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At least 883 records · Page 49Linked to original sources
PubMed1994

Various approaches to laparoscopic hysterectomy.

The advantages of the laparoscopic mode of access for hysterectomy include shorter recovery time and less pain and scarring. The laparoscopic component of the hysterectomy is usually combined with a vaginal component. The relative proportions of the procedure, performed laparoscopically and vaginally, vary considerably between surgeons. The main problem associated with the laparoscopic approach is to ensure adequate hemostasis while avoiding damage to the urinary tract. A variety of differing techniques have been developed in attempts to ensure the safe and efficient removal of the uterus laparoscopically.

Female↗
PubMed1991

Medicosurgical approach to diagnosis and treatment of ectopic pregnancy.

Early ectopic pregnancy screening using vaginal ultrasonographic technology together with measurement of beta human chorionic gonadotropin (beta-hCG) and human chorionic somatomammotropin is possible within the first 2 weeks of the missing menses, prior to the appearance of symptoms. This article summarizes the main available treatment modalities, focusing primarily on the pelviscopic surgical tube-conserving approach and on instillation of intrachorionic drugs (methotrexate alone or in combination with ornipressin) and injection of prostaglandin F2 alpha. While the pelviscopic surgical approach can be applied in nearly all cases of ectopic pregnancy, irrespective of pregnancy duration, the pelviscopic medicosurgical approach is only appropriate for the treatment of early ectopic pregnancies until the 8th week of gestation in patients without fluid collection in the pouch of Douglas and beta-hCG values below 2000 mU/mL. The transvaginal intrachorionic drug instillation as a simple medicosurgical approach performed under ultrasonographic guidance without anesthesia remains restricted to the treatment of early viable ectopic pregnancy. A brief account of the expectant treatment of patients with nonviable ectopic pregnancy is given, underlining the prerequisites of decreasing beta-hCG values and the absence of fluid in the pouch of Douglas. Although spontaneous resorptions have been observed in a number of cases of the disease, no clear evidence is available on the reconstitution of tubal function and patency.

Chorionic Gonadotropin↗
PubMed2025

Identification of Sample Processing Errors in Microbiome Studies Using Host Genetic Profiles.

In microbiome studies, sample processing errors are frequent and difficult to detect, especially in large studies involving multiple sites, personnel, and sample types. We present two complementary approaches to identify such errors using host DNA profiled via metagenomic sequencing of microbiome samples. The first approach compares host SNPs inferred from metagenomics to independently obtained genotypes (e.g., microarray genotypes) to match samples to their donors, while the second method compares metagenomics-inferred SNPs between samples to identify samples supplied by the same donor. Furthermore, we demonstrate that combining these methods with experimental metadata provides greater confidence in the identification of errors. Analyzing a longitudinal vaginal microbiome dataset, we demonstrate the ability of our approach to identify mislabeled samples. Using subsampling, we further show that our methods are robust to low sequencing coverage. Overall, our analysis highlights the frequency of processing errors in microbiome studies. We therefore recommend applying error-detection methods in all studies with suitable data.

Journal Article↗
PubMed1999

The effect of the learning curve on the duration and peri-operative complications of laparoscopically assisted vaginal hysterectomy.

BACKGROUND: Hysterectomy is the commonest elective major gynecological operation and the laparoscopic approach is increasingly an option. We evaluated the influence of the learning curve on the duration of surgery and also the peri-operative complications. METHODS: A retrospective study of the case records of patients who had laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy between August 1993 and July 1997. RESULTS: Over a four year period 86 cases of laparoscopically assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy were performed; the main indication being menstrual disorders. The mean duration of surgery was 116 minutes. There was a significant difference in the mean duration of surgery between the first two years (123 minutes) and the last two years (110 minutes) (p<0.02). The difference in the mean duration of surgery performed either by consultants or senior registrars under supervision (115 versus 116 minutes) was not significant (p>0.05). The overall complication rate was 16% with a majority (85%) occurring in the first two years of the study period. Three cases (5%) were converted to conventional abdominal hysterectomy. After the initial learning phase there was a significant reduction in the complication rates. CONCLUSIONS: The impact of the learning curve on the duration of surgery is gradual. The perceived duration of surgery should not be a disincentive for senior trainees provided they are already proficient in minor laparoscopic surgery, cases are suitably selected and adequate supervision is provided.

