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PubMed1991

Clinical approach to vaginal/vestibular masses in the bitch.

The most common causes of vaginal/vestibular masses in the bitch are vaginal prolapse, vaginal neoplasia, and urethral neoplasia protruding into the vaginal vault. Other possible causes are clitoral enlargement, vaginal polyps, uterine prolapse, and vaginal abscessation or hematoma. Vaginal prolapse usually can be distinguished from neoplasia by the age of the patient, the time of occurrence during the estrous cycle, and the site of origin of the mass. Prolapse usually occurs in bitches under 4 years of age during proestrus, estrus, or at the end of diestrus and usually arises from the floor of the vagina, except for urethral tumors that protrude from the external urethral orifice. Appropriate diagnostic workup of bitches with vaginal vestibular masses includes complete history and physical examination, vaginal cytologic and vaginoscopic examination, retrograde vaginography or urethrocystography, serum progesterone and estradiol concentrations, and, in the case of suspect neoplasms, surgical or excision biopsy of the mass.

Animals↗

PubMed2003

Management of surgically hypogonadal patients unable to take sex hormone replacement therapy.

Lifestyle changes in diet, exercise and the environment may help to prevent or ameliorate hot flashes and low bone density in men and women after surgical castration. Conventional medications, including megestrol acetate, SSRIs or clonidine, may improve hot flashes but may have limiting side effects. Some complementary and alternative approaches, including black cohosh, vitamin E, and soy products, work as well as placebo to decrease hot flashes and may be helpful, because they have low toxicity. Acupuncture and neurontin are promising but must be studied further. With regards to the prevention of osteoporosis and fractures in men and women, bisphosphonates are the most potent of the currently available agents; calcitonin is less effective. PTH has a large beneficial effect but is not yet available and is less well studied. In women, continued sexual intercourse and use of vaginal lubricants and moisturizers help to minimize symptoms of vaginal atrophy but do not ameliorate urinary symptoms. Low dose local estrogen treatment is a promising approach for the latter complaints.

Contraindications↗

PubMed1998

Validation of national algorithms for the diagnosis of sexually transmitted diseases in Brazil: results from a multicentre study.

OBJECTIVE: To validate STD flow charts for the management of genital discharge and genital ulcer currently recommended by the National STD Control Programme in Brazil. METHODS: A study was conducted in five Brazilian STD clinics from January to June 1995. After an interview, a clinical examination was performed by a physician, who recorded a presumptive diagnosis, based on his/her clinical experience. This diagnosis was compared with a gold standard laboratory diagnosis in order to calculate sensitivity, specificity, and positive predictive value of the clinical diagnosis. The validity of the simulated national flow charts was assessed using the same method. RESULTS: A total of 607 men and 348 women participated in the study. Gonorrhoea was the aetiology most frequently detected in men with urethral discharge. The sensitivity of the clinical diagnosis was far lower than the sensitivity fo the national flow chart, using the syndromic approach, for both gonococcal and chlamydial urethritis. Adding a simple laboratory test (Gram stain) to the national flow chart increased the specificity and positive predictive value for gonorrhoea. Among the women with vaginal discharge, a cervical infection was detected in 17%, a vaginal infection in 74%, and mixed infection in 9%. The sensitivity of the diagnosis for cervical infection increased from 16% (clinical aetiological approach) to 54% (when adding a syndromic approach) and to 68% when adding a risk assessment, as in the national flow charts. The cure or improved rate of genital ulcers was 96% after 1 week. CONCLUSIONS: The results of the study will help to convince policy makers and those involved in training healthcare workers in Brazil of the public health advantages of the syndromic approach, as an essential part of STD/HIV control activities.

Adult↗

PubMed1978

A technique for vaginal oophorectomy.

If retention or removal of the postmenopausal ovary is to receive similar attention at vaginal hysterectomy as at abdominal hysterectomy, more consideration must be given to the development of safe and secure techniques for vaginal oophorectomy. Technical problems relating to exposure and accessibility are obviously more pronounced with a transvaginal surgical approach. When salpingo-oophorectomy is surgically inaccessible, oophorectomy may often be performed. A stitch embodying a single penetration of the mesovarium is described for suture ligation.

