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At least 127 records · Page 7Linked to original sources
PubMed2000

Nontrichomonal Purulent Vaginitis: Clinical Approach.

Although trichomonal vaginitis and cervicitis are responsible for most presentations of a frankly purulent vaginal discharge, nontrichomonal vaginitis and purulent exudate are being seen in an increasing number of cases. Purulent vaginitis remains poorly defined and largely ignored, with little increase in the amount of knowledge we have of this not infrequent entity. Accordingly, a variety of empirical therapies, often including multiple simultaneous measures, are prescribed. Considerable numbers of causes are now identified, and this review describes a step-by-step approach to diagnosis and management.

Journal Article↗
PubMed2000

Anterior approach bilateral sacrospinous ligament fixation for vaginal vault prolapse.

The sacrospinous ligament fixation (SSLF) was first described as a unilateral fixation; however, bilateral fixation, when possible, allows a symmetrical vaginal reconstruction and provides additional vaginal vault support. We evaluated the outcome of treating total vault prolapse using a bilateral SSLF through an anterior vaginal approach. From July 1996 to July 1999, 28 patients (mean age 67) underwent bilateral SSLF procedures through an anterior vaginal approach. All patients had either grade 3 or 4 vault prolapse, and all patients had associated enteroceles, cystoceles, and rectoceles. All patients underwent fluorourodynamic evaluation including an abdominal leak point pressure (ALPP) with reduction of the vaginal prolapse. A pubovaginal sling was performed in 25 patients and all 28 patients underwent an anterior colporrhaphy, rectocele, and enterocele repair. A vaginal paravaginal repair was performed in 22 cases. At a mean follow-up of 17 months (range 5 to 35), 27 of 28 patients were cured, 1 patient had an asymptomatic unilateral grade 1 vault prolapse, 2 patients had developed small asymptomatic cystoceles and there had been no recurrence of rectoceles or enteroceles. Stress incontinence had been cured in all patients; however, 2 patients continued to have mild urge incontinence requiring <1 pad per day. Two patients complained of transient gluteal pain. We believe the anterior approach bilateral SSLF is a safe procedure with excellent medium term results in women with grade 3 to 4 vaginal prolapse.

Aged↗
PubMed1982

Urethrovaginal and vesicovaginal fistula. A review of 29 patients.

During an 11-year period 29 women were treated for 6 urethrovaginal and 24 vesicovaginal fistulae. In all patients the urethrovaginal fistula was preceded by an operation for a benign lesion. Of the 24 patients with vesicovaginal fistulae 11 had a benign and 13 a malignant primary disease. Endoscopy, vaginal examination and IVP provided in most cases sufficient information with which to establish a diagnosis. The urethrovaginal fistulae were operated on either by a vaginal approach (3 patients); two recurrences occurred but healed after reoperation. Of the 24 patients with vesicovaginal fistulae, 14 underwent a combined operation usually including omentum interposition, while 10 underwent primary diversion. Primary cure ensued after 9 of 14 combined operations; recurrences were operated on by a combined approach in 2 patients, vaginal in one and with fibrin occlusion in one. Eight of the 10 patients who underwent urinary diversion had a malignant disease. A vaginal approach in recommended at the primary reconstruction of urethrovaginal fistulae, whereas a combined suprapubic and vaginal approach is recommended in vesicovaginal fistulae as well as in recurrent urethrovaginal fistulae.

Adult↗
PubMed1982

Experience with a laterally based vaginal flap approach for urethral diverticulum.

We found 15 cases of urethral diverticula in female patients who were evaluated for recurrent urinary tract infection. A voiding cystourethrogram was the most useful investigative technique. All cases were managed by a vaginal approach, using a laterally based flap incision. There were no complications with this easily learned technique, which makes full exposure of the diverticulum easy and covers the urethral defect with intact vaginal wall. Using this technique we have had no delayed healing, fistula formation or incontinence. A history of gonorrhea may have an etiologic role in acquired diverticula.

Adult↗
PubMed2005

Bilateral iliococcygeal fixation for vaginal vault prolapse and enterocele repair using a new suturing device--the digital needle driver.

