Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Vaginal Approach”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,009 records · Page 56Linked to original sources
PubMed1996

Recurrent bacterial vaginosis--an old approach to a new problem.

Bacterial vaginosis (BV) is a common cause of abnormal malodorous vaginal discharge and can be frustrating to manage in its recurrent form. Metronidazole is the standard treatment, but is unacceptable to many women when given repeatedly. Results of treating recurrent BV using a single vaginal washout with 3% hydrogen peroxide are analysed. A total of 30 symptomatic women with clinically confirmed recurrent BV in the absence of other genital infections were recruited after informed consent. Hydrogen peroxide (3%) was instilled into the vagina, left for 3 minutes and drained. Reassessment was at 3 weeks after treatment. A total of 23 women completed the study. Symptoms cleared completely in 78% (18/23), improved in 13% (3/23) and remained unchanged in 9% (2/23). All the 3 women with improved symptoms had a mild vaginal discharge, but only one of them was still able to perceive the malodour. The amine test was negative in all 23 women including the 2 (9%) who felt no change in their symptoms following treatment. Mixed anaerobes isolated in all women before treatment were not re-isolated, and microscopy did not show 'clue cells' in the vaginal discharge following treatment. Vaginal acidity was restored to normal in all but one (96%). No side-effects were observed in the treated women. Hydrogen peroxide (3%) used as a single vaginal wash was as effective as any other agent in current use in clearing the vaginal malodour of bacterial vaginosis at 3 weeks after treatment.

Administration, Intravaginal↗
PubMed2004

Information for women after CS: are they getting enough?

Of the factors known to influence rising caesarean section (CS) rates in Scotland, it is without doubt the practice of repeat elective CS that is the major determinant. Accounting for a national rate of 30%, the high incidence of CS performed in women after one previous caesarean birth does not reflect the evidence underpinning a trial of labour as preferred practice (Expert Advisory Group on Caesarean Section in Scotland, 2001). Indeed, several factors are considered to influence the practice of trial of vaginal delivery after CS. These include the durability of the uterine incision performed at the primary CS, prolonged pregnancy and individual obstetrician and women's preferences (Enkin et al, 1995). However, in relation to the latter, few studies have addressed the views of women and their choice of mode of delivery in a subsequent pregnancy following previous caesarean birth. The evidence available suggests there is still a considerable number of women who have experienced a lack of involvement and information in relation to their childbirth experience (Churchill et al, 2000; Fleissig, 1993). A small exploratory, descriptive study was designed to examine women's role in choosing a repeat elective CS or trial of vaginal delivery following previous caesarean birth. Due to time constraints, a survey approach was adopted, as surveys tend to be less time-consuming than other methods (Parahoo, 1997). For ethical reasons, eligibility was considered only after the medical decision for proposed mode of delivery had been made. Therefore, recruitment did not take place before 36-weeks' gestation. Using a self-administered questionnaire, data was collected from 38 respondents over an eight-week period. Results demonstrated that 23 women (60%) reported involvement in the decision-making process. Of those women, 16 were having a trial of vaginal delivery and seven were having a repeat elective CS. Few women (n=9, 39%) addressed medical factors for their decision, compared to the majority of women (n=16, 69%) who addressed non-clinical and personal issues.

Adult↗
PubMed1997

Vaginal hysterectomy for benign uterine disease in the laparoscopically confirmed frozen pelvis.

Extensive pelvic adhesions present difficulty with access to the uterus, but they may not account for significant symtomatology, although their dissection may account for a significant deal of morbidity. Results of this study are based on a retrospective analysis of operations by a single surgical team. Eight patients with benign uterine pathology and frozen pelvis diagnosed laparoscopically underwent vaginal hysterectomy. The surgeries were accomplished uneventfully and without significant perioperative morbidity. This approach appears to be an efficient surgical option for hysterectomy, which by-passes the need for and the potential morbidity of an extensive intra-abdominal adhesiolysis by laparotomy or laparoscopy.

Adult↗
PubMed1990

Vaginal intraepithelial neoplasia: diagnosis and management.