Castration↗

PubMed2001

First trimester abortion with mifepristone and vaginal misoprostol.

This study assessed the efficacy and side effects of first trimester medical abortion using mifepristone and vaginally administered misoprostol. Medical abortion was first introduced in Denmark in December 1997, and the acceptability of this new approach in a Danish population was evaluated. The study included the first 100 women seeking medical abortion. The gestational age was from 33 to 56 days. All received 600 mg mifepristone (RU 486) orally followed 2 days later by vaginally administered misoprostol 400 microg. Success was defined as achieving complete abortion without the need for surgical evacuation. Ninety-three percent achieved a successful medical termination of pregnancy. Side effects were few, and the acceptability was high. Ninety percent of the women would prefer medical abortion in case of a new unwanted pregnancy. The combination of mifepristone and vaginally administrated misoprostol is effective, safe, has few side effects and is well accepted by Danish women.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

Laparoscopic-assisted vaginal vs. abdominal surgery in patients with endometrial cancer stage 1.

BACKGROUND: The development of new diagnostic and surgical methods has brought a differentiated approach to the surgery of endometrial cancer. The aim of this study was to verify the peri- and postoperative differences between laparoscopic and open procedures. METHODS: In the period from January 1995 to August 2001 a total of 86 patients were treated for endometrial cancer stage 1. Of these, 28 patients were treated by laparoscopic-assisted vaginal hysterectomy (LAVH) and bilateral salpingo-oophorectomy (BSO), while 58 patients were treated by total abdominal hysterectomy (TAH) and BSO. The two patient groups were comparable in all aspects. RESULTS: The average hospital stay in the LAVH group was 2.7 days compared to 5.4 days for the TAH group. There were fewer complications in the LAVH group (7%) compared to the laparotomy group (14%). CONCLUSIONS: Laparoscopic-assisted vaginal hysterectomy seems to be acceptable in the treatment of stage 1 endometrial carcinoma.

Adult↗

PubMed1995

[Malignant vulvo-vaginal melanoma. Review of the literature and a clinical case].

Vaginal melanoma is a quite rare pathology and represent the 2.6% of overall primitive vaginal tumors. The development of this disease is very aggressive and the 5 years survival is only the 7%. A radical surgical effort seems not improve the survival than a wide local exision. The authors give in this article a wide review of the literature about the vaginal melanoma and the personal observation. We believe that despite the unfrequency of this disease, it could be always taken in mind on the clinical approach with aged women.

Age Factors↗

PubMed2004

The tensile strength of Cooper's ligament suturing: comparison of abdominal and transvaginal techniques.

This study was designed to compare the strength and position of sutures anchored into Cooper's ligament utilizing a minimally invasive transvaginal suturing technique, versus the 'open' abdominal approach. In 12 fresh cadavers, Cooper's ligament was accessed via abdominal and vaginal incisions. After randomization, polytetrafluoroethylene (00) sutures were spaced along one ligament with the transvaginal device (n=36). Contralaterally, sutures were placed abdominally (n=36). Progressive load was applied until suture breakage or dislodgement, and tensile strength was measured using a digital tensiometer. Peak tension averaged 14.5 psi for abdominal and 12.96 psi for vaginal (p=0.28). Suture breakage rather than ligament 'pullout' was more likely for abdominal (95 vs. 56%, p=0.0001). Vaginal and abdominal sutures demonstrated nearly identical mean distances from mid-symphysis (4.62 vs. 4.24 cm, p=0.56). Peak tension was not correlated with suture location (r2=0.17, p=0.28). We conclude that transvaginal suturing, using the minimally invasive device, achieved similar tensile strength and position to the open technique. Transvaginal sutures were associated with greater likelihood of ligament 'pullout' before suture breakage under maximal load; however, the clinical implications of this finding are uncertain.

Abdomen↗

PubMed1996

Sacrospinous ligament fixation by palpation: variation of the Richter procedure.