The objective of our study was to evaluate the surgical feasibility, efficacy and safety of the digital needle driver (DND 202), a modified, flexible surgical device, during iliococcygeal fixation (ICF) for vaginal vault prolapse and enterocele repair. A prospective longitudinal study was carried out among 21 consecutive patients who underwent bilateral iliococcygeal fixation at St George's Hospital, London. All patients filled a comprehensive questionnaire for pre- and post-operative prolapse, urinary, bowel and sexual symptoms and underwent pre- and post-operative site-specific vaginal examination, following the standardized International Continence Society scoring for prolapse, pre-operative urodynamic studies and analysis of the surgical results. The outcome measures were the feasibility of the procedure, the time needed, intra- and post-operative complications, short-term post-operative prolapse-associated symptoms and pelvic organ prolapse quantification. The mean age of the patients was 65 [5] years and the mean body mass index (kg/m(2)) was 23 [2.7]. In addition to ICF, 8 patients underwent vaginal hysterectomy, 18 had posterior repairs, 7 had anterior repairs and 6 had TVT. The mean time for ICF was 20 [11] minutes, the mean blood loss per surgical procedure was 264 [225] mL and the mean hospitalization time was 4.6 [1.2] days. Postoperatively, one patient had mesh erosion. At short-term post-operative evaluation none of the patient had prolapse symptoms. There was a statistically significant improvement in all stages of the apical and posterior walls prolapse (p < 0.001). The mean total vaginal length was significantly shorter postoperatively (7.8 [1.0] cm vs 6.6 [1.4] cm, p < 0.001). Thus, we can conclude that the use of DND device may facilitate the vaginal approach for vaginal vault prolapse and enterocele repair.

Aged↗
PubMed1988

[Technic of percutaneous anterior colpopexy under endoscopic control for orthostatic and urinary stress incontinence in women (Stamey's operation)].

Percutaneous anterior colpopexy, as described by Stamey, constitutes a simple, reliable method for treatment of orthostatic and stress incontinence of urine in women. As with all operations destined to correct this infirmity, its aim is to replace the bladder neck and initial part of urethra into spaces subject to pelvic pressure. The principle of the operation consists of solidly attaching the whole thickness of particularly the para-cervicourethral vagina fibrous layer to the anterior abdominal wall by means of two solid monofilament threads of caliber 2, scissoring on the threads being prevented by insertion of a 1 X 0.5 cm vascular prosthesis. The operation mainly involves a vaginal approach: the vaginal incision in T exposing the bladder neck. Two abdominal incisions 2 cm in length and avoiding the aponeurosis are made 1 cm above the pubis from one side of the median line to the other. These allow Stamey's needles to be passed behind the symphysis up to the vaginal incision under endoscopic control. Cystoscopy is an essential part of surgery since it allows verification of good positioning of thread exactly at the bladder neck level and of the quality of the hyperelevation of posterior lip of bladder neck obtained. As effective as other retropubic anterior colpopexies, this procedure under endoscopic control has the major advantage of avoiding opening of Retzius space, with its inevitable morbidity, and of being possible without difficulty in previously operated patients. It should undoubtedly be included in the therapeutic armament used for this frequent infirmity.

Cystoscopy↗
PubMed1999

The new techniques of gynaecologic laparoscopy. Gasless, open Hasson, optic trocar.

BACKGROUND: New techniques of laparoscopy: gasless, open Hasson, optic trocars allow to avoid the risks of vessel and bowel injuries. The objective of this study was to evaluate the capability of a retractor system as an alternative to conventional technique without pneumoperitoneum and to assess if the system facilitates the use of conventional surgical instruments during gynaecological surgery. METHODS DESIGN: Prospective evaluation. SETTING: University-affiliated county hospital. PATIENTS: Gasless laparoscopy surgery was performed on 49 patients between December 1995 and July 1996 with a retractor system without pneumoperitoneum consisting of an intrabdominal retractor using conventional surgical and laparoscopic instruments and to enable a simultaneous vaginal approach. RESULTS: Gasless laparoscopy was successful in 44 (90%) of cases. A simultaneous vaginal approach was used in one third of indications including vaginal myomectomy and laparoscopic assisted hysterectomy. Conversion to laparotomy was required in 5% of cases. Mean procedure duration was 90 minutes and mean hospitalisation time was 5.7 days. CONCLUSIONS: The introduction of new techniques of laparoscopy: gasless, open Hasson, optic trocars has broadened the application of operative laparoscopy. Gasless technique in lieu of conventional laparoscopy can be performed reliably and safely for most gynaecological indications. The most outstanding benefit of this method is that it can be combined with a vaginal approach which is not possible using a pneumoperitoneum due to gas leakage. The place of gasless laparoscopy will depend on continuing development by instrument manufacturers, in order to achieve an instrument providing vision as good as that seen with the pneumoperitoneum.

