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PubMed1995

Excision of endometriosis in the pouch of Douglas by combined laparovaginal surgery using the Maher abdominal elevator.

Twenty-one patients with stage 3 or 4 endometriosis in the pouch of Douglas had combined laparovaginal surgery using the Maher abdominal wall elevator. Opening the pouch of Douglas at the beginning of the operation allowed the combined surgery. Instruments were introduced through both the vagina and accessory laparoscopic incision. And a finger was placed in the vagina to palpate and detect abnormal tissue and assist in blunt dissection. The extent of pathologic tissue in the pouch of Douglas was easily identified. This approach allowed flexibility in maximizing the optimum route, vaginal or laparoscopic, to remove the uterus, and facilitated rectal surgery. The alternatives of laparoscopic and laparotomy surgery have limitations compared with combined laparovaginal surgery, particularly deep in the pelvic cavity.

Abdomen↗
PubMed2002

New immunotherapeutic strategies to control vaginal candidiasis.

The widespread occurrence of mucosal infections caused by Candida, in particular recurrent vulvovaginal candidiasis among fertile-age women, together with the paucity of safe candidacidal antimycotics, have prompted a great number of investigations into the immunotherapy of candidal vaginitis. This article will discuss three different experimental approaches demonstrated to be potentially transferable to human disease: (1) the use of antibodies against well-defined cell-surface adhesins or enzymes; (2) the generation of yeast killer-toxin-like candidacidal anti-idiotypic antibodies and their engineered molecular derivatives (e.g. single chains, peptides); and (3) the generation of therapeutic vaccines and immunomodulators.

Antibodies, Fungal↗
PubMed2002

Embolization of uterine artery in terminal stage cervical cancers.

Ligation of the hypogastric artery has been a standard and effective procedure in controlling massive bleeding in advanced cervical carcinoma. The authors wanted to demonstrate the selective use of embolization of hypogastric or uterine artery to achieve the same end result--the stoppage of vaginal bleeding. In a number of cases, surgical approach may not be appropriate either because of the critically ill patient or because of the highly deformed pelvic anatomy due to radiotherapy or to the recurrence of cancerous tissue. As an alternative therapy, we used selective embolization of the uterine artery in eight patients. In all the patients, embolization served to control bleeding. As the bleeding was brought under control, a gradual recovery of the patient was generally observed. The most common side-effect was temporary severe pain related to ischemia of tumoral tissue. Embolization may be regarded as an effective procedure, which can be used to control massive bleeding in selected cervical cancer patients.

Adult↗
PubMed2001

Can variability in the hormonal status of elderly women assist in the decision to administer estrogens?

Hormone replacement therapy (HRT) has been proposed for the prevention and treatment of many chronic conditions, ranging from osteoporosis, heart disease, urinary incontinence, and Alzheimer's disease. With the exception of osteoporosis, however, many of the suggested benefits remain controversial. Part of the controversy stems from the relative absence of randomized controlled trials, particularly those enrolling sufficient numbers of elderly women. We propose that another factor may also contribute, one that has been overlooked - failure to consider the variable endogenous estrogen status of elderly women. Highly variable levels of estrogens are present in nearly all postmenopausal women, even at advanced ages. Similar to other endocrine systems, estrogen deficiency and the need for its replacement are, therefore, likely to be relative rather than absolute. Recent studies indicate that elderly women who are less able to compensate for declining ovarian 17beta-estradiol production by adipose synthesis of estrone (E1) may be at greater risk for certain chronic conditions associated with relative estrogen deficiency. Because many markers of estrogen deficiency exhibit overlap between risk groups, their clinical usefulness as predictors of frailty, disability, and response to HRT has been limited. Future studies will need to focus not only on the use of highly variable circulating serum estrogen levels but also on markers of overall estrogenic effects at the level of individual target tissues (i.e., markers of bone turnover, karyopyknotic index on a vaginal wall smear). We propose that a clinical approach that takes into consideration the remarkable heterogeneity (physiological as well as psychological) of elderly women will enable us to approach the decision about HRT in a more individualized and possibly better targeted fashion.

Aged↗
PubMed1999

A prospective randomized study comparing intramuscular with intravaginal natural progesterone in programmed thaw cycles.

