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PubMed1975

Early complications of sterilization in women not recently pregnant.

This study was conducted to evaluate the complications occurring during operation and from the time of operation until the follow-up vist at one to eight weeks after operation, for patients sterilized by culdoscopy, colpotomy, laparoscopy, or laparotomy. Surgeons were unable to perform the elected procedure in less than 1 per cent of the patients, independent of the method of approach. With endoscopic techniques, the most common operative difficulty was in obtaining an adequate view of the tubes. Excessive blood loss appeared more frequent with both vaginal techniques. Postoperatively, pelvic infections were more frequent with both the vaginal techniques, while incisional complications were more frequent with both the abdominal techniques. Operative and hospitalization times were significantly shorter, and the proportion of women resuming normal activities within four weeks of sterilization was higher with the endoscopic methods. Laparoscopy appeared to be the preferable procedure. While technical difficulties, operative complications, surgical and hospitalization times, and the time until the patient resumed normal work activities were similar with laparoscopy and culdoscopy; infection of the pelvis was more frequent after culdoscopy.

Adult↗
PubMed1991

Radical cystectomy (anterior exenteration) in the female patient.

Anterior exenteration in the female patient can be performed accurately with a disciplined anatomic approach. The lymphadenectomy provides staging for the carcinoma. Excision of the uterus, a portion of the vagina, and the urethra reduces the potential for pelvic recurrence. Vaginal reconstruction and continent urinary diversion provide a better quality of life with maintenance of sexual function and urinary continence.

Carcinoma, Transitional Cell↗
PubMed1977

The treatment of early cancer of the corpus uteri.

This paper analyses the results of post-operative radiotherapy in 256 cases of cancer of the corpus uteri. Myometrial invasion by tumour was shown to be significantly related to histological grading (p less than 0.001) as it was to recurrence rates (p less than 0.025). By placing patients into one of three subsets according to the depth of myometrial invasion, survival was sufficiently different for each subset to validate their use, not only for prognostic purposes but to determine the type of radiotherapy indicated. Radiotherapy was given as either local intravaginal treatment using an obturator loaded with 60Co or by a combination of this and external beam teletherapy. The value of using radiotherapy to treat the whole pelvis as opposed to treating only the vaginal tissues was significant (p less than 0.01) in terms of local disease control for the deep myometrial invasive group. In terms of survival, external beam therapy was of benefit for all three subsets, i.e. superficial, not more than half and more than half myometrial invasion. A planned approach to post-operative radiotherapy was significantly better for the series as a whole compared to previous ad hoc approaches (p less than 0.01). The treatment methods used did not produce unacceptable morbidity.

Adult↗
PubMed2006

Women's experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks.

OBJECTIVE: To explore women's experiences of decision making about mode of delivery after previous caesarean section. DESIGN: A qualitative interview study. SETTING: Two city maternity units in southwest England and Eastern Scotland. SAMPLE: Twenty-one women who had recently delivered a baby and whose previous child was delivered by caesarean section. METHODS: Semi-structured interviews analysed using the framework approach. MAIN OUTCOME MEASURES: Women's views on the influence of uncertainty on decision making, issues concerning information provision and decision-making roles. RESULTS: Experiences of decision making varied considerably. Some women were certain about choosing either vaginal birth after caesarean or repeat elective caesarean section, others were very uncertain and for some this uncertainty persisted after the birth. Information was most commonly provided by hospital doctors (mainly consultants) and more often related to procedural issues rather than possible health risks and benefits. Women felt they had to actively seek information rather than it being provided routinely. Most women were able to make their own decision about mode of delivery. Health professionals generally took a supportive role whichever mode of delivery was chosen. Although many women were comfortable with this approach, some felt they would have liked more guidance. CONCLUSION: On the whole, women experienced having control over the decision about planned mode of delivery. For many, making this decision was difficult and for some it was the cause of prolonged anxiety. Women were often making the decision without being provided with comprehensive and specific information about possible health risks and benefits. We are currently conducting a randomised controlled trial to investigate whether access to a decision aid is beneficial to women in this situation.

Adult↗
PubMed2005

Comparison of LightCycler PCR and culture for detection of group B streptococci from vaginal swabs.