Female↗
PubMed1983

Techniques for surgical repair of vesicovaginal fistulae.

The surgical therapy of vesicovaginal fistulae is discussed on the basis of a surgical material of 15 patients treated over a period of 5 years. The combined, transvesical-vaginal approach was used in 5, the transvesical approach in 3, and the vaginal approach in 3 cases. Ureterosigmoidostomy was performed in 1 case. Spontaneous healing of the fistula ensued in 3 cases. The types of surgery employed are commented upon.

Female↗
PubMedDate not supplied

Laparoscopic assistance after vaginal hysterectomy and unsuccessful access to the ovaries or failed uterine mobilization: changing trends.

OBJECTIVES: We conducted retrospective and prospective clinical studies at the Columbus Hospital of Rome to point out changes in choosing the route for performing hysterectomy; to evaluate the feasibility of vaginal hysterectomy (VH) and oophorectomy, even in commonly considered contraindications to the vaginal route; to describe a method of laparoscopic oophorectomy following vaginal hysterectomy; and laparoscopic assistance in impossible vaginal hysterectomies. METHODS: From November 1999 to November 2001, 226 patients (age 46.1+/-4.6 years, range 35 to 58) underwent hysterectomy for benign pathologies: 22 (9.7%) underwent total laparoscopic hysterectomy for the presence of severe endometriosis, limited access to the fornices, or immobile uterus with no lateral mobilization; 204 (90.3%) underwent vaginal hysterectomy. Patients with uterine prolapse were excluded. Uterine size, previous cesarean deliveries, pelvic surgeries and the requirement of prophylactic oophorectomy were not considered contraindications to the vaginal approach. We retrospectively analyzed 509 hysterectomies performed in the previous 2 years from 1997 through 1998. RESULTS: During vaginal hysterectomy, adnexectomy was possible in 90.6% of the cases in which it was indicated (unilateral in 21.8% because of adnexal pathology) and was technically impossible in 9.3%. In 4 patients (1.9%), it was not possible to complete a vaginal hysterectomy, owing to the presence of thick adhesions obliterating the cul-de-sac, to severe endometriosis, or to other unforeseen circumstances. In these few patients with difficult access to the ovaries (2.9% of all VH) or with difficulties in mobilizing the uterus, we resorted to laparoscopy. The pneumoperitoneum was achieved with an insufflation tube inserted via the vagina into the abdominal cavity and packing the vagina. Thus, the risks associated with the insertion of the Veress needle were avoided. In all but 2 patients in whom conversion to laparotomy was necessary, laparoscopy was successfully completed. No major complications occurred. In the retrospective analysis of 509 hysterectomies, we determined that 29% were vaginal, 43% abdominal, and 28% laparoscopic (mostly LAVH). In the following years, LAVH allowed the conversion of a significant number of abdominal or laparoscopic hysterectomies to a vaginal route, showing that the vaginal approach was possible in most of cases. CONCLUSIONS: The vaginal approach is feasible in more than 90% of cases even if oophorectomy is required. In the few cases with difficult access to ovaries or difficulties in mobilizing the uterus, the laparoscopic route can easily be adapted by packing the vagina and obtaining a pneumoperitoneum without the risk and loss of time of the insertion of the Veress needle. In this way, it is possible to avoid a great number of LAVH, reducing operating time and the risks of a concomitant procedure.

Adult↗
PubMed2006

[Complications of tension-free vaginal tape procedure: a comparison of the vaginal and abdominal approaches].