OBJECTIVE: To present our method of sacro-spinous ligament fixation by palpation and compare it to the classical approach described by Richter. MATERIAL: In addition to the standard instruments needed for vaginal surgery, we use a Rasemond dissector, a small O'Shaugnessy dissector with smooth branches. We also use a Bengolea forceps and a monothread-nylon (Ethilon), decimal 4 suture loaded on a needle with a 30-mm curve. PATIENTS: Twenty patients underwent this procedure from 03/15/1978 to 05/19/1995. Their ages ranged from 46 to 86 years with a mean age of 64.7 years. METHOD: This was a retrospective study of the indications, results and complications associated with this technique. RESULTS: With an average follow-up of 7 years, we observed 90% success, 10% recurrences, and no complication directly attributable to this technique. This technique is valuable because of its effectiveness and simplicity. CONCLUSIONS: Sacrospinous fixation by palpation is more simple and provides the same results as the classic exposure technique. We describe the technique in this text. The efficacy of sacro-spinous ligament fixation by palpation would be improved by its systematic and bilateral use. Its value must be confirmed by a controlled prospective study to confirm our impression that our technique carries fewer risks.

Aged↗

PubMed1995

Comparison of high dose-rate and low dose-rate dose distributions for vaginal cylinders.

PURPOSE: The identification of appropriate high dose-rate parameters required to produce a "uniform" dose distribution on the surface of a vaginal cylinder. The high dose-rate dose distribution is then compared to the traditional low dose-rate dose distributions obtained with Burnett cylinders. METHODS AND MATERIALS: Dose distributions were calculated for 2, 3, and 3.5 cm diameter Burnett cylinders with and without crossing sources. Three models for the high dose-rate cylinders were developed and compared. High dose-rate dose distributions were calculated for 2, 3, and 3.5 cm diameter cylinders with and without anisotropic corrections for various dose specification points. RESULTS: Low dose-rate distributions are not uniform over the surface of the applicator. The exact distribution depends upon cylinder diameter and upon the exact source loading. High dose rate dose distributions can be configured to provide for a "uniform" dose on the surface, if an apex dose specification point is used together with dose specification points on the surface of the applicator opposite each dwell position. CONCLUSIONS: The conversion of low dose rate techniques to high dose rate techniques for vaginal cylinders involves an appreciation of the details of dose distributions of both approaches. The comparison between traditional low dose-rate distributions and high dose-rate distributions shows that, unlike the low dose-rate distributions, a relatively uniform high dose-rate distribution can be obtained independent of cylinder diameter. The clinical significance of the differences in the low dose-rate and high dose-rate dose distributions remains to be determined by long-term follow up of patients treated with high dose-rate techniques.

Carcinoma↗

PubMed2004

Predictive value of the clinical diagnosis of lower genital tract infection in women.

OBJECTIVE: We hypothesized that diagnostic approaches to lower genital tract infections are inaccurate and proposed this study to evaluate typical approaches. STUDY DESIGN: Clinical diagnoses were made with symptoms, direct observation, wet mount, vaginal pH, and amines in 598 women with genital complaints. Laboratory testing for N gonorrhoeae, yeast, T vaginalis, C trachomatis, and bacterial vaginosis by Gram stain. RESULTS: The most frequent symptoms were vaginal discharge (64%), change in discharge (53%), malodor (48%), and pruritus (32%). The infection rates were 46% bacterial vaginosis, 29% yeast, 12% trichomoniasis, 11% chlamydia or gonorrhea; 21% of the patients had no infection. The symptoms did not predict laboratory diagnosis. Clinical signs and symptoms with office-based tests and microscopy improved the accuracy of diagnoses. Amsel's clinical diagnosis of bacterial vaginosis was the most sensitive at 92%. The sensitivity of wet mount diagnosis of trichomoniasis was 62%, of yeast by microscopy was 22%, and of mucopus for the prediction of gonorrhea and/or chlamydia was 30%. CONCLUSION: Symptoms alone should not be used to direct treatment in instances in which resources permit more complete evaluation with office-based testing that includes microscopy. Treatment failures or diagnostic uncertainty should prompt specific laboratory testing.

Adolescent↗

PubMed2005

Urological surgical techniques.

