations by measurement of plasma progesterone concentrations. It has been studied whether the response to a progestagen treatment of ewe lambs apparently close to puberty could be modified by the onset of the ovarian events preceding puberty. The effect of the presence or absence of ovulations prior to progestagen treatment on the potential reproductive performance (fertility, litter size and fecundity), embryo development [embryo quality and interferon-tau (IFNtau) secretion], luteal function (progesterone secretion in vitro) and endometrial progesterone content was studied in seven ovulating (Ov+) and nine nonovulating ewe lambs (Ov-) on day 14 after mating. The best potential reproductive results were obtained with Ov+ animals, although these differences could not be initially attributed to either different progesterone secretion in vitro or concentration of endometrial progesterone. Irrespective of the experimental groups, secretion of progesterone by luteal tissue from ewe lambs with normal embryos was significantly greater (p<0.05) than that of animals with abnormal embryos or with no embryos. Normal embryos secreted a higher amount of IFN-tau than those embryos classified as abnormal (p<0.07). In conclusion, ewe lambs which exhibit luteal activity before puberty have the highest levels of reproductive performances after a progestagen treatment. Corpora lutea from ewe lambs with normal embryos had higher rates of progesterone secretion in vitro and their embryos had a higher IFN-tau production by the embryos, indicating greater capacity for subsequent development.

Animals↗
PubMed2001

The association of smoking with vaginal flora, urinary tract infection, pelvic floor prolapse, and post-void residual volumes.

OBJECTIVE: This study examined the association of smoking with changes in vaginal flora, the prevalence of urinary tract infection, genital prolapse, and incomplete bladder emptying. METHODS: The authors conducted a retrospective review of charts for 305 women. In addition to smoking habits, data on age, parity, degree of genital prolapse, vaginal flora, urinary residual, urinary tract infection, and hormone replacement therapy were collected and analyzed. RESULTS: Smoking did not correlate with urinary tract infection, the amount of post-void urine residual volumes, or pessary use. Smoking was significantly associated with the presence of a severe degree of genital prolapse. Smoking independently affected vaginal flora, increasing the odds of developing bacterial vaginosis. CONCLUSION: Smoking was associated with an increased risk of developing bacterial vaginosis and having severe genital prolapse. Smoking was not associated with urinary tract infection or the amount of post-void residual urine.

Journal Article↗
PubMed2002

Medical abortion in the first trimester.

Pregnancy can be terminated safely by inducing abortion medically at any stage of gestation. Antagonists such as mifepristone block the action of progesterone and hence result in uterine contractions and increase the sensitivity of the uterus to prostaglandins. In the last 15 years the combination of a single dose of mifepristone (600 mg) followed 48 hours later with a suitable prostaglandin (1 mg gemeprost vaginal pessary or 400 microg oral misoprostol) has been licensed in most countries in Europe and the USA for induction of abortion in the early weeks of pregnancy. The safety and efficacy of these methods is comparable to vacuum aspiration at the same gestation. The complete abortion rate is related to the type and dose of prostaglandin, the route of administration as well as the gestation and parity. Published data suggest that the dose of mifepristone can be reduced from 600 mg to 200 mg without loss of efficacy. Although misoprostol tablets are formulated for oral use, extensive clinical experience has demonstrated vaginal administration is more effective and is associated with fewer side-effects. Successful abortion using medical methods requires a well organized service which includes referral without delay and a robust system of follow up to identify failures. The failure rate as reflected by the number of women who require surgical intervention falls with increasing experience. In those countries where medical abortion has been freely available for about 10 years, such as France, Scotland and Sweden, about 60-70% of eligible women elect for this method.

Abortifacient Agents↗
PubMed2001

[Pelvic organ prolapse].

