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PubMed1986

Lower genitourinary infections in women.

Vaginitis, cystitis, urethritis, and cervicitis are common diagnoses made in women attending family physicians' offices. Recent research has fundamentally altered available information on the diagnosis and management of these common genitourinary infections. This clinical review discusses presenting symptoms, physical findings, laboratory diagnostic aids, treatment, and follow-up for each lower genitourinary syndrome in women concluding with a summary flow chart illustrating an overall recommended approach.

Amoxicillin↗
PubMed2005

Surgical management of posterior vaginal wall prolapse: an evidence-based literature review.

The aim of this review is to summarize the available literature on gynecological management of posterior vaginal wall prolapse. A MEDLINE search and a hand search of conference proceedings of the International Continence Society and International Urogynecological Association was performed. Two randomized trials demonstrated that the transvaginal approach to rectocele is superior to the transanal repair in terms of recurrent prolapse. The traditional posterior colporrhaphy with levator ani plication was largely superceded by fascial repairs with similar anatomic success rates but favorable functional outcome. The midline fascial plication may offer a superior anatomic and functional outcome compared to the discrete site-specific fascial repair. Controlled studies are necessary to evaluate whether a sacrocolpopexy combined with posterior mesh interposition is an effective alternative to the transvaginal repair. There is currently no evidence to recommend the routine use of any graft and complications such as mesh erosion, infection, and rejection have to be considered.

Evidence-Based Medicine↗
PubMed2005

Minilaparotomy hysterectomy: a valid option for the treatment of benign uterine pathologies.

OBJECTIVE: To evaluate feasibility and outcome of minilaparotomy hysterectomy in a consecutive series of patients. STUDY DESIGN: Cohort analytic study. From October 1995 to March 2001, 148 out of 228 (65%) consecutive hysterectomies for benign gynecologic disease were performed by an abdominal route. Minilaparotomy hysterectomy (transversal cutaneous incision < 10 cm, within the pubic hair) was attempted in all patients with benign uterine disease and contraindications for vaginal surgery. Surgical parameters were prospectively assessed in terms of length of incision, operative time, estimated blood loss, duration of ileus, perioperative complications and length of postoperative stay. RESULTS: A minilaparotomic approach was performed in 118 patients (80%). Conversion to Pfannenstiel was necessary in three cases. The minilaparotomy incision, 8 cm (range 6-10) of median length, was performed below the pubic hair line. The median operating time was 50 min (range 34-88). No intraoperative complications or perioperative blood transfusions were reported, while minor postoperative complications occurred in 16 patients (14%). The median postoperative stay was three days (range 2-5). CONCLUSIONS: The minilaparotomy hysterectomy is feasible in the majority of women undergoing hysterectomy for benign disease. Because of the excellent outcome achieved, it should be considered a valid alternative to the classic abdominal hysterectomy.

Adult↗
PubMed1987

The application of intracavernous injection of vasoactive medications for erection in men with spinal cord injury.

Obtaining and sustaining an erection that is firm enough and adequate for vaginal penetration and satisfactory completion of intercourse are common problems for the male spinal cord injury patient. Intracavernous injection of vasoactive substances offers a new treatment option but it must be approached with caution in this population. During the last year we placed 20 spinal cord injury men (16 paraplegics and 4 quadriplegics) on self-injection of papaverine alone or with phentolamine. Of the patients 19 were able to obtain an erection adequate for penetration. The patient who did not obtain an adequate erection had anomalous penile venous drainage. Six episodes of priapism occurred in 3 patients: 1 had a surgical shunt placed elsewhere before he entered our program, and 2 were treated with aspiration of the corpora and injection of epinephrine. All 3 patients subsequently have been able to obtain satisfactory erections with use of lower doses of papaverine alone.

Adult↗
PubMed1976

Imperforate anus.

Sucessful treatment of the child with imperforate anus yields an individual with satisfactory continence and a healthy urinary tract. These goals are achieved by accurate evaluation of the newborn, optimal technical results, and conscientious follow-up. The infant born with one of these malformations frequently has a serious associated anomaly which also requires early specific diagnosis and management. When the bowel has passed through the puborectalis in utero, the deformity can often be definitively treated in the neonate by dilations or anoplasty. However, if a urinary or high vaginal fistula is present, or if the anomaly is of the supralevator type, definitive surgery is best postponed some months and the neonate given a colostomy. We have found the sacroabdominoperitoneal approach to be the most satisfactory pullthrough procedure for the supralevator lesion. The children with high, supralevator anomalies have higher mortality rates and, in one out of four cases, have suboptimal fecal continence. They require the utmost in technical skill and continuing care if they are to lives free of social stigma. The mortality rate in all other types is low and the functional continence uniformly acceptable.

Abnormalities, Multiple↗
PubMed2002

Retained placenta continues to be fatal but frequency can be reduced.

