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Sample records for vaginal hysterectomy lavh

  1. [Operating time of laparoscopically assisted vaginal hysterectomy (LAVH)--the causative factors and the course of the postoperative period].

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    Bobin, Leszek; Maciołek-Blewniewska, Grazyna; Malinowski, Andrzej

    2007-03-01

    The aim of the study was to find the causative factors of prolongation of the operating time of laparoscopically assisted vaginal hysterectomy (LAVH) and to analyse the influence of the operating time on the course of the postoperative period. Retrospective analysis of 103 LAVH procedures performed from June 2002 to April 2006 for benign conditions. All the cases have been divided in two groups, depending on the operating time: 45 procedures up to 90 minutes (average 76, range 50-90) and 58--over 90 minutes (average 126, range 95-210). In both groups we have analysed patient characteristics, indications, uterine size, intra- and postoperative complications, blood loss, hospital stay, the day of the return to the general diet, anaesthetic and antibiotic demand in postoperative period. There were 42.2% of postmenopausal patients in the "short-time" LAVH group and 17.2% in the "long-time" LAVH group (p < 0.05). 8.9% women in the short LAVH group and 31.0% in the long LAVH group had had no vaginal deliveries (p < 0.05). There was no significant difference in previous surgery history between the groups. Significant correlation of operating time of LAVH with patient weight (r = 0.26, p < 0.01) and BMI (Body Mass Index) (r = 0.21, p < 0.05) was noted. Uterine size was bigger in the long LAVH group (p < 0.01). There was one intraoperative complication (bowel injury) and three postoperative ones (two cases of bleeding to abdominal cavity demanding reoperation and one to the abdominal wall from injured superficial epigastric artery), all occurred in the long LAVH group. The average perioperative decrease in haemoglobin concentration was insignificantly higher in the long LAVH group (2.0 g% vs 1.4%). There was 4.4% rate of antibiotic demand after the short LAVH procedures and 24.1% after the long ones (p < 0.05). There was no significant difference in anaesthetic demand. The average day of introducing the general diet was 1,0 (range 1-2) in the short LAVH group and 1,4 (range

  2. [Significance of laparoscopic assistance in vaginal hysterectomy].

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    Malinowski, Andrzej; Bobin, Leszek; Maciołek-Blewniewska, Grazyna

    2005-01-01

    The objective of this publication was the analysis of laparoscopically assisted vaginal hysterectomies (LAVH) performed in Department of Surgical and Endoscopic Gynecology of Polish Mother Health Centre Research Institute. There was the analysis of 57 LAVHs performed from June 2002 to December 2003. Following parameters were evaluated: indications to LAVH, operating time, weight of the removed uterus, complications, blood loss, duration of postoperative hospitalisation, the day of introducing general diet, anesthetic and antibiotic demand in postoperative period. There were indications to LAVH: fibroid uterus, endometrial hyperplasia, endometrial cancer, adnexal mass, cervix dysplasia. Previous laparotomy and caesarean section, endometriosis, narrow vagina of non-parous women were additional indications to use of laparoscopy during the operation. Complications were found in two (3,5%) cases: bleeding to abdominal cavity from infundibulo-pelvic ligament demanding reoperation and superficial epigastric artery injury no demanding reoperation. There were no infection, conversion to laparotomy, abdominal cavity organs injury and other complications. It was observed short time of introducing general diet, low anesthetic consumption and short post-operation stay in hospital (mean 3,6 days). Laparoscopically assisted vaginal hysterectomy is an operation with a small risk of intra- and postoperative complications, quick return to general diet and full life activity, short post-operation stay in hospital, low anesthetic consumption and good cosmetic effect. Use of laparoscopic stage in vaginal hysterectomy make possible evasion of laparotomy in the situation of impossible performance of ordinary vaginal hysterectomy.

  3. Laparoscopic supracervical hysterectomy and uterine morcellation ...

    African Journals Online (AJOL)

    2015-02-23

    Feb 23, 2015 ... sites completely healed and histology result confirmed. Leiomyoma Uteri. Discussion. Advances in hysterectomy range from laparoscopic‑assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), LSCH and more recently robotic. TLH. Literature on laparoscopic hysterectomy in Nigeria.

  4. assisted vaginal hysterectomy versus abdominal hysterectomy on ...

    African Journals Online (AJOL)

    J Gynecol Surg 1989;. 5: 213-216. 2. Garry R. Various approaches to laparoscopic hysterectomies. Curr Opin Obstet. Gynecol 1994; 6: 215-222. 3. Dickec RC, Greenspan J. Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. Am J Obstet. Gynecol ...

  5. Incidence of and risk factors for febrile morbidity after laparoscopic-assisted vaginal hysterectomy

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    Wongpia I

    2014-04-01

    Full Text Available Iyara Wongpia, Jadsada Thinkhamrop, Kanok Seejorn, Pranom Buppasiri, Sanguanchoke Luanratanakorn, Teerayut Temtanakitpaisan, Kovit Khampitak Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand Background: The purpose of this study was to assess the incidence of and risk factors for postoperative febrile morbidity after laparoscopic-assisted vaginal hysterectomy (LAVH. Methods: This retrospective study was carried out using the medical records of women with benign gynecologic conditions who underwent LAVH between June 2007 and May 2012 at Srinagarind Hospital in Thailand. Data were collected to assess baseline patient characteristics, occurrence of body temperature ≥38°C on two occasions at least 6 hours apart in the 24 hours following the surgical procedure, and possible risk factors related to postoperative febrile morbidity. Results: In total, 199 women underwent LAVH during the study period. They had a mean age of 46±6 years, a mean body mass index of 24.0±3.2 kg/m2, a mean surgical duration of 134±52 minutes, median estimated blood loss of 200 mL, a mean total hospital stay of 5±2 days, and a mean postoperative hospital stay of 3±2 days. Postoperative febrile morbidity was documented in 31 cases (15.6%. The cause of postoperative fever was unknown in most cases, with only two cases having an identifiable cause. The risk of postoperative febrile morbidity was highest in women treated with more than two antibacterial agents and with a regimen of more than 3 days. Conclusion: This study shows a moderately high rate of febrile morbidity after LAVH, for which the main risk factors were use of multiple drugs and doses for antibiotic prophylaxis. Keywords: laparoscopic-assisted vaginal hysterectomy, febrile morbidity, incidence, risk factors

  6. Health-related quality of life after laparoscopically assisted vaginal hysterectomy: is uterine weight a major factor?

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    Torng, Pao-Ling; Chang, Wen-Chun; Hwang, Jing-Shiang; Hsu, Wen-Chiung; Wang, Jung-Der; Huang, Su-Cheng; Chen, Chen-Fang; Su, Ta-Chen

    2007-03-01

    To assess uterine size, symptom severity, and hemoglobin level as determinants of health-related quality of life (HRQOL) in women subsequently undergoing laparoscopically assisted vaginal hysterectomy (LAVH). Sixty-one consecutive women with uterine leiomyoma or adenomyosis undergoing LAVH were studied using a prospective cohort design. The Chinese version of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire was assessed preoperatively. The Taiwan brief version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire and a self-assessment of the perceived health status were assessed preoperatively and 1 day, 1 week, 12 weeks, and 18 months postoperatively. Women with a greater uterine weight did not report a greater severity of symptoms than those with lower uterine weight. Women with more severe symptoms had lower preoperative hemoglobin levels and were usually younger. Their perceived health status and their scores in physical domain of WHOQOL-BREF were also significantly lower, indicating a poorer HRQOL. The mixed-effects model found that a normal (higher) baseline hemoglobin level and a greater symptom severity were associated with a significant improvement of HRQOL in the physical domain of WHOQOL-BREF following LAVH. Preoperative symptom severity, but not uterine weight, was associated with long-term improvement in HRQOL after LAVH. Women with severe symptoms could be considered for LAVH before development of anemia.

  7. VAGINAL HYSTERECTOMY - CEFUROXIME, METRONIDAZOLE OR BOTH

    NARCIS (Netherlands)

    KAUER, FM; WIJMA, J; MANSON, WL

    1990-01-01

    A randomized double-blind prospective study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy. Overall antibiotic prophylaxis was effective in abscess prevention (one abscess in 68 patients).

  8. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

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    Bo Sung Yoon

    2014-12-01

    Conclusion: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

  9. A comparison of abdominal and vaginal hysterectomies in Benghazi, Libya.

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    Agnaeber, K; Bodalal, Z

    2013-08-01

    We performed a comparative study between abdominal and vaginal hysterectomies using clinical data from Al-Jamhouria hospital (one of the largest maternity hospitals in Eastern Libya). Various parameters were taken into consideration: the rates of each type (and their subtypes); average age of patients; indications; causes; postoperative complications; and duration of stay in the hospital afterwards. Conclusions and recommendations were drawn from the results of this study. In light of the aforementioned parameters, it was found that: (1) abdominal hysterectomies were more common than vaginal hysterectomies (p < 0.001); (2) patients admitted for abdominal hysterectomies are younger than those admitted for vaginal hysterectomies (p < 0.001); (3) the most common indication for an abdominal hysterectomy was menstrual disturbances, while for vaginal hysterectomies it was vaginal prolapse; (4) the histopathological cause for abdominal and vaginal hysterectomies were observed and the most common were found to be leiomyomas and atrophic endometrium; (5) there was no significant difference between the two routes in terms of postoperative complications; (6) patients who were admitted for abdominal hysterectomies spent a longer amount of time in the hospital (p < 0.01). It was concluded that efforts should be made to further pursue vaginal and laparoscopic hysterectomies as a viable option to the more conventional abdominal route.

  10. Postpartum Prolapsed Leiomyoma with Uterine Inversion Managed by Vaginal Hysterectomy

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    Kelly L. Pieh-Holder

    2014-01-01

    Full Text Available Background. Uterine inversion is a rare, but life threatening, obstetrical emergency which occurs when the uterine fundus collapses into the endometrial cavity. Various conservative and surgical therapies have been outlined in the literature for the management of uterine inversions. Case. We present a case of a chronic, recurrent uterine inversion, which was diagnosed following spontaneous vaginal delivery and recurred seven weeks later. The uterine inversion was likely due to a leiomyoma. This late-presenting, chronic, recurring uterine inversion was treated with a vaginal hysterectomy. Conclusion. Uterine inversions can occur in both acute and chronic phases. Persistent vaginal bleeding with the appearance of a prolapsing fibroid should prompt further investigation for uterine inversion and may require surgical therapy. A vaginal hysterectomy may be an appropriate management option in select populations and may be considered in women who do not desire to maintain reproductive function.

  11. Vaginal vault suspension during hysterectomy for benign indications

    DEFF Research Database (Denmark)

    Bonde, Lisbeth; Noer, Mette Calundann; Møller, Lars Alling

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: Several suspension methods are used to try to prevent pelvic organ prolapse (POP) after hysterectomy. We aimed to evaluate agreement on terminology and surgical procedure of these methods. METHODS: We randomly chose 532 medical records of women with a history......: Regarding medical records, agreement on terminology was good among patients undergoing pooled suspension in cases of hysterectomy via the abdominal and vaginal route (agreement 78.7, 92.3%). Regarding videos, agreement on surgical procedure was good among pooled suspension patients in cases of hysterectomy...... via the abdominal, laparoscopic, and vaginal routes (agreement 88.9, 97.8, 100%). Agreement on individual suspension methods differed regarding both medical records (agreement 0-90.1%) and videos (agreement 0-100%). CONCLUSIONS: Agreement on terminology and surgical procedure regarding suspension...

  12. Unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse

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    Assem A.M. Elbiaa

    2015-09-01

    Full Text Available Aim of the study was to estimate the incidence of unexpected premalignant gynecological lesions in women undergoing vaginal hysterectomy for utero-vaginal prolapse. Material and methods : Eighty women with asymptomatic utero-vaginal prolapse were included in this prospective study for vaginal hysterectomy after preoperative preparation and after written informed consent. Women included in this study were screened preoperatively by high vaginal swab, Pap smear, endometrial biopsy and trans-vaginal ultrasound. Surgically removed uteri and ovaries were sent for histopathological examination. Results of histopathological examination as gold standard were compared with conventional gynecological screening methods. Results : Histopathological examination of surgically removed uteri and ovaries after vaginal hysterectomy for uterovaginal prolapse showed abnormal findings in 61.25% (49/80 of studied cases (10 chronic cervicitis; 20 cervical intra-epithelial neoplasia-1 [CIN-1]; 5 CIN-2; 2 CIN-3; 10 simple endometrial hyperplasia without atypia and 2 simple serous ovarian cyst. Also, histopathological examination showed premalignant changes in 33.75% (27/80 of studied cases (20 CIN-1; 5 CIN-2 and 2 CIN-3, which mean 50% sensitivity of pre-operative Pap smear to detect premalignant cervical changes. Conclusions : Asymptomatic women with utero-vaginal prolapse may have associated premalignant lesions which may not be detected by conventional screening methods, and this should be explained preoperatively for women undergoing surgery, especially if conservative management was considered.

  13. ["Learning curve" robotic radical hysterectomy compared to standardized laparoscopy assisted radical vaginal and open radical hysterectomy].

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    Pilka, R; Marek, R; Dzvinčuk, P; Kudela, M; Neubert, D

    2013-01-01

    To compare intraoperative, pathologic and postoperative outcomes of "learning curve" robotic radical hysterectomy (RRH) with laparoscopy assisted radical vaginal hysterectomy (LARVH) and abdominal radical hysterectomy (ARH) in patients with early stage cervical carcinoma. Comparative study. Department of Obstetrics and Gynecology, University Hospital, Olomouc. The first twenty patients with cervical cancer stages IA2-IIA underwent RRH and were compared with previous twenty LARVH and ARH cases. The procedures were performed at University Hospital Olomouc, Czech Republic between 2004 and 2011. There were no differences between groups for age, body mass index, tumor histology, number of nodes removed or preoperative hemoglobin levels. The median theatre time in the learning period for the robot procedure was reduced from 400 min to less than 223 min and compared well to the 215 min for an open procedure. We found differences between the pre- and postoperative hemoglobin levels (RRH, 14.9 ±7 .6; LARVH, 23.0 ± 8.5; ARH, 28.0 ± 12.4). This difference was statistically significant in favor of RRH group ( p= 0.0012). Mean length of stay was significantly shorter for the RRH group (7.2 versus 8.8 days,p = 0.0005). Mean pelvic lymph node count was similar in the three groups. None of the robotic or laparoscopic procedures required conversion to laparotomy. The differences in major operative complications between the two groups were not significant. Based on our experience, robotic radical hysterectomy showed better results than traditional laparoscopically assisted radical vaginal hysterectomy in early stage cervical carcinoma cases. Introduction of this new technique requires a learning curve of less than 20 cases that will reduce the operating time to a level comparable to open surger.

  14. Analysis of Risk Factors for Post-Hysterectomy Vaginal Vault Prolapse

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    Mahmut Kuntay kuntay Kokanali

    2015-03-01

    Conclusions: Vault prolapse after hysterectomy is a relatively rare complication. Elderly age, obesity, chronic obstructive lung diseases, prior genital prolapse sugery, vaginal hysterectomy, genital prolapse as indication of hysterectomy and the number of vaginal delivery and #8805;2 increase vault prolapse risk. Identification of these risk factors is important to prevent this complication. [Cukurova Med J 2015; 40(1.000: 63-71

  15. Post-hysterectomy vaginal cuff cancer secondary to HPV infection and CIN: A case report.

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    Liu, Xiaoxia; Yue, Ying; Zong, Shan

    2013-07-01

    We present a case report of secondary vaginal cancer after complete hysterectomy due to myoma that was complicated by low-grade cervical intraepithelial neoplasia (CIN I) and human papilloma virus (HPV) infection. After complete hysterectomy, the HPV DNA level in the vaginal tissue was obviously increased, and vaginal cancer was diagnosed 6 months later. We conclude that HPV infection can cause vaginal cancer after complete hysterectomy in cases complicated by CIN. Therefore, HPV should be regularly assessed during the postoperative follow-up period.

  16. Advances on minimally invasive approach for benign total hysterectomy: a systematic review [version 1; referees: 2 approved

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    Marina de Paula Andres

    2017-08-01

    Full Text Available Hysterectomy is one of the most commonly performed gynecologic surgeries, mainly for uterine myomas, abnormal uterine bleeding, and prolapses. It can be performed through several routes, each of which has its advantages and disadvantages. We conducted this systematic review to evaluate recent advances in surgical outcomes of benign total hysterectomies by any route: vaginal (VH, laparoscopic (LH, laparoscopically assisted vaginal (LAVH, single-port (SP, and robotic-assisted laparoscopy (RH. The search was applied to the PubMed electronic database by using keywords “hysterectomy” and “uterine benign disease”, “adenomyosis”, and “myoma”. Prospective and randomized trials of the last 3 years were included. Nine studies were selected and showed that VH was superior to LH, LAVH, and RH in terms of hospital stay and operation time and had the same complication rate and lower costs. SP hysterectomy had no clear advantages over VH or conventional LH.

  17. Trocar-guided total tension-free vaginal mesh repair of post-hysterectomy vaginal vault prolapse.

    NARCIS (Netherlands)

    Milani, A.L.; Withagen, M.I.J.; Vierhout, M.E.

    2009-01-01

    INTRODUCTION AND HYPOTHESIS: The objective of this study was to report 1 year anatomical and functional outcomes of trocar-guided total tension-free vaginal mesh (Prolift) repair for post-hysterectomy vaginal vault prolapse with one continuous piece of polypropylene mesh. METHODS: We conducted a

  18. [Uterus preserving surgery versus vaginal hysterectomy in treatment of uterine descent: a systematic review].

    NARCIS (Netherlands)

    Detollenaere, R.J.; Boon, J. den; Vierhout, M.E.; Eijndhoven, H.W. van

    2011-01-01

    OBJECTIVE: To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse. DESIGN: Systematic review. METHOD: We searched in Pubmed, Embase, the Cochrane Library and the reference lists of relevant publications for articles comparing uterus

  19. Vaginal cuff closure: a comparison between the vaginal route and laparoscopic suture in patients undergoing total laparoscopic hysterectomy.

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    Hwang, Jong Ha; Lee, Jae Kwan; Lee, Nak Woo; Lee, Kyu Wan

    2011-01-01

    To compare the vaginal route and laparoscopic suture for vaginal cuff closure (VCC) in patients undergoing a total laparoscopic hysterectomy (TLH). A total of 471 women who required hysterectomy were allocated to two groups. 261 women had TLH via VCC by the vaginal route and 210 women had TLH via VCC by laparoscopic suture. All TLHs were performed by the same laparoscopic surgeon. The cuff-related complications included vaginal disruption (3.4%), dehiscence (1.27%), vaginal vault bleeding (1.91%), vaginal spotting (19.32%), granulation (1.27%), cuff infection (1.49%), and yellowish vaginal discharge (6.16%). No difference in vaginal cuff complications was found between the laparoscopic and vaginal approach. The median operation time was significantly shorter for the laparoscopic suture (76.74 min, range 40-220; 95% CI 74.84-83.45) than the vaginal route for VCC (85.77 min, range 45-290; 95% CI 86.87-95.36) after hysterectomy (p < 0.001). For VCC with TLH, laparoscopic suture was a safe and less time-consuming procedure. The cuff-related complications were similar in the two groups. Copyright © 2010 S. Karger AG, Basel.

  20. Vaginal Migration of Ventriculoperitoneal Shunt Catheter and Cerebrospinal Fluid Leak as a Complication of Hysterectomy.

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    Houten, John K; Smith, Shiela; Schwartz, Amit Y

    2017-08-01

    Ventriculoperitoneal (VP) shunting is a common neurosurgical procedure to treat hydrocephalus that diverts cerebrospinal fluid from the cerebral ventricles to the peritoneal cavity for reabsorption. The distal catheter may potentially migrate through any potential or iatrogenic opening in the peritoneal cavity. Increasingly successfully management of childhood hydrocephalus and adult-onset conditions leading to hydrocephalus, such as subarachnoid hemorrhage, is leading many adult female patients harboring VP shunts needing to undergo hysterectomy. Hysterectomy creates a potential defect though which a VP shunt catheter may migrate. It is not known whether the hysterectomy cuff closure technique may affect the likelihood of distal catheter migration though the repair site. We report the case of a 38-year-old woman with a VP shunt who underwent laparoscopic hysterectomy via an open vaginal cuff technique who subsequently presented with vaginal cerebrospinal fluid leakage secondary to migration of the distal shunt catheter through the hysterectomy cuff. Vaginal migration of the distal VP shunt catheter is a possible complication of hysterectomy. The authors postulate that an open cuff hysterectomy closure technique may increase the risk of catheter migration, an issue that may be better understood with further investigation. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. [Abdominal sacrocolpopexy in surgical treatment of complete vaginal vault prolapse after hysterectomy].

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    Durdević, Srdan; Vejnović, Tihomir; Curcić, Aleksandar; Mladenović-Segedi, Ljiljana; Maksimović, Marko

    2008-01-01

    The vaginal vault prolapse after hysterectomy is a complex disorder, which can be associated with the prolapse of anterior or posterior vaginal wall or cystorectocele. The exact incidence is unknown, and is within the range from 1 - 43% of operated patients. In order to achieve the complete surgical reconstruction of the pelvic floor disorder, a surgeon must have good knowledge of normal anatomic relations of pelvic organs. Twenty-nine women with the vaginal vault prolapse after hysterectomy were operated at Clinic for Gynecology and Obstetrics in Novi Sad during the period fiom 1995 - 2007. After standard preoperative procedures, positioning of the patient and inferior medial abdominal incision, the supportive graft made of non-resorptive materials was fixed to the vaginal fornix and sacral periost from the promontory to the level of S 3-4 vertebrae. The average age of the patients was 61.4 years. The following supportive materials were used: mersilen mesh (16), allograft made of m. rectus abdominis fascia (5), prolen (4), fascia lata strip (2) and common Silk sutures (2). Additional operations (Moschowitz Douglasoraphy, Kelly-Marion anterior vaginal repair, colpoperineoplasty and Burchcolposuspension) were performed in 20 (68.9%) patients. There were 7 (23.8%) postoperative complications. The erosion of mersilen mesh was detected in 2 (6.8%) patients, and recurrence of vaginal vault prolaps and cystorectocele in 3 (10.2%) patients. According to other authors, the erosion of synthetic materials occurs in about 3.4%, and recurrence of vaginal vault prolaps in 0-22% of operated patients. The complete vaginal vault prolaps after hysterectomy is a complex anatomic disorder which has a great impact on the life quality and significantly disturbs patient s psychosocial sphere. Surgical treatment involves abdominal or vaginal access and is planned individually for each patient.

  2. Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review.

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    Dedden, Suzanne J; Geomini, Peggy M A J; Huirne, Judith A F; Bongers, Marlies Y

    2017-09-01

    Laparoscopic and vaginal hysterectomies are common gynaecological procedures. Same-day discharge is usual care in various gynaecological procedures like laparoscopic sterilisation and laparoscopic oophorectomies. In major procedures like vaginal or laparoscopic hysterectomy patients are usually admitted overnight. We systematically reviewed the literature to identify complications, risk factors for (re)admittance, financial consequences and patient satisfaction of same-day discharge after a vaginal or laparoscopic hysterectomy. We systematically searched PubMed, UptoDate, Embase, Cochrane and CINAHL database from inception until July 16th 2016. We selected randomized controlled trials, prospective and retrospective cohort studies assessing the safety and feasibility of same-day discharge after vaginal or laparoscopic hysterectomy. The outcome parameters that were assessed were admission rate, re-admission rate, minor and major complications, patient satisfaction and financial consequences. 27 articles were included in the systematic review. All studies provided data about the admission rate and therefore failure of same-day discharge. Eleven prospective studies were included which compromised a total of 2391 hysterectomies. The percentage of overnight admissions was median 9.3% [0-25%]. Eight retrospective studies, which screened their patients before undergoing an outpatient hysterectomy, showed in 1500 subjects a mean admission rate of 10% [4,4-64%]. Four retrospective studies, which considered a large total cohort of 142,799 hysterectomies had a mean admission rate of 59,7% [48-79%]. The overall re-admission rate was low, varying from 0.73-4.0%. Minor complications were reported in respectively 4,3% and 7,3% in prospective respectively retrospective trials. Major complications were described in 0.7%-3.6% of all cases. Generally high satisfaction rates were reported in the observational trials. Same-day discharge after laparoscopic and vaginal hysterectomy seems

  3. Effects of horizontal vs vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy: a prospective randomized study.

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    Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Topcu, Hasan Onur; Aksakal, Orhan Seyfi; Doganay, Melike

    2014-01-01

    To compare the effects of horizontal and vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy. Prospective randomized study (Canadian Task Force classification I). Teaching and research hospital, a tertiary center. Fifty-two women with POP-Q stage 0 or 1 uterine prolapse were randomized into 2 groups using vertical (n = 26) or horizontal (n = 26) vaginal cuff closure. All patients underwent vaginal hysterectomy. Vagina length in the 2 groups was compared preoperatively, immediately after surgery, and at 6 weeks postoperatively. Mean (SD) preoperative vagina length in the horizontal and vertical groups was similar (7.87 [0.92] cm vs 7.99 [0.78] cm; p = .41). Immediately postoperatively, the vagina was significantly shorter in the horizontal group than in the vertical group (6.61 [0.89] cm vs 7.51 [0.74] cm; p vagina was still significantly shorter in the horizontal group (6.55 [0.89] cm vs 7.42 (0.73) cm; p vagina length before and after surgery was also significantly higher in the horizontal group than in the vertical group (-1.26 [0.12] cm vs 0.49 [0.11] cm; p vagina length better than does horizontal cuff closure. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Recurrence of vaginal prolapse after total vaginal hysterectomy with concurrent vaginal uterosacral ligament suspension: comparison between normal-weight and overweight women.

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    Rappa, Carlo; Saccone, Gabriele

    2016-11-01

    Obesity is one of the most important risk factors for the development and progression of the pelvic organ prolapse. However, data regarding whether obesity is a risk factor for recurrence after pelvic organ prolapse surgery are controversial. The aim of this study was to estimate the risk of recurrent prolapse in any vaginal compartment after total vaginal hysterectomy with concurrent uterosacral ligament vaginal vault suspension among normal-weight women compared with either overweight or obese women. This is a 5-year retrospective cohort study of women who underwent total vaginal hysterectomy with concurrent vaginal uterosacral ligament suspension at one referral center for pelvic organ prolapse in Italy from January 2010 to January 2015. All women who underwent total vaginal hysterectomy with concurrent uterosacral ligament suspension were included in the analysis. Laparoscopic approach was excluded. Women were classified according to the body mass index of 2 groups: (1) normal weight (body mass index, 18.5-24.9 kg/m2) and (2) either overweight (body mass index, 25.0-29.9 kg/m2) or obese (body mass index, ≥30.0 kg/m2). The primary outcome was the incidence of recurrent prolapse in any vaginal compartment (anterior, posterior, or apical). Recurrent prolapse was defined as prolapse extending beyond the hymen with straining (pelvic organ prolapse quantification points Ba, C, Bp ≥0) or repeat treatment for prolapse with either pessary or surgery. Uterosacral ligament suspensions were performed with a vaginal approach with the use of sutures placed in the intermediate uterosacral ligament, at or above the ischial spine, and affixed to the vaginal apex. Delayed absorbable sutures were used, with 2 sutures per side. Three hundred sixty women who underwent total vaginal hysterectomy with concurrent uterosacral ligament suspension with at least 6 months of follow up after surgery were included in the study. The overall incidence of recurrent prolapse in any vaginal

  5. [Vaginal hemorrhage after hysterectomy as a complication of alcohol-induced liver cirrhosis].

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    Marzotko, E; Pfeiffer, R; Nenning, H; Köhler, U

    1996-01-01

    We report on a 50-year-old woman with a decompensated alcoholic liver cirrhosis and Korsakow syndrome since 1991. In July 1992, an abdominal hysterectomy with bilateral salpingoophorectomy was made because of an endometrial carcinoma pT1NOMO. A postoperative abscess of the vaginal stump was evacuated. The patient was admitted three years later with a massive vaginal bleeding. Her general appearance and nutritional status were bad. The vaginal bleeding was caused from ruptured varicose pelvic veins secondary to portal hypertension. Neither conservative (vaginal tamponade, infusions) nor operative (laparotomy with an intraabdominal and transvaginal tamponade) therapy was successful. The patient died as a result of severe bleedings. We discuss differential diagnostics and planning therapy.

  6. Utilization of apical vaginal support procedures at time of inpatient hysterectomy performed for benign conditions: a national estimate.

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    Ross, Whitney Trotter; Meister, Melanie R; Shepherd, Jonathan P; Olsen, Margaret A; Lowder, Jerry L

    2017-10-01

    Apical vaginal support is considered the keystone of pelvic organ support. Level I evidence supports reestablishment of apical support at time of hysterectomy, regardless of whether the hysterectomy is performed for prolapse. National rates of apical support procedure performance at time of inpatient hysterectomy have not been well described. We sought to estimate trends and factors associated with use of apical support procedures at time of inpatient hysterectomy for benign indications in a large national database. The National (Nationwide) Inpatient Sample was used to identify hysterectomies performed from 2004 through 2013 for benign indications. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to select both procedures and diagnoses. The primary outcome was performance of an apical support procedure at time of hysterectomy. Descriptive and multivariable analyses were performed. There were 3,509,230 inpatient hysterectomies performed for benign disease from 2004 through 2013. In both nonprolapse and prolapse groups, there was a significant decrease in total number of annual hysterectomies performed over the study period (P support procedure was performed in only 85,879 (3.1%). There was a significant decrease in the proportion of hysterectomies with concurrent apical support procedure (high of 4.0% in 2004 to 2.5% in 2013, P support procedure. During the study period, 718,578 (20.5%) inpatient hysterectomies were performed for prolapse diagnoses and 266,743 (37.1%) included an apical support procedure. There was a significant increase in the proportion of hysterectomies with concurrent apical support procedure (low of 31.3% in 2005 to 49.3% in 2013, P support procedure. This national database study demonstrates that apical support procedures are not routinely performed at time of inpatient hysterectomy regardless of presence of prolapse diagnosis. Educational efforts are needed to increase awareness of the

  7. Histerectomia vaginal: o laparoscópico é necessário? Vaginal hysterectomy: is the laparoscope necessary?

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    Octacílio Figueiredo Netto

    1998-10-01

    pode ser realizada na grande maioria dos casos.Purpose: the laparoscope can be used to convert an abdominal into a vaginal hysterectomy when there are contraindications for the vaginal approach, and not as a substitute for simple vaginal hysterectomy. The purpose of the present study is to discuss the role of laparoscopy in vaginal hysterectomy. Methods: between February 1995 and September 1998, 400 patients were considered candidates for vaginal hysterectomy.Exclusion criteria included uterine prolapse, adnexal tumor and uterine immobility. The Heaney technique was used, and different morcellation procedures were employed for the removal of enlarged uteri. Results: the mean age and parity was 46.9 years and 3.2 deliveries, respectively. Twenty-nine patients (7.2% were nulliparous, and 104 (26.0% had never delivered vaginally. Three hundred and three patients (75.7% had a history of previous pelvic surgery, the most common being cesarean section (48.7%. The most frequent indication was leiomyoma (61.2%, and the mean uterine volume was 239.9 cm³ (30-1228 cm³. Vaginal hysterectomy was successfully performed in 396 patients (99.0%, and 73 surgeries (18.2% were done by residents. The mean operative time was 45 min. Diagnostic/operative laparoscopy was performed in 16 patients (4.0%. Intraoperative complications included 6 cystotomies (1.5% and one rectal laceration (0.2%. There were four conversions (1.0% to the abdominal route. Postoperative complications occurred in 24 patients (6.0%. Two hundred and eighty-one patients (70.2% were discharged 24 h after surgery. Conclusions: the laparoscope does not seem to be necessary in cases were the uterus is mobile and there is no adnexal tumor. The main role of the laparoscope may be to increase the awareness of gynecologists to the possibility of a simple vaginal hysterectomy in the majority of cases.

  8. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial

    NARCIS (Netherlands)

    Detollenaere, R.J.; Boon, J. den; Stekelenburg, J.; Hout, J. in't; Vierhout, M.E.; Kluivers, K.B.; Eijndhoven, H.W. van

    2015-01-01

    OBJECTIVE: To investigate whether uterus preserving vaginal sacrospinous hysteropexy is non-inferior to vaginal hysterectomy with suspension of the uterosacral ligaments in the surgical treatment of uterine prolapse. DESIGN: Multicentre randomised controlled non-blinded non-inferiority trial.

  9. Outpatient vaginal hysterectomy: Comparison of conventional suture ligature versus electrosurgical bipolar vessel sealing.

    Science.gov (United States)

    Giraudet, G; Lucot, J P; Sanz, F; Rubod, C; Collinet, P; Cosson, M

    2017-05-01

    The aim of our study was to evaluate the feasibility of vaginal hysterectomy in an ambulatory care system and the best way to perform it between conventional and bipolar vessel sealing system ligatures. This was a prospective study of 32 patients with vaginal hysterectomy at Lille University Hospital between December 2013 and May 2015. Two surgical techniques were compared: conventional suture ligature (CSL) and electrosurgical bipolar vessel sealing (BVS). Patients stayed in classical hospitalization but were managed how if they were in an ambulatory unit to evaluate their capacity to come back home the same evening of the surgery. The evaluation of same-day discharge was based on Post Anesthetic Discharge Scoring System (PADSS) score?9/10 and Visual Analogic Scale (VAS) score?4/10. Other data collected were: operative time, uterus weight, peroperative bleeding, PADSS score at the 8th postoperative hour, VAS score at the 4th, 6th, 8th, 12th and 24th postoperative hours, the presence of postoperative nausea/vomiting and rehospitalization. In the BVS group, 93.8% of patients validated the combined score (PADSS+VAS) on the evening of the intervention against 50% of patients in the CSL group (P<0.05). Hundred percent of BVS group patients were discharged on the day after surgery against 87.5% in the CSL group. The VAS was significantly lower in the BVS group at the 8th (1.4), 12th (1.2) and 24th (1.3) postoperative hours. Operative time was significantly shorter in the BVS group. We found more events such as nausea/vomiting in the CSL group. Vaginal hysterectomy is feasible in an ambulatory care system most of times. By reducing postoperative pain, electrosurgical bipolar vessel sealing would promote outpatient hospitalization. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. An audit of indications and complications associated with elective hysterectomy at SVMCH and RC, Ariyur, Pondicherry

    Directory of Open Access Journals (Sweden)

    Nidhi Bansal, Hiremath PB, Meenal C, Vishnu Prasad

    2013-04-01

    Full Text Available Background: Hysterectomy is the most common gynaecological surgery performed worldwide Menorrhagia secondary to uterine fibroids and abnormal menstrual bleeding are the two most common indications for hysterectomy. An important factor impacting on the incidence of complications of hysterectomy, apart from the indication for surgery, is the surgical approach. Most surgeons perform up to 80% of procedures by the abdominal route. The incidence of LAVH performed for benign lesions has progressively increased in recent years. Methods : Surgical indications and details, histological findings, and postoperative course were reviewed and analysed for 340 patients who underwent hysterectomy in 2011 and 2012.Results : In our study, fibroid uterus (27.9 % was the leading indication for performing hysterectomies followed by a DUB (22.9% and uterovaginal prolapse (UVP-21.8%. During the study period (2011-2012, most hysterectomies were performed abdominally (54.4%. Overall post operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the vaginal and laparoscopic group ( p value= 0.001 . Conclusion: We need to ensure that trainees acquire competency in performing hysterectomies vaginally, which is clearly safer than the abdominal approach.

