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At least 847 records · Page 47Linked to original sources
PubMed1996

Correction of stress urinary incontinence: laparoscopy combined with vaginal suturing.

The authors review the published techniques of laparoscopic colposuspension combined with vaginal suturing. Particular emphasis is given to their own technique, first published in 1992, and to that of Harewood (1993), which is similar. Both involve a Burch-like colposuspension using a technique similar to that of Gittes and Loughlin. This is possible looking inside the pelvis through a laparoscope and using a handle-needle. Published results are similar (about 70% success rate), but the authors point out that the Breda technique is simpler, cheaper, and less time consuming (only one trocar instead of three) and has had a longer follow-up (up to 3 years instead of 19 months). The authors review many other similar techniques reported between 1993 and 1995 with good results but based on rather limited experience. The conclusion is that the laparoscopic technique with vaginal suturing seems a promising way to approach stress urinary incontinence in the female patient.

Female↗
PubMed2003

Laparoscopic surgery for gynaecological oncology.

PURPOSE OF REVIEW: The use of laparoscopic staging and/or surgery in the field of gynaecological oncology was pioneered in the early 1990s. The issue has been very controversial from the beginning, with some justification in view of the possible consequences of faulty cancer surgery. After more than 10 years, long-term follow-up and comparative studies, both of which are required in clinical oncological research, are now available. RECENT FINDINGS: A number of papers have confirmed the absence of significant adverse effects on survival after laparoscopic diagnosis or surgery in gynaecological cancers. New developments cover virtually all the basic techniques in cancer surgery, excluding major exenterative surgery. The use of an extraperitoneal technique for aortic dissections is emerging. New indications, such as radical vaginal trachelectomy, pelvic sentinel node identification, interval debulking surgery of adnexal malignancies, or the liberal use of surgical staging of uterine cancers, have been developed as a direct result of the availability of laparoscopic techniques. SUMMARY: Continuing worldwide interest clearly demonstrates that laparoscopic techniques are now part of the armamentarium of the gynaecological oncologist. Postoperative morbidity and recurrence risk do not seem to be affected. Cost-efficiency of laparoscopic procedures is based on the reduction of hospital stay. Combined training in gynaecological oncology and in laparoscopic surgery is, more than ever, mandatory as a means of avoiding the risk of inadequate staging or the mismanagement of pelvic malignancies. The diversity of techniques, including laparotomy, laparoscopy, and vaginal surgery, allows the individualization of surgical approaches, whereby tumour size and local or general conditions can be taken into account.

Female↗
PubMedDate not supplied

Laparoscopic abdominal cerclage.

Abdominal cerclages are necessary when the standard transvaginal cerclages fail or anatomical abnormalities preclude the vaginal placement. The disadvantage of the transabdominal approach is that it requires at least 2 laparotomies with significant morbidity and hospital stays. We discuss a case of abdominal cerclage performed laparoscopically. We feel it offers less morbidity and in the proper hands eliminates or significantly shortens hospital stays.

Adult↗
PubMed2001

Epidemiological correlates of hysterectomy, a hospital based study 1995 -1996 at Ain Shams Maternity Hospital.