Retained placenta is potentially lift-threatening not only because of retention per se, but because of associated haemorrhage and infection as well as complications related to its removal. These risks are increased in women in poor social circumstances due to pre-existing malnutrition, anaemia and unsupervised home deliveries. The present study was undertaken to assess the situation in this rural area. A previous study at the same place suggested preventive strategies an and individualised approach. Incidence of retained placenta has been 0.23% of all births over 15 years. Of the deliveries at Kasturba Hospital, the incidence of retained placenta was 0.008% (two of 23,838 vaginal deliveries). Sixty-five women were admitted with retained placenta after home deliveries and three after delivery at other hospitals The age of most of the patients was between 20 and 29 years and most were para 2 or 3. In twenty-three (32.4%) cases, women had delivered preterm. Twelve (16.9%) women had previous uterine surgery and 10 (14.1%) had had a retained placenta in the past. Twenty-six (36.61%) women had come in a state of severe shock. Thirty-six (50.7%) women required general anaesthesia for manual removal. One woman with an adherent placenta had to undergo hysterectomy (1.40%). The maternal mortality was 5.6%. Perinatal loss was 7.04%. It is unfortunate that of the four deaths, two women had actually delivered at a near by district hospital and were referred moribund and died. A properly conducted delivery can reduce the incidence of retained placenta and if retention occurs, timely appropriate treatment can save life.

Adult↗
PubMed1988

Early closure of posthysterectomy vesicovaginal fistulas.

This report presents the results of early closure of 11 posthysterectomy vesicovaginal fistulas, using a modified transvaginal approach. Early repair of this complication is acceptable and probably desirable. Review of the English literature indicate that these 11 patients comprise the single largest series of patients treated by early vaginal repair.

Adult↗
PubMed1992

[Disabling rectocele: rectal plication by perineal approach. Apropos of 20 cases].

Rectocele is a frequent rectal static disorder. Its usual clinical manifestation is a distressing outlet obstruction. Surgical treatments actually proposed are based on a trans-anal approach. Perineal approach has specific interests as shown on a consecutive series of 20 patients operated on between January 90 and January 92. The surgical modalities were, after mobilization of the recto-vaginal wall, careful concentric folding of the rectocele followed by suturing the rectal fascia and pre-anal levatorplasty without associated colpectomy. Results (mean follow-up: 15 months) showed: 1) anatomic correction obtained in 18 cases, without local complications, but one dyspareunia, 2) restoration of normal rectal evacuation in 16 cases. The 4 functional failures were observed in patients with associated anorectal disorders (anismus, colon inertia).

Adult↗
PubMed1992

Improvement of sexual behavior in aged rats by p-chlorophenylalanine and methysergide.

The effects of methysergide, a serotonin antagonist, and p-chlorophenylalanine (PCPA), a serotonin synthesis blocker on the sexual behavior of intact old male rats at 19-23 months of age and female rats at 17-18 months of age were studied. Female rats with prolonged vaginal cornification and a lordosis quotient (LQ) of less than 50%, and male rats displaying no ejaculation were selected as experimental animals. The receptivity of aged female rats, but not the approach behavior to males nor proceptivity was improved by PCPA or methysergide. The LQ of intact aged female rats in non-exit tests was improved by the i.p. administration of 50 mg/kg B.W. of PCPA 2 to 4 hours prior to the sexual behavior test or 3 mg/kg B.W. of methysergide 4 hours prior to the test. Total mount frequency and mount latency of intact aged male rats were improved by the administration of methysergide (3 mg/kg B.W.), while total mount frequency and intromission latency were improved by the administration of PCPA (20 mg/kg B.W. for 4 days). The present results together with the finding from our previous study suggest that the increase of serotonin (5-HT) activity per se plays an important role in the decline of receptivity of aged female rats and the copulatory activity of aged male rats.

Aging↗
PubMed1980

[Surgical treatment of cervical carcinoma (author's transl)].

At the Gynaecological Hospital of Rostock University radical abdominal surgery was performed on 321 cases of cervical carcinoma and radical vaginal surgery on 268 cases, between 1950 and 1972. The five-year survival rates were 73.5 or 83.8 per cent, respectively. Indications as well as morbidity and lethality of either approach are discussed, and the authors' personal experience is reported. - The value of lymphography has remained to be disputed. Reasons are given for general renunciation of presurgical irradiation and for sole use of radiological techniques and their limited applicability in postsurgical treatment.

Adult↗
PubMed1998

[Retrovesical leiomyoma: a case report].

A 41-year-old woman was admitted to our hospital with the chief complaint of difficulty of urination during the previous 2 years. Physical examinations revealed a smooth round mass of about 6 cm in diameter at the vaginal anterior wall. DIP and MRI showed a retrovesical tumor which was composed of benign leiomyoma, according to the transvaginal needle biopsy report. The retrovesical tumor was excised by the transvaginal approach. The tumor, 7 x 6 x 4 cm in size and 109 g in weight, was histologically diagnosed as leiomyoma. This is the 21st case of retrovesical leiomyoma reported in the literature in Japan.

