[Recommendations for diagnosis and therapy of premenstrual syndrome (PMS). 2006].
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Biomedical subjects
Z Pastor
Publications and source records attributed to Z Pastor.
[Abdominal hysterectomy--risk factor in development of urinary incontinence? Results of a questionnaire study].
OBJECTIVE: To evaluate the risk of urinary incontinence development after abdominal hysterectomy for benign gynecological disease. DESIGN: Retrospective questionnaire study. SETTING: Obstetrics and Gynecology Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Questionnaire study of women in which abdominal hysterectomy for benign gynecological disease was performed from January till December 2001 at our Department of Gynecology and Obstetrics. The questionnaire included questions about symptoms of stress, urge and mixed urinary incontinence. They were evaluated in connection with age, parity, hormonal status and body mass index. Student t-test was used for the statistical analysis. RESULTS: 114 (59.7%) from all sent-out questionnaires were obtained. In 15.8% cases (18 from 114) de novo urinary incontinence after surgery developed. 77.8% (14 from 18) from these patients suffered from genuine stress incontinence. The rest (4 from 18) of the women had symptoms of mixed incontinence. Study results draw attention to 13.1% women (15 from 114) in which preoperative stress incontinence persisted even after hysterectomy. Preoperative stress incontinence was cured in 6.1% (7 from 114) cases after hysterectomy. Age, parity, hormonal status and body mass index were not statistically different in all groups after surgery. CONCLUSIONS: The results of the study show relatively high risk of urinary incontinence development after abdominal hysterectomy in previously continent women. The results also show high persistence of the stress incontinence symptoms in women who did not inform about their incontinence even if they were asked about it. Higher quality of further health education of the women with drawing their attention to both the possibility of surgical treatment of urinary incontinence simultaneously with hysterectomy are the most important aspects how to make the current gynecological surgical therapy more effective.
Adult↗
[Abdominal sacral colpopexy in the treatment of posthysterectomy vaginal vault prolapse].
OBJECTIVE: To evaluate the safety and efficacy of the abdominal sacral colpopexy in the treatment of posthysterectomy vault prolapse. DESIGN: Retrospective clinical trial. SETTING: Obstetric and Gynecologic Department, The Charles University 2nd Medical School and Faculty Hospital Motol, Prague. METHODS: A group of 18 patients with vaginal vault prolapse after hysterectomy who underwent abdominal sacral colpopexy between July 2001 and June 2003 was studied. Ten women had undergone previous abdominal and 8 previous vaginal hysterectomy. All patients were operated on by one surgeon. Preoperative evaluation consisted of physical examination, age, parity, body mass index, history of previous pelvic surgery and hormonal status. The cure rate and complications were evaluated in follow-up. RESULTS: The mean age was 59.5 (41-72) years, the median parity was 2.05 (1-5). Seven (38.9%) patients were slightly overweight (BMI 25-30 kg/m2), one (5.6%) patient was obese (BMI 33.4 kg/m2) and 10 (55.5%) had normal weight (20-25 kg/m2). The average period of follow-up was 14.9 months (6-24). The cure rate was 94.4% (17 of 18 patients). No serious intraoperative complications occurred. Postoperative complications occurred in 2 (11.2%) cases (one urgent and one stress urinary incontinence). The complications were resolved and the patients were free of negative postoperative symptoms in the time of the last follow-up visit. CONCLUSIONS: Vaginal vault prolapse is an infrequent complication after both vaginal and abdominal hysterectomy. The study shows that abdominal sacral colpopexy is an effective and safe surgical procedure in the treatment of posthysterectomy vault prolapse. The operative technique is simple but the surgery should be performed by experienced pelvic surgeons able to resolve intraoperative complications.
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[Prevalence of the female urinary incontinence. Results from a questionnaire study].
OBJECTIVE: To evaluate the prevalence of urinary incontinence in patients of gynecological practise aged 31-60. DESIGN: Prospective questionnaire study. SETTING: Obstetric and Gynecologic Department, Charles University 2nd Medical Faculty and Teaching Hospital Motol, Prague. METHODS: Questionnaire study of 561 women aged 31-60 examined with gynecological problems (not for the symptoms of urinary incontinence) from November 2001 till October 2002 in standard gynecological practise. The questionnaire included history, evaluation of urinary continence, lasting of the symptoms, body mass index, obesity, age, parity. Stress, urgent and mixed incontinence and influence on the sexual life were also evaluated. Cochran Mantel-Haenszel test and chi2 test were used for the statistical analysis. RESULTS: The incontinence rate in the group of 533 evaluated patients (95% completed questionnaires from 561) of gynecological practise was 23.8%. 81.1% of incontinent patients in the study suffered from stress urinary incontinence. For an easy survey and analysis the patients were divided into three age groups (31-40, 41-50, 51-60). Prevalence of the urinary incontinence rised with age. Statistically significant lower prevalence of urinary incontinence was in the age group 31-40 (p<0.0005). Influence of parity on the prevalence of incontinence was statistically significant only in the age group 31-40 (p=0.002). Obesity had no statistical impact on prevalence of urinary incontinence (p=0.79). 5.5% of incontinent women suffered from negative effect of urinary incontinence on sexuality; the differencies among the age groups were not statistically significant. CONCLUSIONS: The results of the study show high prevalence of urinary incontinence in population of healthy women of gynecological practise. Low interest for the treatment is in contrast with high prevalence of this symptom. Higher quality of the enlightenment with attention to the prevention and therapy of urinary incontinence in population is the way how to improve quality of lives of the afflicted women.
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[Female sexual dysfunction].
OBJECTIVE: Comprehensive information about female sexual dysfunctions and possibilities of their treatment. DESIGN: Review article. SETTING: Institute for Postgraduate Medical Education, Prague. METHODS: Analysis of the literary data (texts in medical journals, monographies, textbooks, internet--"Medline") and author's clinical experience. CONCLUSIONS: Female sexual dysfunctions are highly prevalent but not well defined and understood. Existing definitions and classifications of female sexual dysfunctions are reevaluated and revised at present. Contemporary classification was expanded to include psychogenic and organic causes of desire, arousal, orgasm and sexual pain disorders. The female sexual response cycle is initiated by neurotransmitters which increase pelvic blood flow, vaginal lubrication, clitoral and vaginal reactivity. The effect of the therapy consists in the stabilization of the hormonal levels. New drugs with vasocongestive effect on genital are discussed.
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[Importance of correct interpretation of incidental detection of intraocular administration of silicone oil on the CT image].
Liquid silicone is used in ophthalmology as one of the possible substitutes of the vitreous body and for internal tamponade of the vitreous space in pars plana vitrectomy (PPV). The intraocular presence of silicone causes marked changes of the CT image of the bulbus. As the number of patients treated by PPV is steadily increasing (this applies in particular to patients with diabetes and AIDS), the probability increases that the radiologist will encounter this image. Typical changes in the CT image of the bulbus after PPV using a silicone cerclage strip with administration of silicone oil (SO) into the vitreous space: 1. Disfiguration of the bulbus after application of the cerclage strip, 2. the area of the vitreous body is visualized as a hyperdense area with a slit-like hypodense space between SO and the bulbar wall. Knowledge of these changes will avoid errors in the interpretation of accidentally recorded CT images.
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