  11. Quality of life and sexual function of patients following radical hysterectomy and vaginal extension.

    Science.gov (United States)

    Ye, Shuang; Yang, Jiaxin; Cao, Dongyan; Zhu, Lan; Lang, Jinghe; Chuang, Linus T; Shen, Keng

    2014-05-01

    Radical hysterectomy (RH) has negative consequences on sexual function due to a shortened vagina, vaginal dryness, and dyspareunia. Peritoneovaginoplasty aims to extend vagina by vesical peritoneum and anterior rectal wall to improve postoperative sexual function. The aim of this study was to investigate whether vaginal extension can improve sexual function and quality of life and the problem of sexual dysfunction in early-stage cervical cancer survivors (CCSs) in China. Case-control and questionnaire-based methods were employed. Thirty-one patients who had undergone vaginal extension following RH and 28 patients with matching factors after RH alone were enrolled in the study. Both groups were assessed retrospectively by questionnaires at least 6 months after treatment. The European Organization for Research and Treatment of Cancer Quality-of-Life questionnaire cervical cancer module and the Sexual Function Vaginal Changes Questionnaire are validated measurements for disease- and treatment-specific issues. Vaginal length was 10.03 ± 1.26 cm and 5.92 ± 1.05 cm in study and control group, respectively (P sexual activity at the time of interview, averaging 6 months between treatment and sexual activity. While difficulty emptying bladder, incomplete emptying, and constipation were the most commonly reported symptoms, no significant difference was observed regarding pelvic floor symptoms. Reduced vagina size and shortened vagina was significantly more prominent in the control group, whereas both group presented with hypoactive sexual desire (88.1%), orgasm dysfunction (71.8%), and low enjoyment or relaxation after sex (51.3%). Shortened vagina was significantly less reported in study group, while no difference was observed in other sex-related dimensions. Vaginal extension does not worsen pelvic floor symptoms. Sexual rehabilitation interventions are of significance and should be paid more attention to the CCSs in China. © 2014 International Society for

  12. Histerectomia Vaginal Assistida por Laparoscopia em Pacientes com Necessidade de Anexectomia Laparoscopically Assisted Vaginal Histerectomy in Patients Requiring Adnexectomy

    Directory of Open Access Journals (Sweden)

    Francisco José Cândido dos Reis

    1998-12-01

    Full Text Available Objetivos: avaliar as vantagens da laparoscopia como instrumento para conversão de histerectomias abdominais em vaginais em pacientes com indicação de anexectomia concomitante, considerando-se a segurança e os custos hospitalares adicionais relativos ao procedimento. Pacientes e Métodos: estudo de caso controle envolvendo 9 pacientes submetidas à Histerectomia Vaginal Assistida por Laparoscopia (HVAL e 18 pacientes-controle submetidas à Histerectomia Abdominal (HA, associadas à anexectomia. Foram avaliadas as características pré-operatórias e os resultados do procedimento. Os grupos HVAL e HA são semelhantes quanto à idade, paridade, cesáreas anteriores, cirurgias prévias e IMC. Resultados: o grupo HVAL apresentou tempo cirúrgico médio de 163,9 minutos e o grupo HA de 142,8 minutos. Não ocorreram complicações pós-operatórias no grupo HVAL, ao passo que no grupo HA houve 2 casos de deiscência de sutura e 1 caso de hérnia incisional. A mediana do tempo de internação foi de 1 dia no grupo HVAL e 2 dias no grupo HA; a mediana do período de convalescença por sua vez foi de 2 e 4 semanas respectivamente. No grupo HVAL, 55,6% das pacientes necessitaram de medicação analgésica no pós-operatório, o que ocorreu em 100% das pacientes do grupo HA. Conclusões: a HVAL mostrou-se vantajosa em relação à HA em termos de melhor recuperação e menor incidência de complicações no pós-operatório. O procedimento é factível com segurança em um Hospital Universitário, não implicando tampouco em custos adicionais com equipamentos ou instrumental.Purpose: to evaluate the advantages of the laparoscopic approach for conversion of abdominal hysterectomies in vaginal hysterectomies in patients with indication of concomitant adnexectomy, being considered the safety and the additional costs of the procedure. Patients and Methods: cases: 9 patients submitted to Laparoscopically Assisted Vaginal Hysterectomy (LAVH associated with

  13. Long-term outcomes for different vaginal cuff closure techniques in robotic-assisted laparoscopic hysterectomy: A randomized controlled trial.

    Science.gov (United States)

    Tsafrir, Ziv; Palmer, Matthew; Dahlman, Marisa; Nawfal, A Karim; Aoun, Joelle; Taylor, Andrew; Fisher, Jay; Theoharis, Evan; Eisenstein, David

    2017-03-01

    This randomized controlled trial aimed to evaluate the outcomes of different vaginal cuff closure techniques in robotic-assisted total laparoscopic hysterectomy. Ninety women undergoing robotic-assisted total laparoscopic hysterectomy for benign disease were randomized to three vaginal cuff closure techniques: running 2.0 V-Lock™ (Arm 1), 0 Vicryl™ figure-of-eight (Arm 2), and running 0 Vicryl™ with Lapra-Ty(®) (Arm 3). Patients' records were reviewed for age, body mass index, smoking status and relevant co-morbidities. Operative times for vaginal closure and total length of surgery, estimated blood loss, and peri-operative complications were collected. Patients were evaluated at 2 and 6 weeks post-operatively, and interviewed 1year following surgery by a telephone survey. Outcomes evaluated were vaginal cuff dehiscence, pain, dyspareunia and bleeding. The study arms did not differ with respect to estimated blood loss (50mL in each arm; p=0.34), median vaginal cuff closure time (14.5, 12 and 13min, respectively; p=0.09) or readmission (p=0.55). In the 1-year follow-up (54/90 respondents; 60%), there were no significant differences among study arms for vaginal bleeding, cuff infection or dyspareunia. Only women belonging to arm 3 reported vaginal pain (0%, 0% and 23%, respectively; p=0.01). No cases of vaginal cuff dehiscence were observed. The type of closure technique has no significant impact on patient outcomes. In the absence of a clear advantage of one technique over the others, the decision regarding the preferred method to close the vaginal cuff in robotic-assisted total laparoscopic hysterectomy should be based on surgeons' preference and cost effectiveness. Copyright © 2016. Published by Elsevier B.V.

  14. [Quality of life and sexual function of cervical cancer patients following radical hysterectomy and vaginal extension].

    Science.gov (United States)

    Ye, Shuang; Yang, Jiaxin; Cao, Dongyan; Zhu, Lan; Lang, Jinghe; Shen, Keng

    2014-08-01

    To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension. Case-control and questionnaire- based method was employed in this study. Thirty-one patients of early-stage (I b1-I b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group, while 28 patients with matching factors and RH only during the same period were allocated to control group. There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis, tumor stage and follow-up time (P > 0.05). Patients were assessed retrospectively by validated self-reported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment. Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0 ± 1.3) cm and (5.9 ± 1.0)cm in study group and control group respectively (P = 0.000). Sixty-eight percent (21/31) of cases in study group and 64% (18/28) of cases in control group had resumed sexual activity at the time of interview, and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively, in which there was not statistical significance (P > 0.05). No difference was observed regarding pelvic floor symptoms (P > 0.05) while difficulty emptying bladder, incomplete emptying and constipation were most commonly reported. Both group presented with hypoactive sexual desire

  15. Effect of systematic local infiltration analgesia on postoperative pain in vaginal hysterectomy

    DEFF Research Database (Denmark)

    Hristovska, Ana-Marija; Kristensen, Billy B; Rasmussen, Marianne A

    2014-01-01

    MEASURES: Pain, nausea, vomiting and opioid requirements were assessed for 32 h as well as time spent in the post-anesthesia care unit and time to first mobilization. RESULTS: Pain at rest was significantly reduced after one, four and eight hours in the ropivacaine group (p ≤ 0.001-0.01). Pain during...... coughing was significantly reduced after one and four hours (p ≤ 0.001 and p ≤ 0.003), and pain during movement was significantly reduced after four hours (p ≤ 0.02). Opioid requirements and time spent in the post-anesthesia care unit were significantly reduced in the ropivacaine group (p ....001, respectively), as well as the time to first mobilization (p operative systematic local infiltration analgesia reduces postoperative pain in patients undergoing vaginal hysterectomy, facilities mobilization and improves early recovery....

  16. Hysterectomy - laparoscopic - discharge

    Science.gov (United States)

    ... a shower the day after surgery. If tape strips were used to close your skin, they should ... cancer Endometriosis Hysterectomy Uterine fibroids Patient Instructions Hysterectomy - abdominal - discharge Hysterectomy - vaginal - discharge Review Date 2/18/ ...

  17. Surgical approach to hysterectomy for benign gynaecological disease

    NARCIS (Netherlands)

    Aarts, J.W.M.; Nieboer, T.E.; Johnson, N.; Tavender, E.; Garry, R.; Mol, B.W.; Kluivers, K.B.

    2015-01-01

    BACKGROUND: The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH). OBJECTIVES: To assess the effectiveness and safety of different surgical approaches to hysterectomy

  18. Histerectomía vaginal en pacientes sin prolapso uterino Vaginal hysterectomy in patients with uterus prolapse

    Directory of Open Access Journals (Sweden)

    Miguel Emilio García Rodríguez

    2011-06-01

    previous operations and the uterus size as exclusion factors to choice the hysterectomy technique. The aim of present research was to determine the effectiveness and feasibility of vaginal hysterectomy by Heaney's technique, carried out in patients without uterus prolapse even in presence of the above mentioned factors. METHODS. A multivariate, descriptive and observational study was conducted in a sample including 1 000 patients operated on in the General Surgery service of the "Martín Chang Puga" University Hospital in Nuevitas municipality (Camagüey province, between May, 1994 and December, 2006. A database was designed in Excel transferred to SPSS professional statistical package to carry out univaried, bivaried and multivariate analyses, which finally were represented in frequency and percentages tables. A significance of p = 0.05 was used. RESULTS. The 6% of patients were nulliparous and the 23,5% had previous surgeries of pelvis. A 82,6% of patients had uteri with no more than an approximate value of 12 weeks of pregnancy and the uterine fibroma was the leading cause (88,5% of intervention. Only a 4,1% of patients need blood transfusion. The perioperative and postoperative complications accounted for the 1,7% and the 19,3%, respectively. The 97,2% of patients stayed less than 48 hours in the hospital and the 99,4% go back to normal life. CONCLUSIONS. The nulliparity, the uterus size and the previous operations were not considered like isolated and excluding factors for the vaginal route. However, the type of hysterectomy will depends of the decision of the attending physician and the patient, according the costs and benefits involved in each case.

  19. Comparison of Midterm Efficiency and Complications of Tension-Free Vaginal Tape Alone and Tension-Free Vaginal Tape Performed with Vaginal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Emre Sinan Güngör

    2017-09-01

    Full Text Available Aim: To evaluate and compare the results and complications of tension-free vaginal tape (TVT when performed alone or with vaginal hysterectomy (VH and to evaluate the mid-term success rates of TVT for both groups. Methods: A retrospective study was performed on 179 patients who had TVT alone for stress urinary incontinance (SUI or TVT with VH for SUI and vaginal prolapse. Demographic, outcome and complication data were obtained from medical records. The main outcome measures were postoperative SUI and voiding dysfunction. Results: The mean age of the patients who underwent TVT and TVT+VH were 50.2±6.8 and 52.2±8.1, respectively (p>0.05 and the mean parity was 4±2.07 and 4.15±2.02, respectively (p>0.05. The success rate was significantly higher in TVT alone group than in TVT+VH group (93.6% vs. 84.5%, p0.05. Overall complication rate was higher in TVT+VH group (4.2% vs. 9.5%, p<0.05. Postoperative residuel urine volumes were significantly higher than preoperative residuel urine volumes in both groups (p=0.001. Due to mesh rejection, second surgery was performed in one patient from both groups to reomove the mesh. Conclusion: Midterm success rates were significantly higher in TVT group than in TVT+VH group, but success rates in TVT+VH were acceptable. Overall complication rates were higher in TVT+VH group; requirement for a second surgery was similar for both groups.

  20. Surgical approach to hysterectomy for benign gynaecological disease

    NARCIS (Netherlands)

    Nieboer, Theodoor E.; Johnson, Neil; Lethaby, Anne; Tavender, Emma; Curr, Elizabeth; Garry, Ray; van Voorst, Sabine; Mol, Ben Willem J.; Kluivers, Kirsten B.

    2009-01-01

    BACKGROUND: The three approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (LH). Laparoscopic hysterectomy has three further subdivisions depending on the part of the procedure performed laparoscopically. OBJECTIVES:

  1. Tinidazol versus cefazolina na antibioticoprofilaxia de histerectomia vaginal e abdominal Tinidazole versus cefazolin in antibiotic prophylaxis of vaginal and abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    José Antonio Simões

    2008-11-01

    das mulheres submetidas à histerectomia vaginal sugere que essa infecção deve ser melhor pesquisada e devidamente tratada antes da cirurgia.PURPOSE: to compare the efficacy of tinidazole and cephazolin on the febrile and infectious morbidity of post vaginal and abdominal hysterectomy antibiotic prophylaxis. METHODS: randomized clinical study, where women admitted to hospital for hysterectomy were randomly allocated in one of the following antibiotic prophylaxis groups: Group C (2 g of IV cephazolin in the anesthetic induction; Group T (2 g of tinidazole orally, 12 hours before the surgery; or Group C+T (2 g of tinidazole orally 12 hours before the surgery and 2g of IV cephazolin in the anesthetic induction. Cervicovaginal smears were collected for specific cultures and the diagnosis of bacterial vaginosis (BV was based in Amsel and Nugent's criteria. The patients were reevaluated 7 and 30 days after the surgery for signs of febrile and/or infectious morbidity. The χ2 or the Fisher's exact test was used to assess differences among the three groups, with a significance level of 5%. The sample power (1-β was calculated through the SAS program. RESULTS: seven days after the hysterectomy, infectious morbidity was diagnosed in 6.6% of the women, but with no significant difference among the three groups studied (p=0.12. There was no febrile or infectious morbidity at the immediate post-surgical period or after 30 days from the surgery. BV ratio at the pre-surgical period was significantly higher among the women submitted to vaginal hysterectomy, rather than among the ones submitted to abdominal hysterectomy (27 versus 7%, p=0.02. BV ratio was also higher after 30 days, among the women submitted to vaginal hysterectomy (20 versus 8%, though without statistical significance (p=0.19. CONCLUSIONS: the use of tinidazole, isolated or associated with cephazolin has not presented higher efficacy, than the use of cephazolin, alone to prevent febrile or infectious morbidity post

  2. Histerectomía vaginal en pacientes sin prolapso uterino Vaginal hysterectomy in patients with uterus prolapse

    National Research Council Canada - National Science Library

    Miguel Emilio García Rodríguez; Ramón Ezequiel Romero Sánchez

    2011-01-01

    ... de la investigación fue determinar la eficacia y factibilidad de la histerectomía vaginal por la técnica de Heaney, practicada en pacientes sin prolapso uterino, incluso en presencia de los factores antes mencionados. MÉTODOS. Se realizó...

  3. Therapeutic effect of laser vaporization for vaginal intraepithelial neoplasia following hysterectomy due to premalignant and malignant lesions.

    Science.gov (United States)

    Wang, Yan; Kong, Wei-Min; Wu, Yu-Mei; Wang, Jian-Dong; Zhang, Wei-Yuan

    2014-06-01

    The aim of this study was to evaluate the therapeutic effect of laser vaporization for vaginal intraepithelial neoplasia (VAIN) after hysterectomy in Chinese women and to identify factors affecting persistence/recurrence. Twenty-eight VAIN patients after hysterectomy due to cervical intraepithelial neoplasia (group 1) and 11 VAIN patients due to cervical cancer (group 2) were reviewed retrospectively. All patients were treated with at least one episode of laser vaporization between 2010 and 2011, and then followed up every 3 months for at least 1 year. Cox regression analysis was used to identify independent factors predicting persistence/recurrence. All VAIN patients achieved remission after two episodes of laser treatment, with 85.7% complete regression in group 1 and 54.5% in group 2. The first episode of the treatment had a significantly higher success rate in group 1 than in group 2 (46.2% vs 0.0%). All patients had no recurrence during a mean follow-up time of 22.8-27.8 months (range 12-39 months). However, infection persisted in 21 (61.8%) of 34 human-papillomavirus-positive patients after laser vaporization. Severity of VAIN was the only significant independent predictor of persistence/recurrence after one episode of the treatment (adjusted odds ratio, 4.08; 95% confidence interval, 1.28-12.96; P = 0.017). Laser treatments were well tolerated with no major side-effects. Laser vaporization may be a useful option for the treatment of VAIN after hysterectomy. However, a follow-up is required to assess the long-term efficacy of laser treatment. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  4. Socioeconomic factors may influence the surgical technique for benign hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Ottesen, Bent; Diderichsen, Finn

    2012-01-01

    Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background....

  5. The Manchester procedure versus vaginal hysterectomy in the treatment of uterine prolapse

    DEFF Research Database (Denmark)

    Tolstrup, Cæcilie Krogsgaard; Lose, Gunnar; Klarskov, Niels

    2017-01-01

    -intervention rate, complications and operative outcomes. METHODS: We systematically searched Embase, PubMed, the Cochrane databases, Clinicaltrials and Clinical trials register using the MeSh terms "uterine prolapse", "uterus prolapse", "vaginal prolapse" "pelvic organ prolapse", "prolapsed uterus", "Manchester...

  6. A Review of Comparison of Complications of Vaginal Hysterectomy with and without Concomitant Surgery for SUI: A 5 Years’ Experience at a Tertiary Care Hospital of Pakistan

    Directory of Open Access Journals (Sweden)

    Raheela Mohsin Rizvi

    2013-01-01

    Full Text Available Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH with repair alone. The basic characteristics like age, BMI, and degree of prolapse showed no statistical difference among two groups. The main comorbidities in both groups were hypertension, diabetes, and bronchial asthma. We observed no significant differences in intraoperative and postoperative complications except for cuff abscess, need for medical intervention, and readmission following discharge from hospital, which were higher in cases with vaginal hysterectomy with concomitant TVT. Conclusions. Vaginal hysterectomy is an efficient treatment for uterovaginal prolapse with a swift recovery, short length of hospital stay, and rare serious complications. The addition of surgery for USI does not appear to increase the morbidity.

  7. A clinical audit of hysterectomy in Bowen university teaching ...

    African Journals Online (AJOL)

    There were three(3) deaths following emergency hysterectomy performed on account of primary postpartum haemorrhage. Conclusion: Hysterectomy remains a major gynaecological procedure. Necessary steps are needed to ensure that gynaecologist acquire skills for hysterectomy especially vaginal hysterectomy and ...

  8. Socioeconomic factors may influence the surgical technique for benign hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Ottesen, Bent; Diderichsen, Finn

    2012-01-01

    Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background.......Owing to significantly improved outcomes, vaginal hysterectomy is the recommended standard approach when feasible in preference to abdominal hysterectomy. It is, however, not clear whether the use of vaginal hysterectomy varies with the women's socioeconomic background....

  9. Long-term outcome of native tissue reconstructive vaginal surgery for advanced pelvic organ prolapse at 86 months: Hysterectomy versus hysteropexy.

    Science.gov (United States)

    Lo, Tsia-Shu; Pue, Leng Boi; Hung, Tai-Ho; Wu, Pei-Ying; Tan, Yiap Loong

    2015-07-01

    To evaluate and compare the long-term outcome of sacrospinous ligament fixation (SSF) in combination with various other compartment defect native tissue repairs with hysterectomy or hysteropexy. Medical records of 159 patients who underwent surgery for pelvic organ prolapse (POP) between April 2004 and August 2008 were reviewed retrospectively. Patients were assessed at baseline and at 5-year postoperative follow-up. SSF, anterior (AC) and posterior colporrhaphy (PC), both with and without hysterectomy, were performed. Primary outcome was objective cure (POP quantification system [POP-Q] ≤1) and subjective cure (negative response to questions 2 and 3 on Pelvic Organ Prolapse Distress Inventory 6 [POPDI-6]). Subanalysis was done on patients who had uterus preserved compared with those with vaginal hysterectomy. Postoperative data were available for 146 patients: 120 in the hysterectomy group and 26 in the hysteropexy group. Mean age, parity, postmenopausal status and mean operating time in the hysterectomy group were significantly higher than in the hysteropexy group. At median follow-up of 86 months, objective cure at overall compartments for all patients was 67.8%, and for subjective cure, this was 64.4%. There was no difference in the adjusted odds ratio for objective and subjective cure rates in both groups, but the hysterectomy group had a significantly lower mean total POPDI-6 score. SSF plus AC and PC have a low reoperation rate despite a moderate success rate at 7-year follow-up. There was no difference in the adjusted objective, subjective success rates and sexual function between sacrospinous hysteropexy and hysterectomy. The hysterectomy group, however, had fewer bothersome prolapse symptoms. © 2015 The Authors. Journal of Obstetrics and Gynaecology Research © 2015 Japan Society of Obstetrics and Gynecology.

  10. Laparoscopic approach to hysterectomy

    OpenAIRE

    Nazik, Hakan

    2013-01-01

    Modern laparoscopic surgery is widely used throughout the world as it offers greater advantages than open procedures. The laparoscopic approach to hysterectomy has evolved over the last 20 years. Hysterectomies are performed abdominally, vaginally, laparoscopically or, more recently, with robotic assistance. Indications for a total laparoscopic hysterectomy are similar to those for total abdominal hysterectomy, and most commonly include uterine leiomyomata, pelvic organ prolapse, and a...

  11. Adjuvant chemoradiation after laparoscopically assisted radical vaginal hysterectomy (LARVH) in patients with cervical cancer. Oncologic outcome and morbidity

    Energy Technology Data Exchange (ETDEWEB)

    Gruen, Arne; Musik, Thabea; Stromberger, Carmen; Budach, Volker; Marnitz, Simone [Charite Univ. Medicine Berlin, Campus Virchow-Klinikum, Berlin (Germany). Dept. of Radiooncology; Koehler, Christhardt; Schneider, Achim [Charite Univ. Medicine Berlin, Campus Mitte- und Benjamim Franklin, Berlin (Germany). Dept. of Gynaecology; Fueller, Juergen; Wendt, Thomas [Jena Univ. Hospital (Germany). Dept. of Radiooncology

    2011-06-15

    Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation. A total of 55 patients (range 28-78 years) with cervical cancer on FIGO stages IB1-IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH. At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed. With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients. (orig.)

  12. Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer: oncologic outcome and morbidity.

    Science.gov (United States)

    Gruen, Arne; Musik, Thabea; Köhler, Christhardt; Füller, Jürgen; Wendt, Thomas; Stromberger, Carmen; Budach, Volker; Schneider, Achim; Marnitz, Simone

    2011-06-01

    Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation. A total of 55 patients (range 28-78 years) with cervical cancer on FIGO stages IB1-IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH. At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed. With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients.

  13. Vaginal Cuff Dehiscence Presenting with Free Air 60 Days after Robotic-Assisted Hysterectomy

    Directory of Open Access Journals (Sweden)

    D. Munger

    2017-01-01

    Full Text Available Introduction. The vast majority of patients presenting with pneumoperitoneum have visceral organ perforation and require urgent diagnostic laparoscopy. Nonsurgical causes are relatively rare and may be attributed to multiple etiologies. Case Presentation. Here we describe the case of a 38-year-old Caucasian female who presented to the emergency department with three days of cramping, epigastric abdominal pain. Her physical exam was notable for tenderness to palpation in the epigastric area and abdominal and chest X-rays showed free air under the diaphragm. Free air around the porta hepatis was verified on CT scan. Approximately 90% of pneumoperitoneum cases are due to perforation of visceral organs and therefore require operative management. An urgent exploratory laparoscopy revealed no clear source of free air, but postoperatively the patient developed a large volume of watery discharge from her vagina. Subsequent workup revealed a 1 cm vaginal cuff dehiscence which was later repaired with no postoperative complications. Conclusion. Although the majority of patients with pneumoperitoneum require urgent exploratory laparoscopy, a careful diagnostic workup may reveal sources of free air that are not related to hollow viscous perforation. Vaginal cuff dehiscence represents a rare yet nonurgent source of pneumoperitoneum. This differential should be considered in light of the possible intra- and postoperative complications of surgery.

  14. A randomized prospective trial of the postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy for the treatment of symptomatic uterine fibroids: clinical trial design

    Directory of Open Access Journals (Sweden)

    Park Noh

    2009-01-01

    Full Text Available Abstract Background Laparoscopy-assisted vaginal hysterectomy is one of the definite methods for the treatment of symptomatic uterine fibroids with lesser intraoperative bleeding and shorter hospitalization compared with abdominal hysterectomy. However, laparoscopy-assisted vaginal hysterectomy cannot preserve uterus and can show postoperative complications by the change of pelvic structure. Thus, laparoscopic uterine artery ligation has been introduced for relieving the symptoms caused by uterine fibroids in place of hysterectomy. The current study was designed to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to evaluate the efficacy of laparoscopic uterine artery ligation which can treat symptomatic uterine fibroids with the preservation of uterus. Methods and design Patients enrolled the current study are randomized to laparoscopic uterine artery ligation or laparoscopy-assisted vaginal hysterectomy. The primary outcome is to compare postoperative quality of life between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Cancer patients version 3.0. Secondary outcomes are to evaluate the volume reduction of uterus, uterine fibroids and ovaries by the 2 treatments, to compare the improvement of subjective symptoms using 11-point symptom score and postoperative clinical outcomes between laparoscopic uterine artery ligation and laparoscopy-assisted vaginal hysterectomy, and to investigate the improvement of postoperative vaginal bleeding by laparoscopic uterine artery ligation. Discussion Among treatment methods for symptomatic uterine fibroids with the preservation of uterus, laparoscopic uterine artery ligation is expected to have the efficacy like uterine artery embolization, which appeared to be safe for routine use with

  15. Total versus subtotal hysterectomy

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Anna Birthe

    2005-01-01

    women chose total and 105 women chose subtotal abdominal hysterectomy. No significant differences were found between the 2 operation methods in any of the outcome measures at 12 months. Fourteen women (15%) from the subtotal abdominal hysterectomy group experienced vaginal bleeding and three women had...

  16. Peripartum hysterectomy in Denmark 1995-2004

    DEFF Research Database (Denmark)

    Sakse, Abelone Elisabeth; Weber, Tom; Nickelsen, Carsten Nahne Amtoft

    2007-01-01

    BACKGROUND: Severe postpartum hemorrhage (PPH) is a potentially life-threatening situation that sometimes requires a hysterectomy. We examined the national incidence, risk factors, indications, outcomes and complications of peripartum hysterectomy following vaginal and caesarean delivery. METHODS...

  17. Laparoscopic approach to hysterectomy

    Directory of Open Access Journals (Sweden)

    Hakan Nazik

    2013-04-01

    Full Text Available Modern laparoscopic surgery is widely used throughout the world as it offers greater advantages than open procedures. The laparoscopic approach to hysterectomy has evolved over the last 20 years. Hysterectomies are performed abdominally, vaginally, laparoscopically or, more recently, with robotic assistance. Indications for a total laparoscopic hysterectomy are similar to those for total abdominal hysterectomy, and most commonly include uterine leiomyomata, pelvic organ prolapse, and abnormal uterine bleeding. When hysterectomy is going to be performed, the surgeon should decide which method is safer and more cost-effective. This paper aims to make a review of the indications, techniques and advantages of laparoscopic hysterectomy as well as the criteria to be used for appropriate patient selection.

  18. Outcomes of vaginal hysterectomy and constricting colporrhaphy with concurrent levator myorrhaphy and high perineorrhaphy in women older than 75 years of age

    Directory of Open Access Journals (Sweden)

    Töz E

    2015-06-01

    Full Text Available Emrah Töz, Aykut Özcan, Nesin Apaydin, İbrahim Uyar, Betül Kocakaya, Gülin Okay Department of Gynecology and Obstetrics, Tepecik Education and Research Hospital, İzmir, Turkey Objectives: We performed constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy, and investigated the intraoperative complications, and short-term outcomes of these constricting procedures in patients aged 75 years or older.Methods: We searched our hospital database for cases, between January 2011 and January 2014, of women aged over 75 years who underwent surgery for pelvic organ prolapse of stage 2 or higher, via vaginal hysterectomy, constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy, with or without treatment of urinary incontinence. All volunteers were evaluated via pelvic examination using the pelvic organ prolapse quantification system, the modified Decision Regret Scale–Pelvic Floor Disorders form, the Satisfaction Decision Scale–Pelvic Floor Disorders form, and the Pelvic Floor Distress Inventory form.Results: Fifty-four patients were included in the study. The mean follow-up time was 24.4 months after constricting surgery (range: 8–44 months. There were four cases (7% of de novo urge incontinence (the symptoms resolved upon prescription of anticholinergic medication. Two patients developed de novo stress urinary incontinence after the procedure and were treated via transobturator sling surgery using Safyre T® polypropylene monofilament slings. No anatomical or subjective recurrence of prolapse was noted during the follow-up period. No patient required additional surgery for recurrence of prolapse.Conclusion: Constricting anterior and posterior colporrhaphy, levator myorrhaphy, and high perineorrhaphy with concurrent hysterectomy is a feasible, safe, and effective surgical option in elderly patients at low anesthesiological risk. The decision

  19. Outcomes of vaginal hysterectomy for uterovaginal prolapse: a population-based, retrospective, cross-sectional study of patient perceptions of results including sexual activity, urinary symptoms, and provided care

    Directory of Open Access Journals (Sweden)

    Löfgren Mats

    2009-04-01

    Full Text Available Abstract Background Vaginal hysterectomy is often used to correct uterovaginal prolapse, however, there is little information regarding outcomes after surgery in routine clinical practice. The objective of this study was to investigate complications, sexual activity, urinary symptoms, and satisfaction with health care after vaginal hysterectomy due to prolapse. Methods We analyzed data from the Swedish National Register for Gynecological Surgery (SNRGS from January 1997 to August 2005. Women participating in the SNRGS were asked to complete surveys at two and six months postoperatively. Of 941 women who underwent vaginal hysterectomy for uterovaginal prolapse, 791 responded to questionnaires at two months and 682 at six months. Complications during surgery and hospital stay were investigated. The two-month questionnaire investigated complications after discharge, and patients' satisfaction with their health care. Sexual activity and urinary symptoms were reported and compared in preoperative and six-month postoperative questionnaires. Results Almost 60% of women reported normal activity of daily life (ADL within one week of surgery, irrespective of their age. Severe complications occurred in 3% and were mainly intra-abdominal bleeding and vaginal vault hematomas. Six months postoperative, sexual activity had increased for 20% (p = 0.006 of women and urinary urgency was reduced for 50% (p = 0.001; however, 14% (n = 76 of women developed urinary incontinence, 76% (n = 58 of whom reported urinary stress incontinence. Patients were satisfied with the postoperative result in 93% of cases and 94% recommended the surgery. Conclusion Vaginal hysterectomy is a patient-evaluated efficient treatment for uterovaginal prolapse with swift recovery and a low rate of complication. Sexual activity and symptoms of urinary urgency were improved. However, 14% developed incontinence, mainly urinary stress incontinence (11%. Therefore efforts to disclose latent

  20. Tinidazole Versus Cefazolin In Antibiotic Prophylaxis Of Vaginal And Abdominal Hysterectomy [tinidazol Versus Cefazolina Na Antibioticoprofilaxia De Histerectomia Vaginal E Abdominal

    OpenAIRE

    José Antonio Simões; Michelle Garcia Discacciati; Giana Balestro Poletti; Eliane Brolazo; Gabriela Daoud Crema; Cláudia Ferreira Pereira

    2008-01-01

    OBJETIVO: comparar a eficácia do tinidazol e da cefazolina na antibioticoprofilaxia da morbidade febril e infecciosa pós-histerectomia vaginal e abdominal. MÉTODOS: estudo clínico randomizado, no qual as mulheres internadas para histerectomia foram aleatorizadas para um dos seguintes grupos de antibioticoprofilaxia: Grupo C (2 g de cefazolina EV na indução anestésica); Grupo T (2 g de tinidazol VO 12 horas antes da cirurgia); ou Grupo C+T (2 g de tinidazol VO 12 horas antes da cirurgia e 2 g ...

  1. Factors for a Successful Laparoscopic Hysterectomy in Very Large Uteri

    Directory of Open Access Journals (Sweden)

    Harald Krentel

    2017-01-01

    Full Text Available Minimally invasive hysterectomy is a standard procedure. Different approaches, as laparoscopically assisted vaginal hysterectomy, vaginal hysterectomy, and subtotal and total laparoscopic hysterectomy, have been described and evaluated by various investigations as safe and cost-effective methods. In particular, in comparison to abdominal hysterectomy, the minimally invasive methods have undoubted advantages for the patients. The main reason for a primary abdominal hysterectomy or conversion to abdominal hysterectomy during a minimal invasive approach is the uterine size. We describe our course of action in the retrospective analysis of five cases of total minimal-access hysterectomy, combining the laparoscopic subtotal hysterectomy and the vaginal extirpation of the cervix in uterine myomatosis with a uterine weight of more than 1000 grams, and discuss the factors that limit the use of laparoscopy in the treatment of big uteri. Trail Registration. The case report is registered in Research Registry under the UIN researchregistry743.

  2. Complete Utero Vaginal Prolapse in a Woman with Prolapsed ...

    African Journals Online (AJOL)

    vault. Vaginal myomectomy, followed by interval vaginal hysterectomy, and pelvic floor repair a week later resulted in a satisfactory outcome. Keywords: Fibroid, Interval vaginal hysterectomy, Utero‑vaginal prolapse, Vaginal myomectomy. Access this article online. Quick Response Code: Website: www.amhsr.org. DOI: *****.

  3. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial.

    Science.gov (United States)

    Song, Taejong; Cho, Juhee; Kim, Tae-Joong; Kim, Im-Ryung; Hahm, Tae Soo; Kim, Byoung-Gie; Bae, Duk-Soo

    2013-01-01

    To compare cosmetic satisfaction with laparoendoscopic single-site surgery (LESS) compared with multi-port surgery. Randomized controlled trial (Canadian Task Force classification I). University hospital. Twenty women who underwent laparoscopically-assisted vaginal hysterectomy (LAVH) via LESS or multi-port surgery. Laparoendoscopic single-site surgery or multi-port surgery. Cosmetic satisfaction was assessed using the Body Image Questionnaire at baseline and at 1, 4, and 24 weeks after surgery. Of the 20 LESS procedures, 1 was converted to multi-port surgery because of severe adhesions, and 1 woman assigned to undergo multi-port surgery was lost to follow-up. The 2 surgery groups did not differ in clinical demographic data and surgical results or postoperative pain scores at 12, 24, and 36 hours. Compared with the multi-port group, the LESS group reported significantly higher cosmetic satisfaction at 1, 4, and 24 weeks after surgery (p surgery, LESS is not only a feasible approach with comparable operative outcomes but also has an advantage insofar as cosmetic outcome. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  4. ureteric perforation following laparoscopic assisted vaginal ...

    African Journals Online (AJOL)

    2011-03-03

    Mar 3, 2011 ... SUMMARY. Ureteric injury is one of the most common complications of hysterectomy, both in open ... the laparoscopic hysterectomy (abdominal or vaginal approaches) is ... primary end to end anastomosis due big gap, the.

  5. Subtotal versus total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Ottesen, Bent; Alling Møller, Lars Mikael

    2015-01-01

    , constipation, pain, sexuality, quality of life (Short Form-36 questionnaire), hospital contacts, and vaginal bleeding. RESULTS: The questionnaire was answered by 197 of 304 women (64.8%) (subtotal hysterectomy [n = 97] [63.4%]; total hysterectomy [n = 100] [66.2%]). Mean follow-up time was 14 years and mean......, randomized clinical trial without blinding. Eleven gynecological departments in Denmark contributed participants to the trial. Women referred for benign uterine diseases who did not have contraindications to subtotal abdominal hysterectomy were randomized to subtotal (n = 161) vs total (n = 158) abdominal...... hysterectomy. All women enrolled in the trial from 1996 to 2000 who were still alive and living in Denmark (n = 304) were invited to answer the validated questionnaire used in prior 1 and 5 year follow-ups. Hospital contacts possibly related to hysterectomy from 5 to 14 years postoperatively were registered...

  6. LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY FOR ...

    African Journals Online (AJOL)

    hi-tech

    2004-05-01

    May 1, 2004 ... Presenting complaints (n=149). Complaint. No. Menorrhagia. 86 (57.7%). Dysmenorrhoea/Chronic pelvic pain. 27 intermenstrual bleeding. 21. Post coital bleeding (normal pap smears). 9. Asymptomatic uterine fibroids. 3. Renal changes on IVP. 3. Table 4. Significant previous surgery (n=149). Surgery. No.

  7. Trachelectomy for cancer of the cervix: dargent's operation. Vaginal hysterectomy for early cancer of the cervix stage IA1 and CIN III

    DEFF Research Database (Denmark)

    Ottosen, Christian

    2011-01-01

    obstetrical outcomes. The procedure is a combination of laparoscopy for pelvic lymphadenectomy and challenging classic vaginal surgery to resect the tumour, part of the parametrium and upper vagina. Complications are in the range of 8-13%. Recurrence and death occur in 5 and 3%, respectively, as good...

  8. Hysterectomy - slideshow

    Science.gov (United States)

    ... GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Hysterectomy - Series—Normal anatomy URL of this page: //medlineplus.gov/ency/presentations/ ...

