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Results for “Vaginal Approach”

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PubMed2005

Which procedure for incontinence?

Approximately 16-29% of women will complain of incontinence at the menopause. A multidisciplinary approach to treatment is essential and surgery is usually reserved for women who have failed to improve sufficiently with conservative measures, such as pelvic floor exercises. The Burch colposuspension remains the 'gold standard' procedure for stress urinary incontinence, against which all newer procedures are compared. It is normally carried out under general anaesthesia and requires an abdominal approach, most often by a low transverse incision. Tension-free vaginal tape (TVT) is the most popular procedure at present and has largely replaced colposuspension in many units. However, there are concerns about both its long-term safety and the lack of data on efficacy beyond the first few years. Initial reports of transobturator tape suggest that it may have a similar efficacy to TVT but with a lower rate of serious complications; however, large comparative studies and longterm follow-up data are currently unavailable. Collagen and silicone injected around the urethra can be used in a selected group of patients under local anaesthetic but the success rates are disappointingly low.

Female↗

PubMed1977

Increasing uterine response to vaginal distension during late pregnancy in sheep.

Intrauterine pressure changes were monitored in 5 pregnant ewes and uterine venous prostaglandin (PG) F concentrations were determined after distension of the vagina. Uterine contractility and utero-ovarian PGF concentrations were elevated by vaginal distension and the magnitude of both effects increased as parturition approached.

Animals↗

PubMed1992

Intrauterine intravascular transfusion for fetal haemolytic anaemia: the Western Australian experience.

OBJECTIVE: To report the first four years' clinical experience with fetal intravascular blood transfusion for the treatment of fetal haemolytic anaemia in Western Australia. SETTING: King Edward Memorial Hospital, Perth, which is the sole tertiary level perinatal centre in Western Australia with a referral base of approximately 25,000 pregnancies each year. METHODS: Transfusion was by injection of packed cells from Rh-negative donors into the fetal umbilical vein near the site of insertion into the placenta. Fetal haemoglobin levels were measured before and after each transfusion. In most cases, the fetus was paralysed by intramuscular tubocurarine. RESULTS: Sixty intravenous transfusions were performed in 20 pregnancies. At the time of the initial transfusion, the mean haemoglobin level was 5.8 g/dL (range, 2.5-8.5 g/dL) and six fetuses had signs of hydrops. The case survival rate was 80% and the procedure survival rate was 93%. Three of the deaths occurred in the first five cases. Caesarean section was performed during two of the procedures, one because of bleeding from the cord puncture site and one because of tamponade of the umbilical vessels. CONCLUSION: Fetal intravascular transfusion is a highly effective treatment for fetal alloimmunisation and allows pregnancies to continue to term and to be delivered vaginally. However, the procedure may be difficult and requires a team approach with ready access to fetal monitoring and emergency caesarean section. Our results suggest that increasing experience of the team is a major factor in improved outcome.

Adult↗

PubMed2005

Leading the development of an ECV service.

This article has identified an area of practice that needed to be developed. Despite the service being a medical procedure, it fitted into the remit of my role. The findings provide a well-established with improving ECV clinical skills. The drive now will be to review the way women receive information about ECV (or ensure that they have the opportunity for a vaginal breech birth, if this is their choice). There is also the need to improve the chance of a vaginal birth following successful ECV. This initiative demonstrates a multidisciplinary team approach, working together to provide a service, which has been found to be safe and, above all, evaluated favourably by women.

Adult↗

PubMed1997

Vault haematoma following laparoscopic hysterectomy.

Thirty consecutive patients underwent transabdominal ultrasound scanning on day 2 postoperatively in order to provide data on the incidence of vaginal vault haematoma following laparoscopic hysterectomy. Details of postoperative morbidity, both inpatient and after discharge, were recorded. Results support the view that there is no significant association between the presence of vaginal vault haematoma (73%) and the incidence of posthysterectomy febrile morbidity (16.7%). Furthermore the incidence of vault haematoma after laparoscopic hysterectomy is comparable to literature figures for both abdominal and vaginal hysterectomy, whilst that of febrile morbidity is at least equivalent if not reduced for the laparoscopic approach. We believe this provides further evidence confirming the safety of the laparoscopic approach to hysterectomy.

Female↗

PubMed1998

[Prolapse of the small intestine through a surgically closed introitus vaginae after vaginal hysterectomy followed by subsequent colpectomy].

We report on an unusual case of small bowel prolapse through a hiatus in the closed introitus vaginae after previous total colpectomy. The interval between colpectomy and present prolapse was nearly 4 years. The intestinum was reponated by abdominal approach, but a partial resection of the small bowel was not to avoid. The possible complications after vaginal hysterectomy resp. colpectomy are discussed. According to literature we didn't find a similar case.