A simple programmed thaw cycle is described, during which the endometrium is prepared with oral oestradiol, followed by a natural progesterone source. This method involves minimal blood tests and uses inexpensive medications. Originally, an i.m. progesterone-in-oil preparation was used. Although highly successful in achieving high serum progesterone concentrations, the daily injections of the oily compound were found to be problematic from the patients' perspective. To examine the possibility of replacing the injectable progesterone with a vaginal preparation we conducted a prospective randomized study of 1 year's duration, during which time 170 and 184 thawing cycles were done with injectable and vaginal progesterone respectively. Although the progesterone blood concentrations obtained with the injectable preparation were more than twice those obtained with the vaginal progesterone, the clinical pregnancy rates (defined as percentage thawing cycles with gestational sac(s)/embryo transfer as demonstrated on ultrasound, 4 weeks after embryo transfer) were similar for both groups (15.9 and 16.8% respectively). Implantation and abortion rates were also comparable. These results agree with previous reports of higher uterine progesterone concentrations after the vaginal application. We conclude that the combination of oral oestradiol and vaginal progesterone is an effective, simple and inexpensive approach for programmed thaw cycles.

Administration, Intravaginal↗
PubMed1997

Actions of spermicidal and virucidal agents on electrogenic ion transfer across human vaginal epithelium in vitro.

Human ectocervical tissue was removed at operation over the menstrual cycle mounted as a sheet in vitro in an Ussing-style chamber and incubated in bicarbonate saline. The net electrogenic ion transport was measured as the short-circuit current (Isc in muamps/cm2) and was characterised as mainly (60-86%) an amiloride-sensitive electrogenic Na+ transport (lumen to serosa). Serosal application of amiloride had no effect. Serosal application of ouabain, a selective Na(+)-pump inhibitor, reduced the Isc to near zero but neither theophylline (10 mM) nor furosemide (1 mM) had any action. The data are compatible with a model ectocervical vaginal cell having an amiloride-sensitive Na+ entry mechanism at the lumenal membrane and a Na(+)-pump at the basolateral membrane removing the ion from the cell. The effects of the putative virucides, chlorhexidine and benzalkonium chloride, were tested on the preparation. Mucosally added chlorhexidine (2 mg/ml) had no effect on the Isc or tissue resistance but benzalkonium chloride, at concentrations between 0.06-1.2%, caused a rapid fall in the Isc. At the highest concentration this was only partly reversible even after two washes with fresh buffer. At the lowest concentration (0.03%) benzalkonium chloride sometimes caused an initial increase in the Isc which then fell to zero. In all the tissues even after the Isc was reduced to near zero, nigrosin left in contact with the tissue for 5 min. did not enter and stain the cells, indicating the detergent had a selective membrane action rather than causing a non-specific increase in permeability. The preparation allows objective measurements to be made of the initial acute membrane actions of putative spermicides and virucides on human vaginal ectocervical epithelial cells and offers a new approach of assessing their pharmacological/toxicological actions.

Adult↗
PubMed1988

Paraurethral leiomyoma in women.

Two rare cases of paraurethral leiomyoma in women are presented. Physical examination and cystourethrography with previous cytourethroscopy revealed the seat of the masses. Surgical approach by means of incision of the anterior vaginal wall allowed for the complete enucleation of the tumors.

Female↗
PubMed2000

[A case of female pseudohermaphroditism caused by maternal androluteoma].

Female pseudohermaphroditism is a condition characterized by various degree of external genitalia virilization in a patient with female internal genitalia and karyotype (XX). External genitalia is masculinized congenitally when female fetus is exposed to excess androgenic environment. Fetal metabolic abnormalities, like congenital adrenal hyperplasia, are the most common causes of female pseudohermaphroditism, however there is a low incidence of gestational hyperandrogenism caused by maternal pathology. We report a case of female pseudohermaphroditism secondary to a maternal ovarian luteoma of pregnancy producing androgenic hormones. The newborn presented a severe degree of external genitalia virilization with high urogenital sinus (stage Prader V). Moreover we describe the main steps of diagnostic iter that are necessary both to exclude other causes of virilization and to study all anatomical aspects in view of the surgical correction. The operation consists in two phases of action: an early clitorisvulvoplasty according to Passerini-Glazel and a late vaginal pull-through with anterior saggital transanorectal approach (ASTRA).

Disorders of Sex Development↗
PubMed1984

Needle bladder neck suspension for female stress incontinence.

A highly successful transvaginal bladder neck suspension for female stress urinary incontinence is described and illustrated. Precise lateral placement of sutures, maximum mobilization of the anterior vaginal wall and bladder neck, and ease of approach are keys to the technique. The procedure can be utilized in any setting with minimal complications and with neither obesity nor multiple previous surgeries as contraindications.

Female↗
PubMed2005

Vaginitis in Turkish women: symptoms, epidemiologic - microbiologic association.