  9. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2015-02-01

    Full Text Available According to a nation-wide population-based study in Taiwan, along with the expanding concepts and surgical techniques of minimally invasive surgery, laparoscopic supracervical/subtotal hysterectomy (LSH has been blooming. Despite this, the role of LSH in the era of minimally invasive surgery remains uncertain. In this review, we tried to evaluate the perioperative and postoperative outcomes of LSH compared to other types of hysterectomy, including total abdominal hysterectomy (TAH, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total laparoscopic hysterectomy (TLH. From the literature, LSH has a better perioperative outcome than TAH, and comparable perioperative complications compared with laparoscopic-assisted vaginal hysterectomy. LSH had less bladder injury, vaginal cuff bleeding, hematoma, infection, and dehiscence requiring re-operation compared with TLH. Despite this, LSH has more postoperative cyclic menstrual bleeding and re-operations with extirpations of the cervical stump. LSH does, however, have a shorter recovery time than TAH due to the minimally invasive approach; and there is quicker resumption of coitus than TLH, due to cervical preservation and the avoidance of vaginal cuff dehiscence. LSH is therefore an alternative option when the removal of the cervix is not strictly necessary or desired. Nevertheless, the risk of further cervical malignancy, postoperative cyclic menstrual bleeding, and re-operations with extirpations of the cervical stump is a concern when discussing the advantages and disadvantages of LSH with patients.

  10. Low adherence to cervical cancer screening after subtotal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Møller, Lars Mikael Alling; Gimbel, Helga Margrethe

    2015-01-01

    INTRODUCTION: A reason for not recommending subtotal hysterectomy is the risk of cervical pathology. We aimed to evaluate cervical cancer screening and to describe cervical pathology after subtotal and total hysterectomy for benign indications. METHODS: Data regarding adherence to screening.......7% were not screened. We found a minimum of one abnormal test in 28 (10.8%) after subtotal hysterectomy and one after total hysterectomy. No cervical cancers were found. CONCLUSIONS: Adherence to cervical cancer screening after subtotal hysterectomy in a Danish population is suboptimal and some patients...... have unnecessary tests performed after total hysterectomy. Clarification of the use of cervical/vaginal smears after hysterectomy is needed to identify women at risk of cervical dysplasia or cancer. FUNDING: Research Foundation of Region Zealand, University of Southern Denmark, Nykøbing Falster...

  11. Robotic-assisted hysterectomy: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Smorgick N

    2017-03-01

    Full Text Available Noam Smorgick Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Abstract: Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis, hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy. Keywords: robotic-assisted hysterectomy, single-site laparoscopy, minimally invasive hysterectomy

  12. Predicting the development of stress urinary incontinence 3 years after hysterectomy

    NARCIS (Netherlands)

    Lakeman, M.M.E.; van der Vaart, C.H.; van der Steeg, J.W.; Roovers, J.P.W.R.

    2011-01-01

    We aimed to develop a prediction rule to predict the individual risk to develop stress urinary incontinence (SUI) after hysterectomy. Prospective observational study with 3-year follow-up among women who underwent abdominal or vaginal hysterectomy for benign conditions, excluding vaginal prolapse,

  13. Supracervical versus total hysterectomy in women undergoing hysterectomy for benign gynaecological disease - a new danish recommendation

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Jørgensen, Annemette; Schroll, Jeppe Bennekou

    time and less intraoperative bleeding. Conclusions The overall quality of evidence was very low. The panel assesses that most women want to avoid cyclic vaginal bleeding after hysterectomy. Women with indications for hormone replacement therapy (HRT) that experience cyclic vaginal bleeding after......Background In May 2015 we published a national clinical guideline on hysterectomy for benign gynaecological conditions in cooperation with the Danish Health and Medicines Authority. One of nine investigated areas of interest was whether to perform total or supracervical hysterectomy in women....... The important outcomes were defined as quality of life, cyclic vaginal bleeding, operating time, intraoperative bleeding and post-operative infections. A search specialist conducted a systematic literature search for publications from 2004 to 2014 in English, Danish, Norwegian and Swedish. In our first search...

  14. Changes in incontinence after hysterectomy.

    Science.gov (United States)

    Kruse, Anne Raabjerg; Jensen, Trine Dalsgaard; Lauszus, Finn Friis; Kallfa, Ervin; Madsen, Mogens Rørbæk

    2017-10-01

    Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy. 108 patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively. Sample size calculation indicated that 102 women had to be included. The incontinence status was estimated by a Danish version of the ICIG questionnaire; further, visual analogue scale, dynamometer for hand grip, knee extension strength and balance were applied. Work capacity was measured ergometer cycle together with lean body mass by impedance. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. In total 41 women improved their incontinence after hysterectomy and 10 women reported deterioration. Preoperative stress incontinence correlated with BMI (r = 0.25, p incontinence with age (r = 0.24, p incontinence was associated with younger age (r = 0.20, p incontinence was positively associated with BMI (r = 0.22, p = 0.02). A slight but significant loss was seen in lean body mass 13 and 30 days postoperatively. Hysterectomy was not significantly associated with the risk of incontinence; in particular, when no further vaginal surgery is performed. Hysterectomy may even have a slightly positive effect on incontinence and de-novo cure.

  15. [Laparoscopic hysterectomy--brief history, frequency, indications and contraindications].

    Science.gov (United States)

    Tomov, S; Gorchev, G; Tzvetkov, Ch; Tanchev, L; Iliev, S

    2012-01-01

    Hysterectomy is the most common gynecological operation after Caesarean section and the laparoscopic access to uterus removal is one of the contemporary methods showing slow but steady growth in time. In reference to indications and contraindications for laparoscopic hysterectomy, the following directions emerge as controversial: malignant gynecological tumors, uterus size, and high body mass index. Laparoscopic hysterectomy can be taken into consideration at the first stage of endometrial, cervical and ovarian cancer. If there is doubt about an uterus sarcoma and a laparoscopic access is accomplished, a conversion to abdominal hysterectomy must be done. Obesity and big uteri are not a contrarindication for that minimally-invasive access. Today, laparoscopic hysterectomy is a reasonable alternative to total abdominal and vaginal hysterectomy.

  16. Hysterectomy types in Estonia are still different from the Nordic countries.

    Science.gov (United States)

    Veerus, Piret; Lang, Katrin; Toompere, Karolin; Kirss, Fred

    2015-05-01

    To describe hysterectomy rates in different age groups, indications and proportion of surgery types over time. Nationwide register-based study. Estonia. Women who had hysterectomies for benign indications from 2004 to 2011. For each case, diagnosis according to ICD-10, type of surgery according to Nordic Medico-Statistical Committee, age, and time of operation were retrieved from the Estonian Health Insurance Fund database. Mid-year female population statistics were obtained from Statistics Estonia. Rate of hysterectomies per 100 000 women, proportions of different operation types, and main indications for hysterectomies. The total number of hysterectomies was 12 336, with a yearly mean of 1542. The rate of hysterectomies per 100 000 women/year decreased between 2004 and 2011 from 239.1 to 204.9. The proportion of abdominal hysterectomies decreased from 86.0 to 56.1% and the proportion of laparoscopic hysterectomies increased from 6.3 to 34.7%, while the proportion of vaginal hysterectomies remained more or less stable (7.8-9.1%). Most hysterectomies (74.4%) occurred in the age group 35-54 years. The main indications for hysterectomies were leiomyoma (61.5%), female genital prolapse (9.0%) and endometriosis (8.8%). Population rates and indications for hysterectomies in Estonia were similar to those in most Nordic countries, but the proportion of abdominal hysterectomies was higher and that of vaginal hysterectomy lower. The rates of laparoscopic and vaginal hysterectomies should be increased. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  17. Same-day discharge after laparoscopic hysterectomy.

    Science.gov (United States)

    Perron-Burdick, Misa; Yamamoto, Miya; Zaritsky, Eve

    2011-05-01

    To estimate readmission rates and emergency care use by patients discharged home the same day after laparoscopic hysterectomy. This was a retrospective case series of patients discharged home the same-day after total or supracervical laparoscopic hysterectomy in a managed care setting. Chart reviews were performed for outcomes of interest which included readmission rates, emergency visits, and surgical and demographic characteristics. The two hysterectomy groups were compared using χ² tests for categorical variables and t tests or Wilcoxon rank-sum tests for continuously measured variables. One-thousand fifteen laparoscopic hysterectomies were performed during the 3-year study period. Fifty-two percent (n=527) of the patients were discharged home the same-day; of those, 46% (n=240) had total laparoscopic hysterectomies and 54% (n=287) had supracervical. Cumulative readmission rates were 0.6%, 3.6%, and 4.0% at 48 hours, 3 months, and 12 months, respectively. The most common readmission diagnoses included abdominal incision infection, cuff dehiscence, and vaginal bleeding. Less than 4% of patients presented for emergency care within 48 or 72 hours, most commonly for nausea or vomiting, pain, and urinary retention. Median uterine weight was 155 g, median blood loss was 70 mL, and median surgical time was 150 minutes. There was no difference in readmission rates or emergency visits for the total compared with the supracervical laparoscopic hysterectomy group. Same-day discharge after laparoscopic hysterectomy is associated with low readmission rates and minimal emergency visits in the immediate postoperative period. Same-day discharge may be a safe option for healthy patients undergoing uncomplicated laparoscopic hysterectomy.

  18. Effect of robotic surgery on hysterectomy trends: implications for resident education.

    Science.gov (United States)

    Yamasato, Kelly; Casey, Duffy; Kaneshiro, Bliss; Hiraoka, Mark

    2014-01-01

    To compare the surgical approach used for hysterectomy at 2 teaching hospitals before and after introduction of the robotic surgical system. Retrospective cohort study (Canadian Task Force classification II-3). Two gynecologic training sites at the University of Hawaii. Women who underwent hysterectomy between January 1, 2005, and December 31, 2011. ICD-9 procedural codes were used to identify hysterectomies performed between January 1, 2005, and December 31, 2011. Hysterectomies were categorized according to surgical approach: abdominal, vaginal, laparoscopic-assisted vaginal/total laparoscopic, and robotic. Each hysterectomy was also categorized according to primary preoperative diagnosis as general gynecology, gynecologic oncology, and urogynecology. The rates and numbers of hysterectomies performed during 2005-2006 (2 years before acquisition of the robot), 2007-2008 (first 2 years with the robot), and 2009-2011 (3-5 years after acquiring the robot) were compared using χ(2) tests and analysis of variance. The numbers of hysterectomies reported in resident case logs were also collected and compared. A total of 5894 hysterectomies were performed between 2005 and 2011. The total number of hysterectomies performed at Hospital A, which acquired the robotic surgical system, increased over time (p = .04) but remained stable at Hospital B, which did not acquire the robotic surgical system. At Hospital A, the number of robotic hysterectomies increased as the number of abdominal hysterectomies decreased (p robotic hysterectomies (p robotic surgical system was associated with significant changes in the numbers and types of hysterectomies performed in both general and subspecialty gynecology. Although abdominal hysterectomies decreased as robotic hysterectomies increased, other hysterectomies did not. These trends mirror reported resident surgical experience and have implications for resident education. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights

  19. Postpartum hysterectomy

    Directory of Open Access Journals (Sweden)

    Katja Juvan-Kramer

    2006-01-01

    Full Text Available Background: Emergency postpartum hysterectomy (PH is generally performed in the situation of lifethreatening haemorrhage. Incidence according to the literature is between 1/300 and 1/5000 labours. The leading cause in developed world is placenta accreta. Besides standard methods (aplication of drugs, revision of uterus, bimanual compression of uterus etc., conservative surgical methods and embolization of vessels are increasingly used. We wanted to establish the incidence of PH in the Ljubljana Maternity Hospital, use of conservative surgical methods and matching of histological and operative diagnosis. We wanted to check the possibilities for embolization of vessels.Methods: Retrospective analysis of PH in the years 1992–2002 in the Ljubljana Maternity Hospital was done and the incidence of PH was calculated. We analysed patients regarding indications for PH, sort of operation and matching of histological and operative diagnose. We checked the possibilities for embolization of uterine vessels.Results: In the mentioned period 20 labours ended with PH (incidence 1/3124 labours. 17 patients were multiparas, PH was done after caesarean section in 9 cases. The most common indication was rupture of the uterus (6 cases, followed by inflammation of the uterus (5 cases and atony (4 cases. Among conservative methods, application of 15-metil PGF2alpha and oxytocin were most commonly used, the next two were manual exploration of uterine cavity and uterine packing. None of conservative surgical methods were used. Histological and operative diagnosis matched in 16 cases. There were no maternal and neonatal deaths.Conclusions: The incidence of PH in the Ljubljana Maternity Hospital is low. The leading two causes are uterine rupture and inflammation of uterus. None of conservative surgical methods were used. There are good possibilities for embolization of uterine vessels.

  20. Complete utero vaginal prolapse in a woman with prolapsed ...

    African Journals Online (AJOL)

    Case: A case of irreducible complete utero-vaginal and infected sub-mucous fibroid prolapse, in a 45-year-old grandmultiparous woman, is reported. Bed rest and antibiotics failed to relief edema and infection of the vault. Vaginal myomectomy, followed by interval vaginal hysterectomy, and pelvic floor repair a week later ...

  1. Predicting the development of stress urinary incontinence 3 years after hysterectomy

    NARCIS (Netherlands)

    Lakeman, Marielle M. E.; Van Der Vaart, C. Huub; Van Der Steeg, Jan Willem; Roovers, Jan-Paul W. R.

    Introduction and hypothesis We aimed to develop a prediction rule to predict the individual risk to develop stress urinary incontinence (SUI) after hysterectomy. Methods Prospective observational study with 3-year follow-up among women who underwent abdominal or vaginal hysterectomy for benign

  2. The effect of hysterectomy on ano-rectal physiology.

    LENUS (Irish Health Repository)

    Kelly, J L

    2012-02-03

    Hysterectomy is associated with severe constipation in a subgroup of patients, and an adverse effect on colonic motility has been described in the literature. The onset of irritable bowel syndrome and urinary bladder dysfunction has also been reported after hysterectomy. In this prospective study, we investigated the effect of simple hysterectomy on ano-rectal physiology and bowel function. Thirty consecutive patients were assessed before and 16 weeks after operation. An abdominal hysterectomy was performed in 16 patients, and a vaginal procedure was performed in 14. The parameters measured included the mean resting, and maximal forced voluntary contraction anal pressures, the recto-anal inhibitory reflex, and rectal sensation to distension. In 8 patients, the terminal motor latency of the pudendal nerve was assessed bilaterally. Pre-operatively, 8 patients were constipated. This improved following hysterectomy in 4, worsened in 2, and was unchanged in 2. Symptomatology did not correlate with changes in manometry. Although, the mean resting pressure was reduced after hysterectomy (57 mmHg-53 mmHg, P = 0.0541), the maximal forced voluntary contraction pressure was significantly decreased (115 mmHg-105 mmHg, P = 0.029). This effect was more pronounced in those with five or more previous vaginal deliveries (P = 0.0244, n = 9). There was no significant change in the number of patients with an intact ano-rectal inhibitory reflex after hysterectomy. There was no change in rectal sensation to distension, and the right and left pudendal nerve terminal motor latencies were unaltered at follow-up. Our results demonstrate that hysterectomy causes a decrease in the maximal forced voluntary contraction and pressure, and this appears to be due to a large decrease in a small group of patients with previous multiple vaginal deliveries.

  3. Histopathological Analysis of 422 Nononcological Hysterectomies in a University Hospital

    Directory of Open Access Journals (Sweden)

    Seda Ates

    2016-04-01

    Full Text Available Aim: The aim of the study was to evaluate the surgical indications, routes of surgery and the correlation between preoperative diagnosis and histopathological examination of hysterectomy specimens. Material and Method: Medical records and histopathological findings were reviewed and analyzed retrospectively, in 422 consecutive women who underwent hysterectomy over a two-year period from 2011 to 2014. Those with confirmed malignancy before operation were excluded. Cohen kappa statistics were used to measure agreement between preoperative clinical and postoperative histopathological diagnosis which was found to be fair with %u043A value being 0.4. Results: The mean age of our patients was 51.5 ± 8 years. The abdominal route was used in 378 cases (85.5%, the vaginal route in 55 patients (12.4% and the laparoscopic-assisted vaginal hysterectomy in 9 cases (2%. Abnormal uterine bleeding (28.9 % was the most common indication for hysterectomy. The histopathology of the endometrium prior to hysterectomy was reported in 75% of the cases and the most common finding was a secretory or proliferative endometrium. Leiomyomatous uterus was the most frequently encountered pathology (43.7% followed by coexistence of leiomyoma and adenomyosis (17.4% in hysterectomy specimens. Hysterectomy specimens may be unremarkable histopathologically, most of which are vaginal hysterectomies done for uterine prolapsed (kappa=0,407. Discussion: The correlation between the preoperative clinical and the pathological diagnosis were poor in cases with abdominal pain, abnormal uterine bleeding and fibroids. But there was a high correlation in cases with adnexial mass.

  4. The Impact of Sacrospinous Hysteropexy and Vaginal Hysterectomy With Suspension of the Uterosacral Ligaments on Sexual Function in Women With Uterine Prolapse: A Secondary Analysis of a Randomized Comparative Study

    NARCIS (Netherlands)

    Detollenaere, R.J.; Kreuwel, I.A.M.; Dijkstra, J.R.; Kluivers, K.B.; Eijndhoven, H.W.F. van

    2016-01-01

    INTRODUCTION: Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic. AIMS: The aim of this secondary analysis

  5. The Impact of Sacrospinous Hysteropexy and Vaginal Hysterectomy With Suspension of the Uterosacral Ligaments on Sexual Function in Women With Uterine Prolapse : A Secondary Analysis of a Randomized Comparative Study

    NARCIS (Netherlands)

    Detollenaere, Renee J.; Kreuwel, Ilse A. M.; Dijkstra, Jeroen R.; Kluivers, Kirsten B.; van Eijndhoven, Hugo W. F.

    Introduction: Studies on pelvic organ prolapse (POP) surgery show conflicting evidence regarding the impact of uterus preservation and hysterectomy on sexual function and no large randomized trials with long-term follow-up have been published on this topic. Aims: The aim of this secondary analysis

  6. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies Udgivelsesdato: 2008/3...

  7. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  8. [Laparoscopic hysterectomy and training].

    Science.gov (United States)

    Tomov, S; Gorchev, G

    2012-01-01

    Mastering and perception of laparoscopic hysterectomy by gynecologists is a slow process because of the learners' insufficient experience and inadequate training, lack of hospital equipment and the low levels of reimbursement. Analysing science literature data and their own 7-year experience (2004-2011), the authors suggest a training program for laparoscopic gynecological surgery. The process of education for laparoscopic hysterectomy implementation has to be performed at highly specialized centers by highly qualified specialists in accordance with strict principles and strict sequence. After mastering all the laparoscopic approaches to hysterectomy, laparoscopic hysterectomy has to be a method of choice among the methods used by the contemporary gynecologic surgeon.

  9. Vaginal vault prolapse.

    Science.gov (United States)

    Uzoma, Azubuike; Farag, K A

    2009-01-01

    Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life. Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward

  10. Hysterectomy—Current Methods and Alternatives for Benign Indications

    Directory of Open Access Journals (Sweden)

    Michail S. Papadopoulos

    2010-01-01

    Full Text Available Hysterectomy is the commonest gynecologic operation performed not only for malignant disease but also for many benign conditions such as fibroids, endometrial hyperplasia, adenomyosis, uterine prolapse, dysfunctional uterine bleeding, and cervical intraepithelial neoplasia. There are many approaches to hysterectomy for benign disease: abdominal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy (LAVH where a vaginal hysterectomy is assisted by laparoscopic procedures that do not include uterine artery ligation, total laparoscopic hysterectomy (TLH where the laparoscopic procedures include uterine artery ligation, and subtotal laparoscopic hysterectomy (STLH where there is no vaginal component and the uterine body is removed using a morcelator. In the last decades, many new techniques, alternative to hysterectomy with conservation of the uterus have been developed. They use modern technologies and their results are promising and in many cases comparable with hysterectomy. This paper is a review of all the existing hysterectomy techniques and the alternative methods for benign indications.

  11. Optimization strategies for colpotomizer technology during total laparoscopic hysterectomy.

    Science.gov (United States)

    Jackson, Tiffany; Advincula, Arnold P

    2012-12-01

    As technology has evolved, so has the ability to perform a hysterectomy in a minimallly invasive fashion. Currently, total laparoscopic hysterectomy has been further advanced with the advent of uterine manipulation devices that incorporate the use of a cupped colpotomizer. Unfortunately, many gynecologic surgeons lack the understanding of how to fully utilize such a surgical guide to facilitate development of the vesico-uterine reflection, skeletonize uterine vasculature, gain entry into the vagina, and subsequently close the vaginal cuff. Safe completion of these steps has the potential to minimize complications such as ureteral and bladder injury in addition to vaginal cuff dehiscence. The following technical review will address methods for the safe and effective use of various cupped colpotomizer devices during total laparoscopic hysterectomy.

  12. Ectopic pregnancy 6 years after subtotal hysterectomy: A case report.

    Science.gov (United States)

    Sobczyk, O; Levy-Zauberman, Y; Houllier, M; Fernandez, H

    2017-11-29

    Only 57 cases of ectopic pregnancy after hysterectomy have been published. A 34-year-old patient with a history of subtotal hysterectomy for postpartum hemorrhage consulted for acute abdominal pain. The diagnosis of ectopic pregnancy was made using blood pregnancy test and transvaginal ultrasound. Emergency laparoscopy was performed. Urine pregnancy test should be performed in case of unexplained haemoperitoneum in patient of childbearing age with a history of hysterectomy. Fistulous tracts between the patent cervix or the vaginal cuff and the peritoneal cavity may allow fecundation. TEACHING POINTS: (1) Ectopic pregnancy remains a differential diagnosis of abdominal pain and haemoperitoneum in patient of childbearing age even after hysterectomy. (2) Fistulous tract between the residual cervix and the peritoneal cavity or tubes may allow fecundation. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. emergency peripartum hysterectomy

    African Journals Online (AJOL)

    2001-02-02

    Feb 2, 2001 ... patients both had hysterectomy because of fulminant sepsis. One of a 26 year old para 2 who delivered at home, and subsequently presented to hospital with puerperal sepsis. Hysterectomy was done on third day after delivery for progressive deterioration in condition. She tested positive to HIV antibodies.

  14. Psychological functioning after hysterectomy.

    NARCIS (Netherlands)

    Wijma, Klaas

    1984-01-01

    During the past lew years a number of publications regarding the negative effects of hysterectomy have been published in the professional literature as well as in the lay press. This dissertation is a report of a study on the psychological functioning of women after hysterectomy, performed because

  15. Vaginal cysts

    Science.gov (United States)

    ... of tissue. It can be filled with air, fluid, pus, or other material. A vaginal cyst occurs on or under the vaginal lining. ... There are several types of vaginal cysts. Vaginal inclusion cysts ... may collect fluid and develop into a vaginal wall cyst later ...

  16. Routes of hysterectomy in women with benign uterine disease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis.

    Science.gov (United States)

    Chen, Innie; Lisonkova, Sarka; Allaire, Catherine; Williams, Christina; Yong, Paul; Joseph, K S

    2014-10-01

    Minimally invasive hysterectomies performed vaginally or laparoscopically are associated with decreased perioperative morbidity. We examined temporal trends and patient and hospital factors associated with the routes of hysterectomy used in the Vancouver Coastal Health and Providence Health Care regions in British Columbia. We performed a retrospective cohort study of all women who had an elective hysterectomy for a benign indication between 2007 and 2011 in 8 hospitals in the region. Logistic regression modeling with mixed effects was used to estimate adjusted odds ratios and 95% confidence intervals for patient and hospital characteristics associated with the route of hysterectomy. The study involved 4372 women who underwent abdominal (52.3%), vaginal (25.5%) or laparoscopic (22.3%) hysterectomy. From 2007 to 2011, the number of abdominal hysterectomies performed decreased from 58.4% to 47.7%, the number of vaginal hysterectomies performed decreased from 27.5% to 21.1% and the number of laparoscopic hysterectomies performed increased from 14.2% to 31.2% (p Vancouver Coastal Health and Providence Health Care regions. Vaginal hysterectomies are associated with patient characteristics, whereas laparoscopic hysterectomies are associated with patient and hospital characteristics.

  17. A comparison of quality outcome measures in patients having a hysterectomy for benign disease: robotic vs. non-robotic approaches.

    Science.gov (United States)

    Martino, Martin A; Berger, Elizabeth A; McFetridge, Jeffrey T; Shubella, Jocelyn; Gosciniak, Gabrielle; Wejkszner, Taylor; Kainz, Gregory F; Patriarco, Jeremy; Thomas, M Bijoy; Boulay, Richard

    2014-01-01

    To measure procedure-related hospital readmissions within 30 days after discharge for patients who have a hysterectomy for benign disease. Secondary outcome quality measures evaluated were cost, estimated blood loss, length of stay and sum of costs associated with readmissions. Retrospective cohort study (Canadian Task Force classification II-2). Academic community hospital. Patients who underwent hysterectomy to treat benign disease from January 2008 to December 2012. Patients were grouped according to route of hysterectomy: robotic-assisted laparoscopic hysterectomy (robotic), laparoscopic hysterectomy (laparoscopic), abdominal hysterectomy (open via laparotomy), and vaginal hysterectomy (vaginal). Inclusion criteria were met by 2554 patients: 601 in the robotic group, 427 in the laparoscopic group, 1194 in the abdominal group, and 332 in the vaginal group. Readmission rates in the robotic cohort were significantly less (probotic cohorts: Robotic (1%), laparoscopic (2.5%), open (3.5%), vaginal (2.4%). Estimated blood loss, length of stay, and sum of readmission costs were also significantly less in the robotic cohort (probotic-assisted laparoscopic hysterectomy have a significantly lower chance of readmission robotics cohort also experienced a shorter length of stay, less estimated blood loss, and a cost savings associated with readmissions when compared to non-robotic approaches. Prospective registries describing quality outcomes, total sum of costs including 30 days follow-up, as well as patient-related quality of life benefits are recommended to confirm these findings and determine which surgical route offers the highest patient and societal value. Copyright © 2014. Published by Elsevier Inc.

  18. Vaginal Atrophy

    Science.gov (United States)

    ... urinary signs and symptoms: Vaginal dryness Vaginal burning Vaginal discharge Genital itching Burning with urination Urgency with urination More urinary tract infections Urinary incontinence Light bleeding after intercourse Discomfort with ...

  19. Sexuality after hysterectomy.

    Science.gov (United States)

    Katz, Anne

    2002-01-01

    To review the literature regarding sexuality after hysterectomy and identify areas for future research. Articles published between 1970 and 2000 on sexuality and hysterectomy were located using MEDLINE, CINAHL, Psychlit, and Sociofile databases. English language research dealing with the topic was reviewed. Study findings were categorized and include studies of the effect of hysterectomy on sexuality, women's perspectives on hysterectomy, and information sharing with women prior to surgery. A number of studies have explored sexuality after hysterectomy. Many of these studies have methodologic flaws, including vague measures of sexual satisfaction and potential for recall bias. A major source of bias is that the first measure of sexual satisfaction/functioning was performed in the immediate preoperative period when symptoms are more likely to affect sexual functioning. There are a number of gaps in the knowledge base pertaining to this topic. Future research in this area is needed to provide direction for nurses in the clinical area. Topics for future research include what women and their partners want to know about sexuality following hysterectomy and the most efficient methods to provide them with this information. In addition, sexuality in premorbid women needs to be more fully described.

  20. Long-term outcomes following laparoscopic supracervical hysterectomy.

    Science.gov (United States)

    Lieng, M; Qvigstad, E; Istre, O; Langebrekke, A; Ballard, K

    2008-12-01

    Evaluation of long-term outcomes following laparoscopic supracervical hysterectomy (LSH). Retrospective postal questionnaire. Norwegian university teaching hospital. A total of 315 consecutive patients. A questionnaire sent to all patients who underwent a LSH during 2004 and 2005. Persistent vaginal bleeding and pelvic pain, patient acceptability of such symptoms and patient satisfaction following LSH. A total of 240 women (78%) completed the questionnaire. About 24% reported experiencing vaginal bleeding up to 3 years following their hysterectomy, although this was rated as minimal in 90% of cases, resulting in a mean bothersome score of 1.1 (SD 2.0) on a 10-point visual analogue scale (VAS). Women operated on by less experienced surgeons were more likely to report vaginal bleeding following surgery (P = 0.02). About 74% of women reported having menstrual pain prior to surgery, with a mean score of 6.8 (SD 2.1) (10-point VAS). Up to 3 years following surgery, 38% continued to experience menstrual pain, although this was significantly less intense with a mean score of 3.5 (SD 2.2) (P < 0.01). While all women reported a decrease in the amount of pain experienced following the hysterectomy, those having a hysterectomy because of endometriosis reported significantly higher levels of menstrual/cyclical pain after surgery compared with women who had a hysterectomy for other reasons (P < 0.01). Ninety per cent of women reported being satisfied with their surgery. Although vaginal bleeding and pelvic pain are frequently observed following LSH, these symptoms are significantly reduced and patient satisfaction is high.

  1. Vaginal Approaches Using Synthetic Mesh to Treat Pelvic Organ Prolapse

    OpenAIRE

    Moon, Jei Won; Chae, Hee Dong

    2016-01-01

    Pelvic organ prolapse (POP) is a very common condition in elderly women. In women with POP, a sacrocolpopexy or a vaginal hysterectomy with anterior and posterior colporrhaphy has long been considered as the gold standard of treatment. However, in recent decades, the tendency to use a vaginal approach with mesh for POP surgery has been increasing. A vaginal approach using mesh has many advantages, such as its being less invasive than an abdominal approach and easier to do than a laparoscopic ...

  2. Laparoscopic radical hysterectomy with lymphadenectomy: our experience

    Directory of Open Access Journals (Sweden)

    Leon Meglič

    2016-11-01

    Full Text Available BackgroundThe second most common cancer in women up to 65 years of age is cervical cancer. Same cancer is the leading cause of death from gynaecological deseases worldwide.The standard procedure for cervical cancer treatment with FIGO stage including  IB2 is radical hysterectomy sec. Wertheim-Meigs-Novak with or without adnexa with radical pelvic lymphadenectomy and/or para-aortic lymphadenectomy. In the last two decades has with the development of laparoscopy also developed  laparoscopic radical hysterectomy .Laparoscopic radical hysterectomy with pelvic and para-aortic lymph nodes dissection was performed for the first time by Nezhat with coworkers in 1989.Laparoscopic radical hysterectomy with pelvic and/or paraaortic lymphnode dissection in treatement of cervical cancer including FIGO stage IB1 is performed at Dep Ob/Gyn UKC Ljubljana since 2013. The purpose of this article is to evaluate the morbidity and safety of the procedure. MethodsWe retrospectively reviewed the medical records of patients with cervical cancer who underwent laparoscopic radical histerectomy with pelvic and/or paraaortic lymphadenectomy from April 2013 to May 2016. Results34 patient were included, 32 patients with CC FIGO stage IB1, 1 patient with CC FIGO stage IB2, 1 patient with CC FIGO stage IIB.There were four (11,8% bladder lesions, all of them were corrected during the surgery, but no ureteral lesion! There was one (2,9% surgical revision right after the surgery due to assumption of bleeding (though there was no active bleeding found.Three patients (8,8% had permanent urinary dysfunction – retention. One patient (2,9% had dehiscence of vaginal vault after 4 months (after sexual intercourseThere was no ureterovaginal/vesicovaginl fistula after surgery! The mean operating time was 2 hours 55 min, mean admission time after surgery was 8,7 days, mean blood loss during operation was 291 ml. ConclusionsLaparoscopic radical hysterectomy is the method of choice in

  3. Postcoital Transvaginal Evisceration After Hysterectomy: a Case Report

    Directory of Open Access Journals (Sweden)

    A.Oğuz Hasdemir

    2012-01-01

    Full Text Available Transvaginal evisceration is mostly seen at postmenopausal period in a case who had vaginal operation and at premenopausal period it ensues postcoitally after hysterectomy. A 47 year old patient presented to emergency department with a complaint of intestinal herniation through vagina after coitus that had total abdominal histerectomy two months ago. The patient was emergently operated. Her vaginal cuff was sutured transvaginally then laparoscopic irrigation and suction were performed. Although transvaginal cuff repair is sufficient laparoscopic irrigation and suction are thought to be relevant for the management of transvaginal evisceration to prevent peritonitis.

  4. A randomised controlled trial comparing abdominal and vaginal prolapse surgery: effects on urogenital function

    NARCIS (Netherlands)

    Roovers, Jan-Paul W. R.; van der Vaart, C. Huub; van der Bom, Johanna G.; van Leeuwen, Jules H. Schagen; Scholten, Piet C.; Heintz, A. Peter M.

    2004-01-01

    OBJECTIVE: To compare the effects of vaginal hysterectomy (combined with anterior and/or posterior colporraphy) and abdominal sacro-colpopexy (with preservation of the uterus) on urogenital function. DESIGN: Randomised trial. SETTING: Three teaching hospitals in The Netherlands. POPULATION:

  5. Robotic-assisted laparoscopic hysterectomy versus conventional laparoscopic hysterectomy for benign gynaecological disease

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Rudnicki, Martin; Gimbel, Helga

    -analysis was conducted and the quality of evidence was rated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Evidence of low quality showed no differences in the critical outcomes: reoperation, lesion of adjacent structures and vaginal cuff dehiscence...... conventional laparoscopic hysterectomy (LH). Aims: The purpose was to evaluate available evidence on RALH versus LH and to advise surgeons and decision makers in the Danish healthcare system. Methods: A search specialist conducted a systematic literature search. Results were restricted to clinical guidelines...

  6. Emergency peripartum hysterectomy

    DEFF Research Database (Denmark)

    Jakobsson, Maija; Tapper, Anna Maija; Colmorn, Lotte Berdiin

    2015-01-01

    .7%), uterine rupture (n = 31, 14.7%), other bleeding disorders (n = 12, 5.7%), and other indications (n = 8, 3.8%). The delivery mode was cesarean section in nearly 80% of cases. Previous cesarean section was reported in 45% of women. Both preterm and post-term birth increased the risk for emergency peripartum...... 7 days of delivery from medical birth registers and hospital discharge registers. Control populations consisted of all other women delivering on the same units during the same time period. MAIN OUTCOME MEASURES: Emergency peripartum hysterectomy rate. RESULTS: The total number of emergency...... peripartum hysterectomies reached 211, yielding an incidence rate of 3.5/10 000 (95% confidence interval 3.0-4.0) births. Finland had the highest prevalence (5.1) and Norway the lowest (2.9). Primary indications included an abnormally invasive placenta (n = 91, 43.1%), atonic bleeding (n = 69, 32...

  7. Treatment with a gonadotrophin releasing hormone agonist before hysterectomy for leiomyomas: results of a multicentre, randomised controlled trial.

    Science.gov (United States)

    Vercellini, P; Crosignani, P G; Mangioni, C; Imparato, E; Ferrari, A; De Giorgi, O

    1998-11-01

    To ascertain whether uterine shrinkage induced by a gonadotrophin releasing hormone agonist before hysterectomy for fibroids increases the possibility of a vaginal procedure. A multicentre, prospective, randomised, controlled study. One hundred and twenty-seven premenopausal women with a uterine volume of 12 to 16 gestational weeks. Twelve weeks of triptorelin depot treatment before hysterectomy or immediate surgery. Number of vaginal and abdominal hysterectomies, operating time, blood loss, degree of difficulty of the procedure, perioperative serum haemoglobin and haematocrit levels, hospital stay, and patients' overall satisfaction with treatment. After randomisation, four women withdrew from the study, leaving 60 women in the triptorelin arm and 63 in the immediate surgery arm. At baseline evaluation a vaginal hysterectomy was indicated in seven women allocated to pre-operative medical therapy (12%), and in 10 of those allocated to immediate surgery (16%). Clinical assessment after the 12-week GnRH agonist course showed that abdominal hysterectomy was no longer indicated in 25/53 women (47%) as a vaginal procedure appeared appropriate. Thus the overall rate of indication for a vaginal procedure in the pre-operative medical treatment arm was 32/60 cases (53%), with a between-group difference of 37% (95% CI, 26% to 51%; chi2(1) = 19.18, P fibroids and uterine volume of 12 to 16 gestational weeks.

  8. [Medico-legal aspects of hysterectomy].

    Science.gov (United States)

    Jakovljević, Branislava; Segedi, Dimitrije; Mujović-Zornić, Hajrija

    2007-01-01

    Understanding the lawful implementations of surgical procedures, such as hysterectomy, raises practical questions concerning legal relations between a doctor and his patient, and consequences of this relationship, which may be legally relevant. The modern legal theory and practice consider doctors and patients to be partners. Medical practitioners performing surgical procedures are obliged to obtain informed consent. They are also required to inform their patients about indications, course of the operative procedure, postoperative treatment, possible complications during and after the procedure, and quality of life after the operation. Informed conversation should take into account the age, mental status and patient's intellectual abilities. Legal consequences ofsurgical procedures Malpractice litigation mostly concers medical error and negligence. Medical errors should not be confused with ineffective outcome, or complicated postoperative course. Even if the surgical procedure was followed correctly and uneventful outcome took place, there might be some problems. A patient has a right to receive complete information from a physician about the specific nature of a proposed treatment. A physician has an obligation to elucidate and justify, treatment he proposes. Certain codification of all operative procedures may facilitate this task. Codification instructions about procedures, in this case hysterectomy, must include indications for a certain type of hysterectomy (subtotal, total, radical), as well as for the operative technique (abdominal, vaginal, laparoscopic). Patient information brochures should be available in print, and include information about indications and potential risks associated with the proposed surgical procedure. In this way, it is possible to prevent the inconveniences which may arise from insufficient knowledge and information about surgical procedures.