Adult↗
PubMed2003

The homeopathic approach to the treatment of symptoms of oestrogen withdrawal in breast cancer patients. A prospective observational study.

This paper reports on an investigation of the homeopathic approach to the management of symptoms of oestrogen withdrawal in women with breast cancer. Forty-five patients entered the study. The most common presenting symptoms were hot flushes (HF) (n=38), mood disturbance (n=23), joint pain (n=12), and fatigue (n=16). Other symptoms included sleeplessness, reduced libido, weight gain, cystitis, vaginal dryness and skin eruptions. The active intervention was an individualised homeopathic medicine. Forty women (89%) completed the study. Significant improvements in mean symptom scores were seen over the study period and for the primary end-point 'the effect on daily living' scores. Symptoms other than HF such as fatigue and mood disturbance appear to be helped. Significant improvements in anxiety, depression and quality of life were demonstrated over the study period. The homeopathic approach appears to be clinically useful in the management of oestrogen withdrawal symptoms in women with breast cancer whether on or off Tamoxifen and improves mood disturbance. A placebo-controlled trial would be the next stage in this line of inquiry.

Adult↗
PubMed2000

Molecular epidemiology of metronidazole resistance in a population of Trichomonas vaginalis clinical isolates.

Trichomonas vaginalis, the causative agent for human trichomoniasis, is a problematic sexually transmitted disease mainly in women, where it may be asymptomatic or cause severe vaginitis and cervicitis. Despite its high prevalence, the genetic variability and drug resistance characteristics of this organism are poorly understood. To address these issues, genetic analyses were performed on 109 clinical isolates using three approaches. First, two internal transcribed spacer (ITS) regions flanking the 5.8S subunit of the ribosomal DNA gene were sequenced. The only variation was a point mutation at nucleotide position 66 of the ITS1 region found in 16 isolates (14.7%). Second, the presence of a 5.5-kb double-stranded RNA T. vaginalis virus (TVV) was assessed. TVV was detected in 55 isolates (50%). Finally, a phylogenetic analysis was performed based on random amplified polymorphic DNA data. The resulting phylogeny indicated at least two distinct lineages that correlate with the presence of TVV. A band-sharing index indicating relatedness was created for different groups of isolates. It demonstrated that isolates harboring the virus are significantly more closely related to each other than to the rest of the population, and it indicated a high level of relatedness among isolates with in vitro metronidazole resistance. This finding is consistent with the hypothesis that drug resistance to T. vaginalis resulted from a single or very few mutational events. Permutation tests and nonparametric analyses showed associations between metronidazole resistance and phylogeny, the ITS mutation, and TVV presence. These results suggest the existence of genetic markers with clinical implications for T. vaginalis infections.

Animals↗
PubMed1988

The analysis of menstrual bleeding patterns: a review.

Patterns of vaginal bleeding are an important factor in the acceptability of contraceptive methods. The analysis of data obtained from daily menstrual diary records is a major methodological problem to which no satisfactory solution exists. This review describes approaches to the analysis of bleeding patterns among contracepting and non-contracepting women and reviews the difficulties involved. The reference period method, introduced to avoid the arbitrary rules and definitions required for an analysis based on the concept of a menstrual cycle, is discussed and its limitations presented. The review draws on reports of meetings convened by the World Health Organization and the University of Exeter Family Planning Unit to discuss issues in the analysis. Previously unpublished methods are summarized and areas of controversy and topics for further research are identified.

Contraception↗
PubMed1985

Management of the mildly abnormal Pap smear: a conservative approach.

Follow-up and management of the mildly abnormal Pap smear has been the subject of controversy in the medical literature. At Fitzsimons Army Medical Center, patients with initial Pap smears reported as "inflammatory atypia" or mild dysplasia were treated with specific therapy for vaginitis and/or cervicitis. Follow-up smears were performed 6 to 8 weeks later. Of the above groups, 80 and 58%, respectively, were negative on repeat smear. A third group of patients with Pap smears reported as consistent with human papillomavirus (HPV) were not treated but had repeat smears performed at 6 to 8 weeks. Of these, 76.4% reverted to normal. The results of the colposcopically directed cervical biopsies obtained on patients with persistently abnormal smears are reported. These findings support a conservative plan for follow-up of mildly abnormal Pap smears.

Biopsy↗
PubMed1995

A morphologist's approach to the vagina--age-related changes and estrogen sensitivity.

This paper reviews basic facts on vagina histology and ultrastructure with respect to passage of different substances and drugs through the epithelium. Particular interest is devoted to the action mechanism of topically-applied vaginal estrogen, its binding to receptors in different vaginal cell types, and possible local metabolic routes. Differences in estrogen sensitivity between uterus and vagina are discussed as well as the background for the high vaginal sensitivity.

Absorption↗