A review of 42 patients with vaginal intraepithelial neoplasia (VAIN) seen in Gynecologic Department of Veterans General Hospital-Taipei between 1971 and 1987 was made. The patients were from 36 to 79 years of age with a mean 58 of years. Fifteen patients (36%) had synchronous cervical neoplasia, 26 cases (62%) had antecedent cervical neoplasia and one had undergone operation for uterine myoma. Twenty-four of 27 patients with VAIN alone presented an abnormal Papanicolou smear. The upper one third of the vagina was the most common site of the lesion. Multifocal lesions were demonstrated in 58% cases while unifocal disease accounted for 42% cases who had VAIN subsequent to cervical neoplasia. Colposcopically directed biopsies were used for diagnosis in 13 patients. White epithelium and punctation were the most common findings of VAIN. While the results of different treatments were reviewed, surgical excision was found to be the most frequently employed method and radiotherapy was the second. Both were effective and 5 patients died of vaginal disease. On account of the relatively benign nature of VAIN than that of invasive vaginal cancer and the need for preservation of a functional vagina, more conservative approaches, for example, topical 5-Fluorouracil application and carbon dioxide laser vaporization, are discussed.

Adult↗
PubMed1980

Contraception in the adolescent: current concepts for the pediatrician.

An overview is presented of the major methods of contraception available to the sexually active adolescent. Emphasis is given to the combined birth control pill, while the literature describing absolute and relative contraindications to oral contraception is reviewed. It is noted that adolescents with chronic illness must also be evaluated for contraceptive needs. Other methods covered include the intrauterine device, barrier methods (diaphragm, condom, and vaginal contraceptives), injectable contraceptives, postcoital contraception, and methods under current investigation. The approach to each patient must be individualized, based on her coital activity, understanding of alternatives, medical status, and what method is chosen.

Adolescent↗
PubMed1999

Posterior sagittal transanorectal approach in patients with ambiguous genitalia: report of eight cases.

The posterior sagittal transanorectal approach was used for reconstruction of the female genitalia (vaginoplasty) in eight girls with urogenital sinus, high vaginal implantation, and normal rectum, in all cases with a protective sigmoidostomy. These eight patients included four female and four male pseudohermaphrodites. They remain fecally continent, but only seven have urinary continence. One girl has a neuropathic bladder: umbilical discomfort during abdominal straining is present in one patient. One girl married and demonstrated satisfactory sexual intercourse. All patients are alive and healthy, physically and mentally. The transanorectal approach allows separation of the vagina from the urethra and bladder, provides good vaginal mobilization down to the perineum, avoids the utilization of perineal skin flaps and sometimes a laparotomy, and preserves defecation and urinary control. The cosmetic appearance of the genitalia seems to be better than that achieved in the past with other techniques.

Adolescent↗
PubMed2002

[Treatment of vestibular fistulas in older girls].

The vestibular fistula is the anorectal malformation more frequent in females. In this congenital anomaly the anus is located in the vaginal vestibule, having the rectum a common wall with the vagina. With the posterior sagittal approach described by Alberto Peña it changes the treatment of this anorectal malformation, contributing to the possibility of an aesthetic and functional improvement. From 1996 we have operated on 6 girls with ages included between 6 and 22 years (mean of 11 years) that presented a vestibular fistula. Five cases had been operated on in the neonatal period of vestibular fistula carrying out "cut-back", and a case had been operated on for cloaca syndrome. It was carried out in all of them, posterior sagittal approach disecting the rectum, separating it from the vagina and placing it in the sphincter. In a case a colostomy was carried out and in the other five were carried out intestinal cleaning, maintaining absolute diet and postoperative total parenteral nutrition. The evolution has been favorable in all the cases. the functionality of the neo-anus in terms of continence is absolutely normal, presenting an excellent aesthetic aspect. We believe that the posterior sagittal approach is suitable as surgical treatment of the vestibular fistula. The aesthetic improvement and the satisfaction of our patients motivates us to the realization of this technique that also allows us to correct in only one surgical act associated vaginal malformations.

Abnormalities, Multiple↗
PubMed2006

Conservative management of a bleeding renal angiomyolipoma in pregnancy.

