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At least 163 records · Page 9Linked to original sources
PubMed1998

Urinary tract fistulas following gynaecological surgery.

Urinary tract fistulas are a relatively uncommon but important complication of gynaecological surgery. Between 1980 and 1995 we identified 17 patients who developed a urinary tract fistula after gynaecological surgery. Seven of the patients had surgery performed for neoplastic disease but none of these patients received adjuvant radiotherapy before the formation of the fistula. There were 12 vesicovaginal fistulas and five ureteric fistulas. Four of the vesicovaginal fistulas were repaired by the vaginal approach and five vesicovaginal fistulas were repaired by the abdominal route. Three vesicovaginal fistulas were treated by catheterisation alone. Two of the 17 patients took medicolegal action. Early recognition and repair of urinary tract fistulas is recommended. Repair of vesicovaginal fistulas by the vaginal approach is advised. The litigious nature of this distressing condition is lessened when early primary closure is successful.

Journal Article↗
PubMed1975

[Vaginal hysterectomy at the department of gynecology of the university of Graz from 1955 to 1970 (author's transl)].

Report on 2309 vaginal hysterectomies. The leading indication for vaginal hysterectomy was benign disease of the uterus (54.4%). Utero-vaginal prolapse was the indication in approximately 32% of the patients. In 71.1% of the hysterectomies, the vaginal approach for removal of the uterus was selected in malignant and pre-malignant diseases. Of these cases 11.9% had carcinoma in situ and 2.7% had micro-invasive carcinoma of the cervix. 2.6% of these cases had carcinoma of the endometrium. In 69.9% of the cases the vaginal hysterectomy was combined with a colporrhaphy. Previous genital operations or laparotomies where no contra-indication to vaginal hysterectomy. Trauma to the urinary tract or the rectum occurred in 26 cases (1.02%). Post-operatively 3 urinary tract fistulas and 3 rectovaginal fistulas developed. The mortality was 0.51%. Among 272 cases of carcinoma in situ and 62 cases of micro-invasive carcinoma of the cervix treated by vaginal hysterectomy, one case developed a recurrent carcinoma in situ of the vaginal vault eight years after vaginal hysterectomy for carcinoma in situ. One patient treated for micro-invasive carcinoma of the cervix died four years following vaginal hysterectomy in another hospital of suspected pulmonary metastases. The diagnosis was not confirmed by autopsy. Simple total hysterectomy whenever possible by the vaginal approach is at present the maximal treatment in the University Department in Graz for carcinoma in situ and micro-invasive carcinoma of the uterine cervix.

Adult↗
PubMed2003

Technical modification of the nerve-sparing laparoscopy-assisted vaginal radical hysterectomy type 3 for better reproducibility of this procedure.

OBJECTIVE: The goal of this work is to make the technique of nerve-sparing laparoscopy-assisted vaginal radical hysterectomy (LAVRH) type 3 easier and less time consuming. METHODS: Compared with the original LAVRH type 3, laparoscopic preparation of the cardinal ligament is extended to the transection of the upper part of the rectovaginal ligament. In vaginal approach, the preparation begins not as originally with the bladder pillar and ureter, but with transection of the rest of the rectovaginal ligament followed by dorsal eversion of the uterus and, lastly, transection of the bladder pillar with preparation of the ureters. RESULTS: Thirty-two consecutive patients underwent the modified nerve-sparing LAVRH type 3. The mean operative time for the vaginal part of the procedure was 54.3 min, whereas for the original technique for LAVRH type 3, the mean operative time was 143.6 min. CONCLUSION: Prior transection of the rectovaginal ligament in the vaginal approach with dorsal eversion of the uterine fundus makes preparation of the ureter and transection of the bladder pillar easier and significantly less time consuming than in the original LAVRH type 3.

Female↗
PubMed1999

[Bologna procedure in stress urinary incontinence with stage III cystocele (with or without vaginal hysterectomy)].

OBJECTIVES: The vaginal approach constitutes a solution for all types of urinary stress incontinence (USI). The type of surgery depends on the position of the bladder neck and urethra, the quality of the sphincter and the severity of genital prolapse. The objective of this study was to evaluate the efficacy of the Bologna procedure in the treatment of urinary stress incontinence (USI) with stage III cystocele. MATERIAL AND METHODS: This procedure can repair genital prolapse and USI via a 2 cm suprapubic incision, with vaginal hysterectomy, and intraoperative cystoscopy. The patient is placed in the lithotomy position and a Crossen T-shaped vaginal incision is made releasing the anterior wall and allowing the creation of 2 pedicled vaginal flaps posterior to the urethral meatus. The flaps, passed through the suprapubic pelvic fascia, support the bladder neck by means of 2 nonresorbable sutures to the rectus abdominis muscles. Fifty-four patients were treated by the Bologna procedure with or without vaginal hysterectomy from 1990 to 1996 and were reviewed with a mean follow-up of 30 months (16 to 46 months). All women (mean age: 63.4 years) underwent a preoperative clinical examination, renal ultrasound, cystoscopy and urodynamic assessment (37 cases). RESULTS: Twelve patients developed postoperative complications (9 local infections, 3 cases of deep vein thrombosis with one pulmonary embolism). All complications were treated by local drainage and/or removal of the suspension sutures. Continence was excellent in 45 women (83.3%), improved in 4 (7.4%), and unchanged in 5 (9.3%). The anatomical results were excellent with correction of prolapse in 48 patients (89%). Six patients subsequently developed prolapse of the vaginal dome and 5 complained of voiding discomfort. CONCLUSION: USI and genital prolapse must be treated simultaneously. The vaginal approach is minimally invasive and can treat both diseases during the same operation.