Urinary tract injuries during gynaecological surgery are increasing with the advent of more complex and laparoscopic techniques; ureteric and bladder injuries are the most common. Adequate knowledge of the anatomy will help avoid some problems, but prompt recognition during surgery offers the best chance of treatment without long-term compromise. When the problems are not recognised during surgery, various techniques can be used to effect repair. Surgery for stress incontinence has undergone many changes in technique in recent years. Any procedure needs to combine a low morbidity with high long-term success rates. Colposuspension has been the 'gold standard' for many years, against which other techniques are judged. A laparoscopic approach has reduced hospital stay, although with increased morbidity. The tension-free vaginal tape technique is now widely employed as the first-line procedure. It is a relatively easy technique to learn, with a good success rate and low morbidity; long-term results are still awaited. This chapter deals with two aspects of urogynaecological surgery. The first section reviews urinary tract injuries occurring during gynaecological surgery. In the second section we look at recent developments in surgery for urinary stress incontinence.

Female↗

PubMed2000

Clinical management and prevention of sexually transmitted diseases: a review focusing on women.

This review highlights some of the difficulties inherent in controlling sexually transmitted diseases (STDs) in developing countries--especially amongst women. Considerable efforts have been made to improve the syndromic approach to STD management but the poor performance of the algorithm for managing vaginal discharge limits the effectiveness of this strategy. The facilitating role of the human immunodeficiency virus (HIV) has been the main impetus to STD control rather than reduction of morbidity in women, especially pregnant women and their children. There are no easy solutions--but action on several fronts, with more attention to core groups, men and adolescents is indicated.

Developing Countries↗

PubMed1999

Resectoscopic treatment of uterus didelphys with unilateral imperforate vagina complicated by hematocolpos and hematometra: case report.

OBJECTIVE: To describe a technique for treating hematocolpos and hematometra in patients with uterus didelphys and unilateral imperforate vagina involving the use of resectoscopy under ultrasonographic control. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 13-year-old girl with uterus didelphys with unilateral hematometra, hematocolpos, and ipsilateral renal agenesis. The girl complained of severe abdominal pain, which appeared with each of her menses. INTERVENTION(S): The intervention was performed by a vaginoscopic approach to preserve the integrity of the hymen. The first incision on the vaginal wall was performed in correspondence with the hematocolpos under continuous ultrasonographic guidance with the use of a straight resectoscopic loop. Resection of the vaginal septum was continued with the use of an angled resectoscopic loop until almost complete excision of the septum was achieved. MAIN OUTCOME MEASURE(S): Clinical, echographic, and vaginoscopic findings before the operation and 2 and 6 months after the operation. RESULT(S): The surgical procedure was easy to perform. Almost complete excision of the septum was achieved with just a few passages of the resectoscope. Complete drainage of both the hematocolpos and the hematometra was confirmed by ultrasonography. The postoperative period was completely uneventful. Clinical and vaginoscopic evaluations 6 months after the operation confirmed the integrity of the hymen, the complete resolution of clinical symptoms, and the persistence of a large communication between the two vaginas. CONCLUSION(S): Resectoscopic excision under ultrasonographic guidance of the vaginal septum in a girl with uterus didelphys with unilateral hematometra and hematocolpos was effective and easy to perform, and it fully respected the integrity of the reproductive system.

Adolescent↗

PubMed1987

Posterior sagittal exposure for reconstructive surgery for cloacal anomalies.

We treated seven girls with a cloacal anomaly through a posterior sagittal exposure. Six patients, aged 5 months to 2 1/2 years, underwent a primary reconstructive operation with urethroplasty, vaginoplasty, and posterior sagittal anorectoplasty as a single procedure. All had undergone diverting sigmoid colostomies as newborns, four had previous vesicostomies, and one had a vaginostomy. The seventh girl, a 9-year-old, had undergone a number of attempts at reconstruction. All underwent endoscopy and contrast studies of the cloaca before definitive reconstruction. This preoperative evaluation gave necessary information regarding the length and caliber of the cloacal channel and the level of confluence of the urinary, genital, and intestinal tracts. However, major decisions regarding reconstruction were often possible only in the operating room. To construct a neoanus with optimal sphincteric control, all seven underwent posterior sagittal anorectoplasty. Two required laparotomies to mobilize additional colonic length. Three developed urethrovaginal fistulae after repair. Critical decisions regarding urethral and vaginal reconstruction depend on the findings at cystoscopy and operation. The posterior sagittal approach gives excellent exposure for these decisions and the subsequent reconstruction of three functioning perineal orifices.

