SEARCH · PubMed Health

Results for “Vaginal Approach”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 973 records · Page 54Linked to original sources

PubMed1982

Intrafascial abdominal and vaginal hysterectomy: a reappraisal.

This study was designed to provide anatomic and physiologic evaluation of the intrafascial approach to hysterectomy. Anatomy of the pericervical fascia and its relationship to the fascial and muscular layers of the vagina and the cardinal and sacrouterine ligaments were studied in human and nonhuman primates. The effect of hysterectomy on the length, configuration, and axis of the vagina was evaluated using vaginal casts. Intrafascial abdominal and vaginal hysterectomies have many advantages. Damage to the urinary tract and bowel is minimized. Separation and later closure of the pericervical fascia may allow more effective hemostasis, obliterate dead space, decrease the area of raw surfaces, and separate the vaginal cuff from the retroperitoneal space. These are the principal factors in the prevention of postoperative infection. Intrafascial hysterectomy preserves the complex anatomic relationships between the endopelvic fascia and the vagina. It provides good vaginal support and preserves or improves the length, configuration, and axis of the vagina. Intrafascial hysterectomy is indicated only for treatment of benign disease.

Adolescent↗

PubMed2001

Vaginal vault fixation and prevention of enterocele recurrence by high midline levator myorraphy: physical examination and questionnaire-based follow-up.

OBJECTIVES: To assess outcome following a vaginal repair (high midline levator myorraphy, HMLM) for vaginal vault prolapse. METHODS: Women were identified who had undergone HMLM between December 1995 and September 1998. A structured telephone interview consisting of 5 questions was conducted in all those who could be reached. The most recent results of physical examination, based on office records, were also collected. RESULTS: Thirty-five of 47 women completed the interview (average age 71 years, mean time since surgery, 27.9 months). Five patients had developed recurrent prolapse requiring repair (anterior enterocele in 3, vault prolapse in 1, symptomatic cystocele in 1). Recurrent cystoceles were noted on examination in 7 women (5 grade 1, 2 grade 2). Overall, 17 women were extremely satisfied with the result (>90% satisfied); 6 were dissatisfied (<50%). Five women were noted to have transiently reduced unilateral ureteral drainage intraoperatively, and all cases were resolved after the removal or replacement of one of the levator myorraphy sutures. One patient required re-exploration for ureteral obstruction, which resolved after replacement of a suture and stenting. CONCLUSIONS: Levator myorraphy is safe, effective, and easily taught. The rate of recurrent prolapse associated with this technique is similar to other techniques for vaginal vault fixation, but it avoids the disadvantages of an abdominal approach and is more technically straightforward to perform than sacrospinalis fixation.

Aged↗

PubMed2007

Vaginal birth after caesarean section (VBAC): exploring women's perceptions.

AIMS AND OBJECTIVES: This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. BACKGROUND: The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites' choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision-making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. DESIGN AND METHODOLOGY: Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. RESULTS: This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. CONCLUSIONS: Informed choice is the key to effective women-centred care. Women must have access to non-biased evidence-based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. RELEVANCE TO CLINICAL PRACTICE: This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho-social implications may supersede their physical concerns about birth.

Decision Making↗

PubMed1994

The bladder neck support prosthesis: a nonsurgical approach to stress incontinence in adult women.

OBJECTIVE: Our purpose was to evaluate a vaginal device designed to support the bladder neck in women with urinary stress incontinence. STUDY DESIGN: Thirty-two physically active incontinent women underwent urodynamic evaluation and maintained a bladder diary before enrollment and after 4 weeks of device use. Outcome measures included changes in number of reported incontinence episodes, urine loss on stress testing, and changes in urodynamic parameters with the device in place. Patient comfort, convenience, and satisfaction were also evaluated. RESULTS: Thirty women completed the study. Twenty-five (83%) were dry with the device in place. Weekly incontinence episodes decreased from 10 to three (p < 0.05). Significant changes in functional urethral length, pressure transmission ratio, and urethral cotton swab stress angle were noted. No evidence of urethral obstruction was noted. The subjects found the device comfortable, easy to use, and convenient. CONCLUSION: The bladder neck support prosthesis reduces stress incontinence and normalizes urodynamic parameters in the same manner as a colposuspension.