Elective Surgical Procedures↗
PubMed2004

Maternal colonisation with group B streptococcus and effectiveness of a culture-based protocol to prevent early-onset neonatal sepsis.

This study was conducted to find out the group B streptococcus colonisation of pregnant women in Kocaeli, Turkey. A culture plus individualised high-risk-based antibiotic prophylaxis was compared with high-risk-based approach alone. The screening of women was performed via vaginal and anal cultures for group B streptococcus (GBS). The maternal GBS colonisation rate was found to be 6.5%. All colonised women or preterm labours with unavailable culture results until delivery received prophylactic antibiotics. Neonatal colonisation rate and early-onset neonatal sepsis due to GBS was 1/200. The unscreened 900 women received prophylactic antibiotics due to a risk factor-based approach. The neonatal colonisation rate was 17/900 (p = 0.1), and the rate of early-onset neonatal sepsis was 3/900 (p = 0.6). A culture plus individualised high-risk-based antibiotic prophylaxis provided an insignificant change in neonatal colonisation and early-onset neonatal sepsis with GBS when compared with high-risk-based approach alone.

Adult↗
PubMed1982

[Advantages of short-term therapy in vaginal mycoses from a socio-psychological viewpoint].

As has become evident from an interview of 161 patients affected by vaginal mycosis, the subjective experience of the disease must be seen in relation to the sociopsychological problems involved. Assumed negative reactions to the disease in the patient's social environment as well as fear and uncertainty regarding the aetiology of the disease make it hard for the patient to accept her disease, which would surely favour a steadfast therapeutic behaviour. For the gynaecologist the finding of a "vaginal mycosis" represents an unproblematic affection since it is easily controllable with antimycotics. The result of this different approach to the disease by doctor and patient is non-compliance of the vaginal mycosis patient: the patient goes to see her doctor soon after the appearance of complaints, but tends to terminate treatment prematurely when the subjective complaints subside, in order to avoid a further confrontation with the disease. An adequate, short-term treatment of vaginal mycosis, the course of which is supervised both clinically and microbiologically, thus appears to be the right way of solving the problem of non-compliance.

Administration, Topical↗
PubMed1994

Genitourinary reconstruction in obstetric fistulas.

Although most recent literature concerning female urinary tract fistulas has addressed the problem of postoperative and post-irradiation fistula, obstetrical fistula is more common worldwide. A series of fistula repairs predominantly caused by obstructed labor is presented. During a 30-months interval 139 procedures were performed on 98 patients with fistulas at a variety of anatomical locations or on patients with type III urinary incontinence following fistula repair. The fistulas were caused by obstructed labor in 94.9% of the patients. Repair was done vaginally in 110 cases, abdominally in 25 and by a combined approach in 3. Of the patients 81% were dry after 1 procedure and all but 4% were dry after multiple procedures. The subjective observations of moderate to severe vaginal scarring, or severe damage to the urethra or bladder neck were the best predictors of adverse outcome.

Adult↗
PubMed1991

Use of vaginal hysterectomy for the management of stage I endometrial cancer in the medically compromised patient.

Vaginal hysterectomy was performed on 31 patients with stage I endometrial cancer because of medical problems which placed them at high risk for morbidity and mortality from abdominal surgery. These risk factors included morbid obesity (87%), hypertension (58%), diabetes mellitus (35%), and cardiovascular diseases (26%). The perioperative morbidity was minimal, with only four patients (13%) experiencing complications requiring extended hospital stays and no deaths. Adjuvant radiotherapy was administered in 35% of patients with either deep myometrial invasion or unfavorable histology. The 3- and 5-year disease-free survival rates were 100 and 93%, respectively. The only cancer-related death occurred 4.5 years following surgery. Although the authors are not advocating vaginal hysterectomy as standard treatment of endometrial cancer, this approach provides an acceptable alternative to abdominal surgery in the medically compromised patient.

Adult↗
PubMedDate not supplied

[Surgery for urogenital prolapse].

