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Biomedical subjects

P Bakas

Publications and source records attributed to P Bakas.

At least 19 recordsLinked to original sources
PubMed2005

Tension-free vaginal tape for elderly women with stress urinary incontinence.

OBJECTIVE: To investigate the efficacy of the tension-free vaginal tape (TVT) procedure for the management of stress urinary incontinence (SUI) in elderly women. METHOD: A total of 55 women aged between 65 and 86 years underwent a TVT procedure for urodynamic SUI. Of these, 15 (27%) had undergone previous surgery for treatment of SUI. Before the TVT procedure, a complete medical history was taken and a gynecologic examination performed. RESULTS: Operating time ranged between 11 and 35 min (excluding the time of concomitant surgery, if any); hospitalization time ranged between 1 and 5 days; and no severe intraoperative or postoperative complications occurred. Cure occurred in 39 (76%) of 51 evaluable patients and its rate was positively associated with bladder neck mobility. Among patients in whom the angle of displacement on the Q-tip test was less than 30 degrees , 42% became continent whereas among those in whom it was 30 degrees or higher, 90% became continent (P<.001). Among those in whom the angle was between 20 degrees and 30 degrees, 57% became continent, and among those in whom it was less than 10 degrees, 80% remained incontinent. CONCLUSION: The TVT procedure in elderly women with SUI offers a satisfactory cure rate; however, in patients with significantly decreased bladder neck mobility (an angle <20 degrees on the Q-tip test), the results are not encouraging.

Aged↗
PubMed2004

Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of methotrexate.

AIM: Aim of the study was to investigate the efficacy of single transvaginal ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy with concurrent review of the literature. MATERIALS AND METHODS: Six patients with cervical pregnancy are included in the study. All patients were treated with single transvaginal ultrasound-guided intraamniotic installation of 70 mg of methotrexate plus folic acid p.o. The main presenting symptoms were mild to moderate vaginal bleeding and lower abdominal cramp-like pain, resembling the clinical presentation of a threatened abortion. The typical ultrasound findings were the absence of intrauterine gestational sac and the detection of a gestational sac within the cervical canal, invading the anterior or the posterior wall of the cervix and normal appearance of the adnexa, bilaterally. The hourglass-shaped cervix was not characteristic at 5 weeks of gestation but it was at 8 weeks of gestation. DISCUSSION: Ultrasound-guided intraamniotic installation of methotrexate in the management of cervical pregnancy appears to be an effective and safe method but the choice of the method should be depended on the gestational age of cervical pregnancy, the presence of active bleeding or not and its severity, the desire for preservation of future fertility, the presence of coexisting valuable intrauterine pregnancy and the experience of the physician in charge.

Abortifacient Agents, Nonsteroidal↗
PubMed2004

Tension-free vaginal tape efficacy in relation to collagen quantity of pubocervical fascia.

OBJECTIVE(S): To investigate whether the quantity of collagen types I and III in the pubocervical fascia of women with genuine stress incontinence (GSI) affects the efficacy of the tension-free vaginal tape (TVT) procedure. METHODS: Sixty-three patients participated in the study and were divided in 2 groups as follows: 37 patients with GSI and pelvic organ prolapse stage I (group 1), and 26 patients with pelvic organ prolapse stage I but not GSI (control group). Urodynamic studies confirmed the diagnosis of GSI. Biopsies were obtained during surgery from the pubocervical fascia. RESULTS: The quantity of collagen types I and III was statistically significantly reduced in patients with GSI compared to the control group. The efficacy of the TVT procedure in patients with a significant reduction in collagen type I was an 82.1% cure. In patients with a significant reduction in collagen type III, the TVT efficacy was an 85.1% cure. The efficacy of the TVT procedure was not statistically significantly different between patients with GSI and a significant reduction in collagen types I and III, and patients with no reduction in collagen types I and III. CONCLUSIONS: The significantly reduced quantity of collagen types I and III in the pubocervical fascia of women with GSI does not affect the efficacy of the TVT procedure at an average of 25 months of follow-up.