OBJECTIVE: To determine the relationship between clinical-epidemiologic findings and microbiologic results in vaginitis. METHODS: A prospective study of 212 women with vaginal symptoms was undertaken. Each patient underwent an evaluation that included standardized history, interview after pelvic examination and vaginal culture. RESULTS: Only 45% of patients received diagnosis. Only two symptoms were more frequently noted with diagnosis. Itching was more frequent in vulvovaginal candidiasis (VCC) whereas odor was more frequent in Bacterial vaginosis (BV). BV was associated with a history of spontaneous and induced abortion, increased number of pregnancy, vaginal douching practice and intrauterine contraceptive device usage. VVC was found to be associated with no contraceptive usage and previous vaginitis history. CONCLUSION: Presenting symptoms alone or with microbiologic studies has limited value, and that of the women with vaginal symptoms may lack a microbiologic diagnosis. Evidence-based approaches that produce highly accurate diagnostic and effective treatment regimens would be expected in the future.

Adult↗
PubMed1993

[Hysterectomy in obstetrical practice (1979-1990)].

Caesarean hysterectomy and hysterectomy after vaginal delivery from 1979 to 1990, the indications, the complications and the mother's outcome are retrospective investigated. By 41010 births the hysterectomy rate is 0.068%, caesarean hysterectomy-15 (0.056%), and hysterectomy after vaginal delivery-12 (0.030%). The common est caesarean hysterectomy indications are infected uterus, haemorrhage, myoma, carcinoma colli uteri (80%). Haemorrhage and rupture uteri (75%) are the general hysterectomy indications after vaginal birth. A low complication rate is found out, 3 women are deceased (11.11%) in the group of hysterectomy after vaginal delivery. The authors have underlined benefits of the preferred recently organ keeping approach.

Bulgaria↗
PubMed1994

Vaginal birth after lower segment caesarean section.

One delivery in eight in the UK is by caesarean section. Women who have had a previous caesarean section may approach a midwife in subsequent pregnancies because they want more control over their labour. Vaginal birth after caesarean section (VBAC) is a safe option for women with a lower segment scar. Factors associated with a favourable outcome include spontaneous labour and freedom of movement during labour. Factors hindering successful outcome include reduced mobility, use of oxytocin, and time limits set on progress of labour.

Female↗
PubMed2006

Vaginal hysterectomies performed in a residency program: can we increase the number?

OBJECTIVE: To evaluate if a concerted effort to increase the number of vaginal hysterectomies performed in a residency program could be accomplished safely when a standard approach vs. a concerted effort was utilized. STUDY DESIGN: A retrospective case review was performed for all patients undergoing vaginal hysterectomy at 1 hospital in a residency program. At Denver Health Medical Center, the Gynecology Division made a concerted effort to increase the number of vaginal hysterectomies performed. All hysterectomies from July 1998 to December 2003 were reviewed retrospectively. Abstracted data included age, race, parity, primary diagnosis, past medical history, past surgical history, history of pelvic inflammatory disease/sexually transmitted disease, removal of ovaries, conversion to an abdominal procedure, complications, length of hospital stay, and change in hematocrit. RESULTS: Over 1,029 hysterectomies were performed during the study period. In the first 3 years, 190 vaginal hysterectomies were performed. During the second 3 years, 320 hysterectomies were performed vaginally; laparoscopic vaginal hysterectomies were excluded. The percentage of vaginal hysterectomies performed increased from 37% to 60%. Age, race, uterine weight, primary diagnosis and past medial history were not significantly different (p>0.05). A significant difference was noted during the second period with regard to parity, previous surgeries, history of sexually transmitted diseases, removal of ovaries, length of hospital stay and complication rate. CONCLUSION: When there is a concerted effort to perform vaginal hysterectomies in lieu of abdominal ones in a residency program, the number can increase without increasing the complication rate.

Clinical Competence↗
PubMed1999

The Vecchietti procedure for surgical treatment of vaginal agenesis: comparison of laparoscopy and laparotomy.

OBJECTIVE: Our goal was to describe the outcomes of women with vaginal agenesis who had surgical creation of a neovagina using the Vecchietti technique over a 20-year period. We also sought to determine whether the laparoscopic approach would result in similar outcomes as laparotomy. METHOD: Retrospective analysis of 76 women with vaginal agenesis treated at the University of Verona Hospital between 1976 and 1996 with the Vecchietti procedure. Operative and postoperative records were reviewed, and sexual histories were obtained. Data were analyzed based on surgical approach and postoperative sexual satisfaction. Continuous data were analyzed with student's t-test, and categoric data were analyzed using Fisher's exact test. RESULT: Those who underwent the Vecchietti procedure with a laparoscopic approach (N = 7) had similar complication rates (0% vs. 13.0%, P = 0.59) and postoperative neovaginal depth (74.9 mm vs. 73.7 mm, P = 0.93) as those with laparotomy (N = 69). Similar proportions of women reported inadequate vaginal lubrication (28.6% vs. 17.4%, P = 0.61) and sexual satisfaction (100% vs. 78.3%) in the laparoscopy and laparotomy groups as well. Operative complications, neovaginal depth, or degree of lubrication were not good predictors of sexual satisfaction. CONCLUSION: Outcomes in those women who underwent the Vecchietti technique via the laparoscopic approach are comparable to those who underwent laparotomy.