Urogenital prolapse can have a significant impact on quality of life. As the population continues to age, the prevalence of urogenital prolapse is increasing, and the lifetime risk of requiring surgery for urogenital prolapse or incontinence is now approximately 11%. The majority of women presenting with symptomatic prolapse suffer from multiple defects of pelvic support and require comprehensive repair to relieve symptoms. An understanding of normal pelvic support structures provides the basis for the anatomic approach to repair. Many appropriate options exist for surgical correction of urogenital prolapse. Procedures to reestablish apical support include culdoplasty techniques, uterosacral ligament suspension, sacrospinous suspension and colpopexy. Repair of the anterior compartment can be achieved with colporrhaphy and paravaginal repair. Posterior compartment defects are repaired with colporrhaphy, site-specific rectovaginal repair and perineorrhaphy. Most often, surgical correction of urogenital prolapse can be performed vaginally, which avoids the risks associated with laparotomy. Laparoscopic approaches for apical support and paravaginal repair may reduce the risks associated with laparotomy, but long-term follow-up data are not yet available with these techniques. The use of graft reinforcement for anterior and posterior repairs may offer improved success rates, particularly in patients with recurrent prolapse. However, further outcome studies are needed and the risks associated with the use of mesh must be considered.

Female Urogenital Diseases↗
PubMed1981

Termination of very early pregnancy by vaginal suppositories-(15S)-15-methyl prostaglandin F2 alpha methyl ester.

A new approach to terminate very early pregnancy was tried on 49 healthy women who were proven to be pregnant from 31 to 47 days from their last menstrual period. All pregnancies were confirmed either by UCG or serum HCG-B subunit. (15S)-15-Methyl PGF2 alpha Methyl Ester in a suppository form was administered in two separate doses: 1.0 mg initial dose followed by 3.0 mg one hour later. Patients were kept under observation for 8 hours. Blood sampling for progesterone, HCG-B, and prostaglandin levels were assayed at 0 degree, 30', 1 degree, 4 degrees, 8 degrees and 14 days. Patients were re-examined at a two week follow-up visit. Pelvic examination and pregnancy tests were performed to confirm whether the pregnancy was successfully terminated. There were no significant changes in serums progesterone and HCG-B levels during the 8-hour observation period. Both levels declined significantly to very low levels at 14 days post-therapy, confirming the clinical impression of successful termination of pregnancy. Plasma prostaglandin levels rose as early as 30 minutes after initiation of therapy, peaked at 4 hours and declined gradually afterwards. Most side effects such as nausea, vomiting, diarrhea and cramps, although clinically manageable, were still bothersome. One patient experienced an episode of vasovagal syncope. The majority of patients required medical observation up to 6 hours. Clinical implications of this new approach of termination of very early pregnancy are discussed.

Abortion, Induced↗
PubMed1993

Vaginal hysterectomy for myomatous polyp.

Vaginal hysterectomy was performed in 28 perimenopausal women with large myomatous polyps protruding from the cervix. The vaginal route was selected for hysterectomy instead of the usual abdominal approach, based on assessment made after examination under anesthesia following polypectomy. All patients made an uneventful recovery. In women who need hysterectomy, we recommend that removal of myomatous polyps vaginally should be followed by a thorough assessment for deciding the route of hysterectomy. In most cases, the choice would be vaginal hysterectomy, sparing the women the trauma of an abdominal operation.

Blood Loss, Surgical↗
PubMed2005

Bulbocavernosus muscle flap in the repair of complicated vesicovaginal fistula.

AIM: To investigate the transposition of the bulbocavernosus muscle flap for repairing complicated vesicovaginal fistulas. METHODS: Vesicovaginal fistulas were repaired via combined abdominal and perineal approaches. Through an abdominal approach, the fistula and surrounding scar tissue were excised thoroughly. A perineal incision was made between the orifices of the urethra and the vagina, dissecting until the fistula. The vaginal defect was closed through either the abdominal or the perineal approach depending upon its position. Through the abdominal approach, the bladder defect was closed in two layers with the suture lines vertical to each other. The bulbocavernosus muscle was freed through an incision between the labium majus pudendi and the labium minus pudenda, without damaging the pudendal vascular supply. The bulbocavernosus muscle flap was tunneled beneath the labium minus pudendi, and was sutured in place on the bladder wall over the fistula repair site. RESULTS: Nine patients with complicated vesicovaginal fistulas were treated using this technique. After surgery, no symptoms of vagina leakage, urinary incontinence, or urethral stricture were reported by any of the patients, and they reported normal sexual function. CONCLUSIONS: Transposition of the bulbocavernosus muscle flap is an excellent technique with low morbidity and high success rate for repairing complicated vesicovaginal fistulas.

