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At least 649 records · Page 36Linked to original sources
PubMed2005

A posterior sagittal approach for revision vaginoplasty.

OBJECTIVE: To review our experience with revision vaginoplasty without using bowel, by the posterior sagittal approach. PATIENTS AND METHODS: The notes of eight patients (median age 12.3 years, range 9.0-15.6) were retrospectively reviewed; all had had revision vaginoplasty using a posterior sagittal approach. Their original diagnosis was cloacal anomaly in three, urogenital sinus in two, cloacal exstrophy in two, and congenital adrenal hyperplasia in one patient. RESULTS: Indications for re-operation included: haematocolpos in four patients, absent vaginal opening in two, hydrocolpos in one, and vesico-vaginal fistula in one. The vagina was reconstructed by total urogenital mobilization in seven patients and in one by anastomosing anterior and posterior aspects of a duplicated vagina. The vagina was mobilized by up to 6 cm in this manner. Bowel was not required for any of the vaginoplasties. The median (range) inpatient stay was 6 (4-17) days after surgery and the median follow-up was 35.3 (4.5-50) months. One patient developed a vesico-vaginal fistula and vaginal stenosis, and had further surgery. Two patients required subsequent use of vaginal dilators. The remainder have had a satisfactory outcome. CONCLUSIONS: For revisional vaginal surgery the posterior approach provides excellent exposure, and can be useful in dealing with a variety of pathologies. Combined with total urogenital mobilization, vaginoplasty can be successful despite long common channels. However, there were still several complications.

Adolescent↗
PubMed1991

Eradication of methicillin-resistant Staphylococcus aureus vaginitis with mupirocin.

We report the case of a 54-year-old, quadriplegic woman with a methicillin-resistant Staphylococcus aureus (MRSA) vaginal infection. After failing a five-day course of intravenous vancomycin therapy, the patient was treated for ten days with mupirocin ointment applied intravaginally twice daily, which resulted in eradication of the infection. This report details a novel approach in treating MRSA vaginal infections.

Administration, Intravaginal↗
PubMed2003

Abnormal vaginal bleeding in the nonpregnant patient.

Vaginal bleeding is a common complaint in most emergency departments. Abnormal vaginal bleeding causes many patients a great deal of stress and inconvenience. Although treatment of most cases is straightforward, vaginal bleeding can herald serious occult disease including cancer, coagulopathy, and systemic illness. Vaginal bleeding can also be the initial complaint in patients suffering sexual abuse or trauma. From an emergency medicine perspective, vaginal bleeding should be approached in terms of whether the patient is stable or not. Subsequent evaluation should exclude or treat problems that might cause the patient's condition to deteriorate. The emergency physician is able to provide initial therapy for most causes of vaginal bleeding, and in most cases the patient must be referred to a gynecologist for further evaluation and treatment.

Adolescent↗
PubMed2005

Vaginal hysterectomy and abdominal hysterectomy for treatment of endometrial cancer in the elderly.

OBJECTIVE: The purpose of this study was to analyze the outcome of vaginal and abdominal hysterectomy for treatment of endometrial cancer in elderly patients. METHODS: In a retrospective series of 171 patients with age > or =70 years and at stages I-III, we evaluated operative and hospitalization data, as well as morbidity, mortality, and long-term survival associated with vaginal and abdominal hysterectomy. A total of 128 patients were operated on with vaginal hysterectomy and 43 cases underwent abdominal hysterectomy. RESULTS: Medically compromised patients were significantly more frequent in the vaginal surgery group (P = 0.01). Overall, the 10-year disease-specific survival rates after vaginal and abdominal hysterectomy were 80% and 78%, respectively (P = n.s.). Limiting the analysis to stage I (130 patients), 10-year disease-specific survival was 83% in 95 women operated on by the vaginal route and 84% in 35 patients operated by the abdominal approach (P = n.s.). Patients in the vaginal surgery group had a significantly shorter operative time (P = 0.01), less blood loss (P < 0.05), and were discharged earlier (P < 0.05). Severe complications occurred in 5.4% of the vaginal and in 7.0% of the abdominal procedures. Perioperative mortality was zero after vaginal hysterectomy and 2.3% after abdominal hysterectomy, respectively. CONCLUSIONS: Vaginal hysterectomy showed a high cure rate, shorter operative time, less blood loss, reduced morbidity, and no mortality and therefore may be considered the elective approach for treatment of elderly patients with endometrial cancer.

Aged↗
PubMed2000

Cost and quality-of-life issues associated with different surgical therapies for the treatment of abnormal uterine bleeding.