Adult↗
PubMed2004

Mucinous tumors of the appendix presenting as primary tumors of the ovary. Report of two cases.

Primary tumors of the appendix are rare and most of them are unrecognized preoperatively, presenting as appendicits, pelvic masses or with no typical abdominal pain. Two cases of mucinous tumors of the appendix presenting as primary ovarian tumors are described. It is important for the gynecologist-oncologist to include mucinous tumors of the appendix into the differential diagnosis of any case of mucinous ovarian tumor and peritoneal pseudomyxoma, especially when these tumors are associated with extraovarian disease.

Adenocarcinoma, Mucinous↗
PubMed2004

Outcome of patients with ovarian metastatic tumors. Report of 83 cases and review.

UNLABELLED: The aim of the study was to review patients with metastatic ovarian tumors in relation to their outcome and clinical characteristics. METHODS: It was a retrospective study including 83 patients with histopathological diagnosis of metastatic ovarian tumor. The examined parameters include age of the patients, origin of the tumor, consistency and appearance of the tumor, histological type and 5-year survival. RESULTS: The 5-year survival time of patients with metastatic ovarian tumors originating from the genital tract was 14.8% and for metastatic ovarian tumors originating outside the genital tract 5.4%. CONCLUSION: The presence of metastatic ovarian tumors should always be included in the differential diagnosis of a pelvic mass. Difficulties in identification of the primary tumor site are present mainly in cases of metastatic tumors from the colon, while metastasis to the ovary from the breast tends to form small nodules in the ovary.

Adult↗
PubMed2003

Tension-free vaginal tape in the management of recurrent stress incontinence.

METHODS: Thirty-three patients with failed previous incontinence surgery had a Tension-free vaginal tape (TVT) inserted. Preoperative evaluation included uroflow, filing and voiding cystometry, urethral profilometry and a Q-tip test. Factors assessed postoperatively included cure, improvement or failure rates at 20.5 months follow-up, complications, and preoperative and postoperative values of a Q-tip test. RESULTS: The overall success rate was 70% at a mean of 20.5 months follow up (range 12-29 months). In patients with sufficient preoperative mobility of urethra the success rate was 90%, while in patients with a fixed urethra preoperatively the success rate was 33%.

Female↗
PubMed2002

Heterotopic pregnancy at 16 weeks of gestation after in-vitro fertilization and embryo transfer.

We present an heterotopic pregnancy at 16 weeks of gestation following IVF/ET treatment with the ectopic pregnancy located in the left fallopian tube. Intra-abdominal bleeding secondary to an heterotopic pregnancy, causing acute abdominal pain and hemorrhagic shock, should be included in the differential diagnosis even in the second trimester of pregnancy, especially in patients, achieving conception with the use of assisted reproduction techniques.

Adult↗
PubMed2002

Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women.

OBJECTIVE: Objective of the study was to compare the efficacy and the complications of tension-free vaginal tape (TVT) and Burch colposuspension in the treatment of female genuine stress incontinence (GSI). METHODS: In this controlled, prospective, randomized study, participated 35 patients who underwent Burch colposuspension and 36 patients that underwent TVT procedure. Patients with prolapse more than first degree, previous surgical treatment of stress urinary incontinence (SUI) and detrusor instability were excluded from the study. RESULTS: The operative time for TVT was significantly shorter compared to BC. The severity and duration of postoperative pain for TVT was significantly less compared to BC. The necessary time for return to normal activity was 10 days for TVT and 21 days for BC. The cure rate after 24 months of follow-up was as follows: TVT: 84% and BC: 86%, while the improvement was 7% for TVT and 6% for BC. CONCLUSIONS: TVT and Burch colposuspension are equally effective in the management of female GSI at two years follow-up. TVT procedure requires much less operative time, has much shorter hospitalization time, with significantly less postoperative pain and faster return to normal daily activities than Burch colposuspension.