BACKGROUND: Bleeding angiomyolipomas in pregnancy are rare but may be devastating and potentially fatal. In previous cases, most of these lesions have been managed with urgent nephrectomy or embolization. Only one other case report describes treating these lesions through conservative management and vaginal delivery. CASE: A 32-year-old woman with known bilateral angiomyolipomas presented at 39 weeks of gestation with acute onset left flank pain. The ultrasound result was consistent with a bleeding angiomyolipoma. The patient was otherwise hemodynamically stable and was managed safely in a conservative outpatient approach that consisted of close clinic follow-up, serial hemoglobins, ultrasound studies, and vaginal delivery. CONCLUSION: Bleeding angiomyolipomas in pregnancy were managed successfully through conservative management and vaginal delivery.

Adult↗
PubMed1994

Introduction of laparoscopically assisted vaginal hysterectomy in a private teaching community hospital.

STUDY OBJECTIVE: To compare laparoscopically assisted vaginal hysterectomy (LAVH) with traditional total abdominal hysterectomy (TAH) when the laparoscopic approach is introduced into a private hospital. DESIGN: During 1 year, 49 LAVHs were performed and compared with 51 consecutive TAHs using retrospective chart review and statistical analysis. SETTING: A private, university-affiliated, teaching hospital. PATIENTS: All patients undergoing LAVH, and the first 51 TAHs performed during the study year. MEASUREMENTS AND MAIN RESULTS: No major complications occurred in either group. Significant differences were observed in uterine weight (161 +/- 92 g vs 331 +/- 354 g), operating time (164 +/- 48 min vs 108 +/- 28 min), and hospital stay (2.93 +/- 1.21 days vs 4.00 +/- 1.54 days) for LAVH and TAH, respectively. Hospital charges for LAVH average $4074 more than for TAH, primarily due to the use of disposable laparoscopic equipment. CONCLUSIONS: Laparoscopically assisted vaginal hysterectomy may be performed safely in a private community hospital with appropriate surgeon credentialing and training. Modifying techniques to minimize the use of disposable equipment would make the procedure more cost effective.

Adult↗
PubMed2002

Simplified artificial endometrial preparation, using oral estradiol and novel vaginal progesterone tablets: a prospective randomized study.

There are various successful protocols for artificial endometrial preparation, comprising induction of endometrial proliferation with estrogens and secretory transformation with progestins. The aim of this prospective randomized study was to evaluate a simplified approach for endometrial preparation, comparing two constant doses of oral estradiol combined with a novel low-dose vaginal natural progesterone preparation (100 mg Endometrin tablets). Twenty-nine patients were enrolled in the study and divided randomly into two groups. Both groups received oral estradiol tablets from the beginning of menstruation, group A (15 patients) receiving 4 mg/day divided into two doses of 2 mg each, and group B (14 patients) receiving 6 mg/day divided into three doses. Serum estradiol and progesterone and sonographic thickness of the endometrium were measured on the 1st day of menstruation and on the 6th, 11th, 16th and 21st days of the artificial cycle. Following the first 12 days of estradiol priming, with an endometrial thickness of > or = 8 mm, Endometrin vaginal tablets 100 mg were added twice a day for 10 days. On the 21st cycle day, an endometrial biopsy was taken from all patients using Pipelle. In all 29 patients, appropriate changes in estradiol, progesterone and endometrial thickness were observed. Estradiol levels were significantly higher in the 6 mg/day group on days 6 and 11, but no significant difference was noted in serum progesterone level and endometrial thickess between groups. Histological evaluation of endometrial biopsies, on the 21st day, revealed adequate late-secretory endometrium in 14/15 (93.3%) patients of group A and in 13/14 (92.9%) patients of group B. In conclusion, our results demonstrate that an appropriate endometrial secretory transformation may be induced using an economical regimen of fixed low-dose oral estradiol (4 mg/day) and low-dose vaginal progesterone tablets (Endometrin 100 mg twice daily).

Administration, Intravaginal↗
PubMed2002

Transvaginal extraction of the laparoscopically removed spleen.