Aged↗
PubMed1991

[Stress urinary incontinence. Its surgical management].

Ninety eight patients with stress urinary incontinence treated surgically at Central Military Hospital, were studied. We analyzed the risk factors as age, weight, height, parity, menopause age, and previous medical and surgical procedures. They were divided in two groups. The Group I, vaginal approach, with 35 patients and Group II, retropubic surgery, with 63 patients. There were no differences both groups regarding age, weight, height, parity and menopausal age. The most frequent illness associated with stress urinary incontinence, was pelvic floor relaxation. The complications were 17.1% and 33.3%, respectively. The efficacy of Burch is procedure for the management of stress urinary incontinence, with a success rate of 84.1% versus 62.1% in the vaginal approach, was confirmed.

Adult↗
PubMed2006

Fertility-sparing radical abdominal trachelectomy for cervical carcinoma: technique and review of the literature.

OBJECTIVES: Radical trachelectomy has emerged as a reasonable fertility-sparing operation for selected patients with stage I cervical cancer. The purpose of this report is to describe our technique of radical abdominal trachelectomy, a fertility-sparing operation in women with cervical cancer, and review the current literature on this procedure. METHODS: A review of a prospectively maintained database of all fertility-sparing radical trachelectomy procedures performed at our institution. RESULTS: Between 11/01 and 3/06, we performed a total of 42 fertility-preserving radical trachelectomies with pelvic lymphadenectomy for women with invasive cervical cancer. We had previously reported on 2 pediatric abdominal trachelectomies, which are excluded from this report. Five of the remaining 40 cases had undergone a radical abdominal trachelectomy, and 35 cases were performed laparoscopically with a radical vaginal approach. The characteristics of the 5 adult patients who underwent abdominal radical trachelectomy included stage IB1 disease in all cases, a mean age of 36 years (range, 33-39), and a mean estimated blood loss of 280 ml (range, 50-400); 1 patient with squamous cell carcinoma needed completion radical hysterectomy at the time of trachelectomy due to disease extending into the endometrium, and 1 patient needed postoperative chemoradiation due to a positive parametrial lymph node. The remaining 3 patients resumed normal menstruation postoperatively. All patients remain disease-free at the time of this report. The only remaining uterine blood supply in these patients are the utero-ovarian vessels. There were no postoperative complications, and transurethral Foley catheters were removed in all cases within 2 weeks. CONCLUSIONS: Radical abdominal trachelectomy with pelvic lymphadenectomy is a feasible operation for selected women with stage I cervical cancer who desire to preserve reproductive function. Menstruation and reproductive function may be preserved after bilateral uterine vessel ligation. The procedure expands the inclusion criteria of radical vaginal trachelectomy to patients with distorted cervicovaginal anatomy in which the vaginal approach may not be feasible.

Adenocarcinoma↗
PubMed2005

Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound.

INTRODUCTION AND OBJECTIVE: Cesarean section (CS) is the most common operation in obstetrics, with rising incidence in most countries. As a result of this operation late scar dehiscence may occur, which may lead to uterine rupture in a subsequent pregnancy. In this case series we have described sonographic detection of scar dehiscence after CS and feasibility of vaginal or combined laparoscopic and vaginal scar excision and uterine repair. METHODS: Five consecutive patients underwent vaginal or laparoscopic assisted vaginal approach for repair of suspected scar dehiscence following CS, during a 5 year period. In all cases, transvaginal sonography detected suspicious features of scar dehiscence over the anterior uterine wall. Except of one, all patients had reported recurrent pelvic pain and/or irregular menstrual bleedings. Furthermore all patients planned for a further pregnancy. RESULTS: Resection of the uterine defect and re-constitution of the uterine wall was successfully achieved in all five patients. There were no intra-operative complications and none of the patients required blood transfusion. The mean operation time was 117 min (27-192). Presence of scar tissue was confirmed on histology in all specimens. Four patients remained free of symptoms with no evidence of recurrent scar dehiscence on sonography over a median follow up of 30 months (3-46). One patient had an uneventful pregnancy 24 months after scar removal and was delivered by repeat CS at 39 weeks' gestation. CONCLUSION: Patients with a history of CS should undergo transvaginal sonography of the scar region in order to detect latent scar dehiscence in combination with uterine wall thinning prior to planning further pregnancy. In suspected cases, a combined laparoscopic - vaginal or vaginal approach can be employed to repair the defect.