Adult↗
PubMed2002

Q-tip test and tension-free vaginal tape in the management of female patients with genuine stress incontinence.

INTRODUCTION: To compare the Q-tip test before and after performance of the tension-free vaginal tape (TVT) procedure in women with genuine stress incontinence, and to determine the value of the Q-tip test in order to predict the outcome of TVT. METHODS: Thirty-one patients with a diagnosis of stress incontinence but without previous anti-incontinence surgery (group I) and 10 patients with stress incontinence and a history of previous anti-incontinence surgery (group II) participated in the study. None of these patients had an anterior vaginal wall prolapse of greater than stage I according to the International Continence Society Classification and, therefore, the TVT procedure was the only operation performed on these patients. Urethral mobility using the Q-tip test was assessed by the same examiner at the initial physical examination and at the 6-month follow-up examination. Cure was defined as no leakage of urine postoperatively either subjectively or objectively, while failure was defined the objective loss of urine during the stress test. RESULTS: The mean preoperative and postoperative Q-tip measurement in patients without previous operation (group I) was 43.5 +/- 5.84 and 33.38 +/- 4.77 degrees, respectively (mean difference 10.12 degrees), while the cure rate was 87.1%. The mean preoperative and postoperative Q-tip measurement in patients with previous operation (group II) was 17.5 +/- 4.44, and 11.1 +/- 6.88 degrees, respectively (mean difference 6.4 degrees), while the cure rate was 40%. CONCLUSIONS: Adequate mobility of the proximal urethra is associated with a high success rate of the TVT procedure.

Female↗
PubMed2001

Ureteral injuries during gynecological surgery.

The purpose of this study was to review the cases of ureteric injuries during major pelvic surgery that occurred in our department over the last 15 years, in relation to possible predisposing factors and patient management according to the type of injury. From 5,122 major gynecologic operations we found 18 cases of ureteric injury, including 4 cases of urinoma. Parameters that were examined included the indication for surgery and the type of operation, coexisting pathological conditions, the position of and the delay in recognition of the ureteric damage. The incidence of ureteric injury was 0.35%. The time of recognition of injury in 9 cases was during primary surgery and end-to-end anastomosis was performed, whereas in the other 9 cases the injury was recognized after surgery and repair of the ureter was performed, with reimplantation into the bladder in 4 cases and end-to-end anastomosis in 5. Action to prevent the development of iatrogenic ureteral injury must be taken in advance, and the management of ureteric injuries could be improved with prompt recognition and repair by a skilled surgeon.

Adult↗
PubMed2001

The efficacy of bladder distention therapy in the treatment of frequency and urgency.

BACKGROUND: The aim of this retrospective study was to evaluate whether bladder distention therapy is effective in relieving the symptoms of patients experiencing urinary frequency and urgency. MATERIALS AND METHODS: Twenty-six female patients with a history of frequency and urgency who underwent multi-channel urodynamic assessment, were treated with bladder distention therapy for symptomatic relief of their symptoms. Their mean age was 51 years of age (range from 28 to 75 years old). No patient had detrusor-urethral sphincter dyssynergia. Bladder distention therapy was performed in the operating theatre under epidural anesthesia. Statistical analysis was performed with the Student's t-test. RESULTS: The treatment was successful in 9 out of 26 patients after the first attempt (34.6%) and in 10 out of 26 patients after the second attempt (38%) at 1 month follow-up (FLU) and in 4 out of 28 patients at 9 months FLU (15%). Only one out of four patients who had this treatment twice showed improvement of her symptoms. CONCLUSION: Bladder distention therapy in patients with symptoms of overactive bladder dysfunction has a very small success rate (15%) and therefore, has no place in the modern treatment of bladder dysfunction.