  9. Histopathological Study of Uterine and Cervical Lesions in Hysterectomy Specimens.

    Directory of Open Access Journals (Sweden)

    Dr.Varsha Dhuliya

    2016-12-01

    Full Text Available Background: The adult nulliparous uterus is a hollow, pear shaped organ that weights 40-80 grams. It is divided into the Cervix and Corpus. The uterus being a vital reproductive and hormone-responsive organ, is subjected to a variety of physiological changes and benign and malignant disorders. Hysterectomy is the most common major gynecological procedure in the world. It can be done through either abdominal or vaginal route. Aims and objectives: The present study was aimed at detailed histopathological evaluation of all lesion of hysterectomy specimen Material and methods: This was a retrospective study of the gross and histopathological findings of uterus and cervix in 150 hysterectomy specimens received in the pathology department, B. J. Medical college, Ahmedabad during the period from July to December 2015.The hysterectomy specimens received were fixed in 10% formalin for 24 hours, were examined grossly and necessary sections were obtained. The tissue pieces were then processed in automated tissue processor , well labeled paraffin blocks were made. Sections were cut with the help of microtome and were stained routinely by Hematoxylin & Eosin stain and special stains wherever necessary. Sections were examined with the help of light microscopy. Results: Peak age group of hysterectomy was 41-50 years. Most common pathology found was uterine leiomyomas in 55 cases and next to it was adenomyosis. In cervix most common finding was chronic cervicitis in 116 cases. Conclusion: Most common benign lesion in uterus is leiomyoma followed by adenomyosis and in cervix it is chronic cervicitis in hysterectomy specimens received in our department.

  10. Health resource utilization and costs during the first 90 days following robot-assisted hysterectomy.

    Science.gov (United States)

    Dandolu, Vani; Pathak, Prathamesh

    2017-08-07

    To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90 days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5 years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90 days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health

  11. Systematic implementation of laparoscopic hysterectomy independent of uterus size: clinical effect.

    Science.gov (United States)

    Uccella, Stefano; Cromi, Antonella; Bogani, Giorgio; Casarin, Jvan; Formenti, Giorgio; Ghezzi, Fabio

    2013-01-01

    To investigate the effect of uterine weight on the mode of hysterectomy and on perioperative outcomes and to explore how the increasing experience in endoscopic techniques influenced our choice of surgical approach to hysterectomy to treat benign conditions. Retrospective analysis (Canadian Task Force classification II-2). University-based department of obstetrics and gynecology. A series of 1518 consecutive women with benign uterine conditions other than pelvic organ prolapse who underwent hysterectomy at our department between January 2000 and December 2011. Gradual implementation of the laparoscopic approach over years, with the goal of attempting endoscopic hysterectomy whenever possible and irrespective of uterine weight. Comparisons were made on the basis of various approaches to hysterectomy including vaginal hysterectomy (VH), abdominal hysterectomy (AH), and total laparoscopic hysterectomy (TLH) and on uterine weight. Hysterectomies performed included 568 VH (37.4%), 234 AH (15.4%), and 716 TLH (47.2%). Postoperative complications were lower in the TLH group vs the AH group; no significant difference was observed between the VH vs TLH groups or the AH vs VH groups. A marked reduction in the need for open surgery was noted between 2000 and 2011 (p for trend approach was via laparoscopy, with a success rate of 95.6% (n = 43). A marked tendency toward reduction in the use of open surgery was observed through the years when uterine weight was ≥1 kg (p for trend laparoscopic hysterectomy enables a marked reduction in the need for AH. In experienced hands, even very large uteri (≥1 kg) can be safely removed via laparoscopy. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  12. Vaginal cuff dehiscence resulting in small-bowel evisceration. A case report.

    Science.gov (United States)

    Percalli, Luigi; Pricolo, Renato; Passalia, Luigi; Croce, Paolo; Ricco', Matteo; Berretta, Roberto; Marchesi, Federico

    2016-09-13

    Vaginal cuff dehiscence is a rare complication of hysterectomies which seems to be more frequent after surgery with laparoscopic suture of the cuff. We present a clinical case of evisceration of the small bowel emerging from vaginal cuff dehiscence, successfully repaired by positioning a low profile polypropylene ePTFE mesh*.

  13. Vaginal Cancer

    Science.gov (United States)

    Vaginal cancer is a rare type of cancer. It is more common in women 60 and older. You are also more likely to get it if you have had a human ... test can find abnormal cells that may be cancer. Vaginal cancer can often be cured in its ...

  14. Sexuality after total vs. subtotal hysterectomy

    DEFF Research Database (Denmark)

    Zobbe, Vibeke Bahn; Gimbel, Helga Margrethe Elisabeth; Andersen, Birthe Margrethe

    2004-01-01

    The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.......The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies....

  15. Factors influencing the incidence and remission of urinary incontinence after hysterectomy.

    Science.gov (United States)

    Bohlin, Katja Stenström; Ankardal, Maud; Lindkvist, Håkan; Milsom, Ian

    2017-01-01

    Studies on the influence of body mass index, smoking, and mode of delivery on the occurrence of urinary incontinence after hysterectomy are required to provide women with information about how these factors influence continence after a hysterectomy. The aim was to assess the impact of lifestyle factors such as body mass index, smoking, and delivery mode (vaginal/cesarean) on the incidence and remission of urinary incontinence after hysterectomy. This was a cohort study based on pre-, per-, and postoperative (1 year) data retrieved from the Swedish National Register for Gynecological Surgery on 16,182 hysterectomies performed because of a benign indication between 2006 and 2013. Multivariable logistic regression analyses were used to identify independent risk factors for de novo urinary incontinence and postoperative remission of urinary incontinence, presented as adjusted odds ratios with 95% confidence intervals. De novo urinary incontinence was reported by 8.5%, remission of urinary incontinence by 13.3%, and residual urinary incontinence by 16.1% after the hysterectomy. A body mass index ≥30 kg/m(2) (odds ratio, 1.63, 95% confidence interval, 1.37-1.94), having undergone a vaginal delivery (odds ratio, 1.40, 95% confidence interval, 1.14-1.86), the presence of daily urge without incontinence prior to surgery (odds ratio, 1.77, 95% confidence interval, 1.47-2.13), and a uterine weight incontinence. A uterine weight >300 g (odds ratio, 1.98, 95% confidence interval, 1.69-2.33), body mass index incontinence preoperatively (odds ratio, 1.51, 95% confidence interval, 1.29-1.76) were associated with an increased remission of urinary incontinence. Vaginal compared with abdominal hysterectomy was associated with a decreased remission of urinary incontinence (odds ratio, 0.70, 95% confidence interval, 0.57-0.87). There was no effect of age or smoking or a difference between total and subtotal hysterectomy with regard to de novo urinary incontinence or remission of

  16. Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, L L; Zobbe, V; Ottesen, B

    2015-01-01

    (11%) in the SAH group still experienced vaginal bleeding. No other differences were found between the two types of abdominal hysterectomy. AUTHORS' CONCLUSIONS: A smaller proportion of women suffered from UI after TAH than after SAH 5 years postoperatively. Around one in ten women continued......-centre trial performed in 11 departments of gynaecology. POPULATION: Women referred with benign uterine diseases scheduled for abdominal hysterectomy. METHODS: Women were randomised to either SAH (n = 161) or TAH (n = 158). Follow-up data were collected from participants using postal questionnaires sent out 5...... MEASURES: The primary outcome was UI. Secondary outcomes included constipation, prolapse of the vaginal vault or cervical stump, satisfaction with sexual life, pelvic pain, postoperative complications and vaginal bleeding. RESULTS: The response rate was 234/319 (73.4%). A significantly higher proportion...

  17. Changes in incontinence after hysterectomy

    DEFF Research Database (Denmark)

    Kruse, Anne Raabjerg; Jensen, Trine Dalsgaard; Lauszus, Finn Friis

    2017-01-01

    Purpose: Information about the perioperative incontinence following hysterectomy is limited. To advance the postoperative rehabilitation further we need more information about qualitative changes in incontinence, fatigue and physical function of patients undergoing hysterectomy. Methods: 108...... patients undergoing planned hysterectomy were compared pre- and postoperatively. In a sub-study of the prospective follow-up study the changes in incontinence, postoperative fatigue, quality of life, physical function, and body composition were evaluated preoperatively, 13 and 30 days postoperatively...... incontinence correlated with BMI (r = 0.25, p age (r = 0.24, p age (r = 0.20, p

  18. Emergency obstetric hysterectomy for life-threatening postpartum hemorrhage: A 12-year review.

    Science.gov (United States)

    Zhang, Yulong; Yan, Jianying; Han, Qing; Yang, Tingting; Cai, Lihong; Fu, Yuelin; Cai, Xiaolu; Guo, Meimei

    2017-11-01

    The aim of the study was to review the operative experiences of emergency hysterectomy for life-threatening postpartum hemorrhage (PPH) performed over a 12-year period at Fujian Provincial Maternity and Children's Hospital; to examine the incidence and risk factors for emergency obstetric hysterectomy; and to evaluate the curative effectiveness and safety of subtotal hysterectomy for life-threatening PPH.The records of all cases of emergency obstetric hysterectomy performed at Fujian Maternity and Children Health Hospital between January 2004 and June 2016 were analyzed. The incidence, risk factors, and outcomes of hysterectomy, the peripartum complications, and the coagulation function indices were evaluated.A total of 152,023 of women were delivered. The incidence of emergency postpartum hysterectomy was 0.63 per 1000 deliveries: 96 patients underwent hysterectomy for uncontrolled PPH, 19 (0.207‰) underwent hysterectomy following vaginal delivery, and 77 (1.28‰) underwent the procedure following cesarean delivery (P postpartum prothrombin activity ≤ 50% (61.5%), placenta accreta (43.76%), uterine atony (37.5%), uterine rupture (17.5%), and grand multiparity > 6 (32.3%). Forty-one patients underwent subtotal abdominal hysterectomy (STH) and 55 patients underwent total abdominal hysterectomy (TH). The mean operation time was significantly shorter for TH (193.59 ± 83.41 minutes) than for STH (142.86 ± 78.32 minutes; P = .002). The mean blood loss was significantly greater for TH (6832 ± 787 mL) than for STH (6329 ± 893 mL; P = .003). The mean number of red cell units transfusion was higher during TH (16.24 ± 9.48 units vs 12.43 ± 7.2, respectively; P = .047). Postoperative prothrombin activity was significantly higher than preoperative levels (56.84 ± 14.74 vs 44.39 ± 15.69, respectively; P postpartum prothrombin activity < 50% was the greatest risk factor for hysterectomy in most women who

  19. Vaginal evisceration

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Y.C.; Lindenauer, S.M. (Michigan Univ., Ann Arbor (USA) Dept. of Obstetrics and Gynaecology)

    1981-08-01

    A patient with vaginal evisceration due to prior radiation treatment of cervical carcinoma is presented, together with a review to reported cases. The salient features, predisposing causes and management of this unusual problem are discussed.

  20. Vaginal cancer

    Science.gov (United States)

    Hacker NF. Vulvar and vaginal cancer. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker and Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 40. Jhingran ...

  1. Metronidazole Vaginal

    Science.gov (United States)

    Metronidazole is used to treat vaginal infections such as bacterial vaginosis (an infection caused from too much of certain bacteria in the vagina). Metronidazole is in a class of medications called nitroimidazole ...

  2. Vaginal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lesavoy, M.A.

    1985-05-01

    Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split-thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent provides comfort to the patient and ease to the surgeon in maintaining approximation of the skin graft. For large vaginal and perineal defects, myocutaneous flaps such as the gracilis island have been extremely useful for correction of radiation-damaged tissue of the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensue because the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of 3 to 6 months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients.

  3. Preoperative teaching and hysterectomy outcomes.

    Science.gov (United States)

    Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia; Ryan, Marian; Gale, Nancy; Parker, Carla

    2003-06-01

    This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

  4. Length of Catheter Use After Hysterectomy as a Risk Factor for Urinary Tract Infection.

    Science.gov (United States)

    Karp, Natalie E; Kobernik, Emily K; Kamdar, Neil S; Fore, Amanda M; Morgan, Daniel M

    2017-09-13

    The aims of this study were to determine the effect of length of postoperative catheterization on risk of urinary tract infection (UTI) and to identify risk factors for postoperative UTI. This was a retrospective case-control study. Demographic and perioperative data, including duration of indwelling catheter use and postoperative occurrence of UTI within 30 days of surgery, were analyzed for hysterectomies using the Michigan Surgical Quality Collaborative database. Catheter exposure was categorized as low-no catheter placed/catheter removed the day of surgery, intermediate-catheter removed postoperative day 1, high-catheter removal on postoperative day 2 or later, or highest-patient discharged home with catheter. A multivariable logistic regression model was developed to identify factors associated with UTI. An interaction term was included in the final model. Overall, UTI prevalence was 2.3% and increased with duration of catheter exposure (low: 1.3% vs intermediate: 2.1% vs high: 4.1% vs highest: 6.5%, P < 0.0001). High (odds ratio [OR] = 2.54 [1.51-4.27]) and highest (OR = 3.39 [1.86-6.17]) catheter exposure, operative time (OR = 1.15 [1.03-1.29]), and dependent functional status (OR = 4.62 [1.90-11.20]) were independently associated with UTI. Women who had a vaginal hysterectomy with sling/pelvic organ prolapse repair were more likely to have a UTI than those who had a vaginal hysterectomy alone (OR = 2.58 [1.10-6.07]) and more likely to have a UTI than women having an abdominal or laparoscopic hysterectomy with a sling/pelvic organ prolapse repair (OR = 2.13 [1.12-4.04]). Length of catheterization and operative time are modifiable risk factors for UTI after hysterectomy. An interaction between vaginal hysterectomy and concomitant pelvic reconstruction increases the odds of UTI.

  5. Clinical predictors and risk factors for vaginal mesh extrusion.

    Science.gov (United States)

    Khrucharoen, Usah; Ramart, Patkawat; Choi, Judy; Kang, Diana; Kim, Ja-Hong; Raz, Shlomo

    2017-11-24

    Our study aims to enhance the accuracy of the clinical diagnosis in patients with vaginal mesh extrusion following transvaginal mesh placement for pelvic organ prolapse using significant clinical parameters and risk factors. All patients who underwent vaginal mesh removal were retrospectively reviewed from January 2000 to May 2014. Eligible patients were divided into two groups according to the presence of vaginal mesh extrusion. A total of 862 patients, 798 were included. 357 (44.7%) had evidence of vaginal mesh extrusion, and 441 (55.3%) had no evidence of vaginal mesh extrusion. The mean age of the vaginal mesh extrusion group was slightly higher than in the group without vaginal mesh extrusion (58.7 ± 11.2 vs. 56.4 ± 11.5, respectively; p = 0.002). From multivariate analysis, the significant clinical correlations for vaginal mesh extrusion were vaginal bleeding [60 (16.9) vs. 14 (3.2%), p vaginal discharge [45 (12.6) vs. 18 (4.1%), p = 0.001]. The risk factors were multiple mesh implantations [218 (67.06) vs. 175 (39.68%), p vaginal atrophy, both local and systemic hormonal use, smoking status, and hysterectomy status, were not significantly different, as well as the clinical symptoms including dyspareunia, vaginal infection, and symptomatic vaginal bulge. Vaginal bleeding, hispareunia, and vaginal discharge were the most significant clinical predictors for raising suspicion of vaginal mesh extrusion. Multiple mesh implantations were a significant risk factor for extrusion.

  6. Invasive mole of the uterus: A description of two cases managed by hysterectomy

    Directory of Open Access Journals (Sweden)

    Ahmed Samy El-agwany

    2015-12-01

    Full Text Available Gestational trophoblastic disease (GTD is a term used for a group of pregnancy-related tumors. Gestational trophoblastic neoplasia (GTN, is recognized as the most curable gynecologic malignancy. However, many cases are resistant to first line chemotherapy. We present cases of invasive mole. They were diagnosed as a vesicular mole on ultrasonography and underwent suction and evacuation but vaginal bleeding recurred with plateau and rising B-hcg with intramyometrial vascular lesion. Hysterectomy was done that indicated invasive mole. Patients were cured of their symptoms. Surgical therapy (hysterectomy with chemotherapy has shown to achieve remission in these cases especially with resistance to chemotherapy and in perimenopause.

  7. Hysterectomy risk in premenopausal-aged military veterans: associations with sexual assault and gynecologic symptoms.

    Science.gov (United States)

    Ryan, Ginny L; Mengeling, Michelle A; Summers, Karen M; Booth, Brenda M; Torner, James C; Syrop, Craig H; Sadler, Anne G

    2016-03-01

    significantly lower (35 vs 43 years old, P gynecological pain, abnormal gynecological bleeding, and pelvic inflammatory disease seen in those veterans with a history of LSA-V. Premenopausal-aged veterans may be at higher overall risk for hysterectomy, and for hysterectomy at younger ages, than their civilian counterparts. Veterans who have experienced completed sexual assault with vaginal penetration in childhood or in military and those with a history of PTSD may be at particularly high risk for hysterectomy, potentially related to their higher risk of gynecological symptoms. If confirmed in future studies, these findings have important implications for women's health care providers and policy makers within both the VA and civilian health care systems related to primary and secondary prevention, costs, and the potential for increased chronic disease and mortality. Published by Elsevier Inc.

  8. Massive Hematometra due to Congenital Cervicovaginal Agenesis in an Adolescent Girl Treated by Hysterectomy: A Case Report

    Directory of Open Access Journals (Sweden)

    Turki Gasim

    2013-01-01

    Full Text Available A case of massive hematometra with a bicornuate uterus in a 14-year-old mentally handicapped girl complicated by vaginal agenesis and absent cervix is presented. She was managed by abdominal hysterectomy and right salpingo-oophorectomy that included the ovarian cystadenoma. The left ovary was conserved. This treatment was considered appropriate for this patient.

  9. Incidence of postpartum post-cesarean hysterectomy at the Institute of gynecology and obstetrics, Clinical center of Serbia, Belgrade

    Directory of Open Access Journals (Sweden)

    Sparić Radmila

    2007-01-01

    Full Text Available Introduction. Postpartum hysterectomy means hysterectomy at least 6 weeks after delivery or cesarean section. It is usually performed in life-threatening situations. Incidence of postpartum hysterectomy varies from 0.02% to 0.3% of total number of deliveries. Objective. The aim of this study was to show and compare the incidence of postpartum hysterectomy after the cesarean section at the Institute of Gynecology and Obstetrics, Clinical Center of Serbia. We compared two five-year periods: the first period 1987-1982 and the second 2000-2004. Method. The retrospective study analyzed all patients treated at the Institute of Gynecology and Obstetrics who had had hysterectomy until six weeks after vaginal delivery or cesarean section. We analyzed the number of deliveries and the number of postpartum hysterectomies. Results. There were 50,467 deliveries (3,542 cesarean sections and 91 postpartum hysterectomies (70 or 76.92% after cesarean section in the first period. In the second period, there were 34,035 deliveries (7,105 cesarean sections and 64 hysterectomies (39 or 60.94 % after cesarean section. The overall incidence of postpartum hysterectomy was 1.98/1,000 in the first and 1.88/1,000 deliveries in the second period. The incidence of post-cesarean hysterectomy decreased from 19.76/1,000 in the first period to 5.49/1,000 in the second period. Conclusion. It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality. .

  10. Variation in NHS utilisation of vault smear tests in women post-hysterectomy: A study, using routinely collected datasets

    Directory of Open Access Journals (Sweden)

    Wilson Sue

    2008-03-01

    Full Text Available Abstract Background 20% of women living in the UK have a hysterectomy during their lifetime, levels are higher in the USA, making it one of the most commonly performed major surgical procedures. Understanding of the indications for hysterectomy and of the rationale for follow-up of women post hysterectomy is currently limited. Guidelines concerning follow-up by means of vaginal vault cytology tests exist but these are not based on 'gold standard' evidence. Furthermore, the extent to which current practice reflects these guidelines is unclear. This study aims to determine the factors associated with variability in hysterectomy rates and subsequent follow-up after surgery by use of the vaginal vault smear cytology test. Methods/Design All women resident in the West Midlands region, of the United Kingdom, who had a hysterectomy operation between 1st April 2002 and 30th March 2003 will be identified from the Hospital Episodes Statistics database which also contains proxy data on deprivation status, derived from postcode and self declared ethnicity. These data will be linked to regional cervical screening records for each woman and histopathology laboratory records from the relevant hospitals. Study objectives are to describe: Indications for the hysterectomy operation, histology at hysterectomy, subsequent follow-up by use or non-use of vaginal vault cytology tests and variation between histological groups. Additionally the data will be categorised according to a woman's cytology screening history prior to surgery (i.e. always normal, borderline, resolved abnormalities, CIN etc and these different groups compared. Variations in these outcomes according to age, deprivation and ethnic group will also be examined. Analysis will be undertaken using SPSS. Discussion This study will clarify patterns of current practice in one large English region and determine whether this practice reflects existing guidelines. The study will also strengthen the evidence

  11. Peripartum hysterectomy: an evolving picture.

    LENUS (Irish Health Repository)

    Turner, Michael J

    2012-02-01

    Peripartum hysterectomy (PH) is one of the obstetric catastrophes. Evidence is emerging that the role of PH in modern obstetrics is evolving. Improving management of postpartum hemorrhage and newer surgical techniques should decrease PH for uterine atony. Rising levels of repeat elective cesarean deliveries should decrease PH following uterine scar rupture in labor. Increasing cesarean rates, however, have led to an increase in the number of PHs for morbidly adherent placenta. In the case of uterine atony or rupture where PH is required, a subtotal PH is often sufficient. In the case of pathological placental localization involving the cervix, however, a total hysterectomy is required. Furthermore, the involvement of other pelvic structures may prospectively make the diagnosis difficult and the surgery challenging. If resources permit, PH for pathological placental localization merits a multidisciplinary approach. Despite advances in clinical practice, it is likely that peripartum hysterectomy will be more challenging for obstetricians in the future.

  12. [Terminological and classification aspects of laparoscopic hysterectomies].

    Science.gov (United States)

    Tomov, S; Gorchev, G; Tzvetkov, Ch; Iliev, S; Gincheva, D

    2012-01-01

    There is a great variety of terms and concepts describing laparoscopic hysterectomy in scientific literature. The term "laparoscopic hysterectomy" includes different operations where the laparoscope is used as an aid for a hysterectomy. The first classifications related to hysterectomy laparoscopic procedures were suggested by Munro and Parker (1993) Johns and Diamonds (1994) and Garry et al. (1994). Based on them is the American Association of Gynecologic Laparoscopists (AAGL) classification of 2000. Reich defined basic terms easy to use in clinical practice. The elaboration of a suitable classification system describing the size of laparoscopic intervention in hysterectomy is a prerequisite for an adequate comparison of the results of scientific researches.

  13. The decline of hysterectomy for benign disease.

    LENUS (Irish Health Repository)

    Horgan, R P

    2012-01-31

    Hysterectomy is one of the most common gynaecological surgical procedures performed but there appears to be a decline in the performance of this procedure in Ireland in recent times. We set out to establish the extent of the decline of hysterectomy and to explore possible explanations. Data for hysterectomy for benign disease from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2006. The total number of hysterectomies performed for benign disease showed a consistent decline during this time. There was a 36% reduction in the number of abdominal hysterectomy procedures performed.

  14. ELECTIVE ABDOMINAL HYSTERECTOMY: INDICATIIONS AND ...

    African Journals Online (AJOL)

    Approximately two-thirds of the complications involved the urinary tract or the abdominal incision wound. We conclude that although the hysterectomy rate in Enugu, Nigeria, is lower than in advanced countries, the indications and complications of the operation are similar to those from the latter countries. Suggestions are ...

  15. COMPRESSION UTERINE SUTURES TRIUMPH OVER EMERGENCY PERIPARTUM HYSTERECTOMY IN INTRACTABLE ATONIC PPH

    Directory of Open Access Journals (Sweden)

    Kriti Bhatnagar

    2016-07-01

    Full Text Available OBJECTIVE To study the efficacy and morbidity of uterine compression sutures in the management of intractable severe postpartum haemorrhage. METHOD A prospective study was done at Muzaffarnagar Medical College, Muzaffarnagar from Jan 2012 to June 2015. There were total 6149 deliveries and 1803 (29.4% caesarean deliveries and 4346 (70.7% were vaginal deliveries. Uterine compression sutures B-Lynch and modified B-Lynch (Hayman sutures were applied in eight patients. A Vicryl No. 1 or catgut No. 2 sutures were used in straight round body needle. Patient was placed in modified lithotomy position to assess the compression effect of uterine compression suture. RESULT There were eight uterine compression sutures applied in 6149 deliveries (1:800. Five (62.5% were applied at the time of caesarean and three (37.5% were applied after vaginal or assisted vaginal deliveries. Hysterectomy was avoided in seven patients and one patient (12.5% required hysterectomy for intractable bleeding due to DIC. Blood transfusions were given in all patients. Postoperative period was uneventful and there was no maternal death. CONCLUSION Uterine compression sutures should be considered in case of intractable postpartum haemorrhage (atonic and it may obviate the need of hysterectomy and other procedures like hypogastric artery ligation, uterine artery/ovarian artery ligation.

  16. The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy.

    Science.gov (United States)

    Vakili, Babak; Chesson, Ralph R; Kyle, Brooke L; Shobeiri, S Abbas; Echols, Karolynn T; Gist, Richard; Zheng, Yong T; Nolan, Thomas E

    2005-05-01

    To evaluate the incidence of urinary tract injury due to hysterectomy for benign disease. Patients were enrolled prospectively from 3 sites. All patients undergoing abdominal, vaginal, or laparoscopic hysterectomy for benign disease underwent diagnostic cystourethroscopy. Four hundred seventy-one patients participated. Ninety-six percent (24/25) of urinary tract injuries were detected intraoperatively. There were 8 cases of ureteral injury (1.7%) and 17 cases of bladder injury (3.6%). Ureteral injury was associated with concurrent prolapse surgery (7.3% vs 1.2%; P = .025). Bladder injury was associated with concurrent anti-incontinence procedures (12.5% vs 3.1%; P = .049). Abdominal hysterectomy was associated with a higher incidence of ureteral injury (2.2% vs 1.2%) but this was not significant. Only 12.5% of ureteral injuries and 35.3% of bladder injuries were detected before cystoscopy. The incidence of urinary tract injury during hysterectomy is 4.8%. Surgery for prolapse or incontinence increases the risk. Routine use of cystoscopy during hysterectomy should be considered.

  17. Histopathological Study of Hysterectomy Operations in A University Clinic in Tehran From 2005 to 2009

    Directory of Open Access Journals (Sweden)

    Mahmoud Khaniki

    2011-06-01

    Full Text Available Objective: We intended to determine causes and histological pattern of hysterectomies in an Iranianpopulation.Materials and methods: Archived reports of pathology department of a university hospital dated March2005 to March 2009 were retrospectively reviewed. Age, chief complaint, type of operation includingabdominal, vaginal and subtotal hysterectomy, the indication of the operation and the pathology of thespecimen were retrieved from the records.Results: The average rate of hysterectomy was 219 per year. The average age of the patients was49.6±11.3. About 40% of cases aged 45-54 years. The main chief compliant was abnormal uterinebleeding (62.2%. The leading preoperative indication for hysterectomy operations were uterineleiomyoma (24.8% and then abnormal uterine bleeding and abdominal/pelvic mass. The most frequentpathologic findings were leiomyoma (22.0% and adenomyosis (12.1%. In 11.8% of hysterectomyspecimens no pathologic lesion was found.Conclusion: The hysterectomy is rather common in Iran with age dependent pattern of indications andcorresponding pathologies.

  18. Vaginal epithelioid angiosarcoma: a rare case.

    Science.gov (United States)

    Brătilă, Elvira; Ionescu, Oana Maria; Berceanu, Costin; Coroleucă, Ciprian Andrei; Ardeleanu, Carmen Maria; MehedinŢu, Claudia

    2016-01-01

    Epithelioid angiosarcoma of the vagina is a rare variant, easily misdiagnosed as other epithelial neoplasms. On Hematoxylin-Eosin-stained sections, the pathologist encounters sheets of large, mildly to moderately pleomorphic epithelioid cells, with abundant eosinophilic cytoplasm, vesicular nuclei, and prominent nucleoli. We report the case of a 22-year-old woman initially diagnosed with condiloma-like tumor of the left vaginal wall, which turned out positive at immunostaining for epithelioid angiosarcoma. In her case, after the failure of chemotherapy in controlling the relapse of the disease, the only treatment option was radical hysterectomy with bilateral salpingo-oophorectomy.

  19. [Influence of postoperative pelvic floor function on different surgical procedures of hysterectomy].

    Science.gov (United States)

    Tan, A L; Hong, L; Zhao, Y Z; Jiang, L

    2017-05-25

    Objective: To compare the influence of postoperative pelvic floor function after different surgical procedures of hysterectomy. Methods: A total of 260 patients who underwent hysterectomy in Renmin hospital of Wuhan University from January 2012 to January 2014 were enrolled in the study, and divided into 5 groups by different surgical procedures, which were total abdominal hysterectomy (A-TH; 46 cases), total laparoscopic hysterectomy (L-TH; 59 cases), total vaginal hysterectomy (V-TH; 42 cases), abdominal intrafascial hysterectomy (A-CISH; 78 cases), laparoscopic intrafascial hysterectomy (L-CISH; 35 cases). Pelvic examination, pelvic organ prolapse quantitation (POP-Q), test of pelvic muscle strength, pelvic floor distress inventory-short form 20 (PFDI-20) and the female sexual function index (FSFI) questionnaire were measured after 6 months and 12 months. Results: The differences of pelvic organ prolapse incidence after 6 months, A-TH and A-CISH [7% (3/46) versus 3% (2/78)], A-TH and L-CISH [7% (3/46) versus 3% (1/35)] were statistically significance (all P pelvic floor muscle fatigue after 6 months of A-TH and A-CISH [59% (27/46) versus 29% (23/78)], A-TH and L-CISH [59% (27/46) versus 26% (9/35)] were statistically significant (all P pelvic floor muscle strength after 6 months of L-TH and A-CISH [53% (31/59) verus 24% (19/78)], V-TH and A-CISH [60% (25/42) verus 24% (19/78)], V-TH and L-CISH [60% (25/42) verus 23% (8/35)] were statistically significant (all P 0.05), PFDI-20 total score was not statistically significant ( P >0.05). FSFI total score after 6 months and 12 months in A-TH and A-CISH, L-TH and A-CISH, A-CISH and L-CISH were statistically significant (all P pelvic floor function are no statistical difference; as to the surgical resection of hysterectomy, intrafascia hysterectomy compared with extrafascia hysterectomy, the former is more helpful to the protection of the structure and function of the pelvic floor.

  20. Vaginal sponge and spermicides

    Science.gov (United States)

    ... counter; Contraceptives - over the counter; Family planning - vaginal sponge; Contraception - vaginal sponge ... Spermicides and vaginal sponges do not work as well at preventing pregnancy as some other forms of birth control. However, using a spermicide ...

  1. Vaginitis test - wet mount

    Science.gov (United States)

    Wet prep - vaginitis; Vaginosis - wet mount; Trichomoniasis - wet mount; Vaginal candida - wet mount ... a rash, painful intercourse, or odor after intercourse. Trichomoniasis , a sexually transmitted disease. Vaginal yeast infection .

  2. Successful pregnancy with a full-term vaginal delivery one year after n-butyl cyanoacrylate embolization of a uterine arteriovenous malformation.

    Science.gov (United States)

    McCormick, Colleen C; Kim, Hyun S

    2006-01-01

    Uterine arteriovenous malformation (AVM) causes significant morbidity with vaginal bleeding. Traditional therapy is a hysterectomy with no potential for future pregnancy. We present a case of successful superselective embolization of uterine AVM using n-butyl cyanoacrylate with subsequent normal term pregnancy and uncomplicated vaginal delivery in 1 year.

  3. Urological complications after radical hysterectomy: Incidence rates and predisposing factors

    Directory of Open Access Journals (Sweden)

    Likić-Lađević Ivana

    2007-01-01

    Full Text Available Bacground/Aim. Radical hysterectomy is a surgical approach for stage Ib and IIa of cervical cancer. The incidence of intraoperative injuries of the bladder during radical hysterectomy ranges from 0.4-3.7%. The ureter can be crushed, caught in sutures, transsected, obstructed by angulation, or ischemic by the stippling or periureteric fascia. Vesicovaginal and ureterovaginal fistuls are reported to develop in 0.9-2% of patients after radical abdominal hysterectomy. Fistulas usually become manifested or visible at speculum examination within 14 days following the surgery. The aim of this study was to establish the incidence and predisposing factor of urological complications after radical hysterectomy. Methods. The study included a total of 536 patients with invasive stage Ib to IIb cancer of the cervix uteri who had underwent radical hysterectomy. The special elements considered were: the patient’s age; the International Federation of Ginecology and Obstetrics (FIGO stage after pathohistology; duration of operation; the result of preoperative laboratory tests for diabetes, anemia, hypoproteinemia, or disorders of liver or kidney function; ASA status; postoperative surgical infection. Results. The average age of the patients with complications was 48.68 years. All patients with intraoperative ureteric and bladder injuries had statisticaly significant higher stage of disease and operation lasted more than in others without injury. We noticed 1.3% ureteral injuries and 1.49% bladder injuries, more than 50% of the patients with a previously mentioned injuries were operated on more than 3 hours. We found 2.61% vesicovaginal and 2.43% ureterovaginal fistuls. A total of 50% of the patients with bladder injury and vesicovaginal fistuls and 70% of the patients with ureterovaginal fistuls had diabetes mellitus. Postoperative infection of surgical site is a very important factor for the development of fistule. Half of the patients with vesicovaginal

  4. What to Do With Recurrent Prolapse After Vaginal Mesh Failure?

    Science.gov (United States)

    Norinho de Oliveira, Paula; Bourdel, Nicolas; Rabischong, Benoit; Canis, Michel; Botchorishvili, Revaz

    2016-02-01

    To show that in selected cases laparoscopic sacrocolpopexy can be used for the treatment of recurrent pelvic organ prolapse after vaginal mesh surgery. Step-by-step examination of the technique using an educative video. Institutional review board approval was obtained. The authors describe two clinical cases of treatment of recurrent pelvic organ prolapse, after a vaginal mesh surgery, using laparoscopic sacrocolpopexy. A 56-year old patient (para 3, gravida 2) presented with the sentation of bulging in the vagina. On physical examination, the patient had a grade 2-3 vaginal apical prolapse and a stage 4 rectocele. She had a slight mesh contraction but no vaginal extrusion and no pain were reported. Eleven years before, she had a vaginal total hysterectomy for pelvic organ prolapse correction and one year before she had a vaginal prolapse repair using a synthetic mesh. A laparoscopic sacrocolpopexy with bilateral ooforectomy was performed. The second case is of a 54-year old patient (para 2, gravida 2) that presented stress urinary incontinence. On physical examination, the patient had a grade 3 uterine prolapse and grade 2 cystocele. Eleven years before she had a vaginal prolapse repair using a synthetic mesh and a miduretral sling for stress urinary incontinence. Two years before, she had the miduretal sling removed for recurrent urinary infections and dysuria. A laparoscopic sub-total hysterectomy with salpingectomy and ovarian conservation, sacrocolpopexy and a Burch colposuspension was performed. The procedures and postoperative recovery were uneventful. No minor or major complications occurred. The patients were discharged three days after surgery. Laparoscopic sacrocolpopexy is a promising approach for the treatment of recurrent pelvic organ prolapse after vaginal mesh surgery. It appears to be feasible, safe, and effective. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  5. Antibiotic prophylaxis for abdominal hysterectomy.

    Science.gov (United States)

    Mele, G; Loizzi, P; Greco, P; Gargano, G; Varcaccio Garofalo, G; Belsanti, A

    1988-01-01

    Three different regimens of antibiotic treatment have been employed in order to evaluate their efficacy as a profilaxis for abdominal hysterectomy. Two short term administrations (Cephtriaxone and Cephamandole plus Tobramycine) and a conventional full dose treatment (Cephazoline) have been compared over a group of homogeneous patients. No significant differences, except a reduction in postoperative time spent in hospital, have been found among the groups. A reduction in urinary tract infection has also been reported with a single-dose antibiotic prophylaxis.