OBJECTIVES: The objectives of this clinical study is to demonstrate our experience of the abdominal approach (from the abdominal wall to the vagina) for the tension-free vaginal tape (TVT) operation and to identify factors responsible for complications relating to the puncture. MATERIALS AND METHODS: One hundred and fifty-one cases of patients with stress incontinence who underwent the tension-free vaginal tape operation were analyzed. Among them, 75 cases underwent the TVT procedure with the vaginal approach (from the vagina to the abdominal wall) and the remaining 76 cases underwent the TVT procedure with the abdominal approach (from the abdominal wall to the vagina). The TVT procedure with abdominal approach was performed in almost the same manner as described in the guiding booklet provided by Gynecare. Student's t-test was used to detect the differences in ages and operating times between the abdominal and vaginal approach cases. Chi-square test was used to analyze the difference between complication rates of the two procedures. Multivariate logistic regression analysis was used to determine the relationship between complications related to the puncture and such factors as age, concomitant operation for genital organ prolapses, approach routes and past history of intra-pelvic surgery. RESULTS: Differences between the abdominal and vaginal approach cases as regards age of patients and operating time were not significant. Chi-square test showed that the difference between the complication rates of the two procedures was not significant. Complications relating to the puncture consisting of bladder perforation and intra-pelvic hematoma occurred in nine cases in the vaginal approach group. Since an abdominal guide passed very close to the urinary bladder in one case in the abdominal approach group, we counted this as a bladder perforation case. Seven cases out of these ten cases with complications had a past history of intra-pelvic operation. Multivariate logistic regression analysis showed that the risk factors associated with these complications were the vaginal approach procedure [odds ratio (OR) 11.4, 95%confidence interval (CI) 1.4-96.4] and past history of intra-pelvic surgery [OR8.2, 95%CI 1.9-35.5]. CONCLUSION: The difference between the complication rates of the two procedures was not sig- nificant. The vaginal approach puncture and the past history of intra-pelvic surgeries were the risk factors for the complications relating to the puncture.

Abdominal Wall↗
PubMedDate not supplied

A laparoscopic bipolar cutting forceps can assist in a case of difficult vaginal hysterectomy.

A vaginal approach to hysterectomy can become challenging when visualization is limited by poor or absent uterine descent, obesity, or other factors that make an approach to the uterine pedicles difficult. When factors occur that make application or visualization of conventional vaginal instruments difficult, using an instrument designed for laparoscopic application, with its thin, elongated shape, may permit continuation of a vaginal approach. In such a case, a Gyrus bipolar laparoscopic cutting forceps was used for coagulation and transection of the uterine pedicles during a vaginal hysterectomy. This represents a way to expand on traditional techniques for completion of difficult vaginal hysterectomy, which may be used concurrently. Surgical techniques that more easily and safely permit completion of hysterectomy by the vaginal approach can improve outcomes for all.

Arteries↗
PubMed1997

[Vaginal hysterectomy assisted by laparoscopy. Critical and comparative study if vaginal and abdominal hysterectomy at the A.B.C. Hospital of Mexico].

The laparoscopically assisted vaginal hysterectomy offers the possibility to convert abdominal to vaginal approach give to the patient the benefits of ti. The analysis of the first 20 cases in our institution is done and are compared with abdominal and vaginal approaches in some parameters including costs, indications and hospitalization days. The laparoscopically assisted vaginal hysterectomy offers to the patient the benefits of the vaginal approach with hospital stay similar and cost and operative time higher than those for either vaginal and abdominal hysterectomy. The exact role of the laparoscopically assisted vaginal hysterectomy on daily practice still is pending.

Adult↗
PubMed2002

[An epidemiological survey on reproductive track infection and the investigation on syndromic approach on vaginal discharge].

