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Results for “Vaginal Approach”

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At least 1,405 records · Page 78Linked to original sources
PubMed2004

Cystocele repair by a synthetic vaginal mesh secured anteriorly through the obturator foramen.

OBJECTIVE: Our aim was to assess the feasibility and short-term results of cystocele repair by the placement of a synthetic subvesical mesh secured anteriorly through the obturator foramen. STUDY DESIGN: Between 1 November 2001 and 31 July 2002, 30 consecutive patients with a grade 2 (n = 18, 60%) or 3 (n =12, 40%) cystocele were prospectively included in the study. RESULTS: The obturator route was feasible in all cases. No intraoperative complications arose. After a mean follow-up of 6.7 months (range: 2-12), 90% (n = 27) of the patients were cystocele grade 0, 7% (n = 2) grade 1 and failure was observed in a young patient (3%) treated without hysterectomy. Two vaginal erosions (7%) were observed at six and nine months. For the 14 patients (47%) who had sexual relations after surgery, 2 (14%) complained of anterior dyspareunia. CONCLUSION: The obturator approach is a simple and sure technique for placing a polypropylene synthetic subvesical mesh. The long term stability and tolerance of the results must be confirmed.

Adult↗
PubMed2005

Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials.

OBJECTIVE: To evaluate the most appropriate surgical method of hysterectomy (abdominal, vaginal, or laparoscopic) for women with benign disease. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Cochrane Menstrual Disorders and Subfertility Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase, and Biological Abstracts. SELECTION OF STUDIES: Only randomised controlled trials were selected; participants had to have benign gynaecological disease; interventions had to comprise at least one hysterectomy method compared with another; and trials had to report primary outcomes (time taken to return to normal activities, intraoperative visceral injury, and major long term complications) or secondary outcomes (operating time, other immediate complications of surgery, short term complications, and duration of hospital stay). RESULTS: 27 trials (total of 3643 participants) were included. Return to normal activities was quicker after vaginal than after abdominal hysterectomy (weighted mean difference 9.5 (95% confidence interval 6.4 to 12.6) days) and after laparoscopic than after abdominal hysterectomy (difference 13.6 (11.8 to 15.4) days), but was not significantly different for laparoscopic versus vaginal hysterectomy (difference -1.1 (-4.2 to 2.1) days). There were more urinary tract injuries with laparoscopic than with abdominal hysterectomy (odds ratio 2.61 (95% confidence interval 1.22 to 5.60)), but no other intraoperative visceral injuries showed a significant difference between surgical approaches. Data were notably absent for many important long term patient outcome measures, where the analyses were underpowered to detect important differences, or they were simply not reported in trials. CONCLUSIONS: Significantly speedier return to normal activities and other improved secondary outcomes (shorter duration of hospital stay and fewer unspecified infections or febrile episodes) suggest that vaginal hysterectomy is preferable to abdominal hysterectomy where possible. Where vaginal hysterectomy is not possible, laparoscopic hysterectomy is preferable to abdominal hysterectomy, although it brings a higher chance of bladder or ureter injury.

Female↗
PubMed2003

Abnormal bleeding in adolescents.

Abnormal bleeding is a common clinical problem in adolescents, with the vast majority of cases resulting from anovulatory menstrual cycles. Although most episodes of abnormal vaginal bleeding do not cause acute medical complications, bleeding can be traumatic for young patients and their families. Health care providers with a solid knowledge of menstrual physiology and a thorough approach to differential diagnosis can evaluate and appropriately manage adolescents. In this article, we review the maturation of the hypothalamic ovarian axis, the most frequent etiologies of abnormal bleeding, as well as other less common causes and discuss diagnosis and treatment modalities.

Adolescent↗
PubMed2006

[Retroperitoneal approach and pelvic peritoneoectomy in the surgical management of advanced ovarian cancer].