Group B streptococci (GBS) are an important cause of neonatal sepsis and meningitis. New rapid, sensitive and specific methods for detection of GBS in pregnant women are needed in order to provide timely treatment of neonates. The sensitivity, specificity and cost of a LightCycler PCR method was compared with selective culture for the detection of GBS from 400 vaginal swabs. In addition, two DNA extraction methods (simple boiling and automated DNA extraction by Roche MagNA Pure LC) were compared for a subgroup of 100 clinical samples. The sensitivity of the LightCycler PCR assay for the detection of GBS from vaginal swabs was significantly higher than that of culture. There were no culture-positive, LightCycler PCR-negative cases. The efficiencies of the two DNA extraction procedures were not significantly different. The detection of GBS from vaginal swabs by the molecular method (including simple boiling extraction) required the same hands-on time, but the procedure was completed in 1.5 h, compared with c. 48 h for the culture-based approach. Disadvantages of the molecular method are the increased costs (45%) and the absence of antibiogram data. The LightCycler PCR is a promising tool for sensitive, specific and rapid detection of GBS directly from clinical specimens of pregnant women.

Bacterial Typing Techniques↗
PubMed1996

[Vaginal hysterectomy. Role of laparoscopic preparation. Our experience].

The aim of this publication is to define the indications of laparoscopically prepared vaginal hysterectomy. Vaginal hysterectomy is for the authors the best way to perform hysterectomy, but unfortunately it is not always possible in benign lesions and may be insufficient for malignant tumors. As from 1992, they have introduced laparoscopy in their therapeutical approach. From January 1992 to February 1995 they have performed 268 hysterectomies and in 34 cases have done a laparoscopically prepared intervention. They precise their indications, surgical techniques, analyze their results and compare their experience to that found in the literature.

Female↗
PubMed1987

A multicentered phase III comparative clinical trial of depot-medroxyprogesterone acetate given three-monthly at doses of 100 mg or 150 mg: II. The comparison of bleeding patterns. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation Special Programme of Research, Development and Research Training in Human Reproduction.

A multicentered phase III clinical trial was conducted in seven countries to compare two dosages of depot-medroxyprogesterone acetate (DMPA), 100mg and 150mg, given every 90 days. Contraceptive efficacy and side-effects of both regimens were reported previously. Their effect on vaginal bleeding patterns is the object of this paper. A total of 1216 women were randomly assigned to a dose group and 1156 of them provided a menstrual diary. The comparison of the bleeding patterns is made using a 90-day reference period approach and following the guidelines published by WHO. In addition, the longest bleeding/spotting episode and the longest bleeding/spotting-free interval are calculated over the entire diary length. The only difference found between the two dose groups is a higher incidence of amenorrhea with the 150mg regimen. Overall, there is a high degree of consistency between the reasons given by individual women for discontinuing the contraceptive method and their vaginal bleeding pattern during the 90 days preceding discontinuation. However the data revealed large between-centre differences, both in the incidence of specific patterns, and in the identification by women of bleeding problems as reasons for discontinuation. This last point suggests that the life-table analysis underestimates the true incidence of menstrual irregularities. Comments on the reference period analysis method are made.

Amenorrhea↗
PubMed2002

The influence of vaginal bleeding on the sexual behavior of urban, Hispanic women and men.

Irregular menstrual bleeding associated with use of hormonal contraceptives is a leading cause of contraception discontinuation. If bleeding disrupts sexual activity, this could contribute to contraceptive discontinuation. The impact of bleeding on sexual activities other than intercourse is unknown.A self-administered questionnaire in Spanish or English was used to collect information on demographics and the practice of various sexual behaviors during times of vaginal bleeding or spotting. The questionnaire was offered consecutively to 86 men and 75 women attending urban family-planning and young men's clinics. The men and women were approached individually, not as couples. Women reported a mean age of 25 years, a wide range of educational attainment, described themselves as mostly Hispanic (89%), and most chose the Spanish version of the questionnaire (67%). Men also described themselves as mostly Hispanic (80%), and reported a similar range of educational attainment, but were younger (mean age of 21, p < 0.001), and were less likely to choose the Spanish version of the questionnaire (23%, p < 0.001).Kissing, breast touching, and receiving non-genital touching did not change during bleeding or spotting. Forty-five percent of women reported usually receiving genital touching, which declined to 6% during bleeding and to 10% during spotting (p < 0.001). Similar proportions of women reported usually giving genital touching to their partner (50%) during bleeding (41%) or spotting (44%). Men also reported usually giving less genital touching to their partner, but no change in receiving genital touching during bleeding or spotting. Forty percent of women reported usually receiving oral sex, which declined to 4% during spotting or to 0% bleeding (p < 0.001). Forty-two percent of women reported usually giving oral sex, which declined to 23% during bleeding and to 35% during spotting (p = 0.06). Fifty percent of women and 68% of men reported engaging in vaginal intercourse. Among women, reported intercourse declined to 7% during bleeding and to 26% during spotting (p < 0.001). Among men, reported intercourse declined to 19% during bleeding and to 23% during spotting (p < 0.001). The presence of vaginal bleeding or spotting is associated with decreases in genital sexual behaviors among urban, Hispanic women and men. Such disruptions in sexual behavior could contribute to contraceptive discontinuation.