OBJECTIVE: To investigate the reproductive track infection (RTI) situation and risk factors for cervical infection (Neisseria gonorrhoeae or Chlamydia trachomatis) among different kinds of women of childbearing age in Shenzhen city, China. To assess the feasibility of the syndromic approach for vaginal discharge. METHODS: The survey was administrated to 4,744 eligible women in Shenzhen city during October 2001 and April 2002. The subjects included three different kinds of population: 3,895 cases of general population, 438 STD/gynecological clinic outpatients and 411 people with high risk behavior. Gynaecologic examination and RTI laboratory diagnosis were performed for each subject. PCR method-based test was used to detect the Neisseria gonorrhoeae and Chlamydia trachomatis infection. Standardized questionnaire were designed to collect the information about RTI related behaviors, and history of marriage and child bearing, et al. The risk factors, symptoms and signs of cervical infection were analyzed. Syndromic approach was established and its feasibility was assessed. RESULTS: 27.6% of women in Shenzhen were infected with at least one kind of RTI, including 5.0% with cervical infection. The risk factors for cervical infection were: individuals having had new sex partner within last 3 months (OR = 1.6, 95% CI: 1.1 - 2.4), having had the experience of abortion (OR = 1.6, 95% CI: 1.1 - 2.4), aged 25 or less (OR = 1.6, 95% CI: 1.1 - 2.4) and never using condom during sex intercourse (OR = 1.7, 95% CI: 1.1 - 2.4). The sensitivity of syndromic approach of risk assessment and signs for cervical infection among general population was 63.8%, while specificity was 55.1% with the positive predictive value 7.0%. CONCLUSIONS: RTI infection was common among all three kinds of childbearing women in Shenzhen city. The prevalence of RTI was the highest among high risk population, followed by STD/gynecological clinic outpatients. The efficacy of syndromic approach for cervical infection in general population was not ideal.

China↗
PubMed1986

Human seminal antiliquefying agents--a potential approach towards vaginal contraception.

One-hundred-one natural and synthetic enzyme inhibitors or inactivators were screened in vitro against the liquefaction property of human ejaculates with a view to develop antiliquefying agents for vaginal contraception. Of those compounds, 27 demonstrated no effect, 36 quickened and 20 delayed the process of liquefaction, while 18 agents stopped it completely. The highly effective antiliquefying agents also showed spermicidal property and were found to coagulate even the liquid ejaculates. Compounds having antiliquefying property, together with coagulating and spermicidal activities, will offer a highly promising approach towards vaginal contraception.

Contraceptive Agents↗
PubMed2001

Vaginal paravaginal repair: one-year outcomes.

OBJECTIVE: This study was carried out to determine the efficacy and safety of the vaginal approach to paravaginal repair of symptomatic paravaginal defect cystocele. METHODS: This study is an observational case series of 100 consecutive women, referred from December 1996 to August 2000, with symptomatic grade II to IV paravaginal defect cystocele. Preoperative and postoperative pelvic evaluations were performed with the Baden-Walker halfway system. The same surgeon performed all repairs. Fourteen patients had prior anterior repairs, and 530 concomitant procedures were performed. The vaginal approach consisted of a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space, widely exposing the area of the arcus tendineus. A repair was done bilaterally in 95 patients and unilaterally in 5. Between 1 and 6 Gore-tex CV-0 sutures (W. L. Gore and Associates, Inc, Elkton, Md) were placed widely around the arcus tendineus on either side and fixed to appropriate locations on the bladder fascia and anterior vaginal walls. Tying these sutures resulted in dramatic elevation of the lateral superior sulci. Patients were followed up for 1 to 36 months, with a mean of 10.6 months. Criteria for objective cure were defined as the lateral sulci of the anterior vaginal walls being at grade 0 and firmly apposed to the lateral pelvic sidewalls. RESULTS: Of the 100 patients, 34 had grade II, 54 had grade III, and 12 had grade IV paravaginal defect cystocele. Patients were followed up postoperatively for 1 to 36 months: 84 for more than 6 weeks and 55 for 1 year or longer. Our objective cure rate was 98%. Two asymptomatic patients had a unilateral grade I or a bilateral grade II paravaginal defect cystocele. A recurrent midline cystocele occurred in 22 patients between 3 and 11 months after the operation. Twenty-one patients were asymptomatic and one was symptomatic. Twenty-one patients had grade I-II cystocele and one had grade III cystocele. There were 3 major intraoperative hemorrhagic complications; one of the operations was converted to an anterior colporrhaphy. There were a total of 21 major and 14 minor inpatient complications. Twenty-five subsequent complications included various urinary symptoms in 14 patients, long-term lower extremity neuropathy in 2, bloody discharge from intravaginal sutures in 3, absent coital sensation in 1, and recurrent pelvic organ prolapse in 5, all of which included grade III enterocele between 3 and 25 months. CONCLUSIONS: The vaginal approach to the correction of paravaginal defect cystocele is highly effective in our population at a mean of 11 months after the operation. Frequent complications do occur but are largely manageable.