Abnormal uterine bleeding is a common problem among women of reproductive age and can be treated medically or surgically. When medical therapy fails to cure menorrhagia, many women undergo hysterectomy. Over the past 15 years, operative laparoscopy and hysteroscopy increasingly have replaced traditional surgery (i.e., abdominal and vaginal hysterectomy). An endoscopic approach such as LAVH has been added to the therapeutic choices of patient and physician. Additionally, hysterectomy alternatives such as endometrial resection and ablation and myomectomy have been offered to women with significant menorrhagia. This article reviewed the cost and quality-of-life issues of endoscopic treatment versus traditional surgical methods. Vaginal hysterectomy is the least costly of all hysterectomy techniques. Studies have shown that for LAVH, direct costs are higher that abdominal hysterectomy. However, this difference decreases with additional operator experience and with the use of nondisposable instrumentation. The indirect cost of LAVH is significantly less than abdominal hysterectomy because of the more rapid convalescence. With endometrial resection and ablation, direct and indirect costs are significantly less than those of hysterectomy even when high failure rates are factored. Women choose this procedure over hysterectomy because it avoids major surgery, allows for a fast return to normal functioning, and entails short hospitalization. Hysterectomy can lead to many psychologic and physical changes for a woman. It continues to provide a high satisfaction rate because it is a guaranteed cure for abnormal bleeding.

Costs and Cost Analysis↗
PubMed1997

Transvaginal repair of vault prolapse: a review.

OBJECTIVE: To provide a critical assessment of the published literature on transvaginal reconstructive techniques used to suspend a prolapsed vaginal vault. DATA SOURCE: A Medline data base search and a bibliographic review of the relevant articles were conducted to identify all English-language articles on repair of vaginal vault prolapse. METHODS OF STUDY SELECTION: Our literature search identified 34 articles published in peer-review journals and one article reported in another format, describing five different techniques. TABULATION, INTEGRATION AND RESULTS: The size of each study population, modifications of the original surgical technique, complications, and results were tabulated and summarized for each surgical approach. Only sacrospinous ligament vaginal vault suspension and endopelvic fascia vaginal vault fixation had a sufficient number of cases to allow an informative evaluation of their effectiveness in managing vaginal vault prolapse. Of the 1229 patients who had undergone sacrospinous ligament suspension, 1062 were available for varying periods of follow-up; 193 (18%) of these developed recurrent pelvic relaxation--including 32 vaginal vault eversions, 81 anterior vaginal wall defects, 24 posterior vaginal wall prolapses, and 56 support defects at unspecified or multiple sites. Of the 367 patients who had undergone endopelvic fascia vaginal vault fixation, 322 were available for follow-up ranging from 1 to 12 years; 34 (11%) of these patients developed recurrent pelvic relaxation including nine vaginal vault prolapses, two anterior vaginal wall defects, 11 posterior vaginal wall relaxations, and 12 support defects at unspecified or multiple sites. CONCLUSION: Published experience suggests that sacrospinous ligament suspension and endopelvic fascia fixation are effective in managing vaginal vault prolapse. Because of study limitations--including an absence of standardized outcome evaluation, relatively short follow-up periods, a substantial number of patients lost to follow-up, concomitant surgical procedures, and failure to assess visceral and sexual functions--the true efficacy of these two procedures remains inconclusive.

Fascia↗
PubMed2001

Functional cine magnetic resonance imaging in women after abdominal sacrocolpopexy.

OBJECTIVE: To evaluate whether functional cine magnetic resonance imaging (MRI) is a reliable method for verifying postoperative anatomy and function in women after abdominal sacrocolpopexy. METHODS: We did postoperative functional cine MRI in 25 women who had sacrocolpopexies. Visibility of grafts and vaginal and sacral fixation points were assessed and correlated with intraoperative results. Ranges of vaginal movement were calculated and compared with results of postoperative gynecologic examinations. RESULTS: Functional cine MRI achieved full view of vaginas in all cases. The mean vaginal axis was 142 degrees. Grafts were entirely visible in 13 women, partly visible in nine, and not visible in three. Functional cine MRI defined exactly the sacral fixation points in 22 women. Compared with intraoperative results, functional cine MRI showed a higher level of fixation in nine of 11 women. Functional cine MRI defined exact vaginal fixations point in 15 of 25 women. According to the pubococcygeal reference line, the postoperative range of movement of the vaginal apex was 1.8 cm. Recurrent vaginal vault prolapses in three women were detected equally by functional cine MRIs and gynecologic examinations. In those cases, no parts of patches were seen on the images. CONCLUSION: Functional cine MRI provided reliable abdominal sacrocolpopexy follow-up data. It might help with individual surgical planning and augment understanding of benefits and flaws of various surgical approaches to repair of vaginal vault prolapse.

Female↗
PubMed2003

High dose rate (192)Ir afterloading brachytherapy for cancer of the vagina.