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↗
PubMedDate not supplied

Transperineal versus transvaginal color Doppler imaging of the uterine circulation.

Transperineal sonography has been described as being useful in assessing patients in special clinical situations such as posterior placenta previa, preterm labor, stress incontinence, and vaginal atresia. We explored the feasibility of this approach in assessing the uterine circulation in 54 subjects, of whom 36 were postmenopausal. We found that visualization of the uterine artery by the transperineal approach was satisfactory in most patients. The uterine arterial Doppler indices obtained from this approach were compared with those obtained by the transvaginal route. Highly significant correlations were found (correlation coefficient tau for pulsatility index = 0.74, p < 0.0001). No significant differences in results between the two approaches were detected using the Wilcoxon Matched-Pairs Signed-Rank test. We conclude that transperineal Doppler studies of the uterine circulation are possible and may be useful in certain patient groups.

Adult↗
PubMedDate not supplied

Suburethral tape via the obturator route: is the TOT a simplification of the TVT?

Suburethral meshes can be implanted via the classic retropubic route (TVT) or by a new insertion technique that passes the tape into the obturator foramen (TOT). In a retrospective study we compared one 18-month period of 94 TOT (tension-free obturator tape) and one 18-month period of 99 TVT (tension-free vaginal tape), which preceded the change in the approach route. All operations were performed by the same surgeon using the same Prolene mesh and with no other surgical procedure associated. These two series were similar in terms of patient age, previous surgical history, degree of incontinence and preoperative urethral closure pressure. The analysis shows more hemorrhagic complications in the TVT group (10%) than in the TOT group (2%), but the difference was not significant. Bladder injuries were more frequent in the TVT group (10%) than in the TOT group (0%), but there was one urethral injury in the TOT group. The mean follow-up was 29.5 months in the TVT group and 12.8 months in the TOT group. The urinary results were the same, with 90% and 95% cured, respectively. In conclusion, the obturator approach shows identical urinary results to the classic retropubic approach. Because of the nature of the procedure, major hemorrhage and bowel perforation are excluded in the TOT procedure. Thus simplicity, safety and continence result mean that the obturator approach represents the best method of suburethral tape insertion for the treatment of urinary stress incontinence.

Aged↗
PubMed2006

Humanitarian ventures or 'fistula tourism?': the ethical perils of pelvic surgery in the developing world.

The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote 'fistula tourism' rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about 'fistula trips' of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a 'fistula champion' who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.

Altruism↗
PubMed1993

Female circumcision: obstetric issues.

Female circumcision is a problem unfamiliar to most Western obstetrician-gynecologists. We present a case illustrative of the unique management problems posed by these patients during labor. A method of releasing the anterior vulvar scar tissue to allow vaginal delivery is described. Sensitivity and a nonjudgmental approach as to what is culturally appropriate care for these women are of paramount importance.

Adult↗
PubMed1989

Staging of carcinoma of the uterine cervix: MRI-surgical correlation.

Forty-six patients with carcinoma of the uterine cervix were examined with spin-echo magnetic resonance imaging (MRI) using a superconducting magnet operating at a field strength of 0.5 T. All subjects later underwent lymphadenectomy and, when appropriate, radical hysterectomy. Surgical-pathologic correlation was carried out in order to assess the accuracy of the imaging modality in the staging of the disease. In the detection of nodal involvement, the accuracy of MR was 76%. The accuracy in determination of tumour size approached 100%. In the assessment of parametrial and vaginal involvement, the accuracy was 85% and 100% respectively.

Adenocarcinoma↗