Adult↗
PubMedDate not supplied

Indications for laparoscopic surgery in cases of gynecological malignancies (endometrial cancer).

The role of surgery in the treatment of patients with invasive cervical cancer is undisputed, but how radical surgery should be is debatable. Every case requires detailed knowledge of the development and spread of cervical cancer. Tumor volume is the most important diagnostic factor in cervical cancer and also correlates with vascular invasion and lymph node involvement. As radical hysterectomy requires in cervical cancer besides the laparoscopically easy performable lymphadenectomy also the resection of parametria with sceletonisation of ureters we started to treat endometrial cancer with a combined laparoscopic and vaginal approach. In patients with the suspicion of stage I endometrial cancer prior to laparoscopic staging, the prerequisites of histological grading with ploidy and measurement of monoclonal antibodies were performed. All patients underwent a general check with radiography, computer tomography, liver scan, bone scan and lymphography. The performance of lymphadenectomy in cases of stage I endometrial cancer remains a controversial subject. We believe that laparoscopic assisted surgical staging of stage I endometrial cancer is an attractive alternative to the traditional laparotomy-surgical approach. The change from laparotomy to a laparoscopic assisted vaginal approach allows for a similar success rate with the less invasive approach. No complications occurred in this series and the results of our pilot study were satisfactory.

Aged↗
PubMed2000

Laparoscopically assisted radical vaginal versus radical abdominal hysterectomy type II in patients with cervical cancer.

BACKGROUND: In a retrospective study, we compared a laparoscopic radical vaginal approach with abdominal radical hysterectomy type II for treatment of patients with cervical cancer at International Federation of Gynecology and Obstetrics (FIGO) stages I to III. METHODS: Between January 1991 and March 1994, 70 patients with cervical cancer were treated by radical abdominal hysterectomy, and between August 1994 and May 1999, 70 patients with cervical cancer were treated by laparoscopically assisted radical vaginal hysterectomy. Data from both the abdominal group and the laparoscopic-vaginal group were obtained retrospectively. RESULTS: The mean duration of surgery was significantly longer for the laparoscopic-vaginal approach than for the abdominal approach (292.9 vs 209.9 min). Significantly more pelvic lymph nodes were removed by laparoscopy (27 vs 10.7). Blood loss and transfusion rates were significantly lower in the laparoscopic-vaginal group. Intraoperative complications were seen more often during laparoscopic-vaginal surgery (p < 0.05). Early postoperative complications occurred significantly more frequently after the abdominal approach. The mean duration of hospital stay was significantly shorter for patients treated by laparoscopic-vaginal surgery (11.4 vs 22.8 days). CONCLUSION: Compared with laparotomy, the laparoscopic-vaginal approach for treatment of cervical cancer is associated with lower rates of transfusion and early postoperative morbidity.

Adult↗
PubMed2006

Female urethral and bladder neck injury after rape: an appraisal of the surgical management.

The aim of this study was to discuss the surgical management of urethral and bladder neck injury after urethral coitus during rape. A 21-year-old lady presented with total urinary incontinence of 1-year duration after being raped. On examination, she had urethral laceration and a patulous urethra and bladder neck suggesting urethral coitus during the rape. Her introitus and vagina were however normal. She had repair of her urethral laceration and plication of her urethra and bladder neck via a vaginal approach. She regained her continence and voids without any residual urine. Urethral coitus is rare. Urethral coitus in the presence of a normal introitus and vagina is very rare. The urethral and bladder neck injury resulting from this can be satisfactorily corrected by urethral and bladder neck plication via a vaginal approach with the vaginal incisions positioned to forestall suture line apposition, which may lead to wound failure.

Adult↗