OBJECTIVE: To share our experience in surgical management of advanced ovarian cancer applying a retroperitoneal approach and performing pelvic peritoneoectomy for the achievement of an optimal debulking in this disease. MATERIAL: Thirty eight patients age ranging from 36 to 77 years (average 55,7 years) staged: I - 2 (5,3%), II - 4 (10,5%), //III/ - 28 (73,7%) and IV - 4 (10,5%) had been operated on. Thirty patients presented without previous therapy, 3 - after total abdominal hysterectomy with adnexes, 1 - after supravaginal hysterectomy with adnexes, 1 - after unilateral adnexectomy and 3 - after neoadjuvant chemotherapy. METHODS: All 38 patients had been submitted to retroperitoneal approach during the laparotomy and it had been performed surgical procedures including various degrees of radicalness towards the pelvic structures (uterus, parameters vagina) with or without pelvic peritoneoectomy. The latter had been performed in 28 patients (73,7%). Selective lymph node dissection is carried out in 21 cases (55,3%), total omentectomy - in 36 cases (94,7%) and appendectomy - in 23 (60,5%). RESULTS: Maximal (no evidence of disease) and optimal (less than 2 cm lesion) cytoreduction is achieved in 23 (60,5%) and 8 (21,1%) patients, respectively - totally in 81,6% of all patients. The most common site of suboptimal (> 2 cm) residual masses is the anterior rectal wall and cavum Douglasi - 85,7%, Lymph node metastases is detected in 33%, metastases in omentum - in 75%, parametrial invasion - in 25%, vaginal metastases - in 8,3%, metastases in appendix and Fallopian tubes - in 47,8% and 8,8%, respectively and invasion of tumor's capsula - in 34, 2%. CONCLUSION: Retroperitoneal approach and pelvic peritoneoectomy are feasible and safe and lead to high percentage of optimal debulking, which is the main prognostic factor in advanced ovarian cancer patients.

Adult↗
PubMed1995

[Causes and consequences of an unbalanced vaginal ecosystem].

The vaginal microflora of a healthy asymptomatic woman is part of a dynamic ecosystem which is easily disturbed by known and unknown factors. The normal vaginal microflora consists of a broad spectrum of aerobic and anaerobic germs. The anaerobic microaerophilic Doederlin's bacillus (lactobacillus) plays a major role in the microflora, but is only one of the many factors controlling and tuning a well-balanced ecosystem. Although our understanding is still insufficient, basic knowledge of the ecosystem and new results lead to a successful therapeutic approach.

Bacterial Adhesion↗
PubMed1996

Ventral tethering of the vagina and its role in the kinetics of urethra and bladder-neck straining.

Based on the principle that the urethra forms an integral part of the ventral wall of the vagina, the aim of this study was to determine the elements of fixation of this wall and their role in the maintenance of urethral statics during strain exertion. Eight dissections of the female pelvis were performed by a simultaneous high and low approach. The anatomic data were compared with a study of the kinetics of the urethra by dynamic MRI. The lower part of the ventral vaginal wall is tethered to the pubis and the ischiopubic rami by a complex mixed system containing elements of both suspension and support. These elements simultaneously allow a complex and asymmetric movement around the inferior border of the pubic symphysis and maintain urinary continence during straining.

Aged↗
PubMed1996

Guidelines to determine the route of oophorectomy with hysterectomy.

OBJECTIVES: Our purpose was to determine whether there is adequate visibility and access for transvaginal oophorectomy in most patients and the success rate of the transvaginal approach. The final goal was to establish objective guidelines for choosing the route of oophorectomy with hysterectomy. STUDY DESIGN: Patients underwent laparoscopy-assisted vaginal hysterectomy (n = 91) or vaginal hysterectomy (n = 875). Ovarian removal, either unilateral (n = 97) or bilateral (n = 187), was carried out for clinical or prophylactic reasons. The accessibility of the ovaries for transvaginal removal was assessed by stretching the infundibulopelvic ligament and grading the position of the ovaries from 0 (no descent) to III (descent past the hymenal ring with traction). RESULTS: In 158 patients transvaginal bilateral oophorectomy was performed without laparoscopic assistance. In another 29 patients bilateral transvaginal oophorectomy was performed with laparoscopy-assisted vaginal hysterectomy, and prophylactic bilateral oophorectomy by the transvaginal route was successful in all but 1 of 143 patients with ovaries of grade I or higher. In 20 patients laparoscopic lysis of adhesions was necessary to permit transvaginal oophorectomy. Ninety-seven patients underwent transvaginal unilateral oophorectomy, 74 with conventional vaginal hysterectomy and 23 with laparoscopy-assisted vaginal hysterectomy. Among the patients not having oophorectomy, all ovaries had sufficient mobility to have been removed transvaginally. CONCLUSION: Good surgical practice dictates that visibility and accessibility be the primary criteria for selecting the route of oophorectomy with hysterectomy. In most patients the ovaries are visible and accessible to transvaginal removal.