Female↗
PubMed2006

High rate of vaginal erosions associated with the mentor ObTape.

PURPOSE: The transobturator tape method is a newer surgical technique for the treatment of stress urinary incontinence. Limited data exist related to complications with this approach or the types of mesh products used. We report our experience with vaginal erosions associated with the Mentor ObTape and American Medical Systems Monarc transobturator slings. MATERIALS AND METHODS: Beginning in December 2003 selected female patients with anatomic urinary incontinence were prospectively followed after placement of the Mentor ObTape. Beginning in January 2004 we also began using the American Medical Systems Monarc in similar patients. Patients were admitted overnight after surgery, discharged on oral antibiotics, and seen in the clinic at 6 weeks postoperatively. RESULTS: A total of 67 patients have undergone placement of the Mentor ObTape and 9 of those patients (13.4%) have had vaginal extrusions of the sling. Eight patients reported a history of persistent vaginal discharge. One patient presented initially to an outside facility with a left thigh abscess tracking to the left inguinal incision site. Each patient was taken back to the operating room for mesh removal. A total of 56 patients have undergone placement of the AMS Monarc and none have had any vaginal erosions. CONCLUSIONS: Our high rate of vaginal extrusion using the ObTape has led us to discontinue the use of this product in our institution. Continued followup of all of these patients will be of critical importance.

Adult↗
PubMed1997

Polymerase chain reaction analysis of distal vaginal specimens: a less invasive strategy for detection of Trichomonas vaginalis.

We compared polymerase chain reaction (PCR) analysis of specimens obtained from the distal vagina with wet mount microscopy and culture of specimens from the posterior vaginal fornix. One or all three techniques revealed that 61 (20.3%) of 300 women tested were positive for Trichomonas vaginalis. PCR analysis of distal vaginal specimens detected 56 (91.8%) of 61 infections, while wet mount microscopy and culture detected 49 (80.3%) of 61 infections. Results of this study may impact the approach to testing for T. vaginalis by eliminating the requirement of a vaginal speculum examination. The distal vagina is an appropriate testing site for T. vaginalis by PCR analysis.

Animals↗
PubMed1994

A new approach to hysterectomy without colpotomy: pelviscopic intrafascial hysterectomy.

OBJECTIVE: Total abdominal and vaginal hysterectomies have been performed by extrafascial enucleation of the uterus with amputation of the upper vagina. Our new method, which is limited to an intrafascial cylindriform enucleation of the cervix, leaves intact the highly vascularized extrafascial cervical tissue, the corresponding nerves, and the topography of the ureters. STUDY DESIGN: From December 1991 to December 1992, 60 patients underwent an intrafascial hysterectomy by pelviscopy and two patients by laparotomy for leiomyomas, endometriosis, and other intractable bleeding disorders and for a variety of additional benign gynecologic diseases. Uterine extirpation was performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. No electrosurgical equipment, stapling devices, or lasers were used. RESULTS: We analyzed our cases according to intraoperative, immediate postoperative, and late postoperative complications. We had no major complications. Average operating time is compatible with that of conventional total abdominal or vaginal and laparoscopy-assisted vaginal hysterectomy. Blood loss was minimal (average drop of hemoglobin 1.8 gm). Average hospitalization was 50.6 hours. CONCLUSION: There has never been an indication for the removal of the normal cervix at hysterectomy, other than for cancer prophylaxis. The synthesis of supracervical extirpation of the uterus, conization of the cervix, and operative laparoscopy (pelviscopy) enables us to perform a truly laparoscopic hysterectomy without colpotomy. Pelvic floor support is maintained and transvaginal sexual sensation is less likely to be impaired because of the preservation of the cardinal and uterosacral ligaments. With the serrated-edge macromorcellator, morcellated cylinders of cervical and uterine body tissue guarantee a thorough histologic examination and interpretation. Physical stress to the patient is minimized. There are no abdominal or vaginal incisions. The abdominal space remains practically unopened. Pelviscopic intrafascial hysterectomy equates with minimally invasive and organ-preserving surgery. It may be sufficient for cervical and endometrial cancer prophylaxis.

Adult↗