Adult↗
PubMed1990

Persistent vaginitis caused by metronidazole-resistant trichomonas.

Persistent trichomonal vaginitis is usually considered the result of either patient noncompliance with therapy or reinfection. Drug-resistant trichomoniasis may also cause continued infection despite repeated courses of conventional metronidazole therapy. We report two cases of exceptionally persistent and prolonged infection despite repetitive and varied treatments, including parenteral metronidazole. An unconventional approach combining oral and topical therapy resulted in clinical and microbiologic cure in both cases.

Administration, Intravaginal↗
PubMed2003

New approaches for the management of cervical cancer.

Since the introduction of the Pap test by George Papanicolaou, the incidence of cervical cancer has fallen and mortality has decreased, in parallel with effective treatment of the precancerous and in situ stages of the disease. However, women who are not diagnosed through screening usually present with advanced disease. Early invasive disease can be treated successfully with radical abdominal hysterectomy and pelvic lymphadenectomy or with radiotherapy. A surgical alternative is radical trachelectomy, which can preserve fertility in young women. Advances in the techniques of laparoscopy facilitate procedures, such as radical vaginal hysterectomy with laparoscopic lymphadenectomy, that decrease intra-abdominal scarring and length of hospital stays. The presence of lymph node metastases alters the type of therapy. A range of methods is available to assess lymph nodes, including positron emission tomography, a new approach that may be of value. Radiotherapy alone may not be successful in women with locally advanced disease and adding chemotherapy may eradicate systemic micrometastases that are not affected by radiation. Single-agent cisplatin is the current agent of choice for adding to radiotherapy but new agents are being evaluated. Persistent infection with human papillomavirus (HPV) is associated with the development of cervical cancer. Vaccines against HPV are being developed and clinically tested and hopefully in the future it may be possible to eradicate cervical cancer.

Clinical Trials as Topic↗
PubMed1994

[Laparoscopically-prepared vaginal hysterectomy. Our personal experiences (apropos of 35 cases)].

We report our personal experience with 35 laparoscopically prepared vaginal hysterectomies performed over a 3 year period, for January 1990 to January 1993. We give our indications for this new technique present our results. We compared our results with those reported in the literature evaluating indications, technique and complications and demonstrate the numerous advantages of this new technique. Finally, a decision protocol has been prepared in order to chose the optimal approach according to the preoperative work-up.

Decision Support Techniques↗
PubMed1987

Follicular aspiration for in vitro fertilization: sonographically guided transvaginal versus laparoscopic approach.

Laparoscopy is the most commonly used procedure for oocyte retrieval in an in-vitro fertilization (IVF) program. In this study we compared the results of 21 laparoscopic and 21 sonographically guided transvaginal oocyte retrievals using a vaginal probe. Laparoscopically 3.7 and transvaginally 4.8 oocytes per patient were recovered. Overall 6 pregnancies were achieved, giving a pregnancy rate of 14.1% per patient. Vaginal follicular aspiration resulted in a higher oocyte recovery rate. The advantages of the method were a shorter operation time, a superficial anesthesia and, compared to laparoscopy, a less invasive and simpler technique. Therefore this method is now commonly used for routine IVF procedures in our institution.

Adult↗
PubMed2002

The role of electrophysiology in the evaluation of incontinence and prolapse.

PURPOSE OF REVIEW: Apart from histopathology, electrophysiological methods are the only tests to reveal neuromuscular involvement in the absence of gross anatomical lesions. They have played a major role in establishing the neuromuscular lesion due to vaginal delivery as a risk factor for incontinence and pelvic organ prolapse, but there is no consensus on the usefulness of different methods. It is timely to reevaluate their validity, and their role in urogynecology. RECENT FINDINGS: The most important development is the move towards standardization of the diagnostic approach, based on computer assisted quantified techniques of concentric needle electromyography. Studies using less operator biased techniques have confirmed subtle pelvic floor muscle changes in parous women. Reports on usefulness of different tests as predictors of treatment outcome are controversial. SUMMARY: Standardization of concentric needle electromyography strengthened the position of this test as practical and informative. Neuromuscular changes following vaginal delivery have been reconfirmed, but the usefulness of particular electrophysiological tests in the individual patient needs to be further researched. Valid clinical neurophysiological methods remain valuable as research tools for incontinence and prolapse pathophysiology.