  6. Radiation Therapy Results of Invasive Cervical Carcinoma Found After Inappropriate Hysterectomy

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Doo Ho; Kim, Eun Seog; Nam, Kae Hyun; Huh, Seung Jae [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1996-09-15

    Purpose : Hysterectomy without lymph node dissection was considered an inadequate treatment method for invasive uterine cervix cancer. Usually the procedure was performed inadvertently on patients who were thought to have benign or premalignant conditions preoperatively. We analysed radiotherapy results of such patients to evaluate survival rates, failure patterns and prognostic factors according to various conditions. Methods and Materials : Sixty one patients undergoing hysterectomy in the presence of invasive cervical carcinoma were reviewed retrospectively. Preoperative diagnosis were carcioma in situ (38 cases), severe dysplasia(2), myoma(6), uterine bleeding (4), uterine prolapse (2), and early invasive cervix cancer (10) (One patient had myoma and carcinoma in situ coincidently). Patients received postoperative megavoltage radiotherapy form August 1985 to December 1993, and minimum follow-up period was 24 months. Eight patients reveived ICR only, 6 patients ICR and external radiation, and 47 patients received external radiation therapy only. Results : Overall 5-year survival rate and relapse-free survival rate were 83.8%, 86.9% respectively. For patients with retrospective stage IA, IB, IIB (gross residual after surgery), and vaginal cuff recurrence were 90.9%, 88.8%, 38.4%, and 100% respectively. There were 8 cases of treatment failure, most of them (5/8) were in patients with gross residual disease, other patients were full thickness involvement of cervix wall (2/8) except one. Patients with early vaginal cuff recurrence and microinvasive cervical cncer (stage IA) had no treatment related failure. Prognostic factors affecting survival by univariate analysis were status of residual disease, tumor histology and retrospective stage. Conclusion : Adjuvant radiotherapy appeared to be effective treatment method for patients with presumed stage IA, IB and early local recurrent disease after inadvertent hysterectomy. Survivals for patients with gross disease

  7. The Incidence of Concomitant Precancerous Lesions in Cases Who Underwent Hysterectomy for Prolapse

    Directory of Open Access Journals (Sweden)

    Serdar Aydin

    2016-09-01

    Full Text Available Aim: The aim of the study was is to assess the incidence of unexpected gynecological cancers and pre-cancerous lesions following hysterectomy for pelvic organ prolapse to better understand the risks of uterine sparing surgery. Material and Method: This was a retrospective analysis of histopathology findings after hysterectomy for uterine prolapse surgery who underwent preoperative diagnostic work including cervical cytology, transvaginal ultrasonography and endometrial histopathological examination for a high risk group (Postmenopausal women with an endometrial thickness of %u22655 mm and premenopausal women with abnormal bleeding. Patients with a history of endometrial, cervical and/or adnexal precancerous or cancerous pathological conditions and with incomplete medical records were excluded.Results: Results were taken from 106 women who underwent hysterectomy. The abdominal route was used in 22 cases (21.7 %, the vaginal route in 82 patients (77.4 % and laparoscopic-assisted vaginal route in two (1.9 % women. Oophorectomy was performed in 35 (33 % cases. None of the patients had malignant histopathology specimens from hysterectomy. Total premalignant pathology incidence was 7.5 % (8/106. Six (5.7% patients had simple endometrial hyperplasia and 2 patients (1.9 % had cervical intraepithelial neoplasia. Discussion: The incidence of unexpected endometrial, cervical or ovarian malignancy among women who underwent hysterectomy after preoperative diagnostic workup including transvaginal ultrasonograhy, endometrial pathological examination to high risk cases was negligible. The inclusion of low risk endometrial and cervical precancerous lesions increased the incidences. Our results could provide precious data to extrapolate to similar populations with uterine prolapse who desire surgical correction sparing uterus.

  8. Lower urinary tract symptoms after subtotal versus total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Møller, Lars Mikael Alling; Gimbel, Helga

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: Lower urinary tract symptoms (LUTS) are common after hysterectomy and increase after menopause. We aimed to compare subtotal with total abdominal hysterectomy regarding LUTS, including urinary incontinence (UI) subtypes, 14 years after hysterectomy. Main results from ...

  9. Potentially avoidable peripartum hysterectomies in Denmark

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Krebs, Lone; Langhoff-Roos, Jens

    2016-01-01

    to minimize the number of unnecessary peripartum hysterectomies, obstetricians and anesthesiologists should investigate individual cases by structured clinical audit, and disseminate and discuss the results for educational purposes. An international collaboration is warranted to strengthen our recommendations......Objective: To audit the clinical management preceding peripartum hysterectomy and evaluate if peripartum hysterectomies are potentially avoidable and by which means. Material and Methods: We developed a structured audit form based on explicit criteria for the minimal mandatory management...

  10. Emergency peripartum hysterectomy, physical and mental consequences: a 6-year study

    Directory of Open Access Journals (Sweden)

    Denisa-Oana Bălălău

    2016-04-01

    Full Text Available Emergency peripartum hysterectomy (EPH is performed for massive postpartum hemorrhage following a cesarean delivery or vaginal delivery, in order to save the patient’s life. The current study was performed on a sample of 13.162 patients, which underwent cesarean or vaginal delivery during a period of 6 years, from 2010 to 2015, in Bucur Maternity Hospital. There were two subsequential groups consisting in: 6593 patients with cesarean operations and 6569 patients with vaginal delivery. In 12 cases occurred one or more of the risk factors that lead to EPH, divided equally across the two groups above. The main two types of surgery are a more frequent subtotal hysterectomy, which is the preferred type of EPH as it takes less time and is associated with fewer complications, and a total hysterectomy. The majority of procedures were performed at patients over 35 years old (9 of 12, with a median age of 31,16 (ranging from 21 to 44 years old. The most important risk factor present across the lot was multiparity (11 from 12, with cicatricial uterus being the second one (4 of 12. ICU median time was 4,5 days (ranging from 3 to 15 days, with a median blood transfusion necessity of around 2,4 I.U per patient. There were no mother or newborn reported deaths, neither PTSD following EPH.EPH is a procedure performed as last-resort, life-saving surgery, leaving no time for mental preparation of the patients. This may predispose to negative psychological outcomes, especially because they are not part of decision-making process due to the emergency character of hysterectomy.

  11. Movement to outpatient hysterectomy for benign indications in the United States, 2008-2014.

    Directory of Open Access Journals (Sweden)

    Gaby Moawad

    Full Text Available The past decade has witnessed adoption of conservative gynecologic treatments, including minimally invasive surgery (MIS, alongside steady declines in inpatient hysterectomies. It remains unclear what factors have contributed to trends in outpatient benign hysterectomy (BH, as well as whether these trends exacerbate disparities.Retrospective cohort of 527,964 women ≥18 years old who underwent BH from 2008 to 2014. BH surgical approaches included: open/abdominal hysterectomy (AH, vaginal hysterectomy (VH, laparoscopic hysterectomy (LH, and robotic-assisted hysterectomy (RH. Quarterly frequencies were calculated by care setting and surgical approach. We used multilevel logistic regression (MLR using the most recent year of data (2014 to examine the influence of patient-, physician-, and hospital-level preoperative factors and surgical approaches on outpatient migration.From 2008-2014, surgical approaches for LH and RH increased, which coincided with decreases in VH and AH. Overall, a 44.2% shift was observed from inpatient to outpatient settings (P<0.0001. Among all outpatient visits MIS increased, particularly for RH (3.6% to 41.07%. We observed increases in the proportion of non-Hispanic Black and Medicaid patients who obtained MIS in 2014 vs. 2008 (P<0.001. Surgical approach (51.8% and physician outpatient MIS experience (19.9% had the greatest influence on predicting outpatient BH. Compared with LH, RH was associated with statistically significantly higher likelihood of outpatient BH overall (OR 1.23; 95% CI, 1.16-1.31, as well as in sub-analyses of more complex cases and hospitals that performed ≥1 RH (P<0.05.From 2008-2014, rates of LH and RH significantly increased. A significant shift from inpatient to outpatient setting was observed. These findings suggest that RH may facilitate the shift to outpatient BH, particularly for patients with complexities. The adoption of MIS in outpatient settings may improve access to disadvantaged

  12. Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure.

    Science.gov (United States)

    Bodur, Serkan; Dede, Murat; Fidan, Ulas; Firatligil, Burcin F; Ulubay, Mustafa; Ozturk, Mustafa; Yenen, Mufit C

    2017-09-01

    The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.

  13. A common clinical dilemma: Management of abnormal vaginal cytology and human papillomavirus test results.

    Science.gov (United States)

    Khan, Michelle J; Massad, L Stewart; Kinney, Walter; Gold, Michael A; Mayeaux, E J; Darragh, Teresa M; Castle, Philip E; Chelmow, David; Lawson, Herschel W; Huh, Warner K

    2016-05-01

    Vaginal cancer is an uncommon cancer of the lower genital tract, and standardized screening is not recommended. Risk factors for vaginal cancer include a history of other lower genital tract neoplasia or cancer, smoking, immunosuppression, and exposure to diethylstilbestrol in utero. Although cervical cancer screening after total hysterectomy for benign disease is not recommended, many women inappropriately undergo vaginal cytology and/or human papillomavirus (hrHPV) tests, and clinicians are faced with managing their abnormal results. Our objective is to review the literature on vaginal cytology and hrHPV testing and to develop guidance for the management of abnormal vaginal screening tests. An electronic search of the PubMed database through 2015 was performed. Articles describing vaginal cytology or vaginal hrHPV testing were reviewed, and diagnostic accuracy of these tests when available was noted. The available literature was too limited to develop evidence-based recommendations for managing abnormal vaginal cytology and hrHPV screening tests. However, the data did show that 1) the risk of vaginal cancer in women after hysterectomy is extremely low, justifying the recommendation against routine screening, and 2) in women for whom surveillance is recommended, e.g. women post-treatment for cervical precancer or cancer, hrHPV testing may be useful in identification of vaginal cancer precursors. Vaginal cancer is rare, and asymptomatic low-risk women should not be screened. An algorithm based on expert opinion is proposed for managing women with abnormal vaginal test results. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  14. Difficulty in the management of pregnancy after vaginal radical trachelectomy.

    Science.gov (United States)

    Takada, Sakura; Ishioka, Shin-Ichi; Endo, Toshiaki; Baba, Tsuyoshi; Morishita, Miyuki; Akashi, Yushi; Mizuuchi, Masahito; Adachi, Hidefumi; Kim, Miseon; Saito, Tsuyoshi

    2013-12-01

    We have performed 26 vaginal radical trachelectomies (RTs) for patients with early invasive uterine cervical cancer since 2003 and, to date, have experienced 8 deliveries. The procedure has a high risk for preterm labor and the subsequent occurrence of preterm premature rupture of membranes (pPROM). We report the present situation and the limits of follow-up of pregnancy after vaginal RT. Our operative procedure is based on that of Dargent et al. We usually amputate the cervix approximately 10 mm below the isthmus. To remove the parametrium, we cut at the level of type II hysterectomy. Pregnancy courses after vaginal RT were studied in 8 patients with respect to symptoms, cervical length, and several infectious signs. We recommended that patients enter hospital early in their second trimester, and prophylactic daily vaginal disinfection with povidone-iodine and an ulinastatin vaginal suppository were administered. Careful checking for vaginal infectious signs, as well as cervical length and abdominal tension of patients was also performed. Four patients followed up with this modality were able to continue their pregnancies until late in the third trimester. However, this follow-up modality was not effective for patients who showed cervical incompetence due to slack cervical cerclage. They suffered from pPROM at 26 and 19 weeks of gestation. We need a new approach for the management of pregnant patients after vaginal RT with cervical incompetence due to slack cervical cerclage to prevent cervical infection.

  15. Caesarean Hysterectomy | Okeke | Nigerian Journal of Medicine

    African Journals Online (AJOL)

    Subtotal hysterectomy may therefore be the more prudent, safest and fastest option, but the potential problems of a residual cervical stump must always be borne in mind. CONCLUSION: Caesarean hysterectomy though a rare procedure is a life saving obstetric emergency. There is need for adequate exposure and mastery ...

  16. Fatigue and physical function after hysterectomy measured by SF-36, ergometer, and dynamometer.

    Science.gov (United States)

    Lauszus, Finn F; Kallfa, Ervin; Madsen, Mogens R

    2016-07-01

    Information is limited on the early postoperative rehabilitation following hysterectomy. Our purpose was to evaluate the different perioperative modalities of fatigue, pain, quality of life, and physical performance and their time-related. A prospective, follow-up study of a cohort of women undergoing abdominal and vaginal hysterectomy at the Gynecology Department at Herning Hospital, Denmark. Data from 108 women with elective hysterectomy were compared pre- and postoperatively. The fatigue level was scored on a visual analogue scale and SF-36. Objective measurements were performed by dynamometer of hand grip, knee extension strength, and postural stability; further, by ergometer cycle work capacity and by impedance lean body mass. Quality of life was assessed using the SF-36 questionnaire. Patients were examined preoperatively and twice postoperatively. Women lost lean body mass 13 and 30 days after their hysterectomy (p SF-36 revealed that the modality of 'physical functioning' and 'role limitations due to physical problems' remained significantly decreased at the end of the study (p SF-36 30 days after surgery. No impairment of performance was found in physical tests at days 13 and 30 postoperatively.

  17. Laparoscopic supracervical hysterectomy with transcervical morcellation and sacrocervicopexy for the treatment of uterine prolapse.

    Science.gov (United States)

    Dessie, Sybil G; Park, Michele; Rosenblatt, Peter L

    2016-01-01

    The objective is to describe our surgical approach for management of uterine prolapse using 5-mm skin incisions and transcervical morcellation. This video presents a novel approach for laparoscopic supracervical hysterectomy, bilateral salpingectomy, and sacrocervicopexy using only 5-mm skin incisions and transcervical morcellation. The procedure begins with a laparoscopic supracervical hysterectomy with bilateral salpingectomy. A classic intrafascial supracervical hysterectomy (CISH) instrument is then used transvaginally to core the endocervical canal. A disposable morcellator is placed through the remaining cervix to morcellate the uterus and fallopian tubes. Following morcellation, the handle of the morcellator is removed, and it is used during the remainder of the surgery as an access cannula for the sacrocervicopexy. The polypropylene mesh is introduced through this cannula. It is secured to the anterior and posterior vaginal fascia with a suture that is also introduced through the transcervical port. At the conclusion of the surgery, a previously placed 0 Vicryl purse-string suture at the ectocervix is tied down as a cerclage around the cervix once the cannula is removed. The transcervical morcellation technique demonstrated in this video allows the surgeon to maintain 5-mm skin incisions and core the endocervical canal during a laparoscopic supracervical hysterectomy with sacrocervicopexy.

  18. Rates of colpopexy and colporrhaphy at the time of hysterectomy for prolapse.

    Science.gov (United States)

    Fairchild, Pamela S; Kamdar, Neil S; Berger, Mitchell B; Morgan, Daniel M

    2016-02-01

    It has been shown that addressing apical support at the time of hysterectomy for pelvic organ prolapse (POP) reduces recurrence and reoperation rates. In fact, national guidelines consider hysterectomy alone to be inadequate treatment for POP. Despite this, anterior and posterior colporrhaphy are frequently performed without a colpopexy procedure and hysterectomy alone is often utilized for treatment of prolapse. The objectives of this study were to: (1) determine rates of concomitant procedures for POP in hysterectomies performed with POP as an indication, (2) identify factors associated with performance of a colpopexy at the time of hysterectomy for POP, and (3) identify the influence of surgical complexity on perioperative complication rates. This is a retrospective cohort study of hysterectomies performed for POP from Jan. 1, 2013, through May 7, 2014, in a statewide surgical quality database. Patients were stratified based on procedures performed: hysterectomy alone, hysterectomy with colporrhaphy and without apical suspension, and hysterectomy with colpopexy with or without colporrhaphy. Demographics, medical history and intraoperative care, and perioperative care were compared between the groups. Multivariable logistic regression models were created to identify factors independently associated with use of colpopexy and factors associated with increased rates of postoperative complications. POP was an indication in 1557 hysterectomies. Most hysterectomies were vaginal (59.6%), followed by laparoscopic or robotic (34.1%), and abdominal (6.2%). Hysterectomy alone was performed in 43.1% (95% confidence interval [CI], 40.6-45.6) of cases, 32.8% (95% CI, 30.4-35.1) had a colporrhaphy without colpopexy, and 24.1% (95% CI, 22-26.3) had a colpopexy with or without colporrhaphy. Use of colpopexy was independently associated with patient age >40 years, POP as the only indication for surgery (odd ratio [OR], 1.6; 95% CI, 1.185-2.230), laparoscopic surgery (OR, 3.2; 95

  19. Non-opioid pain management in benign minimally invasive hysterectomy: A systematic review.

    Science.gov (United States)

    Blanton, Emily; Lamvu, Georgine; Patanwala, Insiyyah; Barron, Kenneth I; Witzeman, Kathryn; Tu, Frank F; As-Sanie, Sawsan

    2017-06-01

    mixed results in laparoscopic hysterectomies. Paracervical blocks provide pain-reducing benefits in vaginal hysterectomies. Convincing conclusions are difficult to draw because of the heterogeneous and contradictory nature of the literature. There is a clear need for more high-quality research that will evaluate each medication type for posthysterectomy pain control. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Trends in Mode of Hysterectomy After the U.S. Food and Drug Administration Power Morcellation Advisory.

    Science.gov (United States)

    Ottarsdottir, Helga; Cohen, Sarah L; Cox, Mary; Vitonis, Allison; Einarsson, Jon I

    2017-06-01

    To evaluate the trends in mode of surgery for benign hysterectomy after the 2014 U.S. Food and Drug Administration (FDA) morcellation guidelines. This is a retrospective review of all patients who underwent a hysterectomy for benign indications, specifically for leiomyomas, at Brigham and Women's Hospital from 2013 to 2015. The rates of abdominal, vaginal, laparoscopic, and robotic-assisted laparoscopic hysterectomy as well as the perioperative outcomes were compared over the study period. Analysis was performed using multivariable linear, multinomial, and logistic regression. Regression models were adjusted for potential confounders. From 2013 to 2015, 1,530 patients underwent a hysterectomy for benign indications and 639 patients underwent the procedure for the indication of uterine leiomyomas; there was a decrease in the number of hysterectomy cases in the later years. Focusing on the patients with leiomyomas alone, there was a 40-60% decreased odds of a minimally invasive procedure in 2014 or 2015 compared with 2013 [adjusted odds ratio (OR) 0.53 (0.29-0.97) in 2014 and adjusted OR 0.40 (0.22-0.74) in 2015, P=.003]. A 24% decrease in the supracervical approach to hysterectomy was also noted. Despite these trends, the majority of cases in each year were still performed in a minimally invasive fashion. The factor most strongly associated with undergoing a minimally invasive hysterectomy was having a fellowship-trained surgeon perform the procedure [adjusted OR 6.80 (3.65-12.7), P<.001]. There was no significant difference between the year of surgery and occurrence of intraoperative complications or reoperation. Although key perioperative outcomes remained similar, the overall rate of minimally invasive surgery declined at our institution after the FDA's recommendations. With changing practice patterns and vigilance surrounding power morcellation, gynecologic surgeons may still offer patients minimally invasive procedures with all of the accompanying advantages.

  1. Hysterectomy

    Science.gov (United States)

    ... You may still get pregnant after this surgery. Endometrial ablation destroys the lining of the uterus permanently. ... Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated. Page ...

  2. A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions.

    Science.gov (United States)

    Tapper, Anna-Maija; Hannola, Mikko; Zeitlin, Rainer; Isojärvi, Jaana; Sintonen, Harri; Ikonen, Tuija S

    2014-06-01

    In order to assess the effectiveness and costs of robot-assisted hysterectomy compared with conventional techniques we reviewed the literature separately for benign and malignant conditions, and conducted a cost analysis for different techniques of hysterectomy from a hospital economic database. Unlimited systematic literature search of Medline, Cochrane and CRD databases produced only two randomized trials, both for benign conditions. For the outcome assessment, data from two HTA reports, one systematic review, and 16 original articles were extracted and analyzed. Furthermore, one cost modelling and 13 original cost studies were analyzed. In malignant conditions, less blood loss, fewer complications and a shorter hospital stay were considered as the main advantages of robot-assisted surgery, like any mini-invasive technique when compared to open surgery. There were no significant differences between the techniques regarding oncological outcomes. When compared to laparoscopic hysterectomy, the main benefit of robot-assistance was a shorter learning curve associated with fewer conversions but the length of robotic operation was often longer. In benign conditions, no clinically significant differences were reported and vaginal hysterectomy was considered the optimal choice when feasible. According to Finnish data, the costs of robot-assisted hysterectomies were 1.5-3 times higher than the costs of conventional techniques. In benign conditions the difference in cost was highest. Because of expensive disposable supplies, unit costs were high regardless of the annual number of robotic operations. Hence, in the current distribution of cost pattern, economical effectiveness cannot be markedly improved by increasing the volume of robotic surgery. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. NERVE SPARING« RADICAL HYSTERECTOMY – PREVENTION OF POST-OPERATIVE URINARY TRACT DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    Matija Barbič

    2018-02-01

    Full Text Available Background. Radical hysterectomy is performed on woman with cervical cancer or endometrial cancer that has spread to the cervix. Aims. To find whether our modified radical hysterectomy represents nerve sparing. Methods. In 28 patients, modified radical hysterectomy was applied (study group and the width of the parametria and vaginal cuff were measured. Using a point-counting technique, nerve areal density was determined in cross sections of resected parametria at 0.5 cm (A, 1 cm (B, and 1.5 cm (C from the cervix. The results were compared with 26 control patients who underwent classic radical hysterectomy. In the study group urodynamic measurements were performed after operation, and correlations with histologic data were calculated. The survival rates and adjuvant treatment were compared between the groups. Results. Adjuvant treatment was given to 53.57 % in the study and 65.38 % of patients in the control group (P > 0.3. The survival rate after 3 years was 92.85 % in the study and 84.61 % in the control group after more than 5 years. The width of the resected parametria was smaller in the study (mean: right 15.50 mm, left 15.71 mm compared with the control group (mean: right 22.69 mm; P < 0.013; left 22.96 mm; P < 0.011. The nerve areal density in the lateral part of the right parametrium (C right 6.2 % was lower in the study than in the control group (C right 9.7 %; P < 0.01. There were several correlations between parametrial width, nerve areal density and urodynamic parameters. Conclusions. Modified radical hysterectomy is less radical, and apparently also nerve sparing. It does not influence survival rates and does not impair the urinary tract function.

  4. Clinical applications of custom-made vaginal cylinders constructed using three-dimensional printing technology.

    Science.gov (United States)

    Sethi, Rajni; Cunha, Adam; Mellis, Katherine; Siauw, Timmy; Diederich, Chris; Pouliot, Jean; Hsu, I-Chow

    2016-06-01

    Three-dimensional (3D) printing technology allows physicians to rapidly create customized devices for patients. We report our initial clinical experience using this technology to create custom applicators for vaginal brachytherapy. Three brachytherapy patients with unique clinical needs were identified as likely to benefit from a customized vaginal applicator. Patient 1 underwent intracavitary vaginal cuff brachytherapy after hysterectomy and chemotherapy for stage IA papillary serous endometrial cancer using a custom printed 2.75 cm diameter segmented vaginal cylinder with a central channel. Patient 2 underwent interstitial brachytherapy for a vaginal cuff recurrence of endometrial cancer after prior hysterectomy, whole pelvis radiotherapy, and brachytherapy boost. We printed a 2 cm diameter vaginal cylinder with one central and six peripheral catheter channels to fit a narrow vaginal canal. Patient 3 underwent interstitial brachytherapy boost for stage IIIA vulvar cancer with vaginal extension. For more secure applicator fit within a wide vaginal canal, we printed a 3.5 cm diameter solid cylinder with one central tandem channel and ten peripheral catheter channels. The applicators were printed in a biocompatible, sterilizable thermoplastic. Patient 1 received 31.5 Gy to the surface in three fractions over two weeks. Patient 2 received 36 Gy to the CTV in six fractions over two implants one week apart, with interstitial hyperthermia once per implant. Patient 3 received 18 Gy in three fractions over one implant after 45 Gy external beam radiotherapy. Brachytherapy was tolerated well with no grade 3 or higher toxicity and no local recurrences. We established a workflow to rapidly manufacture and implement customized vaginal applicators that can be sterilized and are made of biocompatible material, resulting in high-quality brachytherapy for patients whose anatomy is not ideally suited for standard, commercially available applicators.

  5. Total laparoscopic hysterectomy versus da Vinci robotic hysterectomy: is using the robot beneficial?

    Science.gov (United States)

    Soto, Enrique; Lo, Yungtai; Friedman, Kathryn; Soto, Carlos; Nezhat, Farr; Chuang, Linus; Gretz, Herbert

    2011-12-01

    To compare the outcomes of total laparoscopic to robotic approach for hysterectomy and all indicated procedures after controlling for surgeon and other confounding factors. Retrospective chart review of all consecutive cases of total laparoscopic and da Vinci robotic hysterectomies between August 2007 and July 2009 by two gynecologic oncology surgeons. Our primary outcome measure was operative procedure time. Secondary measures included complications, conversion to laparotomy, estimated blood loss and length of hospital stay. A mixed model with a random intercept was applied to control for surgeon and other confounders. Wilcoxon rank-sum, chi-square and Fisher's exact tests were used for the statistical analysis. The 124 patients included in the study consisted of 77 total laparoscopic hysterectomies and 47 robotic hysterectomies. Both groups had similar baseline characteristics, indications for surgery and additional procedures performed. The difference between the mean operative procedure time for the total laparoscopic hysterectomy group (111.4 minutes) and the robotic hysterectomy group (150.8 minutes) was statistically significant (p=0.0001) despite the fact that the specimens obtained in the total laparoscopic hysterectomy group were significantly larger (125 g vs. 94 g, p=0.002). The robotic hysterectomy group had statistically less estimated blood loss than the total laparoscopic hysterectomy group (131.5 mL vs. 207.7 mL, p=0.0105) however no patients required a blood transfusion in either group. Both groups had a comparable rate of conversion to laparotomy, intraoperative complications, and length of hospital stay. Total laparoscopic hysterectomy can be performed safely and in less operative time compared to robotic hysterectomy when performed by trained surgeons.

  6. Long-term effect of hysterectomy on urinary incontinence in Taiwan

    Directory of Open Access Journals (Sweden)

    Ching-Hung Hsieh

    2011-09-01

    Conclusion: There is a high prevalence of UI among women who have performed hysterectomy, but there is no significant relationship between UI and route of hysterectomy, reason for hysterectomy, including cervical cancer and uterine prolapsed, or year after hysterectomy.

  7. Alternatives to hysterectomy: focus on global endometrial ablation, uterine fibroid embolization, and magnetic resonance-guided focused ultrasound.

    Science.gov (United States)

    Stovall, Dale W

    2011-04-01

    comparing uterine fibroid embolization to vaginal hysterectomy, laparoscopic hysterectomy, or laparoscopic myomectomy. © 2011 by The North American Menopause Society

  8. Total laparoscopic hysterectomy without uterine manipulator at big uterus weight (>280 g).

    Science.gov (United States)

    Mebes, Imke; Diedrich, Klaus; Banz-Jansen, Constanze

    2012-07-01

    The retrospective study included the total laparoscopic hysterectomy without uterus manipulator at big uterus >280 g (Group A), proceeding the same technique as known to show feasibility and safety of its technique, compared with a randomized patient group of a uterus weight below 280 g (Group B). Statistical measurement was proceeded in typical clinical parameters. No statistical differences in age, body mass index, further abdominal surgery, blood loss, and hospital stay were observed. Operating time was significantly different favouring the uterus below 280 g (111.74 min Group A/90.68 min Group B). No increase in intra- or postoperative complications in both groups was observed. Total hysterectomy at big uterus (>280 g) is safe and feasible. Statistical analysis shows a significant shorter operating time only in one parameter (Group B). The technique of hysterectomy without uterus manipulator offers a surgical advancement also at vaginal stenosis, early staged cervix, or endometrial cancer and exhibits an opportunity for laparoscopic advancement in these cases too.

  9. Sepsis: Primary indication for peripartum hysterectomies in a South ...

    African Journals Online (AJOL)

    Background. Peripartum hysterectomies are lifesaving procedures but definitions vary. Indications are variable and dependant on resources and geographical factors. Objectives. To evaluate the incidence, aetiology and complications associated with peripartum hysterectomies in a tertiary hospital in South Africa. Methods.

  10. [Evolution of peripartal hysterectomy at our department - five years evaluations].

    Science.gov (United States)

    Pálová, E; Maľová, A; Hammerová, L; Redecha, M

    2014-06-01

    The purpose of this study was to determine the frequency, indications, complications and risk factors associated with peripartum hysterectomy carried out at our clinical department between 1st January 2008 and 31th December 2012. Peripartum hysterectomy was defined as a hysterectomy performed less than 48 hours after delivery. Clinical characteristic and obstetric histories were retrospectively reviewed between 5 years. There were 20 emergency peripartum hysterectomies among 13 660 deliveries at our department. The overall rate of peripartum hysterectomy was 1,46 per 1000 deliveries. The primary indications for hysterectomy were uncontrolled bleeding caused by uterine hypotony (45%), followed by placenta praevia (25%). Other indications were placental abruption (15%), pelvic endometriosis (5%), placenta increta (5%) and uterus myomatosus (5 %). The incidence of peripartum hysterectomy increased 2-fold in cases of placental patology, and 17-fold in cases of uterine hypotony. Overall, 95% of hysterectomy patients required transfusions.

  11. Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: A novel approach in difficult laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Mun-Kun Hong

    2016-06-01

    Conclusion: This novel minimal invasive method of hysterectomy makes difficulty laparoscopic hysterectomy easy and safe. Preservation of cervical ligaments retains stability in the pelvic floor and may reduce intraoperative complications and subsequent pelvic floor organ prolapse.

  12. Anti-hemorrhagic effect of prophylactic tranexamic acid in benign hysterectomy-a double-blinded randomized placebo-controlled trial

    DEFF Research Database (Denmark)

    Topsoee, Märta Fink; Bergholt, Thomas; Ravn, Pernille

    2016-01-01

    and in 2004, 8% of all women in Denmark undergoing benign hysterectomy experienced a bleeding complication. Tranexamic acid is an antifibrinolytic agent that has shown to effectively reduce bleeding complications within other surgical and medical areas. However, knowledge about the drug's effect in relation......BACKGROUND: Hysterectomy is one of the most frequently performed major gynecological surgical procedures. Even when the indication for the procedure is benign, relatively high complication rates have been reported. Perioperative bleeding seems to represent the most common cause of complications...... 2014. A total of 332 women undergoing benign abdominal, laparoscopic, or vaginal hysterectomy were included in the trial, randomized to either 1 g of intravenous tranexamic acid or placebo at start of surgery. Chi-square test and Student t test statistical analyses were applied. RESULTS: The primary...

  13. Endoluminal release of ureteral ligature after hysterectomy

    Directory of Open Access Journals (Sweden)

    Chih-Jen Wang

    2016-01-01

    Full Text Available Iatrogenic ureteral injury is a well-recognized complication of abdominal total hysterectomy. We report a case of a 57-year-old female who underwent abdominal total hysterectomy for a uterine myoma and experienced severe right flank pain postoperatively. The imaging study displayed an obstruction of the right distal ureter. Under ureteroscopy, an extraluminal ligature was released with a holmium:yttrium–aluminum–garnet laser. The stenotic segment was immediately relieved. Two months later, the intravenous urogram illustrated patency of the distal ureter with regression of right hydronephrosis. There was no recurrent hydronephrosis during 1 year of follow-up.

  14. [Surgical management of pelvic organ prolapse in women: laparoscopic or vaginal sacrocolpopexy?].

    Science.gov (United States)

    Descargues, G; Collard, P; Grise, P

    2008-10-01

    To compare the safety and the efficacy of the laparoscopic and vaginal technique for the surgical management of pelvic organ prolapse, with systematic support of the three compartments and prosthetic reinforcements. Retrospective study of 154 patients presenting a stage 3 or 4 prolapse on one of the three compartments. Laparoscopic procedures were performed with subtotal hysterectomy, double synthetic prosthesis attached to promontory, and douglassectomy. Vaginal procedures were performed with vaginal hysterectomy, anterior colporrhaphy with a hammock using porcine skin collagen implant fixed by transobturator passages, unilateral sacral colpopexy and posterior colporrhaphy. Monitoring was performed at six months and then annually. The laparoscopic technique requires a more important operating time, but a shorter hospitalization. The discovery of three carcinoma reinforces the idea of the interest of uterine radical surgery in these patients. The tolerance of prostheses by laparoscopy is safe. The biological prostheses, introduced vaginally, offer the same advantages. The anatomical results in the medium term (30 months) seem more favorable to laparoscopy than transvaginal approach, as well as functional results but they still need to better evaluated. The two techniques must coexist, ideally without competing with each other but rather complementarily, as the overall rate of recurrence, requiring additional procedure does not exceed 2%. It is therefore important that surgeons, who support prolapse, have a good comprehensive training of the laparoscopic and vaginal techniques.

  15. Paediatric vaginal discharge

    African Journals Online (AJOL)

    Vaginal discharge in the prepubertal patient is a common symptom, and can be a source of distress for the caregiver and con- cern for the healthcare worker. Several factors predispose these patients to the development of recurrent vaginal discharge. Unless noticed by the caregiver, this problem can persist for long periods ...

  16. 437 classic intrafascial supracervical hysterectomies in 8 years.

    Science.gov (United States)

    Morrison, J E; Jacobs, V R

    2001-11-01

    To report technical aspects and practical long-term experience with classic intrafascial supracervical hysterectomy (CISH). Retrospective evaluation (Canadian Task Force Classification II-2). Local community hospital in rural northwest Alabama. Four hundred thirty-seven women. The procedure was performed as described originally but with slight modifications (vaginal manipulator, ETS stapler). Follow-up was 44.7 months (range 3-97 mo). Average operating time was 1 hour 10 minutes (range 46 min-6 hrs, 10 min), average blood loss was 68 ml (range 10-765 ml), average length of hospital stay was 22 hours (range 10 hrs-5 days), and average return to work was 14 days (range 3-28 days). Complications were 11 bleeding cervices (7 occurring within 21 days after surgery, and 4 between 2 and 4 yrs after surgery), 1 case of uterine artery bleeding, 1 ileus, 1 pelvic hematoma, and 5 mucoceles between 2 and 27 months postoperatively. There were three conversions, one because of morbid obesity (185 kg) and two because of large uterus:pelvis ratio. CISH leaves the pelvic floor intact, has short recuperation and high patient satisfaction, and is cost effective at a low complication rate. It is an advanced laparoscopic procedure, is initially technically challenging, and has a learning curve.

  17. Is vaginal mesh a stimulus of autoimmune disease?

    Science.gov (United States)

    Chughtai, Bilal; Sedrakyan, Art; Mao, Jialin; Eilber, Karyn S; Anger, Jennifer T; Clemens, J Quentin

    2017-05-01

    Polypropylene mesh has been used as a means of reinforcing weak tissues in women with pelvic organ prolapse and stress urinary incontinence. We sought to investigate a potential link between the development of systemic/autoimmune disorders and synthetic polypropylene mesh repairs. New York State Department of Health Statewide Planning and Research Cooperative System data were utilized to conduct this retrospective cohort study. Adult women undergoing surgery for pelvic organ prolapse with vaginally implanted mesh from January 2008 through December 2009 in inpatient and ambulatory surgery settings in New York State were identified. Two separate control cohorts were created to compare outcomes, including a screening colonoscopy cohort and a vaginal hysterectomy cohort for benign gynecologic conditions (without pelvic organ prolapse repair or sling). Patients in the mesh cohort were individually matched to the control cohorts based on demographics, comorbidities, and procedure date. The development of systemic/autoimmune disease was determined before and after matching for 1-year, 2-year, 3-year, and entire follow-up (up to 6 years until December 2014) and differences between groups were evaluated. A total of 2102 patients underwent mesh-based pelvic organ prolapse surgery from January 2008 through December 2009. In the control cohorts, 37,298 patients underwent colonoscopy and 7338 underwent vaginal hysterectomy. When patients were matched based on demographics, comorbidities, and procedure time, mesh-based surgery was not associated with an increased risk of developing autoimmune disease at any of the evaluated time periods. Mesh-based vaginal surgery was not associated with the development of systemic/autoimmune diseases. These data refute claims against mesh as a cause of systemic disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Establishment of a national Danish hysterectomy database: preliminary report on the first 13,425 hysterectomies

    DEFF Research Database (Denmark)

    Hansen, Charlotte T; Møller, Charlotte; Daugbjerg, Signe

    2008-01-01

    OBJECTIVE: To describe the concept and early results from the Danish Hysterectomy Database (DHD). DESIGN: Nationwide prospective cohort. SETTING: Denmark. POPULATION: All women who had undergone an elective hysterectomy for benign indication carried out in 2004-2006. METHODS: Structured data...... and parallel causal studies. MAIN OUTCOME MEASURES: Completeness, data validation and department-identifiable clinical indicators (surgical volume, method of hysterectomy, use of antibiotic and thromboembolic prophylaxis, postoperative hospitalization and bleeding complications, surgical infections......%, the rate of bleeding complications from 8 to 6%, the reoperation rate from 5 to 4%, and the readmission rate from 7 to 5%. CONCLUSIONS: Clinical performance indicators, audit meetings and nationwide collaboration are useful in monitoring and improving outcome after hysterectomy on a national level...