UNLABELLED: Hysterectomy is one of the most frequently performed major surgical procedures for women. Study the epidemiological correlates of hysterectomy and identify the different indications that lead to the operation as well as determine its frequency. SUBJECTS AND METHODS: A retrospective study was performed which included 231 women who had undergone hysterectomy during 1995-1996. Data about the various characteristics of women, indication, and type of surgery were retrieved from the medical fles of women in Ain Shams Maternity Hospital. RESULTS: The hospital incidence rate of hysterectomy during 1995-1996 was 9.8/1000 admission, while it rose to 13.8/1000 in the year 2000 (recent data from hospital statistics unit) Epidemiological data showed that the mean age of women was 45.4+/-8.9, the highest frequency of hysterectomy was in the age group 45-54 years (41.2%). Hysterectomy in those aged less than 35 years was 7.3%. Previous abortion accounted for 48.5% early age at menarche (< or =12) was 13%, multiparity (> or =5) was 54.4%. Among women aged less than 35 years, uterine leiomyoma was the commonest indication (29.4%), while dysfunctional uterine bleeding was the commonest indication among those aged 35-<45, and 45-<55 and accounted for 40.6% and 60% respectively. Those aged > or =55 years, uterine prolapse was the commonest indication (53.6%). Malignant neoplasm covered less than 5% of all hysterectomies. Among nullipara, uterine leiomyoma was the most frequent indication (66.7%), while among parous women, dysfunctional uterine bleeding was the most frequent (56%). The most common obstetric indication leading to hysterectomy was uncontrolled postpartum hemorrhage and ruptured uterus (57.2%) of all obstetric causes. The abdominal route was the commonest approach for hysterectomy (54.1%), followed by the vaginal (35.9%). CONCLUSION AND RECOMMENDATIONS: Hysterectomy rate in Ain Shams Maternity hospital showed a significant increase by the year 2000 than during the period of the study. Further studies are needed to identify the reasons for such increase and to reduce unnecessary operations. The present study draws the attention of the importance of prenatal care for early detection of high risk women, and prevent complications of bleeding specially in women under 35 years who may not have completed their families and who may prefer other alternatives to surgery.

Adult↗
PubMed1988

[Treatment in a ventral position of vesicovaginal fistula by ordinary suture or autoplasty of the labia majora].

The authors describe a modification of technique which improves the exposure of vesico-vaginal fistulas treated surgically by a low approach. The patient is placed in a ventral horizontal position with the thighs in abduction, and the buttocks spread apart. With the patient installed in this way, care is facilitated by more anatomical technique. Using this installation it is possible to close the fistula by simple suture (Chassar-Moir) or with interposition of the labium majus (Martius autoplasty).

Female↗
PubMed1996

A morphologist's approach to the vagina.

The author reviews basic facts on vaginal histology and ultrastructure with respect to passage of different substances and drugs through the epithelium. Particular interest is given to the action mechanism of topically applied intravaginal estrogen, its binding to receptors in different vaginal cell types, and possible local metabolic routes for estrogen. Differences in estrogen sensitivity between uterus and vagina are discussed as well as the background for the high sensitivity in the vagina.

Administration, Topical↗
PubMed2001

The clinical utility of a vaginal template designed to standardize suture placement during retropubic colposuspensions.

Suture placement and bite size utilizing a vaginal template are compared to a traditional surgical approach during modified retropubic colposuspension on four fresh-frozen human female cadavers. Overall, a larger suture bite was obtained utilizing the template (71.5 +/- 4.6 vs 46.7 +/- 25.3 mm2, P = 0.001). However, with increased surgical experience the suture bites obtained with the traditional approach and template technique were similar. Inconsistent suture placement relative to the urethrovesical junction and urethra was observed with both techniques. Differences in pelvic floor anatomy make consistent suture placement with respect to the urethrovesical junction and urethra neither possible nor entirely preferable with either technique. There seems to be little clinical value in the use of this vaginal template during modified retropubic colposuspensions.

Cadaver↗
PubMed1990

Antibody response in the bovine genital tract to intrauterine infusion of Actinomyces pyogenes.

Antibody titres and immunoglobulin concentrations were measured in serum and in uterine and vaginal secretions from five heifers after intrauterine infusion of Actinomyces pyogenes. Infection stimulated an increase in uterine antibody titres of IgG2 and IgA, which approached significance. There was no increase in antibody titres in vaginal secretions or in serum. For each class of immunoglobulin, the ratio of specific antibody to immunoglobulin tended to increase in uterine secretions after infection, whereas no change was detected in the serum. These results indicate that at least a portion of the antibody was derived from local uterine synthesis.

Actinomyces↗
PubMed2005

Laparoscopically assisted vaginal radical hysterectomy.