Electromyography↗
PubMed1984

Reversible hypogonadism induced by a luteinizing hormone-releasing hormone (LH-RH) agonist (Buserelin) as a new therapeutic approach for endometriosis.

Ten women with endometriosis (stages I to IV) were treated with twice-daily subcutaneous injections of 200 micrograms of (D-Ser[TBU]6-des-Gly-NH2(10] luteinizing hormone-releasing hormone ethylamide (Buserelin) for 5 days followed by 400 micrograms intranasally three times daily for 25 to 31 weeks. Serum follicle-stimulating hormone levels returned to basal values on the second day of treatment, and serum luteinizing hormone levels progressively decreased to normal within 4 weeks. Serum estradiol decreased below early follicular phase levels within 7 to 30 days and continued to decrease to castrate levels. Light to moderate estrogen withdrawal bleeding was followed by amenorrhea with occasional bleeding or spotting in four women. Abdominal pain and dyspareunia disappeared or were ameliorated after 2 months of treatment. Resorption of endometrial implants was demonstrated by laparoscopy, and endometrial biopsy revealed atrophy or weak proliferation. Ovulation returned within 45 days, and two of four sexually active women became pregnant during cycles 3 and 5. The treatment was well accepted in spite of the expected hot flushes and vaginal dryness. Safety laboratory tests during and after treatment did not reveal any abnormalities. Reversible down-regulation of pituitary/ovarian function using repetitive luteinizing hormone-releasing hormone agonist administration can be a worthwhile approach to medical treatment of endometriosis.

Adolescent↗
PubMed2000

Interposition of fallopian salpinges in the treatment of sigmoidovaginal fistula, secondary to vaginal hysterectomy with failure of previous repair.

A 50-year-old woman, para 4, suffering from uterine fibromatosis and recurrent menometrorrhagia, underwent vaginal hysterectomy with preservation of salpinges. About 15 days after surgery, hydrosoluble contrast enema showed sigmoidovaginal fistula; after about two months there was failure of surgery repair by the rectal endoscopic technique. A month later, we performed repair surgery by the abdominal approach interposing fallopian salpinges between the sigmoid and the vagina. About two months later, a enema showed absence of fistula and today the women is free from disease.

Colon, Sigmoid↗
PubMed2004

[Acellular matrix for functional reconstruction of the urogenital tract. Special form of "tissue engineering"?].

Organ substitution and reconstruction of the urogenital system still poses a problem regarding an adequate substitute. Usually non-organ-specific materials are used for reconstruction (bowl, buccal mucosa). This nonspecific tissue can cause side effects that result from the origin and the natural function. Different groups have shown that an acellular matrix graft in the urinary bladder and the urethra served as a scaffold for complete regeneration of all organ wall components and that this organ-specific regeneration simultaneously facilitates functional restitution. New approaches will presumably effect better regeneration after seeding the matrix with organ-specific cells (i.e., urothelial cells). Smaller studies on genital reconstructive surgery could show that vaginal substitution with an acellular matrix might be possible or that there could be a possible substitute for the tunica during surgical treatment of Peyronie's disease.

Absorbable Implants↗
PubMed2005

Treatment of uterine fibroids by embolization--advantages, disadvantages, and pitfalls.

Uterine fibroids are the most common benign tumors of the female genital tract. Apart from vaginal or abdominal hysterectomy, which has been in use for more than 100 years, the more recently established techniques of laparoscopy and hysteroscopy provide two additional treatment approaches. In cases of symptomatic uterine fibroids, the most widely accepted alternative to surgery is the catheter-supported embolization of uterine arteries (uterine artery embolization, UAE). All patients who wish to be treated by UAE because of symptomatic fibroids should be presented to both gynecologists and radiologists. To the best of our knowledge, there are no interdisciplinary guidelines for UAE. Therefore, it would be very helpful if gynecologists and radiologists could reach an agreement for both indications and treatment strategies. However, there is no defined "gold standard" for fibroid therapy at all. In this respect, the therapeutic approach should be influenced less by the preference of the (potential) surgeon, and more by factors like size, localization, and number of fibroids. In addition, symptoms, ethnicity, and the wish to have children should be considered. Cooperation between radiologists and gynecologists is absolutely necessary, not only for the choice of the optimal treatment and care of patients, but also for the development of useful guidelines and future studies. UAE may be a therapeutic approach for selected patients. In these special cases, embolization is a safe and practical alternative to the established treatment options.

Adolescent↗