Adult↗
PubMed2001

1-Stage feminizing genitoplasty: 8 years of experience with 49 cases.

PURPOSE: We retrospectively evaluated the results of a modified technique for 1-stage feminizing genitoplasty in children with congenital adrenal hyperplasia (CAH) and other rare intersex conditions. MATERIALS AND METHODS: Between 1991 and 1998, 47 infants and 2 adolescents underwent 1-stage feminizing genitoplasty at our hospital. Of the patients 44 had CAH, 2 had the partial androgen insensitivity syndrome and 3 were true hermaphrodites. In 3 patients we used the Passerini-Glazel technique, while in 46 our technique of feminizing genitoplasty was used, which consists of maximal mobilization of the urogenital sinus en bloc including the vagina and urethra via the perineal approach. Two lateral plates built from dorsal split phallic and preputial skin together with the dorsal split urogenital sinus are used to construct the vaginal introitus and labia minora, and the scrotal folds are used to construct the labia majora. Reduction clitoroplasty is done according to the technique of Kogan et al. Mean age plus or minus standard deviation was 0.9 +/- 0.3 years of the patients with CAH and 13 +/- 2.3 of the remainder. Preoperative information, including status of the internal genitalia, anatomical length of the vagina site of communication between the vagina and urogenital sinus, in relation to the pelvic floor, was obtained by transabdominal pelvic ultrasound. RESULTS: Operating time ranged between 120 and 180 minutes, average hospitalization period was 4 to 5 days and mean followup was 4.7 +/- 2.6 years. Preoperative ultrasound provided the correct data regarding the vaginal and internal genitalia anatomy in all cases, and the exact communication site between the vagina and urogenital sinus was demonstrated in 93%. Complications consisted of intraoperative rectal injury in 1 case and mild wound infection of the buttocks area in 3. In 1 case total clitoris loss was observed. All patients who underwent modified genitoplasty have had successful cosmetic and early functional results. Two patients presented with repeat clitoromegalia due to inadequate adrenal suppression. CONCLUSIONS: Our adapted technique of 1-stage feminizing genitoplasty provides good cosmetic and functional results. The functional results of this operation should be reevaluated after puberty and in adulthood.

Adolescent↗
PubMed1997

The pediatric costs of strategies for minimizing the risk of early-onset group B streptococcal disease.

OBJECTIVE: To estimate the pediatric costs associated with the Centers for Disease Control and Prevention (CDC) guidelines for the management of infants born to mothers receiving intrapartum antimicrobial prophylaxis for prevention of early-onset group B streptococcal disease. METHODS: For an annual United States birth cohort of 3.95 million infants, we estimated the cost of pediatric care provided to full-term asymptomatic infants when pediatricians followed the CDC algorithm for the management of infants exposed to intrapartum antimicrobial prophylaxis under culture-based and risk factor-based maternal care approaches. We calculated the relative contribution of pediatric costs to the total costs of preventing a case of early-onset group B streptococcal sepsis. RESULTS: Total pediatric costs were $41 million for a culture-based approach and $33 million for a risk factor-based approach. Hospital and physician costs accounted for more than 78% of this total. The majority (over 95%) of the pediatric costs were associated with vaginal deliveries. Incorporating pediatric costs into previous cost-effectiveness analyses increased the cost per sepsis case averted by as much as 51% for culture-based strategies and by as much as 112% for risk factor-based strategies. Pediatric costs varied with the average length of stay for full-term infants and with the average cost of a hospital day. CONCLUSION: Substantial pediatric costs are associated with the implementation of an obstetric strategy for minimizing the risk of early-onset group B streptococcal disease. Such costs should be included in future cost-effectiveness analyses of different strategies for minimizing the risk of group B streptococcal disease in newborns.