Young patients affected by an early-stage invasive cancer of the cervix are usually treated by surgery. Abdominal radical hysterectomy with pelvic lymphadenectomy is the most widely used technique. With the advent of more conservative surgical approaches, laparoscopy has gained acceptance in gynecologic oncology, opening the way for radical vaginal surgery for cervical cancer. Before this technique becomes widely accepted, it has to be demonstrated that the results, in terms of safety and efficacy, are comparable with the 'standard' abdominal approach. In this chapter we review the technique of laparoscopically assisted radical vaginal hysterectomy and evaluate results of published series.

Female↗
PubMed2003

Vaginal evisceration long after vaginal hysterectomy.

BACKGROUND: Vaginal evisceration can take place many years after vaginal surgery. CASE: An 87-year-old woman presented with evisceration of small bowel through the vagina, 15 years after she underwent a vaginal hysterectomy. On physical examination, her vital signs were normal. Forty centimeters of small bowel was visible emerging from the vagina, appearing viable and nonedematous. Because of the high surgical risk, the bowel was replaced and the defect in the vaginal wall was repaired transvaginally. CONCLUSION: Vaginal evisceration can be treated by a transvaginal surgical approach. Factors such as the medical condition of the patient and the viability of the herniated viscus should dictate the optimal approach in each case.

Aged↗
PubMedDate not supplied

An electron microscopic investigation on the pathogenesis of human vaginal trichomoniasis.

The fine structure of Trichomonas vaginalis and its acid phosphatase activity in the vaginal medium was investigated with the aid of the electron microscope. The relationship among trichomonads, desquamated epithelial cells, macrophages and bacteria was examined with special attention directed towards their phagocytic behavior. Acid phosphatase activity was observed in the Golgi apparatus, phagolysosomes and in the chromatic granules of Trichomonas vaginalis. Macrophages and leukocytes also exhibited activity for acid phosphatase, particularly during phagocytosis. Phagocytosis and digestion of epithelial cells and bacteria by trichomonads was demonstrated. The study of trichomonads in the vaginal medium is considered to be an important approach towards the understanding of the pathogenesis of lesions induced by this parasite.

Acid Phosphatase↗
PubMed1983

Volumetric self-sampling of cervicovaginal fluid: a new approach to ovulation timing.

Cervicovaginal fluid that accumulates in the upper vagina and posterior fornix can be quantitatively correlated with the presumably fertile and infertile phases of the menstrual cycle. With a newly developed Volumetric Vaginal Aspirator that women self-administer, cervicovaginal fluid can be sampled on a daily basis and the sample volume or sample weight recorded. In a total of 18 cycles from 7 different subjects there was a striking 3- to 30-fold increase in sample volume or sample weight above early follicular phase levels that preceded the shift in basal body temperature (BBT) at midcycle. The maximum of sample volume or sample weight near midcycle was defined as "Volume Peak" or "Weight Peak." The magnitude of the Volume Peak or Weight Peak varied in the individual subjects and was between 400 and 1500 microliters or mg. The Volume Peak or Weight Peak generally occurred 1 to 2 days before or on the day of presumptive ovulation. With the BBT shift to luteal phase levels, the sample volume or sample weight sharply declined to early follicular phase levels. The results suggest that changes in sample volume or sample weight of cervicovaginal fluid measured with the self-applicable Volumetric Vaginal Aspirator can be used as an objective basis for approaches to natural family planning and for the assessment of optimal conditions for conception.

Adult↗
PubMed2005

Comparison of preoperative and postoperative pressure transmission ratio and urethral pressure profilometry in patients with successful outcome following the vaginal wall patch sling technique.