Aged↗

PubMed2005

Vaginal wall erosion after transobturator tape procedure.

Transobturator Prolene tape insertion represents a new method of operative treatment for stress urinary incontinence. The first results show that it is a simple and effective procedure accompanied by a minimum number of complications. Since February 2004, 30 Monarc procedures were done at our department and no intraoperative complications were observed. However, two cases (6.7%) of vaginal wall erosion due to the Prolene tape were noted 6 weeks after surgery. In a subsequent surgical procedure, the periurethral portion of the tape was removed and a new Prolene tape was placed through the retropubic space. Three months after secondary surgery both patients were continent, with no sign of erosion. The transobturator approach was introduced to minimize the risk of complications. However, the greater prevalence of vaginal wall erosion after this procedure found in our series demands a scrupulous search for this complication and for the mechanisms leading to its occurrence.

Aged↗

PubMed2006

Vaginal revision of intravesical tension-free vaginal tape 44 h after initial placement: a case report.

Unintentional cystotomy is a known complication of the tension-free vaginal tape procedure and is commonly diagnosed intraoperatively. Delayed diagnosis does occur and various reparative techniques have been described, some requiring laparotomy with intentional cystotomy and repair. We report a case where a 46-year-old woman underwent vaginal reconstructive surgery including placement of a tension-free vaginal tape, which was complicated by unilateral cystotomy. A delayed diagnosis of intravesical tape placement was made requiring reoperation. The patient underwent a minimally invasive transvaginal procedure for removal and immediate replacement of the malpositioned arm of the tape. We conclude that a transvaginal approach may be an acceptable technique for revision and replacement of the tension-free vaginal tape where cystotomy is identified within 44 h after the initial procedure. With this technique, a more invasive surgery including laparotomy with cystotomy might successfully be avoided.

Cystoscopes↗

PubMed1990

Various effects of abdominal and vaginal hysterectomy in benign diseases.

The relative advantages and disadvantages of the transabdominal versus the transvaginal approach to hysterectomy were evaluated and the two procedures were compared for differences in hospitalization, patient age, bowel activity and operating time on the basis of a material of 94 hysterectomized patients. Intestinal complications such as subileus were noted only in subjects who were treated by abdominal hysterectomy. This corresponded with the significant decrease in potassium in abdominally operated patients on the second post-surgical day. Transvaginal hysterectomy was found to be superior in terms of all of these parameters. Complications associated with the two procedures were also compared. Of eight potential complications, seven were found to be confined to laparotomy, while only one occurred after transvaginal hysterectomy which was, however, invariably combined with colporrhaphy. The conclusion from the above should, therefore, be not to select patients indiscriminately for either the transvaginal or the transabdominal approach, but rather to use both routes of access as best fits the circumstances.

Aged↗

PubMed1989

[Early diagnosis of tubal pregnancy with vaginal sonography].

In 19 patients, the transvaginal (TVU) and in 24 patients, the transabdominal (TAU) ultrasound approaches were compared in their ability to identify by visualization the adnexal mass of ectopic pregnancy. The direct visualization of ectopic pregnancy (EUP) was 25% in TAU and 94.7% in TVU approach (p 0.03). All women had a proven EUP in laparoscopy. TAU approach showed a significant inferiority (p 0.02) and TVU a significant superiority (p 0.08) in comparison to palpation. 83% out of 43 women had spotting. Unspecific signs for EUP, like retrouterine fluid, was seen in 20.9%. Striated endometrium was seen in 6.9%, in 37.2% the thickness of endometrium was less than 10 mm, in 55.8% more than 10 mm. A pseudogestationsac was detected in 6.9%, corpus luteum formation in 27.2%. With vaginosonography, organs can be seen at close range, and the specific signs of EUP, an extrauterine ring-formation surrounded by a dam-like structure of the tube, was identified in 94.7%.

Chorionic Gonadotropin↗

PubMed1980

Vaginal discharge in children and adolescents. Evolution and management: a review.

Vaginal discharge is one of the most common gynecologic problems encountered in the pediatric and adolescent populations and may have many causes. A useful way of approaching the diagnosis of a discharge is by categorizing the patient as being prepubertal of postpubertal. In the prepubertal age group, discharge is generally associated with vulvovaginitis. In the postpubertal age group, discharge may be physiologic, or may associated with cervicitis or vaginitis. In each group, gonorrhea and sexual abuse must be ruled out. A practical approach to therapy is outlined.

Adolescent↗

PubMed2006

Chemical modification and formulation approaches to elevated drug transport across cell membranes.