Pelvic organ prolapse of the female is a common disease with age dependent increase in incidence. The committee for standardisation of the International Continence Society recently suggested to avoid classical terms such as cystocele, rectocele or enterocele for the description of prolapse and to replace them by defined landmarks. The "Pelvic Organ Prolapse Quantification" (POPQ) was developed and five different grades of prolapse were defined. This is a true gain for scientific documentation but needs some effort to be implemented in routine practical work. Previous normal vaginal delivery is statistically highly correlated with prolapse, followed by climacteric involution, constitutional factors, physical work, chronic bronchitis, and overweight respectively. The diagnosis is confirmed by clinical examination. Defects of the supportive structures can be precisely assessed with dynamic magnetic resonance imaging. Time will show whether this costly method will become part of routine diagnostic procedures. A patient with moderate prolapse or few complaints may be treated conservatively with pelvic floor training or electrotherapy. Modern pessaries are tried as first line therapy or for patients unwilling to undergo surgery. Local estrogen application should routinely be prescribed for perimenopausal patients. In the last decade laparoscopic techniques have been established in addition to standard methods of pelvic floor reconstruction. These techniques do not follow a new surgical strategy but realise the minimal invasive approach to established methods of pelvic floor reconstruction. Of note, laparoscopic fixation is very convenient for young women who want to preserve their uterus. Long time follow up is not available for most techniques.

Female↗
PubMed2005

Vaginal hormone therapy for urogenital and menopausal symptoms.

Reduction of ovarian steroids at menopause leads to significant changes in the urogenital tract. These changes often worsen with time, particularly in nonsmokers, affecting up to 38% of menopausal women. Urogenital symptoms that clearly respond to estrogen therapy include atrophic vaginitis, dryness, and accompanying dyspareunia. Estrogen reduces urinary tract infections in women plagued by frequent recurrence. The sensation of urgency improves with estrogen but urge incontinence improvement is similar to that with placebo. Stress incontinence does not improve with estrogen. Until recently, vaginal therapy was reserved for local symptoms. Rings make systemic vaginal therapy acceptable and even preferred by some users. Vaginal delivery, like other parenteral therapies, bypasses the gastrointestinal tract, with less anticipated impact on lipids, globulins, clotting, and fibrinolytic factors. Evidence of a lowered risk of venous thromboembolism is reviewed. Options for estrogen therapy include native, synthetic, or biologically derived estrogens delivered by cream, gel, insert (pessary), ring, or tablet. Even the lowest dose estradiol (7.5 mug daily or 25 mug twice per week) shows evidence of systemic absorption. In long-term placebo-controlled studies, bone density was better preserved and lipid profiles were more favorable. Therefore, even these low dose therapies should be opposed by occasional progestogen to prevent endometrial carcinoma. Intermittent therapy is best given for a minimum of 12 days based on laboratory data. Less frequent dosing, although preferred by patients, likely confers a slightly increased risk of hyperplasia. No combination estrogen/progestogen vaginal product is currently available. The best dose to reduce risk of endometrial pathology adequately in the lower dose therapies will be defined not only by the dose and potency of the exogenous estrogen but by the individual is body habitus and lifestyle choices.

Administration, Intravaginal↗
PubMed1995

[Colpohysterectomy. A contribution to gynecologic geriatric surgery].

From 1983 to 1992 we performed 70 interventions because of a total genital prolapse: 51 vaginal hysterectomies and four removals of the cervical stump, both combined with vaginectomy and fifteen vaginectomies of the prolapsed vaginal vault. Two patients underwent another procedure during the same anesthesia: mastectomy and treatment of an inguinal hernia respectively. The youngest patient was 59 years old and the oldest 89. Fifty-four patients were aged between 71 and 82. Thirteen women had worn a pessary before the operation. Fifty-one interventions took less than 75 minutes. Serious postoperative complications included myocardial infarction on postoperative day eight in one patient and bronchopneumonia and cardiovascular decompensation in a second patient. No case of relapsing prolapse has come to our knowledge so far. We hold hysterectomy combined with vaginectomy to be the treatment method of choice in women with total genital prolapse and no further desire of cohabitation. When performed by an experienced surgeon it is the method with the lowest potential of recurrence and therefore to be preferred to other procedures.

Aged↗
PubMed1995

[Laparoscopic ante-fixation of the uterus--modification of the Menge operation].