AIMS: We studied preoperative and postoperative pressure transmission ratio (PTR) and urethral pressure profilometry in patients undergoing the vaginal wall patch sling technique as a first surgical approach for genuine stress incontinence (GSI) with urethral hypermobility. The specific aims were to determine the exact urodynamic parameters, if any, that may be improved postoperatively and to report the urodynamic outcome of the vaginal wall patch sling technique in successful cases. METHODS: Preoperatively, all patients had a positive standing stress test, urethral hypermobility on Q-tip testing, and normal postvoid residual volume. On urodynamics, all patients had equalization of maximum urethral closure pressure (MUCP) on cough profilometry, and absence of detrusor contractions on subtracted cystometry. The PTR for each cough was calculated. Cough spikes were assigned locations in the first, second, third, or fourth quartile of the functional urethral length (FUL). Urethral pressure profilometry was performed at bladder capacity in the sitting position. All urodynamic tests were repeated 3-6 months postoperatively. A two-tailed t-test was used for statistical analysis. RESULTS: Forty-eight patients demonstrated successful outcome at initial follow up and constituted the study population. There was a statistically significant increase in MUCP at stress as well as a statistical increase in PTR in the first, second, and third quartiles of the FUL postoperatively. CONCLUSIONS: The vaginal patch sling technique appears to restore continence both by buttressing the urethra at times of stress as well as repositioning the proximal urethra into the intra-abdominal pressure zone, thus, enhancing pressure transmission to the proximal urethra.

Adult↗
PubMed1979

[Diagnostic value of vaginal mouldings in uterine cancer (author's transl)].

Vaginal mouldings were originally introduced as applicators for uterovaginal radium therapy. After 13 years of experience with this method in the Gustave-Roussy Institute we have found that it is also of great value for diagnostic purposes: it enables the site of the uterine cervical and vaginal lesions to be determined in a more precise manner; areas of invasion of the vagina can be detected which would normally not have been found, either because of the difficulty of performing previous investigations, or because of the extremely superficial nature of certain vaginal lesions: the extent of invasion and the subsequent therapeutic approach can then be radically modified; objective records can be kept in the form of photographs which can be compared with any future mouldings. The vaginal moulding can, in fact, be used as a diagnostic tool during supervision of the patients, when there is the least suspicion of an abnormal finding.

Female↗
PubMed1977

Genital malignancy in pregnancy.

The clinical problems associated with the presence of genital malignancies occurring during pregnancy are presented. This report represents the clinical experience at one medical institution over a 20 year period. Eighty cases of cervical neoplasm, four cases of ovarian carcinoma, five vulva carcinomas, and one vaginal carcinoma are presented. The diagnostic and therapeutic approaches to malignant neoplasia of each area are discussed separately.

Adenocarcinoma↗
PubMed2003

Medico-economic approach to the management of uterine myomas: a 6-month cost-effectiveness study of pelvic embolization versus vaginal hysterectomy.

INTRODUCTION: Uterine artery embolization is a technique that has been recently proposed for the management of uterine myomas an alternative to vaginal hysterectomy. The results provided by the first published studies demonstrate a significant decrease in symptoms in 70-95% of cases. The aim of our study was to compare the cost-effectiveness ratios for pelvic embolization and vaginal hysterectomy looked at from the hospital point of view. MATERIALS AND METHODS: Two populations of patients were randomly selected from women undergoing pelvic embolization or vaginal hysterectomy. We retrospectively measured the cost at 6 months of the two types of procedure (costs of hospitalization, drugs, and complementary examinations) as well as the success of each of them at 6 months. The cost of the techniques themselves were measured prospectively on the basis of four procedures. RESULTS: The cost-effectiveness ratios were 2320 Euros per success (mean cost 2134 Euros per effectiveness 92%) for embolization and 2789 Euros per success (mean cost 2789 Euros per effectiveness 100%) for hysterectomy. DISCUSSION: Pelvic embolization is more cost-effective than vaginal hysterectomy. The integration of the notion of quality of life with the notion of cost should permit a future study to reinforce interest in performing pelvic embolizations in the management of uterine myomas.

Cost-Benefit Analysis↗