Drug delivery across cellular barriers, such as intestinal, nasal, buccal, alveolar, vaginal, ocular and blood-brain, is a challenging task. Multiple physiological mechanisms, such as cellular organisation, efflux, and chemical and enzymatic degradation, as well as physicochemical properties of the drug molecule itself, determine the penetration of xenobiotics across epithelial cell layers. Limited intestinal absorption of many novel and highly potent lead compounds has stimulated an intense search for strategies that can effectively enhance permeation across these biological barriers. This review discusses some of the approaches that have been, and are currently being, investigated for transepithelial drug delivery. Transdermal drug delivery requires a separate discussion on its own and is thus outside the scope of this review article.

Animals↗

PubMed2001

Current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects.

Anterior vaginal prolapse is often caused by defects in the paravaginal fascia. The purpose of this article is to review the current concepts in the diagnosis and surgical repair of anterior vaginal prolapse due to paravaginal defects. Articles related to paravaginal defects were identified through a MEDLINE search of English-language medical journals published between June 1909 and August 2000. Physical examination is usually used to diagnose paravaginal defects, but this method may have low specificity and low positive predictive value. Magnetic resonance imaging may be used to examine the pelvic anatomy, but it is expensive and may not be readily available to all physicians. Transabdominal ultrasound does not appear to be useful for detection of paravaginal defects. Paravaginal repair, both transvaginal and transabdominal approaches, appears to offer favorable cure rates and low recurrence rates of anterior vaginal prolapse. Paravaginal repair does not appear to be as effective as Burch colposuspension for treatment of stress urinary incontinence. The efficacy of laparoscopic paravaginal repair requires additional investigation. Complications including voiding dysfunction, hemorrhage, and urinary tract injury are uncommon. The long-term efficacy of paravaginal repair requires further investigation.

Fascia↗

PubMed2003

Vaginal hysterectomy in generally considered contraindications to vaginal surgery.

OBJECTIVE: The objective was to evaluate the feasibility and complication rate of vaginal hysterectomy with or without adnexectomy in women with enlarged uteri and/or other considered contraindications to the vaginal route. STUDY DESIGN: Over a period of 2 years, a total of 204 women underwent vaginal hysterectomy for benign pathology. Normally considered contraindications to the vaginal route were: moderate to excessive uterine enlargement, nulliparity or no prior vaginal delivery, previous cesarean or pelvic surgeries and adnexal pathologies. Laparoscopy was used only if it became necessary. Patients with uterine prolapse were excluded. The clinical outcomes and complication rate were analyzed even with regards to the type of contraindication. RESULTS: The mean age of the patients was 46.96+/-4.8 years (range: 38-68). The mean uterine weight was 427.74+/-254.75 g (range: 150-2,000). The operative time ranged from 30 to 140 min (mean: 61.59+/-21.80 SD) for vaginal hysterectomy alone, increasing up to 170 min (mean: 83.6+/-38.28 SD) in case of adnexectomy or laparoscopic assistance. The patient characteristics, the uterine weight and the postoperative results and clinical outcome did not differ among the groups of contraindications. Overall, the complication rate was 9.8%. No patient required a transfusion for surgical blood loss, a return to the operating room or readmission to the hospital. During vaginal hysterectomy, adnexectomy was possible in 90.6% of the cases in which it was indicated (unilateral in 21.8% because of adnexal pathology) and was technically impossible in 9.3%. In 4 cases (1.9%) it was not possible to complete vaginal hysterectomy owing to the presence of thick adhesions obliterating the cul-de-sac, of severe endometriosis or other unforeseen circumstances. In these few cases with a difficult access to the ovaries (2.9% of all VH) or with difficulties in mobilizing the uterus, we resorted to laparoscopy. The pneumoperitoneum was achieved by means of an insufflation tube inserted via the vagina into the abdominal cavity and packing the vagina. Thus, the risks associated to the insertion of the Veress needle were avoided. In all but two cases in which conversion to laparotomy was necessary, laparoscopy was successfully completed. CONCLUSIONS: Vaginal hysterectomy appears to be feasible in about 97% of cases in which this approach would have been judged unsuitable. This figure decreases to 94.2% when oophorectomy is indicated.

Adnexa Uteri↗

PubMed2006

Vesicovaginal fistula with secondary vaginal stones.

PURPOSE: We report a rare case of a vesicovaginal fistula associated with secondary vaginal stones that was managed totally endoscopically. MATERIALS AND METHODS: A 52-year-old woman presented with urinary incontinence and perineal pain. On subsequent evaluation, we found a vesicovaginal fistula associated with secondary vaginal stones caused by a retained gauze. Management involved vaginoscopy, intracorporeal shock wave lithotripsy for vaginal stones, and removing retained medical gauze. We performed cystoscopy, laparoscopic cystotomy, transabdominal Foley catheterization of the vesicovaginal fistula for traction, injection of diluted adrenaline-saline solution for better dissection, dissection of the bladder from the vagina, tension-free closure of the bladder and vaginal defects, and closure of the cystotomy. RESULTS: Operative time was 155 minutes and blood loss was 60 mL. The patient was discharged on postoperative day 3, and catheterization time was 14 days. At 3-month follow-up, the patient was fully continent. CONCLUSION: To our knowledge, this is the first reported case of a vesicovaginal fistula associated with secondary vaginal stones which was managed totally endoscopically. We believe that this is a feasible and efficacious approach for the management of such cases.