Laparoscopic removal of normal and moderately enlarged spleens has become the gold standard operation in recent years because its short operative time, technical safety, and quick patient recovery time. The best method for extraction of the removed spleen, however, has not yet been determined. The authors present a new method for the extraction of the laparoscopically removed spleen. Using a transvaginal approach, the organ is removed through an incision on the posterior vaginal wall and exteriorized in a laparobag. The procedure is similar to a routine vaginal hysterectomy, but is technically much simpler to perform.

Cholecystectomy, Laparoscopic↗
PubMed1994

Endometrial hyperplasia: efficacy of a new treatment with a vaginal cream containing natural micronized progesterone.

Seventy-eight premenopausal women affected by benign endometrial hyperplasia (60 simple and 18 complex) were treated from the 10th to the 25th day of the menstrual cycle with a vaginal cream containing 100 mg of natural micronized progesterone in polyethylene glycol base. The treatment lasted 3 months in 58 patients and 6 in the other 16 patients. Four patients were lost from the study. We observed a total of 67 complete regressions (90.5%) of which 58 (78.3%) occurred in the first 3 months and 9 (11.5%) after 6 months of treatment. Simple hyperplasia showed a significantly higher response to treatment in comparison with the complex type (P < 0.001). The most frequent endometrial pattern detected in the patients in whom hyperplasia regressed was of a secretive type. Recurrence of hyperplasia occurred in 1 out of 58 (1.72%) patients at the 3rd month and in 3 out of 49 (6.1%) patients at the 6th month after treatment. There were no significant differences between the two hystological groups in the percentage of recurrence. During treatment we observed a significant reduction of the amount, duration and frequency of the menstrual bleeding. Minimal side-effects were observed. In conclusion, for its effectiveness and safety, vaginal administration of natural micronized progesterone seems to be an interesting approach to benign endometrial hyperplasia, particularly indicated in women also affected by metabolic disorders.

Administration, Intravaginal↗
PubMed2006

[Rhabdomyosarcoma of the genitourinary sinus in children].

Genitourinary rhabdomyosarcoma (RMS) accounts for approximately 25% of all rhabdomyosarcomas. Management of RMS at this site has changed during the last 5 consecutive Intergroup Rhabdomyosarcoma (IRS) trials, with increasing emphasis of bladder and vaginal conservation. As more effective treatment regimens has improved survival, surgical approaches have evolved to less aggressive management of the primary tumour to improve conservation. Various combinations of chemotherapy, irradiation and surgery have resulted in a decreased late sequelae in the group of patients with sarcoma arising in the genitourinary tract.

Child↗
PubMed2006

Health technology assessment of surgical therapies for benign gynaecological disease.

This chapter summarises the evidence of the benefits and harm of surgical therapies for benign gynaecological disease. We have limited the discussion in this chapter to three gynaecological conditions - menorrhagia, endometriosis and benign ovarian tumours - with a further section on the different surgical approaches for performing a hysterectomy for menorrhagia due to dysfunctional uterine bleeding and pelvic masses such as fibroids and benign adnexal masses. The currently available evidence suggests that there is little to choose between the four first-generation endometrial destruction techniques - laser ablation, transcervical resection of endometrium, vaporisation ablation and rollerball ablation - in terms of clinical efficacy and patient satisfaction. There is a paucity of evidence with regards to the comparison of the different second-generation endometrial-destruction techniques but current evidence suggests that bipolar radiofrequency ablation is more effective than thermal balloon ablation for treating menorrhagia. Overall, the second-generation techniques are at least as effective as first-generation methods but are easier to perform and can be done under local rather than general anaesthesia in some circumstances. Hysteroscopic endometrial ablation is an alternative to hysterectomy and should be offered to women with menorrhagia because of its high satisfaction rates, shorter operation time, shorter hospital stay, earlier recovery and reduced postoperative complications; hysterectomy remains the surgical option of choice for women with intractable menorrhagia despite repeated endometrial ablations and for those who do not wish under any circumstances to continue to have menstrual bleeding. The combined use of laparoscopic laser ablation, adhesiolysis and uterine nerve ablation has been shown to have a beneficial effect on pelvic pain associated with mild to moderate endometriosis. Current evidence also supports the use of laparoscopic treatment of minimal and mild endometriosis to improve the on-going pregnancy and live birth rate in infertile patients. The current available evidence suggests that the laparoscopic approach is superior to laparotomy for the surgical management of benign ovarian cysts. It results in less postoperative pain and a shorter postoperative hospital stay; it also costs less. With regards to the surgical approach for performing a hysterectomy for menorrhagia and benign pelvic masses, vaginal hysterectomy should be performed over laparoscopic and abdominal hysterectomy when possible. Where it is not possible to perform the hysterectomy vaginally, then laparoscopic hysterectomy can be employed instead of abdominal hysterectomy to avoid a laparotomy scar. There appears to be no significant advantage in performing a subtotal hysterectomy instead of the total removal of the uterine corpus and cervix.