Adult↗
PubMed2000

Expedited versus conservative approaches for vaginal delivery in breech presentation.

BACKGROUND: In a vaginal breech birth there may be benefit from rapid delivery of the baby to prevent progressive acidosis. However, this needs to be weighed against the potential trauma of a quick delivery. OBJECTIVES: The objective of this review was to assess the effects of expedited vaginal delivery (breech delivery from umbilicus to delivery of the head within one contraction) on perinatal outcomes. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth trials register and the Cochrane Controlled Trials Register were searched. Date of last search: February 1999. SELECTION CRITERIA: Randomised trials of expedited vaginal breech delivery compared with delivery not routinely expedited in women undergoing vaginal breech delivery. DATA COLLECTION AND ANALYSIS: Eligibility and trial quality were assessed by one reviewer. MAIN RESULTS: No studies were included. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the effects of expedited vaginal breech delivery.

Breech Presentation↗
PubMed1975

Systems approach to vaginal delivery of drugs I: development of in situ vaginal drug absorption procedure.

In the framework of the development of drug delivery systems for locally administered contraceptive drugs, a reliable method that can afford quantitative evaluation of drug absorption behavior was explored using the rabit doe. A system was constructed based upon perfusing the drug solution in the vaginal tract. For this purpose, a "rib-cage" type cell was constructed and surgically implanted in the rabbit prior to an experiment. The primary purpose of the present paper is to evaluate the method, including the surgical operation and the perfusion system. The absorption experiments were carried out using n-butanol-1minus 14C as the model solute to survey the reproducibility of the absorption behavior. Experiments were conducted with a number of rabbits on several successive days to determine the day-to-day and animal-to-animal variations. The drug disappearance in the reservoir followed first-order kinetics from which the apparent permeability coefficient was calculated. The results indicated that a set of experiments may be carried out on a single animal and that the method generally affords rather high precision.

Absorption↗
PubMed1976

Systems approach to vaginal delivery of drugs II: In situ vaginal absorption of unbranched aliphatic alcohols.

The absorption of unbranched aliphatic alcohols in the rabbit vagina was studied using a perfusion method, and the absorption rates were found to be first order with respect to the drug concentration in the vagina from methanol to octanol. A physical model involving an aqueous diffusion layer in series with a membrane consisting of aqueous pores and lipoidal pathways was used for analyzing the data. The physically based parameters in the model were determined. An effective diffusion layer thickness ("unstirred layer") of around 0.035 cm was found. The increase in the permeability coefficient for the lipoidal pathway per methylene group was around 2.5 for this homologous series.

Absorption↗
PubMed1976

Systems approach to vaginal delivery of drugs III: Simulation studies interfacing steroid release from silicone matrix and vaginal absorption in rabbits.

A composite physical model involving the simultaneous receding boundary release of drug from a drug suspension-silicone polymer matrix system, diffusion across the aqueous layer, and passive transport across the vaginal membrane consisting of parallel lipoidal and aqueous pore pathways is described. Simulation studies with progesterone and hydrocortisone illustrate matrix release-limiting, membrane absorption, and aqueous diffusion layer-limiting cases when the cylindrical silicone delivery device is interfaced with the vaginal membrane of the rabbit.

Cell Membrane↗
PubMed1977

Systems approach to vaginal delivery of drugs IV: methodology for determination of membrane surface pH.

A physical model including a diffusional layer in series with the membrane was developed for studying the possible differences between the pH at the membrane surface and that in the bulk solution. Both the membrane-secreted substances (acids and bases) and buffer constituents in the bulk solutions are assumed to contribute to the surface pH. Equations derived for this situation, together with experimental determinations of the acidic dissociation constant of the secreted material, the total secretion flux, the flux of total secreted acidic species, and the diffusion layer thickness, allow estimates to be made of the pH at the membrane surface. With the rabbit vagina, the membrane surface pH was close to that of the bulk solution in most cases. These results were supported by the fact that the absorption of 1-alkanoic acids in pH 2.2 phosphate buffers was relatively constant over the buffer concentration range of 0.003-0.1 M phosphate.

Absorption↗
PubMed1977

Systems approach to vaginal delivery of drugs V: in situ vaginal absorption of 1-alkanoic acids.

The vaginal absorption of a homologous series of ionizable compounds, the 1-alkanoic acids, was studied using a perfusion method with a rib-cage cell surgically implanted in the rabbit vagina. The absorption rates of these compounds followed first-order kinetics. The physical model previously used for the 1-alkanols, but accounting for the pKa and pH effects in the present case was employed in the analysis of the carboxylic acid data. The aqueous diffusion layer thickness was 0.031 cm. The permeability coefficient for the lipoidal pathway increased 3.5-fold per methylene group. Both values agree reasonably well with those obtained in the alcohol study.

Absorption↗