Surgical antefixation of the retroflected uterus is today for several reasons a rare event. We report on a forty-year old patient with dyspareunia, dysmenorrhoea and lumbalgia. Elevation of the uterus by means of a Hodge pessary relieved her symptoms. This prompted laparoscopical suspension of the diagnosed retroflexio uteri mobilis. We used a modification of Menge's technique stitching the rotund ligament to the anterior surface of the uterus. This modified technique is especially useful because it can be performed easily by laparoscopy. In addition shortening of the round ligaments achieves a physiological position of the uterus in the pelvis without major changes in the pelvic anatomy.

Adult↗
PubMed1994

[Gemeprost vaginal suppositories versus intracervical sulprostone gel administration for cervic priming in the 1st trimester. A tonometric controlled comparative study].

In a prospective, randomised study, 40 primi- and plurigravida were treated either intracervically with 50 micrograms Sulprostone gel or vaginally with a pessary containing 1 mg Gemeprost in order to soften the cervix prior to first trimester termination of pregnancy. Curettage was performed on average 6.0 and 3.2 hours, respectively, after prostaglandin administration. For objective demonstration of the priming effect, the force required for dilatation of the cervical canal was measured in Newton by a special tonometer before prostaglandin treatment and before operation. The free passability of the cervical canal, the maximal dilatability with a force of 10 N and the increase in dilatability after local prostaglandin application were measured. A modified visual analogue scale was used to evaluate the subjective pain experience. During the time between administration and curettage, no abortion occurred in any of the patients. There were no statistically significant differences between both groups regarding the free passability and the maximal dilatability, however, the increase in dilatability was significantly greater in the Gemeprost group. The visual analogue scale allows the patient to quantify, at least to some extent, her experience of pain, but there were no differences in the rate of uterine cramps between both groups; gastrointestinal symptoms did not occur. Both methods were found to be equally efficient; the advantages of Gemeprost are the ease of administration and the short application-curettage interval; however, the cost for one Gemeprost application is nearly 6-fold higher than that of one Sulprostone gel application.

Abortifacient Agents, Nonsteroidal↗
PubMed1990

[Benzalkonium chloride for vaginal contraception--the vaginal sponge].

From March 1986 to December 1987, a vaginal contraceptive, not yet commercially available in Germany, was studied in 56 women. The substance benzalconium chloride (BZC) was contained in vaginal sponges (n = 46), pessaries (n = 4) and cream (n = 6) at a dose rate of 1.18%. BZC is a surfactant of the ammonium series that ruptures the spermatozoal membrane. It is also a powerful bactericide and viricide. The advantages of the vaginal sponge (intercourse is safe immediately after insertion for the next 24 h and for multiple intercourses) made it pleasant for the women. The rate of transitory local side effects (16%) was acceptable. The vaginal contraception did not interfere with the sexual life. In 645 months of use 10 pregnancies occurred of which 9 happened with the sponge (PI 20.3). Its fixation before the cervix and the release of the spermicide is not reliable enough, so that we cannot recommend the sponge as a safe vaginal contraceptive.

Adult↗
PubMed1986

[Reliability of the vaginal diaphragm as a contraceptive method].

With a failure rate of between 2 and 4 in recent statistics, the vaginal diaphragm can be considered a relatively reliable method of contraception. The physician can therefore recommend this method as an alternative if, e.g., ovulation inhibitors are contraindicated and the patient rejects an intrauterine pessary. In such cases diaphragms are as acceptable as condoms, the more so because the two methods are completely harmless. (Table 9 summarizes the advantages and disadvantages of diaphragms.) Whether, in the final analysis, the condom or the diaphragm is accepted, will largely depend on whether the man or the woman assumes the responsibility for family planning. The physician can use his influence when explaining the contraceptive principle of the diaphragm and showing the patient how to use it to keep the failure rate to a minimum. The present authors consider that even today, good, objective counseling on reliable family planning is one of the physician's most important tasks in the sphere of preventive medicine.

Adolescent↗