Adnexal Diseases↗
PubMed2000

Measurement of consumer preference for treatments used to induce labour: a willingness-to-pay approach.

AIM: The purpose of the study was to assess the acceptability to consumers of two methods of induction of labour using a willingness-to-pay (WTP) approach. The methods compared were amniotomy plus oxytocin and prostaglandin E2 vaginal gel, followed by oxytocin if necessary. METHODS: A description of each method was presented, in questionnaire format, to pregnant women attending a public hospital ante-natal clinic. Women were asked to choose one of the two treatments, then give a valuation in dollar terms for both their preferred treatment and the alternative. RESULTS: It was found that 73.7% of patients preferred gel. The mean maximum WTP for amniotomy plus oxytocin was Aus$133 while that for gel was Aus$178 (P=0.0001). Those who chose amniotomy plus oxytocin were WTP 90% more for their preferred treatment compared with the alternative (Aus$180 vs. Aus$95). Similarly, those who preferred gel were WTP 90% more for their preferred treatment compared with the alternative (Aus$222 vs. Aus$119). CONCLUSION: Consumers were able to assess drug information provided on the two therapies, make an informed choice and to value that choice. Information obtained in this way, combined with information on costs, could be used in policy decision-making.

Journal Article↗
PubMed1978

Dyspareunia and vaginismus.

Dyspareunia and vaginismus are discussed to present information and a structural concept allowing the gynecologist to evaluate these conditions. The presence of subtle pelvic organic factors is frequently found in dyspareunic women referred for sex therapy by physicians. Thus a need for scrupulous evaluation, including laboratory work and other diagnostic tests, with close attention to the history of the patient is urged. In the remaining dyspareunic women and in those with vaginismus, a psychophysiologic conditioned response is present. Treatment approaches are discussed and the techniques of perineal muscle exercise and vaginal self-dilation are presented in detail. Used appropriately, these techniques produce a very high symptom elimination rate in these female sexual dysfunctions.

Dilatation↗
PubMedDate not supplied

Prenatal diagnosis of a lethal multiple pterygium syndrome type II. Case report.

Advances in ultrasound technology and sonographer's experience lead to the description of many rare syndromes and malformations through prenatal diagnosis. Diaphragmatic hernia is a rather common malformation but can be an indicator of different syndromes. We report the prenatal diagnosis of lethal multiple pterygium syndrome type II which has been established in the 34th week of pregnancy. The sonographically detectable symptoms consisted of polyhydramnios, hygroma colli, diaphragmatic hernia, scoliosis, short forearms, hypokinesia of the fetus and pterygia over the large joints. Labour was induced in the 34th week of pregnancy; the neonate died shortly after vaginal delivery as a result of the pulmonary hypoplasia. A multidisciplinary approach in prenatal assessment may help to clarify difficult diagnostic problems and may be of direct benefit for the pregnant patient.

Abnormalities, Multiple↗
PubMed2006

[Transobturator tapes: better than TVT?].

Suburethral slings (or tapes) placed by a transobturator approach may be an alternative to established retropubic tension-free vaginal tapes. Comparisons are hampered by the number of available systems. Injury of the bladder, bowel and major vessels appears less frequent with transobturator systems whereas vaginal tape erosion and infectious complications appear to be more common. Results of adequately powered randomized trials are not yet available.

Female↗