  19. Management of Vaginal Cancer.

    Science.gov (United States)

    Shrivastava, S B L; Agrawal, Gaurav; Mittal, Megha; Mishra, Priyanshi

    2015-01-01

    Vaginal cancer is a rare gynecologic cancer with very little documentation. Literature search to have useful information for the management of vaginal cancer and share. We have searched the PUBMED database, Google search engine and other database. A total of 26 references were taken into account. Once spread from primary other cancers or vulva is ruled out, vaginal cancer is designated to be primary in origin. It was revealed that majority of vaginal cancers reported are squamous cell carcinomas. The most common risk factors implicated are Human Papiloma Virus, age. Most common presenting symptoms were abnormal vaginal bleeding,. Diagnosis requires pathological confirmation. Management depends on staging work-up. Vaginal cancer is staged by FIGO system of staging and TNM staging. There are many prognostic factors influencing the choice of treatment. Lymph node metastasis is one of the important prognostic factors, others to mention are histology, size, age. In a recent SEER analysis of over 2000 patients, the 5 year disease specific survival was 84% for stage 1, 75% for stage II and 57% for advanced tumors. Early carcinomas are generally treated with either surgery or radiation therapy. Advanced cancers are treated with radiation therapy with simultaneous administration of combined chemotherapy. Preventive strategies include safe sex and HPV vaccination. Primary vaginal cancer is a rare entity, if there is no history of cancer cervix or vulva in past or absence of cervical squamous cell carcinoma or vulvar carcinoma within 5 years is usually considered as primary vaginal cancer. Though early stage vaginal cancers have better outcome treated with surgery or radiotherapy or surgery followed by radiotherapy, radiotherapy alone is preferred mode of treatment in vaginal cancers.

  20. Anaesthetic challenges in emergency peripartum hysterectomy in ...

    African Journals Online (AJOL)

    Conclusion: Emergency peripartum hysterectomies challenge the anaesthetist and the obstetrician who have to maintain haemodynamic stability in patients who may have lost volumes of blood, in a setting where blood and colloid availability is often limited. The maternal mortality was higher than that of most of the studies ...

  1. Hysterectomy in Adolescents, in Port Harcourt, Nigeria.

    African Journals Online (AJOL)

    Alasia Datonye

    Results. Majority (78%) of the hysterectomies were in adolescents aged 16 years and above. Sixty percent of them had a secondary education, 78% were unmarried and nine had a previous successful pregnancy. About half the cases resided in rural areas, while half resided in urban settlements. Seventy-one percent of the ...

  2. Elective abdominal hysterectomy: Appraisal of indications and ...

    African Journals Online (AJOL)

    There was no mortality recorded during the period under review. Discussion. The rate of elective abdominal hysterectomy in this study was. 3.3% which was lower than the 10.0% reported by Omokanye et al. in Ilorin,[6] and 18.2% reported by Anzaku and Musa in. Jos.[26] This is partly attributed to the general aversion to.

  3. Life stress and hysterectomy-oophorectomy

    NARCIS (Netherlands)

    Kraaimaat, F.W.; Veeninga, A.T.

    1984-01-01

    The effects of hysterectomy-oophorectomy and life stress in regard to physical and psychological discomfort were investigated. Oophorectomized women reported more physical complaints and more frequent loss of sexual interest than a control group of cholecystectomized women. No differences between

  4. [Clinical analysis of six cases of vaginal intraepithelial neoplasia].

    Science.gov (United States)

    Zhang, Qing-Xia; Zhu, Lan; Lang, Jing-He; Shen, Keng; Huang, Hui-Fang; Pan, Ling-Ya

    2008-03-01

    To investigate the clinical characteristics, diagnosis and treatment of vaginal intraepithelial neoplasia (VAIN). A retrospective study was made of 6 patients with VAIN, who were hospitalized at Peking Union Medical College Hospital from 1980 to 2006. Five cases had a history of hysterectomy, two of whom were because of cervical intraepithelial neoplasia (CIN) or invasive cervical cancer. Four cases had the infection of high-risk oncogenic human papillomaviruses detected with hybrid capture II (HC-II), the other two had no record. In all patients the VAIN lesions were within the upper one third of the vagina. They were all diagnosed by colposcopic examination and directed biopsy after the abnormal cytology by thinprep cytology test (TCT). Six cases of VAIN II-III were treated by excisional surgery. One case had residual lesion and had another surgery 3 months after the first one. Two patients obtained remission at one-year follow-up, three had abnormal cytology by TCT 6 months after surgery, and one had abnormal cytology by TCT at six-month follow-up but normal at one-year follow-up. A history of CIN is the main risk factor for VAIN, so routine vaginal cytology is needed for the patients after hysterectomy due to CIN. Cytology, colposcopic examination and directed biopsy are the mainstays of VAIN diagnosis. Excisional surgery is recommended for the patients with VAIN II-III. Long term follow-up is necessary after treatment.

  5. Vaginal Approaches Using Synthetic Mesh to Treat Pelvic Organ Prolapse.

    Science.gov (United States)

    Moon, Jei Won; Chae, Hee Dong

    2016-02-01

    Pelvic organ prolapse (POP) is a very common condition in elderly women. In women with POP, a sacrocolpopexy or a vaginal hysterectomy with anterior and posterior colporrhaphy has long been considered as the gold standard of treatment. However, in recent decades, the tendency to use a vaginal approach with mesh for POP surgery has been increasing. A vaginal approach using mesh has many advantages, such as its being less invasive than an abdominal approach and easier to do than a laparoscopic approach and its having a lower recurrence rate than a traditional approach. However, the advantages of a vaginal approach with mesh for POP surgery must be weighed against the disadvantages. Specific complications that have been reported when using mesh in POP procedures are mesh erosion, dyspareunia, hematomas, urinary incontinence and so on, and evidence supporting the use of transvaginal surgery with mesh is still lacking. Hence, surgeons should understand the details of the surgical pelvic anatomy, the various surgical techniques for POP surgery, including using mesh, and the possible side effects of using mesh.

  6. Incidence, indications, and predictors of adverse outcomes of postpartum hysterectomies: 20-year experience in a tertiary care centre.

    Science.gov (United States)

    Ibrahim, Marina; Ziegler, Cleve; Klam, Stephanie L; Wieczorek, Paul; Abenhaim, Haim A

    2014-01-01

    Postpartum hysterectomy is an uncommon yet serious obstetric procedure associated with maternal morbidity and mortality. The objectives of our study were to assess the incidence of and indications for PH and to identify predictors of massive hemorrhage and coagulopathy. We conducted a retrospective cohort study on all cases of PH performed at the Jewish General Hospital, McGill University, between 1992 and 2011. Data were collected from individual patient charts and logistics regression models were used to evaluate predictors of adverse events. Over a 20-year study period, there were 76 938 live births and 67 postpartum hysterectomies for an overall incidence of 0.87/1000. Although overall PH rates increased over time predominantly because of increasing rates of planned PH for placental abnormalities, there was a decrease in unplanned emergency postpartum hysterectomies. The main indications for PH were abnormal placentation (64.2%) and postpartum hemorrhage (26.9%). In adjusted analysis, the risk of requiring massive blood transfusion was increased when PH was performed after vaginal delivery or Caesarean section (OR 102.1; 95% CI 4.22 to 2468) and in association with postpartum hemorrhage (OR 9.1; 95% CI 1.3 to 64.3). The risk of massive hemorrhage was lower if occlusive balloons were placed antenatally in the uterine arteries (OR 0.13; 95% CI 0.03 to 0.68) and if PH was performed by a dedicated experienced surgeon (OR 0.23; 95% CI 0.06 to 0.86). Although overall rates of PH are increasing, antenatal recognition of placental pathologies have resulted in fewer postpartum hysterectomies being done as emergencies. The use of occlusive balloons in the uterine arteries and having the procedure performed by a dedicated surgeon skilled in performing postpartum hysterectomy can reduce overall serious morbidity.

  7. Vaginal and Vulvar Cancer

    Science.gov (United States)

    ... Facts About Gynecologic Cancer campaign. The campaign helps women get the facts about gynecologic cancer, providing important “inside knowledge” about their bodies and health. What are vaginal and vulvar cancers? Cancer is ...

  8. Anterior vaginal wall repair

    Science.gov (United States)

    ... may have you: Learn pelvic floor muscle exercises ( Kegel exercises ) Use estrogen cream in your vagina Try ... repair; Urinary incontinence - vaginal wall repair Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  9. Vaginal Yeast Infections

    Science.gov (United States)

    ... Yeast Infections Print A A A en español Infecciones vaginales por hongos What Are Vaginal Yeast Infections? ... keep the amount in a person's body under control. But yeast in the vagina can sometimes "overgrow" ...

  10. Vaginal birth - slideshow

    Science.gov (United States)

    ... ency/presentations/100198.htm Vaginal birth - series—Normal anatomy To use the sharing features on this page, ... Bethesda, MD 20894 U.S. Department of Health and Human Services National Institutes of Health Page last updated: ...

  11. Vaginal bleeding between periods

    Science.gov (United States)

    ... Inflammation or infection of the cervix (cervicitis) or uterus (endometritis) Injury or disease of the vaginal opening (caused by intercourse, trauma, infection, polyp, genital warts , ulcer, or varicose veins) ...

  12. Yeast Infection (Vaginal)

    Science.gov (United States)

    ... vaginal discharge with a cottage cheese appearance Complicated yeast infection You might have a complicated yeast infection ... have an uncomplicated or a complicated infection. Uncomplicated yeast infection For mild to moderate symptoms and infrequent ...

  13. Comparative Effectiveness of Minimally Invasive Hysterectomy for Endometrial Cancer

    Science.gov (United States)

    Burke, William M.; Tergas, Ana I.; Hou, June Y.; Huang, Yongmei; Hu, Jim C.; Hillyer, Grace Clarke; Ananth, Cande V.; Neugut, Alfred I.; Hershman, Dawn L.

    2016-01-01

    Purpose Despite the potential benefits of minimally invasive hysterectomy for uterine cancer, population-level data describing the procedure’s safety in unselected patients are lacking. We examined the use of minimally invasive surgery and the association between the route of the procedure and long-term survival. Methods We used the SEER-Medicare database to identify women with stage I-III uterine cancer who underwent hysterectomy from 2006 to 2011. Patients who underwent abdominal hysterectomy were compared with those who had minimally invasive hysterectomy (laparoscopic and robot-assisted). Perioperative morbidity, use of adjuvant therapy, and long-term survival were examined after propensity score balancing. Results We identified 6,304 patients, including 4,139 (65.7%) who underwent abdominal hysterectomy and 2,165 (34.3%) who underwent minimally invasive hysterectomy; performance of minimally invasive hysterectomy increased from 9.3% in 2006 to 61.7% in 2011. Robot-assisted procedures accounted for 62.3% of the minimally invasive operations. Compared with women who underwent abdominal hysterectomy, minimally invasive hysterectomy was associated with a lower overall complication rate (22.7% v 39.7%; P < .001), and lower perioperative mortality (0.6% v 1.1%), but these women were more likely to receive adjuvant pelvic radiotherapy (34.3% v 31.3%) and brachytherapy (33.6% v 31.0%; P < .05). The complication rate was higher after robot-assisted hysterectomy compared with laparoscopic hysterectomy (23.7% v 19.5%; P = .03). There was no association between the use of minimally invasive hysterectomy and either overall (HR, 0.89; 95% CI, 0.75 to 1.04) or cancer-specific (HR, 0.83; 95% CI, 0.59 to 1.16) mortality. Conclusion Minimally invasive hysterectomy does not appear to compromise long-term survival for women with endometrial cancer. PMID:26834057

  14. Robotic-assisted total laparoscopic hysterectomy versus conventional total laparoscopic hysterectomy.

    Science.gov (United States)

    Shashoua, Abraham R; Gill, Diana; Locher, Stephen R

    2009-01-01

    To compare patient characteristics, operative variables, and outcomes of 24 patients who underwent robotic-assisted total laparoscopic hysterectomy (TLH) with 44 patients who underwent conventional TLH. We retrospectively reviewed the charts of 44 patients with TLH and 24 patients with robotic TLH. Robotic TLH was associated with a shorter hospital stay (1.0 vs 1.4 days, P=0.011) and a significant decrease in narcotic use (1.2 vs 5.0 units, P=0.002). EBL and droP in hemoglobin were not significantly different. The operative time was significantly longer in patients undergoing robotic TLH (142.2 vs 122.1 minutes, P=0.027). However, only need for laparoscopic morcellation, BMI, and uterine weight, not robotic use, were independently associated with increased operative times. Robotic hysterectomy can be performed safely with comparable operative times to those of conventional laparoscopic hysterectomy. Postoperative measures were improved over measures for conventional laparoscopy.

  15. Health care cost consequences of using robot technology for hysterectomy

    DEFF Research Database (Denmark)

    Laursen, Karin Rosenkilde; Hyldgård, Vibe Bolvig; Jensen, Pernille Tine

    2017-01-01

    and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1...... to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator....

  16. Pedagogic approach in the surgical learning: The first period of “assistant surgeon” may improve the learning curve for laparoscopic robotic-assisted hysterectomy.

    Directory of Open Access Journals (Sweden)

    Angeline Favre

    2016-11-01

    Full Text Available Background: Hysterectomy is the most frequently surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal and appear as a promising surgical technique in gynaecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring.Methods: We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France. We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1 and the control of surgical skills phase (Phase 2. The phase was defined by mastering the basic surgical tasks. Secondarily we compared these two periods for operative time, blood losses, Body Mass Index (BMI, days of hospitalisations and uterine weight. We finally studied the difference of the learning curve between an experimented surgeon (S1 who practised the first the robot-assisted hysterectomies and a less experimented surgeon (S2 who first assisted S1 and then operated on his own patients.Results: 154 robot-assisted hysterectomies were analysed. 20 procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 minutes compared to the control of surgical skills phase (125.8 minutes, p=0.003. No difference between these two periods for blood losses, BMI, days of hospitalisations and uterine weight were demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant

  17. Pedagogic Approach in the Surgical Learning: The First Period of "Assistant Surgeon" May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy.

    Science.gov (United States)

    Favre, Angeline; Huberlant, Stephanie; Carbonnel, Marie; Goetgheluck, Julie; Revaux, Aurelie; Ayoubi, Jean Marc

    2016-01-01

    Hysterectomy is the most frequent surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal) and appear as a promising surgical technique in gynecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring. We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci ® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France). We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1) and the control of surgical skills phase (Phase 2). The phase was defined by mastering the basic surgical tasks. Secondarily, we compared these two periods for operative time, blood losses, body mass index (BMI), days of hospitalizations, and uterine weight. We, finally, studied the difference of the learning curve between an experimented surgeon (S1) who practiced first the robot-assisted hysterectomies and a less experimented surgeon (S2) who first assisted S1 and then operated on his own patients. A total of 154 robot-assisted hysterectomies were analyzed. Twenty procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 min) compared to the control of surgical skills phase (125.8 min, p  = 0.003). No difference between these two periods for blood losses, BMI, days of hospitalizations and uterine weight was demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant decrease of the operative

  18. Factors influencing the choice of hysterectomy approach for the management of fibroid uterus

    Directory of Open Access Journals (Sweden)

    Felix Wu Shun Wong

    2013-05-01

    Conclusion: Certain clinical parameters determine the choice of hysterectomy approach. Surgeons' expertise also has significant influence over the choice between laparoscopic and traditional approaches for hysterectomy.

  19. Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

    Directory of Open Access Journals (Sweden)

    Monica Hagan Vetter

    2015-01-01

    Full Text Available Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered.

  20. Sexual Outcomes and Satisfaction with Hysterectomy: Influence of Patient Education

    Science.gov (United States)

    Bradford, Andrea; Meston, Cindy

    2010-01-01

    Introduction Many women experience improved sexual function after hysterectomy. However, a sizeable minority of women report worsened sexual function after the surgery, and concerns about the effect of surgery on sexual function are common among women planning to undergo hysterectomy. Aim The present study examined the role of education about the potential sexual consequences of hysterectomy in predicting self-reported outcomes and satisfaction with the procedure. Methods We conducted a cross-sectional survey of 204 women who had undergone simple hysterectomy in the preceding 3–12 months. Participants volunteered in response to a Web-based advertisement. Main Outcome Measures Participants indicated their current sexual function using the Female Sexual Function Index (FSFI), and reported positive and negative sexual outcomes experienced after hysterectomy using a checklist. Participants also completed questionnaire items regarding satisfaction with hysterectomy and education from their physicians about sexual risks and benefits prior to surgery. Results Current sexual function scores were related to self-reports of positive and negative sexual outcomes following hysterectomy and overall satisfaction with hysterectomy. Education from a physician about possible adverse sexual outcomes was largely unrelated to self-reports of having experienced those outcomes. However, education about possible negative sexual outcomes predicted overall satisfaction with hysterectomy when controlling for self-reports of positive and negative sexual outcomes. Conclusion Education about potential negative sexual outcomes after surgery may enhance satisfaction with hysterectomy, independent of whether negative sexual outcomes were experienced. Including a discussion of potential sexual changes after surgery may enhance the benefits of presurgical counseling prior to hysterectomy. PMID:17087803

  1. Prospective comparison of tissue trauma after laparoscopic hysterectomy types with retroperitoneal lateral transsection of uterine vessels using ligasure and abdominal hysterectomy.

    Science.gov (United States)

    Demir, Ahmet; Bige, Ozgur; Saatli, Bahadir; Solak, Ahmet; Saygili, Uğur; Onvural, Ata

    2008-04-01

    The aim of this study was to evaluate the level of tissue trauma after laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels using ligasure as compared with abdominal hysterectomy. A total of 45 women with various indications for hysterectomy were randomized into laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy. Laparoscopic and total laparoscopic hysterectomy with retroperitoneal lateral transsection of uterine vessels was performed by four-puncture laparoscopy and pre-, postoperative and postoperative 24th hour levels of interleukin-6 (IL-6) and C-reactive protein (CRP), the mean operative time, drop in hemoglobin concentration, weight of removed uterus, VAS scores, hospitalization period and major and minor operative complications were analyzed prospectively. CRP and IL-6 levels were significantly higher in the abdominal hysterectomy group compared to either laparoscopy groups at the postoperative 24th hour. There were no significant differences in the levels of CRP and IL-6 between the two laparoscopy groups. The longest operative times were observed in the total laparoscopic hysterectomy group. Laparoscopic surgery causes less tissue trauma than the conventional open surgery; however, we observed no difference between the laparoscopic hysterectomy groups concerning the postoperative inflammatory response. We may prefer laparoscopic hysterectomy instead of total laparoscopic hysterectomy under suitable conditions, since laparoscopic hysterectomy causes the same level of tissue trauma as total laparoscopic hysterectomy, but has the advantage of a significantly shorter operative time. Meanwhile, hysterectomy done by laparoscopy with retroperitoneal lateral transsection of uterine vessels using ligasure is an effective and safe procedure.

  2. Vaginal intraepithelial neoplasia: a therapeutical dilemma.

    Science.gov (United States)

    Frega, Antonio; Sopracordevole, Francesco; Assorgi, Chiara; Lombardi, Danila; DE Sanctis, Vitaliana; Catalano, Angelica; Matteucci, Eleonora; Milazzo, Giusi Natalia; Ricciardi, Enzo; Moscarini, Massimo

    2013-01-01

    Vaginal intraepithelial neoplasia (VaIN) represents a rare and asymptomatic pre-neoplastic lesion. Its natural history and potential evolution into invasive cancer are uncertain. VaIN can occur alone or as a synchronous or metachronous lesion with cervical and vulvar HPV-related intra epithelial or invasive neoplasia. Its association with cervical intraepithelial neoplasia is found in 65% of cases, with vulvar intraepithelial neoplasia in 10% of cases, while for others, the association with concomitant cervical or vulvar intraepithelial neoplasias is found in 30-80% of cases. VaIN is often asymptomatic and its diagnosis is suspected in cases of abnormal cytology, followed by colposcopy and colposcopically-guided biopsy of suspicious areas. In the past, high-grade VaIN and multifocal VaIN have been treated by radical surgery, such as total or partial upper vaginectomy associated with hysterectomy and radiotherapy. The need to maintain the integrity of reproductive capacity has determined the transition from radical therapies to conservative ones, according to the different patients' characteristics.

  3. Partial vaginal expulsion of a leiomyosarcoma

    Directory of Open Access Journals (Sweden)

    Kaori Yokochi

    2013-06-01

    Full Text Available Uterine sarcomas are an uncommon and heterogeneous group of tumors that account for 3-7% of the malignant neoplasms of the uterus and approximately 1% of all malignant tumors of the female genital system. The main clinical manifestations are abnormal uterine bleeding in pre- or postmenopausal women. Pelvic pain, abdominal distension, urinary urgency, and profuse and fetid leukorrhea are other frequent complaints. The authors present a case of a 48-year-old patient that was in amenorrhea for 2 years, who sought treatment for vaginal bleeding. On physical examination, the abdomen was distended, painful in the hypogastrium and upon examination of the external genitalia, it was observed the exteriorization of an amorphous “mass”. The patient was submitted to uterine curettage. The results of the histological examination revealed leiomyosarcoma. Staging workup showed an enlarged uterus with endometrial lesion, and non-calcified pulmonary nodules. The patient underwent a pan-hysterectomy and chemotherapy, and is under oncologic treatment. The authors call attention for the unusual form of presentation of this entity.

  4. Hysterectomy in Adolescents | Akani | Tropical Journal of Obstetrics ...

    African Journals Online (AJOL)

    Subjects and Methods: We evaluated the trends and factors that necessitated hysterectomy among adolescents seen at the University of Port Harcourt Teaching Hospital, Port-Harcourt (UPTH), Nigeria.This is a retrospective descriptive analysis of 28 cases of hysterectomies managed at the UPTH over a 17-year period.

  5. Recognition and Management of Urologic Injuries With Laparoscopic Hysterectomy.

    Science.gov (United States)

    Dassel, Mark W; Adelman, Marisa R; Sharp, Howard T

    2015-12-01

    Injuries to the urinary tract during laparoscopic hysterectomy are quite rare, but are among the most serious injuries that occur during gynecologic surgery. Injury rates among subtypes of laparoscopic hysterectomy have been found to be similar. The most effective way to avoid urinary tract injury is knowledge of urinary tract anatomy and careful and thoughtful dissection.

  6. Should hysterectomy be performed for the treatment of endometriosis?

    African Journals Online (AJOL)

    When there is a medical or surgical indication for a hysterectomy apart from endometriosis the following discussion is not really relevant. The question deals with the role of hysterectomy purely for the management of endometriosis. Women, who have pelvic pain due to endometriosis that is unresponsive to conventional ...

  7. Socioeconomic indicators and hysterectomy status in the United States, 2004.

    Science.gov (United States)

    Erekson, Elisabeth A; Weitzen, Sherry; Sung, Vivian W; Raker, Christina A; Myers, Deborah L

    2009-09-01

    To examine the association between socioeconomic indicators and hysterectomy. We performed a cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance Survey database. The effect of multiple socioeconomic exposures (education level, annual income and employment status) on hysterectomy status was evaluated. Logistic regression was used to estimate ORs between the multiple exposures and the outcome of hysterectomy status. Our analytic sample included 180,982 women. Prior hysterectomy was reported by 26.4%. After adjusting for confounders, women who had not graduated from high school had 1.75 times higher odds (95% CI 1.68-1.83) of having a hysterectomy as compared to women who were college graduates, and women with an annual household income of higher odds (95% CI 1.02 to 1.10) of having a hysterectomy as compared to women who reported an income of > $50,000/year. Women who were unemployed did not have higher odds of having a hysterectomy than women who were employed. Socioeconomic indicators of education level and income are associated with hysterectomy status; however, employment status is not.

  8. Abdominal Hysterectomy at University of Ilorin Teaching Hospital: A ...

    African Journals Online (AJOL)

    Abdominal Hysterectomy at University of Ilorin Teaching Hospital: A 5-year Review. ... Conclusion: Abdominal hysterectomy is a safe operative procedure and i/t is a viable treatment option to a variety of gynaecological disorders. Adequate preoperative assessment, intraoperative and post operative measures to reduce ...

  9. Elective Hysterectomy at the University of Uyo Teaching Hospital: A ...

    African Journals Online (AJOL)

    Elective Hysterectomy at the University of Uyo Teaching Hospital: A 3-Year Review. AM Abasiattai, EA Bassey, AJ Umoiyoho. Abstract. A 3-year review of elective hysterectomies performed at the University of Uyo Teaching Hospital was carried out. The aim was to determine the indications and outcome of elective ...

  10. Incidence of pelvic organ prolapse repair subsequent to hysterectomy

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2017-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare the incidence of subsequent pelvic organ prolapse (POP) repair in women following radical hysterectomy versus total abdominal hysterectomy. METHODS: From the Danish National Patient Registry, we collected data on all radical...

  11. Lower urinary tract symptoms after total and subtotal hysterectomy

    DEFF Research Database (Denmark)

    Gimbel, Helga; Zobbe, Vibeke; Andersen, Birthe Jakobsen

    2005-01-01

    The aim of this Danish multicenter trial was to compare the proportion of women with lower urinary tract symptoms after total abdominal hysterectomy (TAH) and subtotal abdominal hysterectomy (SAH) for benign uterine disorders. A total of 319 women were randomized to TAH (n = 158) or SAH (n = 161)...

  12. 42 CFR 441.255 - Sterilization by hysterectomy.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Sterilization by hysterectomy. 441.255 Section 441.255 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Sterilizations § 441.255 Sterilization by hysterectomy. (a) FFP is not available in expenditures for a...

  13. 42 CFR 50.207 - Sterilization by hysterectomy.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Sterilization by hysterectomy. 50.207 Section 50... GENERAL APPLICABILITY Sterilization of Persons in Federally Assisted Family Planning Projects § 50.207 Sterilization by hysterectomy. (a) Programs or projects to which this subpart applies shall not perform or...

  14. Morbidity after total abdominal hysterectomy | Van Coeverden De ...

    African Journals Online (AJOL)

    Morbidity after total abdominal hysterectomy. H. A. Van Coeverden De Groot, M.A. Jeeva, K.D. Gunston. Abstract. Total abdominal hysterectomy (TAH), the commonest major gynaecological operation performed at the Groote Schuur and Somerset Hospitals, is associated with considerable financial and social problems for ...

  15. MANAGEMENT OF VAGINAL DISCHARGE

    African Journals Online (AJOL)

    Enrique

    Northern Branch. He has conducted numerous clinical trials and has a research interest in infectious diseases with special emphasis on sexually transmitted infections. He is a recipi- ent of the NRFs grant for research in sexually transmitted diseases and is also the principal investigator for a phase III vaginal microbicide.

  16. Vaginal rejuvenation: current perspectives

    Directory of Open Access Journals (Sweden)

    Barbara G

    2017-07-01

    Full Text Available Giussy Barbara,1 Federica Facchin,2 Laura Buggio,3 Daniela Alberico,3 Maria Pina Frattaruolo,3 Alessandra Kustermann1 1Department of Obstetrics and Gynecology, Service for Sexual and Domestic Violence (SVSeD, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 2Faculty of Psychology, Catholic University of Milan, 3Department of Obstetrics and Gynecology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy Abstract: Female genital cosmetic surgery includes several procedures aimed at reaching better female genital appearance and/or improved sexual functioning. Among these procedures, vaginal rejuvenation is considered as one of the most controversial genital cosmetic surgical interventions and involves a range of surgical procedures performed by gynecologists or plastic surgeons to decrease the average diameter of the vagina, mainly for sexual reasons. In this narrative review, vaginal rejuvenation outcomes are examined in order to clarify the current scenario of the different vaginal rejuvenation techniques, as well as their effectiveness and associated complications. Psychological and ethical issues linked to these procedures are also addressed. Keywords: vaginal rejuvenation, female genital cosmetic surgery, vaginoplasty 

  17. [Prevalence of 7 microorganisms in abnormal vaginal secretions (vaginitis)].

    Science.gov (United States)

    Roupas, A; Wyss, R; Anner, R

    1985-10-19

    Seven microorganisms (N. gonorrhoeae, C. albicans, T. vaginalis, G. vaginalis, M. hominis, U. urealyticum and Streptococcus of group B) have been assayed in genital samplings of 164 asymptomatic women (control group) and of 374 women suffering from abnormal vaginal secretions (vaginitis group). All these bacteria except group B Streptococci were isolated in the vaginitis group more frequently than in the control group (p less than 0.01). The proportion of negative cultures for all tested bacteria was 39% in the control group and 6.4% in the vaginitis group (p less than 0.01). This shows an association of these bacteria with 70% of the patients of the vaginitis group and with only 26% of the women of the control group (p less than 0.01). It is to be noted that the pH values are higher in the group of women with vaginitis than in the control group (p less than 0.01). Comparison of the microbial flora during "specific" an "non-specific" vaginitis indicates that G. vaginalis is isolated more frequently in patients with non-specific vaginitis than among those with specific vaginitis (p less than 0.01). Likewise, M. hominis is isolated more frequently in groups of women with either non-specific vaginitis or T. vaginalis vaginitis, than in groups of patients with a C. albicans vaginitis (p less than 0,01). The results of this study indicate that there is a causal relationship between vaginitis and the presence of T. vaginalis. C. albicans, G. vaginalis, M. hominis or N. gonorrhoeae, either as a single or a mixed infection, and that there is a relationship between increased pH values and abnormal vaginal secretions.

  18. Angioembolisation in vaginal vascular malformation.

    Directory of Open Access Journals (Sweden)

    Srivastava D

    2001-01-01

    Full Text Available Vaginal arteriovenous malformations are rare entities and their most common presentation is vaginal haemorrhage. This case report describes a 22-year-old woman who presented at 20 weeks of gestation with slow growing soft and tender swelling at anterior vaginal wall. Diagnosis was confirmed as vaginal vascular malformation on contrast enhanced magnetic resonance imaging. The mass did not subside after delivery and patient developed dyspareunia. It was successfully treated by angioembolisation using polyvinyl alcohol particles. Angioembolisation being safe and effective should be the treatment of first choice for symptomatic vaginal vascular malformation.

  19. Reflex anuria affecting both kidneys following hysterectomy

    Directory of Open Access Journals (Sweden)

    Gholyaf Mahmoud

    2009-01-01

    Full Text Available In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA and acute renal failure (ARF. Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruc-tion. She was managed with hemodialysis, control of hypertension and correction of fluid and elec-trolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum crea-tinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.

  20. Reflex anuria affecting both kidneys following hysterectomy.

    Science.gov (United States)

    Gholyaf, Mahmoud; Afzali, Saeed; Babolhavaegi, Hoshang; Rahimi, Abolfazl; Wagharseyedayn, Seyed A

    2009-01-01

    In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA) and acute renal failure (ARF). Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruction. She was managed with hemodialysis, control of hypertension and correction of fluid and electrolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum creatinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.

  1. Risk factors and management of vaginal mesh erosion after pelvic organ prolapse surgery.

    Science.gov (United States)

    Cheng, Yung-Wen; Su, Tsung-Hsien; Wang, Hsuan; Huang, Wen-Chu; Lau, Hui-Hsuan

    2017-04-01

    Mesh erosion is a serious and not uncommon complication in women undergoing vaginal mesh repair. We hypothesized that mesh erosion is associated with the patient's comorbidities, surgical procedures, and mesh material. The aims of this study were to identify the risk factors and optimal management for mesh erosion. All women who underwent vaginal mesh repair from 2004 to 2014 were retrospectively reviewed. Data on patients' characteristics, presenting symptoms, treatment and outcomes were collected from their medical records. A total of 741 women underwent vaginal mesh repairs, of whom 47 had mesh erosion. The median follow-up period was 13 months (range 3-84 months). Another nine patients with mesh erosion were referred form other hospitals. Multivariate analysis revealed that concomitant hysterectomy (odds ratio 27.02, 95% confidence interval 12.35-58.82; p erosion. Of these 56 women, 20 (36%) were successfully treated by conservative management, while 36 (64%) required subsequent surgical revision. Compared with surgery, conservative treatment was successful if the size of the erosion was smaller than 0.5 cm (p erosions after primary revision, but all successfully healed after the second surgery. Concomitant hysterectomy and hypertension were associated with mesh erosion. In the management of mesh erosion, conservative treatment can be tried as the first-line treatment for smaller erosions, while surgical repair for larger erosions. Recurrent erosions could happen and requires repairs several times. Copyright © 2017. Published by Elsevier B.V.

  2. Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Palle, Connie; Møller, Ann M

    2016-01-01

    in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy. RESULTS: The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7...... kroner (robotic-assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs. CONCLUSION: For women with endometrial cancer or atypical complex hyperplasia, robotic-assisted laparoscopic...

  3. Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy and to estim......INTRODUCTION AND HYPOTHESIS: The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy...

  4. Barbed suture vs traditional suture in single-port total laparoscopic hysterectomy.

    Science.gov (United States)

    Song, Taejong; Lee, San-Hui

    2014-01-01

    To compare surgical outcomes between barbed suture and traditional suture used in repair of the vaginal vault during single-port total laparoscopic hysterectomy (TLH). Case-control study (Canadian Task Force classification II-2). Two institutions. One hundred two patients with benign uterine disease. Single-port TLH using barbed suture (n = 43) or traditional suture (n = 59). Patient characteristics (age, body mass index, demographic data), procedures performed, uterine weight, and uterine disease were similar between the 2 study groups. There were also no differences in operative complications, conversion to other surgical approaches, operative blood loss, postoperative pain, and duration of hospital stay between the 2 groups. Use of barbed suture significantly reduced the time required for vaginal cuff suturing (11.4 vs 22.5 minutes; p suture is less technically demanding than traditional suture (p suture in single-port TLH may aid surgeons by reducing operative time, suturing time, and surgical difficulty. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  5. Pyomyositis after vaginal delivery.

    LENUS (Irish Health Repository)

    Gaughan, Eve

    2011-01-01

    Pyomyositis is a purulent infection of skeletal muscle that arises from haematogenous spread, usually with abscess formation. It can develop after a transient bacteraemia of any cause. This type of infection has never been reported before in the literature after vaginal delivery. A 34-year-old woman had progressive severe pain in the left buttock and thigh and weakness in the left lower limb day 1 post spontaneous vaginal delivery. MRI showed severe oedema of the left gluteus, iliacus, piriformis and adductor muscles of the left thigh and a small fluid collection at the left hip joint. She was diagnosed with pyomyositis. She had fever of 37.9°C immediately postpartum and her risk factors for bacteraemia were a mild IV cannula-associated cellulitis and labour itself. She required prolonged treatment with antibiotics before significant clinical improvement was noted.

  6. [Outcomes of anterior vaginal wall repair using polypropylene mesh].

    Science.gov (United States)

    Huser, M; Pastorčáková, M; Belkov, I; Sedláková, K

    2012-10-01

    Pelvic organ prolapse (POP) is a major health concern especially in the elderly women. Anterior vaginal wall prolapse (AWP) represents the most common form of POP with reoperation rate 30-40% when primary treated by anterior colporrhaphy. Modern surgical techniques of POP repair uses polypropylene (PP) mesh implants to better support pelvic structures and lower the risk of recurrence. Aim of our study was to assess the safety and efficacy of anterior vaginal wall prolapse repair using PP mesh system NAZCA TC (Promedon). The kit consists of preformed PP mesh anchored to pelvic structures by two needle inserters via pre-pubic and trans-obturator route. From January 2010 to February 2011, 21 patients with stage III/IV AWP underwent transvaginal repair with implantation of PP mesh. The stage of POP measured according to POP-Q system, surgery length, blood loss and complications has been evaluated six month after the surgery. Surgery has been assessed as successful when POP stage 0/I o has been reached. In 42.9% of patients AWP repair was combined with other procedures: vaginal hysterectomy or posterior vaginal repair. (Statistical evaluation was done by Wilcoxon test.). The average age of operated women was 62.4±9.4 years, average body mass index was 27.5±4.1 kg/m2, with overall parity of 2.2±1.4 children. The surgery time was 64.0±26.0 minutes with average blood loss of 185.0±17,0 ml. No serious per-operating complication has been recorded. The objective cure rate at 6 months was 90.5%. Statistically significant difference in the position of points Aa, Ba and C (ppolypropylene mesh is an effective and safe technique in the hands of surgeon experienced in classical POP reconstruction techniques. For the assessment of long term efficacy the further follow-up of patients is necessary.