Adult↗
PubMed2001

Changes of collagen type III in female patients with genuine stress incontinence and pelvic floor prolapse.

PURPOSE: Objective of this study was to determine possible changes in the quantity of type III collagen in women with genuine stress incontinence (GSI) and with pelvic relaxation or not. MATERIAL AND METHODS: Ninety-four women participated in the study and they were divided in to three groups as follow: 34 patients with GSI and pelvic relaxation (group 1), 32 patients with pelvic relaxation but without GSI (group 2) and 28 patients with neither pelvic relaxation nor GSI (group 3). All the women underwent a complete pre-operative urodynamic evaluation. The presence of collagen type III was determined by immunohistochemical technique. The X-test was used for statistical analysis. A P<0.05 was considered statistically significant. RESULTS: Collagen type III was significantly reduced (p<0.05) in patients with GSI and pelvic relaxation in both sites of biopsy (group 1), compared to patients in groups 2 and 3. Specimens from women without GSI (group 2 and group 3) had a similar density of collagen type III in both sites of biopsy. CONCLUSION: In this study, we found that women with GSI had less collagen type III around the urethra regardless of the degree of pelvic relaxation. It appears that collagen has a significant role in the maintenance of urinary continence but the mechanism by which collagen metabolism is altered remains unknown.

Biopsy↗
PubMed2001

Management of stress urinary incontinence in women with the use of tension-free vaginal tape.

OBJECTIVES: The objective of this study was to assess the effectiveness and the complications associated with the use of tension-free vaginal tape (TVT) and to assess the possibility of using TVT in combination with anterior colporrhaphy for the management of cystocele. METHODS: Sixty-eight patients who were treated with the TVT procedure for the management of stress incontinence were included in the study. All patients were comparable as regards their age, parity, and BMI. RESULTS: A 90% success rate was achieved at 24 months' follow-up for patients with stage I cystocele, while the success rate of the TVT procedure in patients with anterior coloporrhaphy and TVT was 88.8% at 24 months' follow-up. CONCLUSIONS: TVT seems to be a very good alternative procedure for the management of stress incontinence in women and can be combined with anterior colorrhaphy for the management of cystocele.

Colposcopy↗
PubMed2001

Pudendal nerve terminal motor latency in women with genuine stress incontinence and prolapse.

The aim of this study was to investigate changes in pudendal nerve terminal motor latency (PNTML) time in women with genuine stress incontinence (GSI) and with or without prolapse, in conjunction with measurement of maximal urethral closure pressure (MUCP). Eighty-five patients participated in the study and they were allocated to one of four groups, including the control group. A statistically significant difference was found in the PNTML time between patients with GSI and patients of the control group. The conduction time in patients with prolapse but no GSI did not show a statistically significant difference compared to the patients of the control group. The MUCP was reduced in patients with GSI, but no cutoff value of MUCP, which is pathognomonic of GSI, could be identified. We conclude that GSI is associated with a prolongation of PNTML time and a reduction in MUCP.

Adult↗
PubMed2000

Changes in the quantity of collagen type I in women with genuine stress incontinence.

The aim of this study, was to examine changes in the quantity of collagen type I in the pubocervical fascia of women with genuine stress incontinence (GSI), with and without pelvic relaxation. Seventy-eight patients participated in the study and they were divided into three groups that were comparable with respect to their age and parity. All the patients underwent filling cystometry and patients with detrusor instability were excluded from the study. Biopsies were obtained from the pubocervical fascia. The presence of collagen type I was determined with an immunohistochemical technique. The X-test was used for statistical analysis and a P < 0.05 was considered statistically significant. Collagen type I was significantly reduced in patients with GSI irrespective of the presence or absence of genital prolapse. Thus we found that women with GSI had a significant reduction of collagen type I in the pubocervical fascia which consequently affects the tensile strength of the pubocervical fascia and the support provided to the bladder neck.

Adult↗