Calculi↗

PubMed1993

Transvaginal repair of enterocele.

The urologist actively involved in the treatment of female genitourinary disease must to be able to recognize and treat various forms of pelvic prolapse. Enterocele is commonly seen in conjunction with stress urinary incontinence and cystocele or it may result from surgery to correct these problems. Many techniques to correct enterocele have been developed, including transvaginal repairs as well as intra-abdominal procedures such as the Moschcowitz technique or colpofixation to the sacrum for enterocele with vault prolapse. Surgical management of enterocele must take into account several factors, including the presence of stress urinary incontinence, rectocele, vaginal vault prolapse, prior hysterectomy and the desire to maintain sexual activity. Based on these considerations we discuss our approach to the transvaginal repair of enterocele. In patients without vault prolapse a simple enterocele repair is performed. If vault prolapse is present, then the condition of the anterior vaginal wall is considered. In patients with a cystocele a vault suspension procedure is performed, which involves simultaneous suspension of the uterosacral-cardinal ligament complex and vaginal vault along with the bladder neck and bladder. There are 2 modifications of this technique depending on the degree of cystocele: the 4-corner vault suspension for grades 2 and 3 cystocele, and the vault suspension with grade 4 cystocele repair. Patients with vault prolapse and no cystocele undergo sacrospinous ligament fixation. In elderly patients who are not sexually active, especially if they are in poor medical condition, partial colpocleisis is considered. In these patients partial colpocleisis was not performed as a primary procedure but it was done later in 3 who failed an initial attempt at repair. All coexisting vaginal pathology is fixed at the time of enterocele repair. A total of 83 patients underwent enterocele repair according to this protocol and 81 were available for followup. Mean followup was 15 months (range 3 to 70). Overall a successful result (no recurrence) was achieved in 70 patients (86%). Success for individual procedures was 40 of 49 (82%) for simple repair, 24 of 25 (96%) for vault suspension and 6 of 7 (86%) for sacrospinous fixation. In all cases vault suspension or sacrospinous fixation was able to restore vaginal depth and axis with minimal or no vaginal shortening.

Aged↗

PubMed2001

Relative costs of gynecologic endoscopy vs traditional surgery for treatment of abnormal uterine bleeding.

BACKGROUND: The traditional treatment for abnormal uterine bleeding when medical therapy fails has been abdominal or vaginal hysterectomy. More recently, operative gynecologic endoscopy (laparoscopy and hysteroscopy) has partially replaced this traditional approach. The cost and healthcare utilization of endoscopy compared with traditional surgical methods are poorly understood. OBJECTIVE: To compare the cost and healthcare utilization associated with different gynecologic endoscopic therapies vs traditional methods for the treatment of abnormal uterine bleeding. STUDY DESIGN: Review of the available medical literature. RESULTS: Vaginal hysterectomy is the least costly of all hysterectomy techniques. The direct costs of laparoscopically assisted vaginal hysterectomy are higher than those of abdominal hysterectomy, but the indirect costs are significantly less. The direct and indirect costs of endometrial ablation/resection are significantly lower than those of hysterectomy even when the cost of treatment failures is included. CONCLUSION: Endometrial ablation/resection might be chosen over hysterectomy to treat abnormal uterine bleeding because it avoids major surgery, significantly shortens hospitalization, and allows rapid return to normal functioning.

Female↗

PubMed1992

[Urethral sphincter (G point). Anatomo-clinical correlations].

UNLABELLED: On the basis of 36 cases in sexology, the authors sought the site of the G point on the basis of clinical, ultrasonographic and anatomical findings. CLINICAL FINDINGS: examination of pleasant vaginal sensitivity. Discovered by patients unaware of it. Recognised by patients aware of it. Ultrasonographic findings: localization of a hypoechogenic zone, above all in the lower third of the vagina, corresponding with pleasant vaginal sensitivity and changing after digital vaginal examination and contractions of the levators. Anatomical findings: dissection of the anterior perineum of cadavers seeking this ultrasonographic hypoechogenic structure. These various approaches lead the authors to locate the G point at the urethral sphincter, as was suggested by Grafenberg in 1950, and to situate vaginal and clitoris sensitivity in the same anatomical entity: the urethro-clitorido-vulval entity.

Clitoris↗