Child↗

PubMed2000

Laparoscopic paravaginal repair plus burch colposuspension: review and descriptive technique.

The objective of this article was to review the available literature on laparoscopic Burch urethropexy cure rates and describe the authors' laparoscopic technique and experience with Burch urethropexy and paravaginal repair. A MEDLINE search (1991 to 1999) was performed for articles describing the laparoscopic Burch urethropexy using suture to elevate and stabilize the paraurethral tissue. Also a retrospective chart review of the authors' 171 consecutive patients between January 1997 and December 1999 was done. The laparoscopic Burch urethropexy and paravaginal repair is described using an open laparoscopic technique with 3 accessory ports for access. A transperitoneal approach is taken to gain access to the space of Retzius. The anterior vaginal wall and its paravaginal defects, if present, are identified. Nonabsorbable sutures are placed in a conventional fashion. The paravaginal repair is used for support of the anterior vaginal wall proximal to the urethral vesical junction and the Burch urethropexy distal to the vesical neck. An average of 6 sutures are used for the paravaginal repair and 4 sutures for the Burch urethropexy. Cystoscopy is performed to ensure no breech of lower urinary tract integrity. In all, 20 articles describing a laparoscopic Burch urethropexy and postoperative cure rate were identified. Cure rates ranged from 69% to 100%. A review of our experience revealed 130 of 171 patients had a Burch urethropexy and paravaginal repair, 23 of 171 patients a Burch urethropexy alone, and 18 of 171 patients a paravaginal repair alone. Of the authors' 171 patients, 4 (2.3%) had injury to the lower urinary tract during laparoscopic Burch urethropexy or paravaginal repair. All 4 injuries were cystotomies, 2 in patients with previous open retropubic urethropexies. No ureteral ligations or intravesical placement of suture was diagnosed. Other surgical parameters for the laparoscopic Burch uethropexy and paravaginal repair include an estimated blood loss of 50 mL, average hospital stay of less than 23 hours, and an average operative time of 70 minutes. All patients had their surgery completed via laparoscopy. The literature review and our personal experience suggests that the laparoscopic Burch urethropexy and paravaginal repair are safe and effective alternatives to traditional laparotomy for the treatment of genuine anatomic stress urine incontinence and cystourethrocele resulting from lateral vaginal wall defects.

Female↗

PubMed1999

Successful non-surgical management of a heterotopic abdominal pregnancy following embryo transfer with cryopreserved-thawed embryos.

Heterotopic pregnancy is an increasingly common complication of assisted reproductive technology. Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy that can present as the extrauterine portion of a heterotopic pregnancy. We present the case of a cryopreserved-thawed embryo transfer that resulted in a simultaneous intrauterine and abdominal pregnancy first recognized at 10 weeks gestation. Ultrasound-guided transvaginal injection of potassium chloride into the abdominal pregnancy resulted in asystole and spontaneous resorption of the ectopic fetus, while the intrauterine pregnancy continued and resulted in a liveborn vaginal delivery at full term. Selective embryo reduction using a non-surgical approach in a haemodynamically stable patient can therefore be considered in the management of heterotopic abdominal pregnancy if diagnosed relatively early.

Adult↗

PubMed1996

Dysfunctional uterine bleeding in adolescents.

Dysfunctional uterine bleeding (DUB) is a common presenting problem for adolescents. New data have emerged on the frequency of the pathologic causes for menorrhagia and the potential to use new therapies such as gonadotropin-releasing hormone analogues. DUB is defined as abnormal vaginal bleeding without an identifiable pathologic condition. In adolescents, DUB is most often due to the anovulatory cycles that result from an immature hypothalamic-pituitary-ovarian axis. Although most adolescents will develop normal, regular menstrual cycles, a significant number may require gynecologic follow-up for persistent abnormal vaginal bleeding. Thus, optimal management of DUB requires a systematic diagnosis and therapeutic approach. This article reviews the pathophysiology, diagnostic evaluation, treatment options, and outcome of DUB in adolescents.

Adolescent↗