  7. Robotic radical hysterectomy in the management of gynecologic malignancies.

    Science.gov (United States)

    Pareja, Rene; Ramirez, Pedro T

    2008-01-01

    Robotic surgery is being used with increasing frequency in gynecologic oncology. To date, 44 cases were reported in the literature of radical hysterectomy performed with robotic surgery. When comparing robotic surgery with laparoscopy or laparotomy in performing a radical hysterectomy, the literature shows that robotic surgery offers an advantage over the other 2 surgical approaches with regard to operative time, blood loss, and length of hospitalization. Future studies are needed to further elucidate the equivalence or superiority of robotic surgery to laparoscopy or laparotomy in performing a radical hysterectomy.

  8. Nerve-sparing radical hysterectomy in cervical cancer

    Directory of Open Access Journals (Sweden)

    Phanida Jarruwale

    2013-05-01

    Full Text Available A new technique of extensive surgical intervention, namely nerve sparing radical hysterectomy (NSRH, was introduced as one of the treatment options for early stage cervical cancer patients because cervical cancer patients suffer from postoperative complications following radical hysterectomy procedure. The step of nerve preservation can reduce postoperative complications, such as bladder or sexual dysfunction problems that occur after a traditional radical hysterectomy procedure. The surgical outcomes seem to be favorable and no serious morbidity was noted. However, further study of the nerve sparing technique is necessary to improve this surgical advantage in the future.

  9. Acute and late vaginal toxicity after adjuvant high-dose-rate vaginal brachytherapy in patients with intermediate risk endometrial cancer: is local therapy with hyaluronic acid of clinical benefit?

    Directory of Open Access Journals (Sweden)

    Concetta Laliscia

    2016-12-01

    Full Text Available Purpose : The aim of the present study was to evaluate the effectiveness of hyaluronic acid (HA in the prevention of acute and late vaginal toxicities after high-dose-rate (HDR vaginal brachytherapy (BT. Material and methods : Between January 2011 and January 2015, we retrospectively analyzed 126 patients with endometrial cancer who underwent extrafascial hysterectomy with or without lymphadenectomy and adjuvant HDR-vaginal BT +/– adjuvant chemotherapy. The total dose prescription was 21 Gy in 3 fractions (one fraction for week. Vaginal ovules containing 5 mg of HA were given for whole duration of vaginal BT and for the two following weeks. Acute and late toxicities were evaluated according to CTCAE vs 4.02. Results : According to the revised FIGO 2009 classification, most tumors were in stage IA (30.9% and in stage IB (57.9%. Thirty-three patients (26.2% received adjuvant chemotherapy before vaginal BT. Five-year disease-free survival (DFS and five-year overall survival (OS were 88% and 93%, respectively. The most common grade 1-2 acute toxicities were vaginal inflammation (18 patients, 14.3% and dyspareunia (7 patients, 5.5%. Two patients (1.6% had more than one toxicity. Late toxicity occurred in 20 patients (15.9%. Grade 1-2 late toxicities were fibrosis (14 patients, 11.1% and telangiectasias (7 patients, 5.5%. Six patients (4.8% had more than one late toxicity. No grade 3 or higher acute or late toxicities were observed. Conclusions : These results appear to suggest that the local therapy with HA is of clinical benefit for intermediate risk endometrial cancer patients who receive adjuvant HDR-vaginal BT after surgery. A randomized trial comparing HA treatment vs. no local treatment in this clinical setting is warranted to further evaluate the efficacy of HA in preventing vaginal BT-related vaginal toxicity.

  10. [Scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit].

    Science.gov (United States)

    Sumano-Ziga, Erika; Veloz-Martínez, María Guadalupe; Vázquez-Rodríguez, Juan Gustavo; Becerra-Alcántara, Geomar; Jimenez Vieyra, Carlos Ramón

    2015-01-01

    Patients with placenta accreta have a high frequency of complications and death risk. The aim of this study was to compare the results of scheduled hysterectomy vs. urgent hysterectomy in patients with placenta accreta in a high specialty medical unit. An observational, comparative, cross-sectional study was conducted by reviewing patient records with confirmed diagnostic of placenta accreta, who attended in a one year period. They were divided into 2 groups based on the type of surgery, scheduled or urgent. Descriptive statistics were applied, with comparisons using Student t-test and chi squared tests. A value of Pplacenta accreta. The mean maternal age was 32 years, with a mean of 5 hours operating time, total bleeding 3135 ml, and 3.5 units of packed cells transfused. There was no statistical difference when comparing these variables with re-interventions, hypovolaemic shock, and intensive care unit admission. Caesarean-hysterectomy with hypogastric artery ligation was the most frequent surgery performed. In this hospital, scheduled and urgent surgical treatment of patients with placenta accreta show similar results, probably because the constant availability of resources and the experience obtained by the multidisciplinary team in all shifts. Nevertheless, make absolutely sure to perform elective surgery while having all the necessary resources. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  11. VESICO VAGINAL FISTULAS – AN EXPERIENCE AT TERTIARY CARE CENTRE IN ANDHRA PRADESH

    Directory of Open Access Journals (Sweden)

    Suniti

    2015-10-01

    Full Text Available Vesicovaginal fistula (VVF is a preventable calamity, which has been an age - long menace in developing countries. The etiology of VVF has shifted from obstructed labor to post - surgical complication due to good obstetric care at primary health centers. In the present study a total of 35 patients with vesico - vaginal fistulas were operated during the 5 years period of study. The most common etiology was post - surgical complication following hysterectomy and caesarian section in 71.42% of cases. Most of the fistulas were simple. The success rate after surgery was 91.4%.Recurrence was seen in 3 cases and is mostly due to complex fistulas

  12. Minimally invasive hysterectomy in Coatis ( Nasua nasua

    Directory of Open Access Journals (Sweden)

    Bruno W. Minto

    Full Text Available ABSTRACT: Some wildlife species, such as coatis, have a high degree of adaptability to adverse conditions, such as fragmented urban forests, increasingly common on the world stage. The increase in the number of these mesopredators causes drastic changes in the communities of smaller predators, interferes with reproductive success of trees, as well as becoming a form of exchange between domestic and wild areas, favoring the transmission of zoonosis and increasing the occurrence of attacks to animals or people. This report describes the use of minimally invasive hysterectomy in two individuals of the species Nasua nasua, which can be accomplished through the use of hook technique, commonly used to castrate dogs and cats. The small incision and healing speed of incised tissues are fundamental in wild life management since the postoperative care is limited by the behavior of these animals. This technique proved to be effective and can greatly reduce the morbidity of this procedure in coatis.

  13. Single-incision total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Sinha Rakesh

    2011-01-01

    Full Text Available Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical port affords maximum cosmetic benefits because the surgical incision is hidden in the umbilicus. The advantages of single-access laparoscopic surgery may include less bleeding, infection, and hernia formation and better cosmetic outcome and less pain. The disadvantages and limitations include longer surgery time, difficulty in learning the technique, and the need for specialized instruments. Ongoing refinement of the surgical technique and instrumentation is likely to expand its role in gynecologic surgery in the future. We perform single-incision total laparoscopic hysterectomy using three ports in the single transumbilical incision.

  14. Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-year ...

    African Journals Online (AJOL)

    : This was to determine the incidence, indications, and outcomes of emergency peripartum hysterectomy at a tertiary hospital in Nnewi, south–east Nigeria. Materials and Methods: A retrospective study of the case files of patients requiring an ...

  15. Cost-Effectiveness Analysis of Morcellation Hysterectomy for Myomas.

    Science.gov (United States)

    Bortoletto, Pietro; Einerson, Brett D; Miller, Emily S; Milad, Magdy P

    2015-01-01

    To estimate the cost-effectiveness of eliminating morcellation in the surgical treatment of leiomyomas from a societal perspective. Cost-effectiveness analysis. Not applicable. A theoretical cohort of women undergoing hysterectomy for myoma disease large enough to require morcellation. None. None. A decision analysis model was constructed using probabilities, costs, and utility data from published sources. A cost-effectiveness analysis analyzing both quality-adjusted life years (QALYs) and cases of disseminated cancer was performed to determine the incremental cost-effectiveness ratio (ICER) of eliminating morcellation as a tool in the surgical treatment of leiomyomas. Costs and utilities were discounted using standard methodology. The base case included health care system costs and costs incurred by the patient for surgery-related disability. One-way sensitivity analyses were performed to assess the effect of various assumptions. The cost to prevent 1 case of disseminated cancer was $10 540 832. A strategy of nonmorcellation hysterectomy via laparotomy costed more ($30 359.92 vs $20 853.15) and yielded more QALYs (21.284 vs 21.280) relative to morcellation hysterectomy. The ICER for nonmorcellation hysterectomy compared with morcellation hysterectomy was $2 184 172 per QALY. Health care costs (prolonged hospitalizations) and costs to patients of prolonged time away from work were the primary drivers of cost differential between the 2 strategies. Even when the incidence of occult sarcoma in leiomyoma surgery was ranged to twice that reported in the literature (.98%), the ICER for nonmorcellation hysterectomy was $644 393.30. Eliminating morcellation hysterectomy as a treatment for myomas is not cost-effective under a wide variety of probability and cost assumptions. Performing laparotomy for all patients who might otherwise be candidates for morcellation hysterectomy is a costly policy from a societal perspective. Copyright © 2015 AAGL. Published by Elsevier Inc

  16. Vaginitis: MedlinePlus Health Topic

    Science.gov (United States)

    ... Spanish Vulvovaginitis - overview (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Vaginitis updates by ... Vaginitis test - wet mount Vulvovaginitis - overview Related Health Topics Trichomoniasis Vaginal Diseases Yeast Infections Other Languages Find ...

  17. A systematic review of ectopic pregnancy after hysterectomy.

    Science.gov (United States)

    Shao, Emily X; Hopper, Kendra; McKnoulty, Matthew; Kothari, Alka

    2017-11-09

    An ectopic pregnancy after hysterectomy is a rare but potentially life-threatening event. Women with this condition might not be appropriately investigated, resulting in delays in diagnosis and treatment. To characterize cases of ectopic pregnancy occurring after hysterectomy. PubMed, Embase, Scopus, and Web of Science were searched using the terms "pregnancy, abdominal" or "pregnancy, tubal" or "pregnancy, ectopic" and "hysterectomy" or "post-hysterectomy" or "post hysterectomy." Case reports or case series published in English up to October 10, 2016, were included. Patients were included if the diagnosis was confirmed by definitive tests such as serum or urine β-human chorionic gonadotropin (β-hCG) testing, ultrasonography evidence of pregnancy, or histology. Patient characteristics were extracted via a standard spreadsheet. A total of 57 patients were included in the analysis. Abdominal pain was the predominant symptom. Implantation in a remaining fallopian tube was common. Most patients were managed surgically. A high index of suspicion and a low threshold for performing a β-hCG pregnancy test is recommended in all women presenting with clinical symptoms of ectopic pregnancy, regardless of the hysterectomy status. This could lead to earlier diagnosis and fewer complications. © 2017 International Federation of Gynecology and Obstetrics.

  18. POLYMETABOLIC DISORDERS AFTER HYSTERECTOMY: A CHANCE OR A RULE?

    Directory of Open Access Journals (Sweden)

    V. I. Podzolkov

    2011-01-01

    Full Text Available Aim. To study the dynamic of metabolic disorders in patients after hysterectomy with intact ovaries. Material and methods. 104 women (aged 44.0±2.1 after hysterectomy with intact ovaries were examined. All patients were split into three subgroups according to time after hysterecto- my (1, 3, and 5 years. 25 women (aged 43.0±1.6 with normal menstrual function were included into the control group. Blood pressure (BP levels and body mass index were measured. Serum lipids profile, plasma levels of immune-reactive insulin (IRI and C-peptide were investigated in fasting condition and after oral glucose tolerance test. Results. Increase in time after hysterectomy was associated with significant elevation of body mass index, systolic and diastolic BP , basal and stimulated IRI and C-peptide levels, as well as serum levels of total cholesterol and low density lipoprotein cholesterol. These parameters had significant positive correlations with time after hysterectomy. Conclusion. Polymetabolic disorders were more prominent in patients with longer time after hysterectomy. These findings can be basis for definition of post-hysterectomy metabolic syndrome stages.

  19. Emergency peripartum hysterectomy in Isfahan; maternal mortality and morbidity rates among the women who underwent peripartum hysterectomy

    Directory of Open Access Journals (Sweden)

    Fatemeh Mostajeran Gurtani

    2013-01-01

    Conclusion : This study indicated the high rate of mortality among patients underwent peripartum hysterectomy. Evaluation of management during referring the patients and designing more studies to evaluate the mortality and morbidities are warranted.

  20. Vaginal Vault Prolapse

    Directory of Open Access Journals (Sweden)

    Azubuike Uzoma

    2009-01-01

    Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article. Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future.

  1. Vaginal haemangioendothelioma: an unusual tumour.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Vaginal tumours are uncommon and this is a particularly rare case of a vaginal haemangioendothelioma in a 38-year-old woman. Initial presentation consisted of symptoms similar to uterovaginal prolapse with "something coming down". Examination under anaesthesia demonstrated a necrotic anterior vaginal wall tumour. Histology of the lesion revealed a haemangioendothelioma which had some features of haemangiopericytoma. While the natural history of vaginal haemangioendothelioma is uncertain, as a group, they have a propensity for local recurrence. To our knowledge this is the third reported case of a vaginal haemangioendothelioma. Management of this tumour is challenging given the paucity of literature on this tumour. There is a need to add rare tumours to our "knowledge bank" to guide management of these unusual tumours.

  2. Cost-Effectiveness of Laparoscopic Hysterectomy With Morcellation Compared With Abdominal Hysterectomy for Presumed Myomas.

    Science.gov (United States)

    Rutstein, Sarah E; Siedhoff, Matthew T; Geller, Elizabeth J; Doll, Kemi M; Wu, Jennifer M; Clarke-Pearson, Daniel L; Wheeler, Stephanie B

    2016-02-01

    Hysterectomy for presumed leiomyomata is 1 of the most common surgical procedures performed in nonpregnant women in the United States. Laparoscopic hysterectomy (LH) with morcellation is an appealing alternative to abdominal hysterectomy (AH) but may result in dissemination of malignant cells and worse outcomes in the setting of an occult leiomyosarcoma (LMS). We sought to evaluate the cost-effectiveness of LH versus AH. Decision-analytic model of 100 000 women in the United States assessing the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life-year (QALY) gained (Canadian Task Force classification III). U.S. hospitals. Adult premenopausal women undergoing LH or AH for presumed benign leiomyomata. We developed a decision-analytic model from a provider perspective across 5 years, comparing the cost-effectiveness of LH to AH in terms of dollar (2014 US dollars) per QALY gained. The model included average total direct medical costs and utilities associated with the procedures, complications, and clinical outcomes. Baseline estimates and ranges for cost and probability data were drawn from the existing literature. Estimated overall deaths were lower in LH versus AH (98 vs 103). Death due to LMS was more common in LH versus AH (86 vs 71). Base-case assumptions estimated that average per person costs were lower in LH versus AH, with a savings of $2193 ($24 181 vs $26 374). Over 5 years, women in the LH group experienced 4.99 QALY versus women in the AH group with 4.91 QALY (incremental gain of .085 QALYs). LH dominated AH in base-case estimates: LH was both less expensive and yielded greater QALY gains. The ICER was sensitive to operative costs for LH and AH. Varying operative costs of AH yielded an ICER of $87 651/QALY gained (minimum) to AH being dominated (maximum). Probabilistic sensitivity analyses, in which all input parameters and costs were varied simultaneously, demonstrated a relatively robust model. The AH approach was dominated

  3. Vaginal pressure during daily activities before and after vaginal repair

    DEFF Research Database (Denmark)

    Mouritsen, L; Hulbaek, M; Brostrøm, S

    2007-01-01

    The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest...... was not related to the type of vaginal repair. The results imply that post-operative counselling should concentrate more on treating chronic cough and constipation than restrictions of moderate physical activities.......The objective of the study was to measure vaginal pressure during various daily activities in patients before and after vaginal surgery for pelvic organ prolapse, searching data for evidence-based activity guidelines. Vaginal pressure (VP) was studied in 23 patients during activities such as rest...... and lifting 2 and 5 kg. Lifting in the walking position created a slightly higher VP compared to other lifting techniques, which did not differ. The VP did not increase when lifting 5 kg compared to 2 kg. Mean VP during coughing and Valsalva were significantly lower 1-5 days after the operation. VP...

  4. Treatment of bulky stage IB and IIB cervical cancers with outpatient neutron brachytherapy, external pelvic radiation and extrafascial hysterectomy

    Energy Technology Data Exchange (ETDEWEB)

    Van Nagell, J.R.; Maruyama, Y.; Yoneda, J.; Donaldson, E.S.; Hanson, M.B.; Gallion, H.H.; Powell, D.E.; Kryscio, R.J.

    1986-01-01

    From January, 1977, to December, 1982, twenty-nine patients with bulky (>4 cms diameter) Stage IB or IIB cervical cancer were treated at the University of Kentucky Medical Center by a combination of out-patient neutron brachytherapy (Cf-252) and external pelvic radiation followed by extrafascial hysterectomy. Residual tumor was present in the hysterectomy specimens of 25 per cent. Complications during and following radiation therapy and surgery were minimal and included vaginal stenosis, proctitis, and hemorrhagic cystitis. The mean duration of hospitalization for surgery in these patients was 6.6 days (range 5-15 days) and postoperative morbidity was low. No patient required blood transfusion. Four patients developed urinary tract infections and two had superficial wound separations. Following treatment, patients were seen at monthly intervals for one year, every three months for two years, and every six months thereafter. No patient has been lost to follow-up. Two patients (7 per cent) developed tumor recurrence and have died of disease (1 of distant metastases; 1 local). The remaining 27 patients (93 per cent) are alive and well with no evidence of disease 24-89 months (mean 48 months) after therapy. No radiogenic fistulae or bowel obstruction were observed. These preliminary results suggest that the combination of outpatient neutron brachytherapy, external pelvic radiation, and extrafascial hysterectomy for patients with Stage IB and IIB cervical cancer is well tolerated. Complications associated with this treatment regimen have been minimal, and the recurrence rate is low. The duration of intracavitary neutron brachytherapy was short, and outpatient therapy was well received by patients.

  5. Early Feeding After a Total Abdominal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Mary Flesher

    2009-02-01

    Full Text Available Background: Oral fluids and food are traditionally introduced slowly after total abdominal hysterectomy (TAH. This descriptive study examined the effect and tolerance of early oral intake following this surgery. Methods: A retrospective chart review was conducted on 164 patients who had been on a clinical pathway following TAH. Comparisons in initiation of fluids and foods, and gastrointestinal effects were made between the early fed group (n=82 and the traditionally fed group (n=82. Results: Both groups had the similar gastrointestinal symptoms postoperatively, but the early fed group had an earlier bowel movement. The early fed group had a statistically significant shorter length of stay. Similar usage of anti-nausea medication and pain medication usage was noted between the two groups, except for a lower usage of Tylenol #3 (acetaminophen with codeine in the early fed group. Conclusions: This study found that early feeding could be tolerated well in TAH patients, with statistically significant improvements in usage of some pain medication and length of stay were noted in the early fed group.

  6. Vaginal microbicides: An overview

    Directory of Open Access Journals (Sweden)

    Hany Abdel-Aleem

    2011-03-01

    Full Text Available It is estimated that more than 340 million new cases of curable sexually transmitted infections occur every year throughout the world in men and women age (15–49years. Women bear an increasing burden of the epidemic as both caregivers for the ill and because of their heightened risk of infection due to biological, economic and social vulnerabilities. There is an urgent need for new prevention strategies that women can use themselves and initiate. A vaginal microbicide defined as substances intended to reduce or prevent transmission of HIV and/or other sexually transmitted infections (STIs when applied topically to genital mucosal surfaces, provides a woman-controlled method applied before sex that could kill, neutralize, or block HIV and other sexually transmitted diseases.

  7. Vaginoscopic resection of vaginal septum.

    Science.gov (United States)

    Nassif, Joseph; Al Chami, Ali; Abu Musa, Antoine; Nassar, Anwar H; Kurdi, Ahmed Toufic; Ghulmiyyah, Labib

    2012-12-01

    We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect.

  8. Surgical and oncological outcome of total laparoscopic radical hysterectomy in obese women with early-stage cervical cancer.

    Science.gov (United States)

    Moss, Esther Louise; Balega, Janos; Chan, Kiong K; Singh, Kavita

    2012-01-01

    To evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m) and nonobese (BMI cervical cancer. Patients were classified as obese, BMI >30 kg/m, or nonobese, BMI obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2-13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3-42 months). She belonged to the nonobese group. The TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.

  9. Management of menorrhagia in primary care—impact on referral and hysterectomy: data from the Somerset Morbidity Project

    Science.gov (United States)

    Grant, C.; Gallier, L.; Fahey, T.; Pearson, N.; Sarangi, J.

    2000-01-01

    OBJECTIVE—To investigate the management of menorrhagia in primary care and its impact on referral and hysterectomy rates.
DESIGN—Prospective observational study.
SETTING—11 general practices from the Somerset Morbidity Project.
SUBJECTS—885 women consulting their general practitioner with menorrhagia over four years.
MAIN OUTCOME MEASURES—Proportions of these women investigated and treated with drugs in primary care, referred to a gynaecologist and undergoing operative procedures. The relation between investigation and prescribing in primary care and referral to and surgery in secondary care.
RESULTS—Less than half of women had a vaginal examination (42%, 95% CI 39% to 45%), or a full blood count (39%, 95% CI 36% to 43%). Almost a quarter of women, 23% (95% CI 20% to 26%), received no drugs and 37% (95% CI 34% to 40%) received norethisterone. Over a third, 38% (95% CI 34% to 40%), of women were referred, and once referred 43% (95% CI 38% to 48%) of women were operated on. Women referred to a gynaecologist were significantly more likely to have received tranexamic acid and/or mefenamic acid in primary care (χ2=16.4, df=1, pmenorrhagia in primary care. Rates of prescribing of effective medical treatment remain low. The decision to refer a woman impacts markedly on her chances of subsequently being operated on. Effective management in primary care may not reduce referral or hysterectomy rates.

 PMID:10942454

  10. A case report of delayed diagnosis of uterine rupture following vaginal delivery

    Directory of Open Access Journals (Sweden)

    Vanessa Falé Rosado

    2017-08-01

    Full Text Available Introduction: A uterine rupture is still a rare event but its incidence appears to be increasing, even in the unscarred uterus. In our case, the uterine rupture presented itself in an unscarred uterus and after a vaginal delivery. Case report: A 36 years old women with three previous normal deliveries, comes to our hospital for assistance at 32 weeks with a poor pregnancy surveillance. After diagnosing Gestational Diabetes, she is admitted for therapeutic adjustment. She is discharged after achieving metabolic control but comes back a few days later with a stillbirth, born by vaginal delivery. Six days later she presents with: fever and pain; anemia leukocytosis and a heterogeneous image on ultrasound. However, was decided to start intravenous antibiotics before choosing for surgery. Her condition worsens and an exploratory laparotomy is done: a posterior uterine wall rupture that required a hysterectomy. Conclusion: Risk factors for uterine rupture were present (maternal age over 35, higher parity, fetal macrosomia but the absence of any symptom, the normal examination after delivery, and mostly, an unscarred uterus, resulted in a delay in the diagnosis of more than one week, leading to catastrophic consequences: hysterectomy. This case reminds us that uterine rupture happens not only in case of previous uterine surgery, and these cases seem to be increasing because of the increase in other risk factors: advanced maternal age and diabetes with resulting fetal macrosomia.

  11. Vaginal extrusion of a ventriculo-peritoneal shunt catheter in an adult.

    Science.gov (United States)

    Bonfield, Christopher M; Weiner, Gregory M; Bradley, Megan S; Engh, Johnathan A

    2015-01-01

    Ventriculo-peritoneal shunts (VPS) are commonly used in the treatment of various neurosurgical conditions, including hydrocephalus and pseudotumor cerebri. We report only the second case of vaginal extrusion of a VPS catheter in an adult, and the first case with a modern VPS silastic peritoneal catheter. A 45-year-old female with a history of VPS for pseudotumor cerebri, Behcet's syndrome, and hysterectomy presented to our institution with the chief complaint of tubing protruding from her vagina after urination. On gynecologic examination, the patient was found to have approximately 15 cm of VPS catheter protruding from her vaginal apex. A computed tomography scan of the abdomen and shunt X-ray series demonstrated no breaks in the tubing, but also confirmed the finding of the VPS catheter extruding through the vaginal cuff into the vagina. The patient had the VPS removed and an external ventricular drain was placed for temporary cerebrospinal fluid diversion. Ventricular catheter cultures were positive for diphtheroids. After an appropriate course of antibiotics, a contralateral ventriculo-pleural shunt was placed one week later. Although vary rare, vaginal extrusion can occur in adults, even with modern VPS catheters.

  12. Vaginal extrusion of a ventriculo-peritoneal shunt catheter in an adult

    Directory of Open Access Journals (Sweden)

    Christopher M Bonfield

    2015-01-01

    Full Text Available Ventriculo-peritoneal shunts (VPS are commonly used in the treatment of various neurosurgical conditions, including hydrocephalus and pseudotumor cerebri. We report only the second case of vaginal extrusion of a VPS catheter in an adult, and the first case with a modern VPS silastic peritoneal catheter. A 45-year-old female with a history of VPS for pseudotumor cerebri, Behcet′s syndrome, and hysterectomy presented to our institution with the chief complaint of tubing protruding from her vagina after urination. On gynecologic examination, the patient was found to have approximately 15 cm of VPS catheter protruding from her vaginal apex. A computed tomography scan of the abdomen and shunt X-ray series demonstrated no breaks in the tubing, but also confirmed the finding of the VPS catheter extruding through the vaginal cuff into the vagina. The patient had the VPS removed and an external ventricular drain was placed for temporary cerebrospinal fluid diversion. Ventricular catheter cultures were positive for diphtheroids. After an appropriate course of antibiotics, a contralateral ventriculo-pleural shunt was placed one week later. Although vary rare, vaginal extrusion can occur in adults, even with modern VPS catheters.

  13. Safety of total laparoscopic modified radical hysterectomy with or without lymphadenectomy for endometrial cancer

    Directory of Open Access Journals (Sweden)

    Masakazu Kitagawa

    2017-02-01

    Conclusion: Total laparoscopic modified radical hysterectomy is safe and feasible for the treatment of early stage endometrial cancer. This procedure can be an alternative to total laparoscopic hysterectomy, especially when the uterus must be removed completely.

  14. Low-Dose-Rate Definitive Brachytherapy for High-Grade Vaginal Intraepithelial Neoplasia

    Science.gov (United States)

    Monnier, Laurie; Dumas, Isabelle; Morice, Philippe; Pautier, Patricia; Duvillard, Pierre; Azoury, Fares; Mazeron, Renaud; Haie-Meder, Christine

    2011-01-01

    Background. Treatment of high-grade vaginal intraepithelial neoplasia (VAIN) is controversial and could include surgical excision, topical medication, brachytherapy, or other treatments. We report the results of low-dose-rate (LDR) vaginal brachytherapy for grade 3 VAIN (VAIN-3) over a 25-year period at Gustave Roussy Institute. Patients and Methods. We retrospectively reviewed the files of all patients treated at Gustave Roussy Institute for VAIN-3 since 1985. The treatment consisted of LDR brachytherapy using a personalized vaginal mold and delivered 60 Gy to 5 mm below the vaginal mucosa. All patients had at least an annual gynecological examination, including a vaginal smear. Results. Twenty-eight patients were eligible. The median follow-up was 41 months. Seven patients had a follow-up brachytherapy was 63 years (range, 38–80 years). Twenty-six patients had a history of VAIN recurring after cervical intraepithelial neoplasia and 24 had a previous hysterectomy. The median brachytherapy duration was 4.5 days. Median doses to the International Commission of Radiation Units and Measurements rectum and bladder points were 68 Gy and 45 Gy, respectively. The median prescription volume (60 Gy) was 74 cm3. Only one “in field” recurrence occurred, corresponding to a 5- and 10-year local control rate of 93% (95% confidence interval, 70%–99%). The treatment was well tolerated, with no grade 3 or 4 late toxicity and only one grade 2 digestive toxicity. No second cancers were reported. Conclusion. LDR brachytherapy is an effective and safe treatment for vaginal intraepithelial neoplasia. PMID:21262875

  15. Adjuvant chemotherapy for endometrial cancer after hysterectomy

    Science.gov (United States)

    Johnson, Nick; Bryant, Andrew; Miles, Tracie; Hogberg, Thomas; Cornes, Paul

    2014-01-01

    Background Endometrial adenocarcinoma (womb cancer) is a malignant growth of the lining (endometrium) of the womb (uterus). It is distinct from sarcomas (tumours of the uterine muscle). Survival depends the risk of microscopic metastases after surgery. Adjuvant (postoperative) chemotherapy improves survival from some other adenocarcinomas, and there is evidence that endometrial cancer is sensitive to cytotoxic therapy. This systematic review examines the effect of chemotherapy on survival after hysterectomy for endometrial cancer. Objectives To assess efficacy of adjuvant (postoperative) chemotherapy for endometrial cancer. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2010, Issue 3), MEDLINE and EMBASE up to August 2010, registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Selection criteria Randomised controlled trials (RCTs) comparing adjuvant chemotherapy with any other adjuvant treatment or no other treatment. Data collection and analysis We used a random-effects meta-analysis to assess hazard ratios (HR) for overall and progression-free survival and risk ratios (RR) to compare death rates and site of initial relapse. Main results Five RCTs compared no additional treatment with additional chemotherapy after hysterectomy and radiotherapy. Four trials compared platinum based combination chemotherapy directly with radiotherapy. Indiscriminate pooling of survival data from 2197 women shows a significant overall survival advantage from adjuvant chemotherapy (RR (95% CI) = 0.88 (0.79 to 0.99)). Sensitivity analysis focused on trials of modern platinum based chemotherapy regimens and found the relative risk of death to be 0.85 ((0.76 to 0.96); number needed to treat for an additional beneficial outcome (NNT) = 25; absolute risk reduction = 4% (1% to 8%)). The HR for overall survival is 0.74 (0.64 to 0.89), significantly

  16. Urinary incontinence - vaginal sling procedures

    Science.gov (United States)

    ... your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried ... vaginal sling; Transobturator sling; Midurethral sling Patient Instructions Kegel exercises - self-care Self catheterization - female Suprapubic catheter ...

  17. Drugs Approved for Vaginal Cancer

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) to prevent vaginal cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

  18. Vaginal itching and discharge - child

    Science.gov (United States)

    ... Images Female reproductive anatomy Causes of vaginal itching Uterus References Davis AJ, Katz VL. Pediatric and adolescent gynecology: gynecologic examination, infections, trauma, pelvic mass, precocious puberty. In: Lentz GM, Lobo ...

  19. Decreasing trend of hysterectomy in Taiwan: A population-based study, 1997–2010

    Directory of Open Access Journals (Sweden)

    Jerry Cheng-Yen Lai

    2015-10-01

    Conclusion: The clinical utilization and primary indications of hysterectomy changed substantially in Taiwan from 1997 to 2010. The continued monitoring of changes in hysterectomy rates will be critical for understanding the appropriate indications for hysterectomy and oophorectomy, the emergence of alternative managements for uterine disorders, and future trends in women's reproductive health.

  20. Extensive cellulitis as the first symptom of ureter lesion after laparoscopic hysterectomy

    NARCIS (Netherlands)

    Ooijen, P. van; Haar, J.F. ter; Pijnenborg, J.M.A.

    2011-01-01

    Laparoscopic hysterectomy as an alternative to abdominal hysterectomy is frequently performed for benign uterine pathology. Although laparoscopic hysterectomy is associated with less pain, quicker recovery, and better short-term quality of life, it is associated with an increased risk of ureter

  1. The indication for hysterectomy as a risk factor for subsequent pelvic organ prolapse repair

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate whether the indication for hysterectomy was itself a risk factor for subsequent pelvic organ prolapse (POP) in Danish women who underwent hysterectomy from 1977 to 2009. METHODS: Data from 154,882 women who underwent hysterectomy...

  2. Vaginal reconstructive surgery for severe pelvic organ prolapses: a 'uterine-sparing' technique using polypropylene prostheses.

    Science.gov (United States)

    De Vita, D; Araco, F; Gravante, G; Sesti, F; Piccione, E

    2008-08-01

    The Ulmsten's "Integral Theory" for pelvic floor dysfunctions is based on the need to reinforce fascias and ligaments with prostheses to obtain a reconstitution of the pelvic floor's anatomy. In September 2004 we developed a "uterine-sparing" surgical technique to correct such pathologies and in this paper we present results obtained. Primary outcome was to evaluate the technique's efficacy, secondary outcomes the resolution of stress urinary incontinence, postoperative pain (VAS scale), safety and complications. This prospective study included patients affected by stage 3 and 4 uterine-vaginal prolapse who wished to conserve their uterus. Those with (1) minor degrees of severity, (2) unfit for surgery, (3) with a clear indication to hysterectomy (i.e. endometrial cancer), (4) with an elevated operative risk (American Society of Anaesthesiologists-ASA score III and IV), (5) previous vaginal surgeries and (6) with moderate/severe defecation problems were excluded. The technique consisted in a sacrospinous colposuspension with polypropylene mesh. The pelvic status was classified according to the international Pelvic Organ Prolapse staging system (POP-Q). Postoperative pain was scored with the VAS Scale. All patients were given the King's Health questionnaire, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Wexner questionnaire. From September 2004 to November 2006 we treated 80 patients. Polypropylene prostheses (Gynemesh-Soft PS, 10cmx15cm - GyneMesh, Gynecare Ethicon - Somerville, NJ, USA) were used to reconstruct the pubo-cervix or the recto-vaginal fascia. We performed an anterior-central vaginal reconstruction in 35 (43.8%) patients, central-posterior in 25 (31%) and total reconstruction in 20 (25%). The median follow-up was 21 months (range 18-26). The severe pelvic prolapse, evaluated with the POP-Q System, was completely treated in all the patients and no recurrences were observed. The urodynamic examination showed a

  3. Predictors of the vaginal microflora.

    Science.gov (United States)

    Newton, E R; Piper, J M; Shain, R N; Perdue, S T; Peairs, W

    2001-04-01

    Our purpose was to define influences on the patterns of the vaginal microflora. We enrolled 617 African American and Mexican American women in a 1-year longitudinal study of sexual behaviors and the vaginal microflora on the basis of the presence of gonorrhea, chlamydial infection, trichomoniasis, or syphilis at the initial visit. The patients were assigned randomly to a behavioral intervention or standard counseling regarding sexually transmitted disease. We reevaluated 508 (82%) and 549 (89%) women at 6 and 12 months, respectively. A comprehensive survey of lower genital tract organisms was conducted at baseline and at 6 and 12 months. Behavioral and microbiologic associations were screened by bivariate analysis. All variables associated with an organism at P 3 times a week, and cunnilingus, fellatio, and anal intercourse at the last sexual encounter. M hominis (but not Ureaplasma urealyticum ), Gardnerella vaginalis, and Lactobacillus species were associated with bacterial vaginosis. Lactobacillus species appeared to protect against bacterial vaginosis and infection with G vaginalis. Sexually transmitted diseases (caused by M hominis, N gonorrhoeae, C trachomatis, and T vaginalis ) were associated with each other. In contrast, hormonal status, vaginal blood, and foreign bodies had little effect. The presence of other microorganisms and race have a more consistent association with the presence or absence of a cervical-vaginal organism than sexual behavior, hormonal status, vaginal devices, or the presence of abnormal vaginal bleeding.

  4. Parecoxib versus dipyrone (metamizole) for postoperative pain relief after hysterectomy : a prospective, single-centre, randomized, double-blind trial.