Adult↗

PubMedDate not supplied

Biotyping of Candida strains with regard to the epidemiology of candidosis. A practical approach.

In 62 strains of Candida albicans cultivated from specimens of patients with recurrent vaginal candidosis or with renal transplants, the biotypes were determined according to several characters: colony morphology, production of chlamydospores, auxanogram of C- and N-substances, zymogram, growth kinetics, adherence capability, proteolytic activity, sensitivity to 6 antimycotics, and serotypes. On the basis of this typing system the endogenous and exogenous sources of chronic vaginal candidosis as well as the sources of systemic candidosis in patients with renal transplants could be evaluated.

Bacterial Typing Techniques↗

PubMed1995

Simplified surgical approach to bladder outlet obstruction following pubovaginal sling.

We report a new technique of vaginal patch interposition to relieve bladder outlet obstruction after a suburethral sling procedure when the obstruction is caused by over correction of the urethrovesical angle. In this technique the sling is incised longitudinally in the midline and dissected laterally. A vaginal patch is obtained from the vaginal mucosa, then interposed and sutured between the 2 cut edges of the sling. This method is characterized by simplicity and low morbidity, while preserving the integrity of the suburethral sling to maintain continence.

Aged↗

PubMed1995

The incidence and significance of acute post-hysterectomy pelvic collections.

In a prospective study, 32 consecutive patients underwent endovaginal pelvic scanning in the first post-operative week following hysterectomy. Twenty-four attended for a further scan at clinical follow up. Vaginal vault fluid collections were identified in 19 women (59%) on the first post-operative scan. Fifteen of the 19 with collections had no significant pyrexia. Out of the entire sample of 32 subjects, six patients (19%) had significant post-operative pyrexia of whom four were in the group with post-hysterectomy vaginal vault collection and two had no collection on their early post-operative scans. All collections detected on the early scans had resolved or were smaller on follow-up scan but two asymptomatic patients who had no collection on the early scan had developed vaginal vault fluid collections on the late follow-up scan. No statistically significant association was demonstrated between the presence of a collection and post-operative pyrexia, surgical approach or operative blood loss The results of this study indicate that the demonstration of vaginal vault collection following hysterectomy is a frequent finding in both febrile and afebrile subjects and does not indicate the need for drainage.

Acute Disease↗

PubMed1990

Insertion of testicular prosthesis: use of vaginal speculum.

We have used a vaginal speculum to insert a testicular prosthesis through the inguinal approach over the past four years. We have found this technique to be easily performed and reproducible in allowing the testicular prosthesis to be placed in the normal dependent position in the scrotum.

Adolescent↗

PubMedDate not supplied

Total laparoscopic hysterectomy: a tried and tested technique.

Gynecologists are increasingly adopting total laparoscopic hysterectomy as their preferred method for performing a hysterectomy. The laparoscopic approach offers a superior view of the anatomy, facilitates meticulous hemostasis, enables the surgeon to perform adnexal surgery and pelvic reconstructive surgery, and reduces morbidity associated with large abdominal incisions. During the last 10 years, the surgeons at the Sydney Women's Endosurgery Centre (SWEC) have developed a laparoscopic technique using the same well-known steps as in the open abdominal approach. The ovarian pedicles are ligated, the uterine pedicles and vaginal vault are sutured laparoscopically, and some novel time-saving maneuvers are adopted.

Adnexa Uteri↗

PubMed1994

Septate uterus with cervical duplication: a rare malformation.

This previously unreported case of complete uterine septum, cervical duplication, and a longitudinal vaginal septum is best explained by the theory of Muller et al. (5), not by classically held views of unidirectional müllerian development. According to their theory, this anomaly could develop from failure of fusion of the most caudad müllerian ducts, resulting in a normal uterine fundus, with a complete septum, cervical duplication, and a longitudinal vaginal septum. This anomaly was accurately characterized using an endoscopic approach.

Abnormalities, Multiple↗

PubMed1976

Colpocystourethropexy: the way we do it.