We report results of brachytherapy for carcinoma of the vagina, utilizing a Nucletron high dose rate system for Delclos Vaginal Applicators (cylinder) and Syed Template Applicators (interstitial). The linear quadratic (LQ) model was used to determine the optimum time-dose-fractionation schedules. Interstitial doses were determined at the isodose line that included gross tumour. Cylinder doses were determined either at the vaginal surface (5 cases), at 0.5 cm depth (5 cases), or at 1.0 cm depth (1 case). For the first treatment (n=19), interstitial templates were utilized in 8 patients and vaginal cylinders in 11. 11 patients received second treatments: 6 templates and 5 cylinders. The median dose of external beam radiation (n=15) was 40.0 Gy followed, after a median 23 day interval, by high dose rate brachytherapy (HDRB) of 4 fractions in 30-42 h; then a median interval gap of 25 days, followed by repeat HDRB. The median total fractionated HDRB dose per patient was 23.0 Gy (range: 6.9 Gy to 40.4 Gy; calculated low dose rate equivalent of 29.8 Gy). Tumour histologies included 14 squamous cell carcinomas, 2 adenocarcinomas, 2 melanomas, and 1 small cell tumour. Three patients experienced early brachytherapy-related complications (diarrhoea, dysuria and labial dermatitis). Three patients (15.8%) developed serious/late complications including ureteral stenosis, painful vaginal necrosis and small bowel obstruction. The first of these patients received 2 templates, the second a cylinder followed by a template and a cylinder, and the third a single cylinder. The 2 year progression-free survival was 39.3% (median 15.7 months), while the 2 year overall survival was 66.1% (median 29.9 months). (192)Ir afterloading HDRB is a feasible approach to women with vaginal cancer with acceptable toxicity and tumour response. Potential advantages include patient preference, outpatient cost-effectiveness in the case of cylinder technique, and no radiation exposure to hospital personnel. Long-term follow-up is needed to further assess late complications, and larger studies are needed to confirm our results.

Adult↗
PubMed1984

Radium needles implant in the treatment of extensive vaginal involvement from cervical carcinoma. A dosimetry appraisal.

An appraisal of the dosimetry of a modified brachytherapy approach is presented for improving the local control of extensive vaginal involvement from carcinoma of the cervix. This approach incorporates radium needles implant to the vaginal disease in conjunction with the usual routine intracavitary radium application. The aim of the interstitial implant is specifically to supplement the dose to the vaginal disease from the intracavitary application. Our procedure for accomplishing this boost in the dose to the vagina depends on the location, extent and thickness of the vaginal lesion following external beam irradiation of the whole pelvis. An increase of greater than 50 per cent in the dose to the vaginal disease is gained by this combination intracavitary/implant approach which has been used in a variety of cases covering virtually all pertinent stages of cervical carcinoma. Discussion of the dosimetry of example cases is presented to demonstrate the value of combining interstitial and intracavitary therapy for this specific clinical application.

Brachytherapy↗
PubMed1993

Laparoscopically assisted radical vaginal hysterectomy.

A vaginal or a laparoscopic approach in radical surgery for cervical carcinoma has been proposed. A pilot study of eight cases shows that an oncologic surgeon familiarized with these techniques is able to take advantage of the benefits of both routes in the same patient: laparoscopic surgery is adapted to lymph node dissection, section of the origin of the uterine artery, and dissection of the ureter under direct vision; vaginal surgery allows a precise incision of the vaginal cuff. Both routes may be used for the section of parameters, but we propose the use of the vaginal route. The combination of vaginal and laparoscopic surgery spares the pain and discomfort of both laparotomy and perineotomy.

Adult↗
PubMed2006

[Treatment of female stress urinary incontinence with tension-free vaginal tape].

OBJECTIVE: To investigate the indication, approaches and prevention of complications in treatment of female stress urinary incontinence (SUI) with tension-free vaginal tape (TVT). METHODS: From September 2003 to December 2004, 40 cases of female stress urinary incontinence were treated, including 8 cases in association with cystocele or rectocele and 1 case in association with uterine prolapse. They ranged from 30 to 70 years in age with an average of 56.3 years. The disease course was 1-42 years (7.2 years on average). All patients received TVT. In the patients suffering from uterine prolapse and cystocele or rectocele, butterfly-shaped mesh patch was applied. RESULTS: All patients achieved satisfactory results. The complications included slight dysuria (2 cases), vesical perforation (1 case) and pelvic hematoma (1 case) and cleared up after treating. All cases were followed up 1 to 15 months and the results were satisfactory. No urinary incontinence and no dysuria reoccurred. CONCLUSION: TVT is effective for SUI.

Adult↗
PubMed1990

The vaginal strips sling operation. An alternative procedure for urinary incontinence.

An alternative approach to the treatment of marked anterior vaginal prolapse and urinary incontinence is presented. Two strips of vaginal skin are used to elevate and suspend the bladder neck and the proximal third of the urethra. Of 82 patients who underwent the operation, 37 had had previous bladder neck repairs for urinary incontinence. A 95.1% success rate was achieved. The procedure is worth considering under certain circumstances.

Adult↗
PubMed1995

[Blood transfusion in benign obstetric-gynecologic disorders].

Objective of our study was to determine the incidence of blood transfusions in patients treated with abdominal or vaginal surgery for benign pathologies, because of high risks (especially infections) connected to this practise, and to evaluate the possibility of a simple medical treatment in patients with anemia and not to use blood transfusions. Examining our activity in a five-year period, from 1988 to 1992, we report that the use of blood was required for only 21 women, 1.5 percent of patients with gynecological problems (10 over 639) and 0.17 percent of pregnant patients (11 over 6208). We had more anemia in the abdominal approach than in the vaginal way. A group of 20 young women, with the efficient cardiovascular system, with severe-mild anemia too, were treated with simple medical support, obtaining, in a short time, good clinical conditions.

Abdomen↗