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Biomedical subjects

S Goldwasser

Publications and source records attributed to S Goldwasser.

4 recordsLinked to original sources
PubMed2001

High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse.

OBJECTIVE: The purpose of this study was to review retrospectively the functional and anatomic outcomes of women who underwent vaginal repair of enterocele and vault prolapse with the use of an intraperitoneal suspension of the vaginal vault to the uterosacral ligaments in conjunction with fascial reconstruction of the anterior and posterior vaginal wall. STUDY DESIGN: Two hundred two women with advanced symptomatic uterovaginal prolapse or posthysterectomy vault prolapse underwent a standard transvaginal procedure to correct their prolapse between January 1997 and June 2000. Anatomic results were assessed by standardized examination from 6 months to 3 years after the operation. Functional results were assessed subjectively and with standard quality of life questionnaires. The average age of the women was 60.3 years. Follow-up data were available for 168 of the 202 women. Fifty-three percent of the women had their uterus in place and underwent a vaginal hysterectomy. The prolapse repair was a primary procedure in 45.2% of the women and was performed for a recurrence or persistence in 54.8% of the women. Sixty percent and 78.6% of women underwent anterior and posterior repair, respectively. Thirty-five percent of the women underwent an anti-incontinence procedure. RESULTS: Eighty-nine percent of the women expressed satisfaction with the results of the procedure. Ten women (5.5%) underwent a repeat operation (by the authors) for recurrence of prolapse in one or more segments of the pelvic floor. Quality of life assessment revealed a significant reduction in all aspects of daily living, when the short forms of the incontinence impact questionnaire and urogenital distress inventory were evaluated before and after the operation. Major intraoperative complications included 5 cases (2.4%) of ureteral injury, 1 case of a small bowel injury, and 1 case of a pelvic abscess that required abdominal exploratory operation and diversion of the colon. CONCLUSION: High uterosacral ligament vaginal vault suspension with fascial reconstruction would seem to provide a durable anatomic repair with good functional improvement in patients with significant complex uterine or vaginal vault prolapse.

Adult↗
PubMed2000

Suprapubic bladder drainage after extraperitoneal cystotomy.

OBJECTIVE: To observe the effects of cessation of continuous bladder drainage after short-term catheterization in women who had extraperitoneal cystotomies. METHODS: The study population included 84 women, 78 of whom had retropubic urethropexies and six of whom had retropubic paravaginal repairs. Intentional cystotomy was done intraoperatively to assure ureteral patency, bladder integrity, and no inadvertent suture penetration into the bladder. All cystotomies were closed in two layers with 3-0 chromic suture. Suprapubic catheters were placed intraoperatively in all cases. In all women except four with gross hematuria, continuous bladder drainage was stopped and voiding trials were started within 24 hours after surgery. Suprapubic catheters were removed when women spontaneously voided 80% of total bladder volume. RESULTS: Suprapubic catheters were discontinued on average 4.1 days after surgery (range 2.7-14.1 days). Average bladder volume at initial clamping of the suprapubic catheter was 382 mL (range 224-510 mL). At this volume the integrity of the cystotomy should have been challenged appropriately. The women were observed for a minimum of 3 months with no immediate or long-term complications. CONCLUSION: Extraperitoneal cystotomy in a nondependent portion of the bladder does not require continuous bladder drainage for more than 24 hours. This information should allow pelvic surgeons to be more liberal with intraoperative cystotomies if bladder integrity or ureteral patency needs to be confirmed.

Cystostomy↗
PubMed1999

A randomized comparison of oral misoprostol versus Foley catheter and oxytocin for induction of labor at term.

OBJECTIVE: We sought to compare the efficacy and safety of oral misoprostol administered to patients with the efficacy and safety in a control group treated with a Foley catheter and oxytocin for induction of labor. STUDY DESIGN: Two hundred patients requiring induction of labor at term with a Bishop score of </=5 were randomized to receive oral misoprostol or a cervical Foley catheter plus oxytocin. Patients in the misoprostol group received 50 microg at 4-hour intervals for a maximum of 6 doses or until an adequate contraction pattern developed. Those in the control group had a Foley catheter inserted in the cervix, whereas oxytocin was administered intravenously by a standard incremental infusion protocol to a maximum dose of 36 mU/min. RESULTS: In multiparous patients the percentage delivered of their neonates within 24 hours and the median induction-to-delivery times were similar in the 2 groups. In nulliparous patients, however, delivery within 24 hours was significantly less likely in the misoprostol group (53.4% vs 82. 5%; P <.001), and the median induction-to-delivery time was longer (23.3 hours vs 17.2 hours; P <.01). There were no differences in the incidence of meconium, chorioamnionitis, low Apgar scores, or cesarean delivery. The incidence of hyperstimulation was higher in the oxytocin-Foley group (4.1% vs 13.1%; P =.02). CONCLUSION: Oral misoprostol is as effective as oxytocin-Foley catheter for inducing labor in multiparous women. Misoprostol appears less efficacious in nulliparous patients.

Administration, Oral↗