In pure stress urinary incontinence the sphincteric mechanism is intact. Restoration of normal position and support to the vesicourethral segment usually re-establish normal sphincteric function. A suprapublic approach is used to gain adequate mobilization of the anteriorr vaginal wall and vesicourethral segment. Full thickness sutures applied in the anterior vaginal wall as far lateral from the urethra as possible are then tied to Cooper's ligament. Forward and upward lifting of the vesicourethral segment is achieved but the urethra is free in a wide retropubic space. Normal position with limited mobility of the sphincteric segment is attained, yet compression or obstruction of the urethra and surgical trauma to the delicate sphincteric musculature are avoided. Adsorbable sutures are used. Permanent fixation is to be achieved by the postoperative fibrosis made possible after all retropubic fat has been cleared away. This technique has been uniformly successful in virginal cases and in the great majority of the least favorable cases, after repeated failures. Adequate mobilization proper placement of sutures and prevention of compression and surgical damage are the keys to longlasting successful repair.

Female↗

PubMed2002

Outcomes of endometrial cancer patients undergoing surgery with gynecologic oncology involvement.

OBJECTIVE: This study was undertaken to compare the outcomes of patients with endometrial cancer who had primary surgery with gynecologic oncology involvement at university or community hospitals. METHODS: The study population consisted of all patients who had primary surgery for endometrial cancer with involvement of the attending physicians of the Division of Gynecologic Oncology. The patients were divided into two groups based on whether their surgery was performed at a university or community hospital. Demographic and clinical data were abstracted from the medical records. RESULTS: There were no significant differences between the two groups with regard to Quetelet index (kg/m(2)); intervals between biopsy and consultation, consultation and surgery, and biopsy and surgery; estimated blood loss; incidence of operative or hospital complications; frequency of appropriate surgical staging; stage distribution; histology or grade; and hospital stay. Patients at a university hospital were significantly older, had a higher severity index, were more likely to have had a vaginal hysterectomy, and participate in a research protocol. Both the Quetelet index and the severity index were significantly higher for patients who had vaginal hysterectomy than for those who had either laparoscopically assisted vaginal hysterectomy or total abdominal hysterectomy. When analyzed by surgical approach, the frequencies of pelvic and paraaortic lymph node sampling were comparable between the groups. Both the Quetelet and severity indices were significantly higher for patients who did not have lymph node sampling. CONCLUSION: Involvement of a gynecologic oncologist at the time of primary surgery for endometrial cancer was associated with comparable outcomes in both the university and community hospital setting.

Body Mass Index↗

PubMed1998

Costs of hysterectomy: does surgical approach make a difference?

We wanted to determine the direct cost of hysterectomies by surgical approach and to estimate the impact on costs if more vaginal hysterectomies were substituted for abdominal hysterectomies for women under 50 years of age. Eleven Ontario (Canada) hospitals provided 1994 cost data based on 1376 hysterectomies. These data were applied to all hysterectomies performed in the province for women under 50 to estimate the cost of subtotal, vaginal (VH), or laparoscopically assisted vaginal hysterectomy (LAVH) relative to total abdominal hysterectomy (TAH). We determined the change in costs if TAHs in Ontario in 1994-1995 had been substituted by VH or LAVH. Teaching and community hospitals were considered separately. VH was less costly than TAH, subtotal, or LAVH. The direct cost for TAH at teaching hospitals was much higher than at community hospitals. Costs relative to TAH were higher for LAVH at community but not at teaching hospitals. From the population baseline rate of 25% VH, 5% LAVH, 10% subtotal, and 60% TAH, we estimated that increasing VH to 45% would lower costs by 2.4%; increasing LAVH to 25% would increase costs by 4.4%. VH is associated with lower costs than TAH or LAVH. However, the magnitude of the substitution and the extent of cost savings should ultimately be based on evaluation of patient outcomes.

Adult↗

PubMed2001

Neisseria gonorrhoeae resistant to ciprofloxacin: first report in Cuba.