Algorithms↗
PubMed2002

Laparoscopic bipolar coagulation of uterine vessels to manage delayed postpartum hemorrhage.

Postpartum hemorrhage (PPH) is a big challenge for obstetricians. Fertility-preserving procedures are encouraged, especially in young women. Bilateral hypogastric (internal iliac) artery ligation, bilateral uterine artery ligation after vaginal delivery or after cesarean delivery, and uterine artery embolization are well documented vascular occlusive methods for treating PPH. To our knowledge, the laparoscopic approach to uterine artery ligation has not been reported. A 29-year-old woman experienced delayed PPH. Although curettage of the uterine cavity to remove retained placenta was performed, bleeding did not stop. We successfully performed a relatively new method--laparoscopic bipolar coagulation of uterine vessels--to stop bleeding and preserve the uterus.

Arteries↗
PubMed1992

Transvaginal intra-abdominal impalement injury.

Impalement injuries due to sexual activity are highly unusual and variable. We have described a case of transvaginal impalement injury of the rectum, bladder, omentum, and mesentery manifested by vaginal bleeding. The patient could not recount how she had been injured. Management of such an injury requires extensive initial evaluation and a multidisciplinary approach to therapy.

Abdominal Injuries↗
PubMed2002

[Congenital absence of the vagina in 126 patients].

OBJECTIVES: To investigate the clinical features and therapeutic results of multiple approaches for congenital absence of the vagina, and to find out the prevention of complications and reconstruction method. METHODS: We analysed retrospectively 126 patients with congenital absence of the vagina from 1979 to 2002. RESULTS: Congenital absence of the vagina occurred in 31.25% urinary tract anomalies and 6.35% musculoskeletal anomalies. Of the 126 patients, 6 received 2 or more than 2 operations, the remaining recovered after reconstruction of the vagina by using the inferior abdominal wall skin flap and pudendal-thigh skin flap. CONCLUSIONS: The techniques should be selected according to the conditions of the patient and features of multiple approaches. Damage to the rectum and urinary tract should be avoided in addition to postoperative retraction or prolapse of flaps and stenosis of the vaginal orifice.

Adolescent↗
PubMed2005

Multifactorial etiology of cervical cancer: a hypothesis.

Cancer of the cervix is the second most common life-threatening cancer among women worldwide, with incidence rates ranging from 4.8 per 100,000 women per year in the Middle East to 44.3 per 100,000 in East Africa. Epidemiologic and clinical data demonstrate that human papillomaviruses (HPV), especially HPV-16 and HPV-18, play at least a major if not a necessary role in the etiology of cervical cancer. However, many investigators acknowledge that HPV is not sufficient to induce cervical cancer and that a multifactorial etiology is likely. HPV can be found in a growing proportion of patients with cervical cancer, approaching 100%, but is not yet found in every patient with disease. Other factors, such as herpes simplex virus type 2 infections, cigarette smoking, vaginal douching, nutrition, and use of oral contraceptives, have been proposed as contributing factors. In the first half of the 20th century, Peyton Rous and colleagues demonstrated the joint action of tars and Shope papillomavirus to consistently induce squamous cell carcinomas in rabbits. Using the Rous model as a prototype, one might hypothesize that some cases of cervical cancer arise from an interaction between oncogenic viruses and cervical tar exposures. Cervical tar exposures include cigarette smoking, use of tar-based vaginal douches, and long years of inhaling smoke from wood- and coal-burning stoves in poorly ventilated kitchens.

Causality↗