BACKGROUND AND OBJECTIVES: The Cuban Ministry of Public Health plans to implement the syndromic approach to sexually transmitted diseases in persons with urethral or vaginal syndrome in Cuba using 500 mg ciprofloxacin as therapy. Although the emergence of clinical isolates of Neisseria gonorrhoeae with decreased susceptibility to ciprofloxacin have been sporadically detected in Cuba, there has been no report of isolates that exhibited significant resistance to this drug. This is the first report of the isolation of a N gonorrhoeae strain resistant to ciprofloxacin in Cuba. STUDY DESIGN: Case report. CONCLUSIONS: This case emphasizes the need for awareness regarding the potential emergence of a clinically significant resistance of N gonorrhoeae in Cuba. There is a need for continued antimicrobial susceptibility surveillance of Cuban isolates to ciprofloxacin and other fluoroquinolones.

Adult↗

PubMedDate not supplied

Perimenopause: an opportunity for health promotion.

Women throughout the world experience menopause, yet the effects of estrogen deficiency, which are more extensive than the commonly reported symptoms of hot flashes, vaginal atrophy, and osteoporosis, are rarely discussed. Using an empathetic approach can enable nurses to teach women more effectively about the multisystem effects of perimenopause and counsel them to implement and maintain the life-style changes necessary for promoting health during this time of life.

Aged↗

PubMed2000

[Treatment of ectopic pregnancy in 2000].

Operative laparoscopy is currently the best treatment for pregnancy (EP). As with laparotomy, laparoscopic treatment of EP can be either conservative (salpingotomy or radical (salpingectomy). After conservative laparoscopic treatment, failures are diagnosed by monitoring the drop in beta-hCG levels. Fertility results after laparoscopic treatment of EP are comparable with those observed after similar treatment by laparotomy. Better knowledge o the risk factors of EP, development of hCG assays using serum progesterone and high resolution sonography using vaginal probes allow early diagnosis of EP and a nonsurgical approach in more than 30% of cases. When inclusion criteria are strict, methotrexate administered by local injection or systemically (1mg/kg) in a single dose or in combination with mifepristone gives a 90 to 95% success rate. Whatever treatment protocol is used, fertility prognosis after EP is not correlated to the features of EP but depends mainly on patient age and past history.

Chorionic Gonadotropin, beta Subunit, Human↗

PubMedDate not supplied

Alaska's obstetrical delivery systems: a descriptive epidemiologic study.

Delivery of obstetrical care in rural Alaska can be very challenging, due to remoteness, lack of medical resources and transportation difficulties. This descriptive study looks at what the current delivery systems for obstetrical care in Alaska are. Alaska's obstetrical delivery systems can be divided into three basic systems. 1) Full comprehensive obstetrical care limited only by lack of neonatal ICU capability. 2) Cesarean delivery capable, but with limited resources. 3) Low risk vaginal deliveries with no cesarean delivery capability except by transports approaching 6 hours. This study raises questions about which system is most effective for which communities. Further studies need to be undertaken to better understand how to provide effective obstetrical care in rural and bush Alaska at an acceptable risk, and at reasonable cost.

Alaska↗

PubMed2003

[Induction of labour: which method to use?].

Induction of labour is a common obstetric instrument to employ when the potential risk to continue a pregnancy is higher than to terminate it. The methods of induction can be pharmacological or mechanical; the choice of the method mainly depends by the cervical ripening, as it is significantly able to influence, according to the type of induction, its final issue. The mechanical methods are: stripping and sweeping of the membranes, hand dilatation of cervix, intrauterine pressure catheters, Laminaria Japonicum, transcervical Foley catheter and amniotomy. To pharmacological methods include some agents such as the prostaglandins (PG), the most common approach to induce a labour, and used above all by vaginal way in patients with unripe cervix. They simulate the natural PG effects at the beginning of delivery and show a great efficiency. There are a lot of PG on the market, but except some of them, as Dinoprostone for PGE2 and Misoprostol for PGE1, no one of them shows the same safety in management of labour. Oxytocin, another inductive method, administered by diluted intravenous infusion, is utilized alone or mainly with other methods when the labour is started or with rupture of the membranes, because it begins or maintains the myometrial contraction.

Abortifacient Agents, Nonsteroidal↗