    Science.gov (United States)

    Soltesz, Stefan; Gerbershagen, Mark U; Pantke, Bernhard; Eichler, Frank; Molter, Gerd

    2008-01-01

    Selective cyclo-oxygenase-2 (COX-2) inhibitors provide postoperative pain relief similar to conventional NSAIDs. However, many of these non-opioid analgesics are available only for oral administration, and are therefore ineffective in patients experiencing postoperative nausea or vomiting. The aim of this study was to compare the analgesic efficacy of the COX-2 inhibitor parecoxib with that of dipyrone (metamizole) administered intravenously for 48 hours after vaginal hysterectomy. Fifty women undergoing vaginal hysterectomy under general anaesthesia were randomly assigned to two groups: the parecoxib group, who received intravenous parecoxib 40 mg intraoperatively and every 12 hours after surgery over a period of 48 hours, and the dipyrone group, who received intravenous dipyrone 2.5 g injected intraoperatively, followed by dipyrone 1 g every 6 hours after surgery over a period of 48 hours. Because of the double-blinded study protocol, patients in the parecoxib groups were required to receive placebo infusions 6, 18, 30 and 42 hours after the operation. Visual analogue scale (VAS [scale 0-10]) scores were recorded 0.5, 1, 2, 3, 4, 6, 9, 12, 15, 18, 24, 36 and 48 hours after surgery. To assess the cumulative opioid administration, all patients were fitted with an intravenous patient-controlled analgesia (PCA) device containing the opioid piritramide. An alpha value of 0.05 was considered statistically significant. VAS scores did not differ between groups with one exception: VAS scores were lower in the parecoxib group 12 hours after surgery than in the dipyrone group (1 and 2, respectively; p < 0.05). No significant differences in cumulative piritramide administration were measured between groups 1 hour or 24 hours after surgery (parecoxib 14.7 [+/- SD 4.4] and 30.6 [+/- 12.8] mg, respectively; dipyrone 11.8 [+/- 4.9] and 36.5 [+/- 10.7] mg, respectively). Parecoxib 40 mg twice daily provides postoperative pain relief equivalent to that of dipyrone 4 g daily during

  5. TOTAL PLACENTA PREVIA AND PERIPARTUM HYSTERECTOMY – CASE REPORT

    Directory of Open Access Journals (Sweden)

    Vladimir Weber

    2018-02-01

    Full Text Available Background. Postpartum haemorrhage usually occurs due to uterus atonia, adherent placenta, placenta accreta, coagulopathy or uterus rupture. In total placenta previa haemorrhage occurs more often and usually is more severe. Case report. We presented the example of severe postpartum haemorrhage with parturient woman after scheduled Caesarean section, due to total placenta previa, which was ended by performing hysterectomy. Conclusions. In postpartum haemorrhage, the treatment is conservative and if there is no improvement timely surgery is required. Abdominal hysterectomy is the final option and in case of severe haemorrhage it proved to be life saving for parturient woman.

  6. Vaginal estrogens for the treatment of dyspareunia.

    Science.gov (United States)

    Krychman, Michael L

    2011-03-01

    Vaginal atrophy, which is associated with vaginal itching, burning, dryness, irritation, and pain, is estimated to affect up to 40% of postmenopausal women. Estrogens play a key role in maintaining vaginal health; women with low serum estradiol are more likely to experience vaginal dryness, dyspareunia, and reduced sexual activity compared with women who have higher estradiol levels. The purpose of this review is to assess the prevalence and impact of dyspareunia, a symptom of vaginal atrophy, on the health of postmenopausal women and to evaluate treatment options using vaginal estrogens (U.S. Food and Drug Administration [FDA] approved). Relevant published literature was identified by searching Index Medicus using the PubMed online database. The search terms dyspareunia, vaginal estrogen, vaginal hormone therapy, vaginal atrophy, and atrophic vaginitis were the focus of the literature review. Current treatment guidelines for vaginal atrophy recommend the use of minimally absorbed local vaginal estrogens, along with non-hormonal lubricants or moisturizers, coupled with maintenance of sexual activity. Vaginal estrogen therapy has been shown to provide improvement in the signs and symptoms of vaginal or vulvar atrophy. Vaginal tablets, rings, and creams are indicated for the treatment of vaginal atrophy, and the FDA has recently approved a low-dose regimen of conjugated estrogens cream to treat moderate-to-severe postmenopausal dyspareunia. The use of low-dose vaginal estrogens has been shown to be effective in treating symptoms of vaginal atrophy without causing significant proliferation of the endometrial lining, and no significant differences have been seen among vaginal preparations in terms of endometrial safety. Women should be informed of the potential benefits and risks of the treatment options available, and with the help of their healthcare provider, choose an intervention that is most suitable to their individual needs and circumstances. © 2010

  7. [Anterior approach sacrospinous colpopexy in a patient with vaginal vault prolapse, stress urinary incontinence and cystocoele with lateral defect].

    Science.gov (United States)

    Malinowski, Andrzej; Bobin, Leszek; Maciołek-Blewniewska, Grazyna

    2006-03-01

    We present a case of vaginal vault prolapse after hysterectomy associated with cystocoele with central and lateral defect and stress urinary incontinence, that was treated surgically with employment of sacrospinous colpopexy through anterior approach (from paravesical space), combined with anterior colporrhaphy by double TOT approach method (that is a butterfly-shaped polipropylen mesh, which arms were carried through upper and lower parts of obturator foramens by tension-free method). There were no postoperative complications. A control examination at 1 and 3 months after the operation showed maintenance of normal anatomic relations, which were obtained as a result of repair, total control of urinary continence and full patient's satisfaction from the operation.

  8. High-intensity focused ultrasound treatment of placenta accreta after vaginal delivery: a preliminary study.

    Science.gov (United States)

    Bai, Y; Luo, X; Li, Q; Yin, N; Fu, X; Zhang, H; Qi, H

    2016-04-01

    To evaluate the safety and efficiency of high-intensity focused ultrasound (HIFU) in the treatment of placenta accreta after vaginal delivery. Enrolled into this study between September 2011 and September 2013 were 12 patients who had been diagnosed with placenta accreta following vaginal delivery and who had stable vital signs. All patients were treated using an ultrasound-guided HIFU treatment system. As indication of the effectiveness of the treatment we considered decreased vascular index on color Doppler imaging, decrease in size of residual placenta compared with pretreatment size on assessment by three-dimensional ultrasound with Virtual Organ Computer-aided Analysis, reduced signal intensity and degree of enhancement on magnetic resonance imaging and avoidance of hysterectomy following treatment. To assess the safety of HIFU treatment, we recorded side effects, hemorrhage, infection, sex steroid levels, return of menses and subsequent pregnancy. Patients were followed up in this preliminary study until December 2013. The 12 patients receiving HIFU treatment had an average postpartum hospital stay of 6.8 days and an average period of residual placental involution of 36.9 days. HIFU treatment did not apparently increase the risk of infection or hemorrhage and no patient required hysterectomy. In all patients menstruation recommenced after an average of 80.2 days, and sex steroid levels during the middle luteal phase of the second menstrual cycle were normal. Two patients became pregnant again during the follow-up period. This preliminary study suggests that ultrasound-guided HIFU is a safe and effective non-invasive method to treat placenta accreta patients after vaginal delivery who have stable vital signs and desire to preserve fertility. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

  9. Infracoccygeal sacropexy in the treatment of vaginal vault prolapse: a prospective study

    Directory of Open Access Journals (Sweden)

    Ghanbari Z

    2007-09-01

    Full Text Available   Background: Vaginal vault prolapse is a significant longer-term complication in patients undergoing hysterectomy. An important cause is generally acknowledged to be weakness in the uterosacral and cardinal ligaments. Vaginal delivery is known to be a risk factor, and obesity and menopause are predisposing factors. Urogynecologists are constantly looking for simple, safe and effective ways to cure vaginal apex prolapse. Infracoccygeal sacropexy, also known as posterior intravaginal slingplasty, is a useful and less-invasive procedure, with low morbidity. The aim of this study is to confirm the efficacy, safety and long-term outcome of infracoccygeal sacropexy for the treatment of vault prolapse.Methods: In a prospective observational study, we performed infracoccygeal sacropexy to treat 26 patients who had at least grade 3 symptomatic vault prolapse secondary to transvaginal hysterectomy. Data collection included anatomic outcome, and intra- and post-operative complications.Results: The mean patient age was 67 years. The mean operation time was 30 minutes and mean blood loss was 130 ml. No intraoperative rectal perforation was seen, and all patients were discharged within 24 hours of surgery. The symptomatic cure of prolapse rate, urgency, nocturia and pelvic pain was 96.2%, 88.8%, 92.6% and 77% orderly. Only one tape rejection occurred in one of the 26 patients."n  Conclusion: Our initial experience with infracoccygeal sacropexy shows an efficacy similar to other more established surgical techniques for the cure of vault prolapse, but with less surgical morbidity. Therefore, the procedure is found to be efficient and safe, with shorter operation times, reduced postoperative complication and shorter hospital convalescence.

  10. Anterior vaginal compartment surgery.

    Science.gov (United States)

    Maher, Christopher

    2013-11-01

    To review the safety and efficacy of anterior vaginal compartment pelvic organ prolapse surgery. Every 4 years and as part of the Fifth International Collaboration on Incontinence we reviewed the English-language scientific literature after searching PubMed, Medline, Cochrane library and the Cochrane database of systematic reviews, published up to January 2012. Publications were classified as level 1 evidence (randomised controlled trials [RCT] or systematic reviews), level 2 (poor quality RCT, prospective cohort studies), level 3 (case series or retrospective studies) and level 4 case reports. The highest level of evidence was utilised by the committee to make evidence-based recommendations based upon the Oxford grading system. A grade A recommendation usually depends on consistent level 1 evidence. A grade B recommendation usually depends on consistent level 2 and/or 3 studies, or "majority evidence" from RCTs. A grade C recommendation usually depends on level studies or "majority evidence" from level 2/3 studies or Delphi processed expert opinion. A grade D "no recommendation possible" would be used where the evidence is inadequate or conflicting and when expert opinion is delivered without a formal analytical process, such as by Delphi. Absorbable mesh augmentation of anterior compartment native tissue repair improves the anatomical outcome compared with native tissue repair alone with no increased complication rate in meta-analysis of 2 RCTS (grade B). Biological grafts in meta-analysis have improved anatomical outcomes with no change in subjective outcomes compared with native tissue repairs (grade B). There is conflicting level 1 evidence to support porcine dermis and a single RCT to support small intestine submucosa as graft agents in anterior compartment prolapse surgery (grade B). Consistent level 1 data support a superior anatomical outcome for polypropylene mesh compared with a biological graft in the anterior compartment. Mesh exposure rate was

  11. Lower limb compartment syndrome as a complication of radical hysterectomy

    OpenAIRE

    Oman, Sarah A.; Schwarz, Daniel; Muntz, Howard G.

    2016-01-01

    Highlights ? Compartment syndrome is a rare complication of prolonged lithotomy position. ? We report a case of compartment syndrome complicating radical hysterectomy. ? Prompt diagnosis is crucial to reduce morbidity from compartment syndrome. ? Awareness of this complication allows surgeons to address modifiable risk factors.

  12. Instilling fear makes good business sense: unwarranted hysterectomies in Karnataka.

    Science.gov (United States)

    Xavier, Teena; Vasan, Akhila; S, Vijayakumar

    2017-01-01

    This paper uses data from two fact-finding exercises in two districts of Karnataka to trace how government and private doctors alike pushed women to undergo hysterectomies. The doctors provided grossly unscientific information to poor Dalit women to instil a fear of "cancer" in their minds to wilfully mislead them to undergo hysterectomies, following which many suffered complications and died. The paper examines a review, made by two separate panels of experts, of women's medical records from private hospitals to illustrate that a large proportion of the hysterectomies performed were medically unwarranted; that private doctors were using highly suspect diagnostic criteria, based on a single ultrasound scan, to perform the hysterectomies and had not sent even a single sample for histopathology; and that the medical records were incomplete, erroneous and, in several instances, manipulated. The paper describes how a combination of patriarchal bias, professional unscrupulousness and pro-private healthcare policies posed a serious threat to the survival and well-being of women in Karnataka.

  13. Danish gynecologists' opinion about hysterectomy on benign indication

    DEFF Research Database (Denmark)

    Gimbel, Helga; Ottesen, Bent; Tabor, Ann

    2002-01-01

    AIMS: To survey Danish gynecologists' recommendations concerning hysterectomy and its method for benign diseases. METHODS: A questionnaire of seven clinical cases was sent to all gynecologists in Denmark (n = 450). The gynecologists were asked to recommend one of 14 possible treatments as the mos...

  14. Page 1 Elective hysterectomy: A clinicopathological review from ...

    African Journals Online (AJOL)

    Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB: Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod 2001; 16:2418-21. Parazzini F, Vercellini P. Panazza S, Chatenouel L, Oldani S: Risk factors for adenomyosis. Hum Reprod. 1997; 12:1275-9. Cicinelli E, Romano F, Anastasio PS, Blasi N, ...

  15. Emergency peripartum hysterectomy in Nnewi, Nigeria: A 10-year ...

    African Journals Online (AJOL)

    The mean duration of hospital stay was 9.8 ± 2.4 days. Conclusion: The incidence of emergency peripartum hysterectomy was high and majority of patients were unbooked. Placenta praevia has emerged as its primary indication. Booking for antenatal care, anticipation, prompt resuscitation, and early surgical intervention ...

  16. Emergency Obstetric Hysterectomy in a Tertiary Hospital in Sokoto ...

    African Journals Online (AJOL)

    hanumantp

    at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure ...

  17. Ureteric injuries following laparoscopic hysterectomy: A report of ...

    African Journals Online (AJOL)

    and pelvic relaxation, and forms 29.2% of all hysterectomies in the ... pelvic surgery, presence of endometriosis, pelvic inflammatory disease .... Pelvic Floor Dysfuct. 2002; 13: 18-21. 12. Oh Br, Kwon D.D., Park K.S., et al. Late presentation of ureteral injury after laparoscopic surgery. Obstet. Gynecol. 2000; 95:337-339. 13.

  18. Influence of alcohol intake on postoperative morbidity after hysterectomy

    DEFF Research Database (Denmark)

    Felding, C; Jensen, L M; Tønnesen, H

    1992-01-01

    Postoperative morbidity after hysterectomy was prospectively studied in 229 consecutive patients in our departments. The incidence of alcohol abuse (greater than 60 gm of alcohol daily) and social drinking (between 25 and 60 gm of alcohol daily) was 6.5% for each. When compared with the social...

  19. The Evaluation Of Histopathological Diagnosis In Hysterectomy Materials

    Directory of Open Access Journals (Sweden)

    Cigdem Kunt isguder

    2016-06-01

    Results: The mean age of the patients was 50.48+/-7.50 (min:38, max:74. Leiomyoma with 77 case (%45.3 was the most hysterectomy indicated disease. Thereafter, dysfunctional uterine bleeding in 50 (%29.49, and endometrial hyperplasia 22 (%12.9 were detected. The other clinical indications were uterine prolapse in 17 patients (%10, chronic pelvic pain in 2 (%1.2 and adenomyosis in 2 (%1.2. The results of histopathological reports belong to hysterectomy materials indicated that leiomyoma was the most common pathological finding with 87 cases (%51.2, subsequently adenomyosis in 35 cases (% 20.5 and endometrial hyperplasia in 31 (18.3 was detected. Endometrial polyp was found in 10 cases (%5.9 and atrophic endometrium in 7 cases (%4.1. Combined pathology was defined in 44 hysteterctomy materials. Leiomyoma and endometrial hyperplasia were detected as the most common combination with a ratio of %50. In addition, chronic cervicitis was seen in %64.7 of cervical examinations of hysterectomy materials. Conclusion: Adenomyosis should be kept in mind while planning the diagnosis and treatment of patients whose admitted with compliants of menometrorrhagia, seconder dysmenorrhea and chronic pelvic pain in 4th and 5th decade. Endometrial sampling caused by the co-existence of leiomyoma and endometrial hyperplasia must be necessary in hysterectomy planned cases for leiomyoma those already have menometrorrhagia. [J Contemp Med 2016; 6(2.000: 87-91

  20. Obstetric Hysterectomy in Rural Democratic Republic of the Congo ...

    African Journals Online (AJOL)

    elearning

    ABSTRACT. The objective of this study was to determine the incidence, indication, and outcome of obstetric hysterectomy at an Eastern DRC rural hospital. This was a seven year retrospective study. The incidence was 0.28%. Mean age and parity of patients was 35.8 and 7 respectively. Trend to have Obstetric ...

  1. Contraceptive vaginal rings: a review.

    Science.gov (United States)

    Brache, Vivian; Faundes, Anibal

    2010-11-01

    Development efforts on contraceptive vaginal rings were initiated over 40 years ago based on two principles: the capacity of the vaginal epithelium to absorb steroids and the capacity of elastomers to release these hormones at a nearly constant rate. Numerous models of contraceptive vaginal rings (CVRs) have been studied, but only two have reached the market: NuvaRing, a combined ring that releases etonogestrel (ENG) and ethinylestradiol (EE), and Progering, a progesterone-releasing ring for use in lactating women. The main advantages of CVRs are their effectiveness (similar to or slightly better than the pill), ease of use without the need of remembering a daily routine, user's ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring. The main disadvantages are related to the mode of delivery; CVRs may cause vaginal discharge and complaints, ring expulsion is not uncommon, the ring may be felt during coitus and vaginal insertion may be unpleasant for some women. The studies reviewed in this article provide evidence that CVRs are safe, effective and highly acceptable to women. There is no doubt that CVRs offer a new, effective contraceptive option to women, expanding their available choices of hormonal contraception. Copyright © 2010 Elsevier Inc. All rights reserved.

  2. [Multipurpose treatment of vaginal infections].

    Science.gov (United States)

    Nikolov, A; Masseva, A; Shopova, E; Georgiev, S

    2012-01-01

    Untreated bacterial vaginosis is related with many complications for non-pregnant women in reproductive age, most common from them are vaginal discharge and postoperative infections. The aim of our investigation was to compare the effectiveness of two therapeutic regimes which consist in Macmiror/Macmiror Complex alone and in combination with Feminella Vagi C for treatment of bacterial vaginosis (BV) and/or mycotic infection. 117 non-pregnant women with symptoms of vaginal infection were prospectively enrolled into two groups according their treatment. First group consist 66 women treated with Macmiror tablets and vaginal capsules followed with local application of Feminella Vagi C, the second group consist 54 women treated with Macmiror tablets and vaginal capsules only. The impact of treatment on clinical symptoms was observed at the end of medication and 20 days after it. Microbiological testing was repeated 20 days after treatment. Over than 80% (78.6 divided by 86.7%) of the cases with vaginal infection (BV and mycotic one) were successfully treated with Macmiror/Macmiror Complex. Supplement treatment with Feminella Vagi C lead to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment. Used medication showed higher efficacy against BV than to fungal infection. According obtained results we may conclude that bacterial vaginosis was better treated with multipurpose treatment (Nifuratel, Nistatin and vit. C) than with Macmiror alone.

  3. Developmental Origin of Vaginal Epithelium

    Science.gov (United States)

    Kurita, Takeshi

    2010-01-01

    The developmental origin of vaginal epithelium has been controversial for nearly a century, with speculation that vaginal epithelium originates from the Müllerian duct, Wolffian duct, and/or urogenital sinus. None of these possibilities has been definitively proven or disproven by direct scientific data. To define precisely the origin of vaginal epithelium, epithelial cells of the Müllerian duct, Wolffian duct, or urogenital sinus were fluorescently labeled in mouse embryos by crossing tdTomato-EGFP dual-reporter transgenic mice with transgenic mouse lines that express Cre recombinase in each type of epithelium. In embryos and newborn mice, the vagina consisted of fused Müllerian ducts plus the sinus vagina of urogenital sinus origin. However, the proportion of the sinus vagina was significantly reduced as the Müllerian vagina grew caudally. By postpartum day 7, the Müllerian vagina extended to the caudal end of the body, whereas the sinus vagina remained only at the junction between the vagina and perineal skin. As the vagina opened in puberty, urogenital sinus epithelium was detected only in the vulva, but not in the vagina. Additionally, from embryo to adult stages, residual Wolffian duct epithelium was present in the dorsolateral stromal wall of the vagina, but not within vaginal or vulvar epithelium. In conclusion, adult mouse vaginal epithelium is derived solely from Müllerian duct epithelium. PMID:20638775

  4. Citología Vaginal

    OpenAIRE

    Arrunategui, Ana María; Fundación Valle de Lili

    2001-01-01

    ¿Qué es una neoplasia?/ ¿Qué grupo de mujeres tiene un mayor riesgo de desarrollar cáncer del cuello de la matriz?/ ¿Cuáles son los síntomas más frecuentes del cáncer del cuello de la matriz?/ Anatomía de los órganos genitales femeninos/¿Cómo se realiza la prueba de la citología vaginal?/¿Cómo se interpretan los resultados de la citología vaginal?/ ¿Toda citología anormal es cáncer?/ ¿Qué otras utilidades tiene la citología vaginal?/ ¿Desde qué edad, hasta que edad y con qué frecuencia debe t...

  5. Comparison of Nerve-Sparing Radical Hysterectomy and Radical Hysterectomy: a Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Zhuowei Xue

    2016-05-01

    Full Text Available Background/Aims: Radical hysterectomy (RH for the treatment of cervical cancer frequently caused pelvic organ dysfunctions. This study aimed to compare the results of pelvic organ function and recurrence rate after Nerve sparing radical hysterectomy (NSRH and RH treatment through systematic review and meta-analysis. Methods: PubMed, Web of Science and China Knowledge Resource Integrated Database were searched from inception to 25 February 2015. Studies of cervical cancer which reported radical hysterectomy or nerve sparing radical hysterectomy were included. The quality of included studies was evaluated using the guidelines of Cochrane Handbook for Systematic Reviews of Interventions. Statistical analysis was performed using Review Manager 5.3 software (Cochrane Collaboration. Results: A total of 20 studies were finally included. Meta-analysis demonstrated that NSRH was associated with less bladder and anorectal dysfunction than RH. The time to bladder and anorectal function recovery after NSRH was shorter than RH. Patients undergoing NSRH also scored higher than patients undergoing RH at Female Sexual Function Index (FSFI. On the other hand, the local recurrence and overall recurrence rate were similar between NSRH and RH. Conclusion: NSRH may be an effective technique for lowering pelvic organ dysfunction and improving the function recovery without increasing the recurrence rate of cervical cancer.

  6. Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: A novel approach in difficult laparoscopic hysterectomy.

    Science.gov (United States)

    Hong, Mun-Kun; Chu, Tang-Yuan; Ding, Dah-Ching

    2016-06-01

    To proposed a novel method for a difficult laparoscopic hysterectomy that spares the cervical ligaments and eliminates the cervical canal and transformation zone of the cervix. A 40-year-old women, gravida 3 para 3, who had had a cesarean delivery previously, was referred to the gynecology clinic due to adenomyosis with menorrhagia and severe anemia. Ultrasonography showed that the uterus was enlarged to 13.5 cm × 10.7 cm × 8.8 cm. After obtaining informed consent, a two-phase laparoendoscopic single-site (LESS) cervical ligaments-sparing hysterectomy was performed smoothly. The patient discharged on 4th day and resumed her sexual life less than 2 months after surgery. This novel minimal invasive method of hysterectomy makes difficulty laparoscopic hysterectomy easy and safe. Preservation of cervical ligaments retains stability in the pelvic floor and may reduce intraoperative complications and subsequent pelvic floor organ prolapse. Copyright © 2016. Published by Elsevier B.V.

  7. Vaginal metastasis as the initial presentation of leiomyosarcoma: a case report.

    Science.gov (United States)

    Villalaín-González, Cecilia; Tejerizo-García, Álvaro; Lopez-Garcia, Patricia; López-González, Gregorio; Oliver-Perez, Ma Reyes; Jiménez-López, Jesús S

    2017-07-26

    Uterine leiomyosarcomas are very rare and highly aggressive tumors that have a high rate of recurrence and poor prognosis, even when early diagnosed. Due to their relative rarity, there is limited research on optimal management strategies. A 60-year-old woman with a history of an asymptomatic uterine leiomyoma presented in October 2015 with postmenopausal bleeding and a friable vaginal cyst that bled when palpated. A partial cystectomy was performed, and malignant-like cystic and solid components were identified. Histopathology diagnosed an unclassifiable malignant epithelioid tumor. Subsequent imaging studies identified a malignant uterine tumor, a metabolically active vaginal lesion, and two benign leiomyomas. An anterior pelvic exenteration (colpectomy, hysterectomy, bilateral adnexectomy, total cystectomy, and cutaneous ureteroileostomy ad modum Bricker) were performed by laparotomy in March 2016. Examination of the surgical specimens identified a 75 × 75-mm leiomyoma, an 80 × 30-mm infiltrating mesenchymal uterine lesion with vascular invasion and tumor emboli, and a 60 × 30-mm perivascular vaginal tumor. Immunohistochemistry indicated a phenotypic transition from a uterine leiomyosarcoma to a vaginal epithelioid lesion; marker expression changed from the uterine tumor actin+/desmin+/caldesmon+/CD10- phenotype, through the tumor emboli, to an actin-/desmin-/caldesmon-/CD10+ phenotype in the vaginal lesion. A high-grade uterine mesenchymal tumor and vaginal metastasis were diagnosed. Adjuvant chemotherapy with docetaxel, gemcitabine, and doxorubicin commenced in May 2016 and treatment has been well tolerated. Differentiating leiomyosarcoma from leiomyoma is challenging and few tools other than microscopic evaluation are available. Vaginal compromise in leiomyosarcoma usually results from tumor extension, not hematogenous metastasis. A vaginal metastasis is a very rare initial presentation. We have found only two cases like this described on published

  8. Vaginal Bleeding: MedlinePlus Health Topic

    Science.gov (United States)

    ... bleeding in pregnancy (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Vaginal Bleeding updates ... late pregnancy Vaginal bleeding in pregnancy Related Health Topics Menstruation Disclaimers MedlinePlus links to health information from ...

  9. Vaginitis: current microbiologic and clinical concepts.

    Science.gov (United States)

    Hill, L V; Embil, J A

    1986-02-15

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a sufficient supply of glycogen, and the alteration in bacterial flora, normally dominated by Lactobacillus spp., and its metabolites that is characteristic of "nonspecific vaginitis". The authors review microbiologic and clinical aspects of the fungal, protozoal and bacterial infections, including the interactions of bacteria thought to produce nonspecific vaginitis, that are now recognized as causing vaginitis. Other causes of vaginitis are also discussed.

  10. Effects of vaginal prolapse surgery and ageing on vaginal vascularization

    NARCIS (Netherlands)

    Weber, M.A.

    2016-01-01

    Ageing affects pelvic floor anatomy and function, resulting in several disorders like pelvic organ prolapse (POP), lower urinary tract symptoms and vaginal atrophy (VA). In this thesis we searched for methods to link the function of pelvic organs to physiological changes. The effects of POP and

  11. Vaginal reconstruction with sigmoid colon in patients with congenital absence of vagina and menses retention: a report of treatment experience in 22 young women.

    Science.gov (United States)

    Yang, Bin; Wang, Ning; Zhang, Shulan; Wang, Mingqian

    2013-01-01

    We evaluated the surgical feasibility, sexual satisfaction and complications of vaginal reconstruction with sigmoid colon in patients with congenital absence of vagina and menses retention. Retrospective analysis of surgical techniques and long-term postoperative follow-up was performed for 22 patients who underwent vaginal reconstruction with sigmoid colon at a single hospital between 1977 and 2011 to treat congenital absence of vagina with menses retention. All patients achieved satisfactory sexual function after marriage. No patients experienced enterospastic abdominal pain during sexual intercourse. The neovaginas accommodated two or more fingers and had depths >10 cm. The mucous membranes were soft and flexible, and secretions of the sigmoid mucosa provided adequate and acceptable lubrication. No patient required vaginal stents, and none developed vaginal stenosis or reported pain with vaginal expansion. Fifteen of the 22 patients underwent hysterectomies due to cervical agenesis; seven retained their uterus and had onset of normal menses postoperatively. Two patients became pregnant 1 year after marriage; one achieved 38-week gestation, underwent cesarean section due to premature rupture of membranes, and delivered a healthy boy. The other experienced natural incomplete abortion and underwent curettage at her local hospital. This study confirms that sigmoid colon vaginal reconstruction is a good choice for treating congenital absence of vagina and menses retention and results in the closest approximation to the physical function of a normal female vagina. Reproductive ability can be retained in many cases for patients with a well-developed uterus and cervix.

  12. Vaginitis: current microbiologic and clinical concepts.

    OpenAIRE

    Hill, L V; Embil, J A

    1986-01-01

    Infectious vaginitis occurs when the normal vaginal flora is disrupted; it may arise when saprophytes overwhelm the host immune response, when pathogenic organisms are introduced into the vagina or when changes in substrate allow an imbalance of microorganisms to develop. Examples of these types of vaginitis include the presence of chronic fungal infection in women with an inadequate cellular immune response to the yeast, the introduction of trichomonads into vaginal epithelium that has a suf...

  13. Characterisation of the vaginal microflora of human ...

    African Journals Online (AJOL)

    Lactobacilli predominate normal vaginal microflora and are important in maintenance of vaginal health. The current study set out to identify and compare culture isolates of vaginal microflora of human immunodeficiency virus (HIV) positive (HIV+) and HIV negative (HIV-) women at different phases during menstrual cycle ...

  14. Decreased beta-carotene levels in exfoliated vaginal epithelial cells in women with vaginal candidiasis.

    Science.gov (United States)

    Mikhail, M S; Palan, P R; Basu, J; Anyaegbunam, A; Romney, S L

    1994-10-01

    Women are more susceptible to vaginal candidiasis when the host immune response is suppressed. The antioxidant nutrient beta-carotene is postulated to possess immunoenhancing properties. The purpose of this study was to investigate beta-carotene concentrations in exfoliated vaginal epithelial (EVE) cells in women with vaginal candidiasis. Beta-carotene levels in EVE cells, collected by a saline lavage technique from 22 women with vaginal candidiasis and 20 normal controls, were analyzed. The diagnosis of vaginal candidiasis was established by the presence of pruritus, white cheesy vaginal discharge, and a positive potassium hydroxide preparation. Beta-carotene levels were assayed using high pressure liquid chromatography. Vaginal cell concentrations of beta-carotene were significantly decreased in women with vaginal candidiasis (P < 0.001). Decreased beta-carotene levels, and possibly other antioxidants, may alter the local immune response resulting in disturbances in the vaginal flora, overgrowth of candida, and the development of vaginal candidiasis.

  15. Vaginal leiomyoma: MRI features with pathologic correlation

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    Avantika Gupta

    2015-06-01

    Full Text Available We present a rare case of vaginal leiomyoma presenting as prolapsed vaginal mass in a 45 years old woman. The leiomyoma was found to arise from the right lateral vaginal fornix with a vascular stalk. MRI showed homogenous hypointense signals on T1W1 and iso to hyperintense signals on T2W1 images with moderate heterogenous enhancement on post contrast images. It was enucleated via vaginal route and the histopathological examination confirmed the diagnosis of vaginal leiomyoma.

  16. Effect of socioeconomic position on patient outcome after hysterectomy

    DEFF Research Database (Denmark)

    Daugbjerg, Signe B; Cesaroni, Giulia; Ottesen, Bent

    2014-01-01

    education and all complications remained unexplained. Furthermore, differences in lifestyle and co-morbidity status only partially explained the higher odds of infection, complications and hospitalization >4 days for unemployed than employed women. CONCLUSION: Women with a low socioeconomic position have......OBJECTIVE: To investigate the association between socioeconomic position (assessed by education, employment and income) and complications following hysterectomy and assess the role of lifestyle, co-morbidity and clinical conditions on the relationship. DESIGN: Register-based cohort study. SETTING...... significantly higher odds of complications following hysterectomy compared with women with a high socioeconomic position. Unhealthy lifestyle and presence of co-morbidity in women with low socioeconomic position partially explains the differences in complications....

  17. Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Madsen, Matias Vested; Istre, Olav; Springborg, Henrik Halvor

    2017-01-01

    . The gynaecologists registered increasing abdominal tensions in no versus eight procedures (p = 0.006) in the deep and standard NMB group, respectively. CONCLUSION: Deep NMB in combination with 8 mmHg pneumoperitoneum prevented sudden abdominal contractions during laparoscopic hysterectomy. FUNDING: This work......INTRODUCTION: Establishment of sufficient muscle relaxation is essential in laparoscopic surgery. During laparoscopy, surgeons can experience abdominal contractions in their patients. Deep neuromuscular block (NMB) has the potential to prevent such episodes. In this study, we explored if deep NMB...... reduces the incidence of sudden abdominal contractions as compared with standard NMB. METHODS: This was a pre-planned secondary analysis of a randomized, controlled study. A total of 110 patients scheduled for laparoscopic hysterectomy were randomized to either deep NMB and 8 mmHg pneumoperitoneum (deep...

  18. Perceptions and practices regarding women's vaginal health following radiation therapy: A survey of radiation oncologists practicing in the United States.

    Science.gov (United States)

    Kachnic, Lisa A; Bruner, Deborah W; Qureshi, Muhammad M; Russo, Gregory A

    Vaginal stenosis (VS) is a recognized complication of pelvic and vaginal radiation therapy (RT). A 26-item survey assessing the signs/symptoms, risk factors, diagnosis, prevention, treatment, and impact of VS on women's sexual health was distributed to radiation oncologists. Descriptive statistics were calculated. Chi-square tests examined differences in categorical responses. A total of 233 (10.5%) participants completed the entire survey. Twelve percent, 21%, and 68% report treating gynecologic (GYN) tumors only, non-GYN pelvic tumors only, or both, respectively. Regarding risk factors, 78% believed that VS can be caused by pelvic RT alone, 91% by vaginal brachytherapy alone, and 98% by combined pelvic RT and vaginal brachytherapy. Approximately one-half of respondents felt that being postmenopausal and having a hysterectomy before radiation therapy were risk factors for VS, whereas the other half felt that these were not risk factors. All respondents agreed that VS is a clinical diagnosis. Respondents indicated that VS symptoms include dyspareunia, vaginal pain, dryness, and/or bleeding (100%, 90%, 85%, and 72%, respectively); 65% indicated all 4. The most commonly recommended treatment for VS is vaginal dilator use. Radiation oncologists who treat GYN-only versus non-GYN cancers were more likely to perform a vaginal examination, to distribute written instructions regarding vaginal dilator use (P = .002), to have vaginal bleeding reported after RT (P = .001), and to refer patients to a sexual counselor (P = .007). Most providers (73%) expressed willingness to participate in prospective research on the diagnosis and treatment of VS. This is the first large-scale survey of radiation oncologists' perceptions and practices regarding VS. There is agreement among providers regarding the signs/symptoms of VS and strategies for its prevention/treatment using vaginal dilators. Further prospective and observational research is needed. This survey shows a willingness on

  19. Vaginal pressure during daily activities before and after vaginal repair

    DEFF Research Database (Denmark)

    Mouritsen, L; Hulbaek, M; Brostrøm, S

    2007-01-01

    , pelvic floor contraction (PFC), coughing, Valsalva, rising from sitting to standing and lifting 2 and 5 kg with four different lifting techniques. VP was measured before, 1-5 days and 4-6 weeks after vaginal repair. Mean VP was four to five times higher during coughing and Valsalva compared to PFC...... and lifting 2 and 5 kg. Lifting in the walking position created a slightly higher VP compared to other lifting techniques, which did not differ. The VP did not increase when lifting 5 kg compared to 2 kg. Mean VP during coughing and Valsalva were significantly lower 1-5 days after the operation. VP...... was not related to the type of vaginal repair. The results imply that post-operative counselling should concentrate more on treating chronic cough and constipation than restrictions of moderate physical activities....

  20. Single-Port Total Laparoscopic Hysterectomy in a Patient With Deep Infiltrating Endometriosis.

    Science.gov (United States)

    Şendağ, Fatih; Peker, Nuri; Aydeniz, Elif Ganime; Akdemir, Ali; Gündoğan, Savaş

    2017-02-01

    Foley catheter were placed. Abdominal access was performed following an open Hasson technique with a 2.0- to 2.5-cm vertical umbilical incision and a 4-channel (with two 10-mm and two 5-mm channels) access port was placed into the peritoneal cavity. On pelvic examination, a 6 × 6-cm right ovarian endometrioma adherent to the pelvic sidewall was detected, along with severe adhesions on the left side between the left adnex and the pelvic sidewall. The uterus was normal. The adhesion on the left side was released using a Harmonic scalpel (Ethicon Endosurgery, Cinncinnati, OH). The pelvic sidewall peritoneum was opened, and the ureters were identified and isolated at the pelvic brim and followed toward the true pelvis. The internal iliac artery, uterine and obliterated umbilical artery, and infundibulopelvic ligament were dissected and identified. The paravesical, pararectal, and rectouterine spaces were opened. Deep infiltrating endometriosis implants on the right side located in the uterosacral ligment and pararectal space were dissected and excised. After restoration of pelvic anatomy, hysterectomy and bilateral salpingo-oophorectomy were performed. The vaginal cuff was closed with intracorporeal knots. The patient was discharged on postoperative day 1, and reported no problems at follow-up. Single-port laparoscopic hysterectomy appears to be a safe and feasible option in patients with deep infiltrating endometriosis, especially when performed by well-experienced surgeons. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  1. [Chronic pelvic pain and cervical endometriosis after a subtotal hysterectomy].

    Science.gov (United States)

    Acosta Martínez, Marcos; Zamora Escudero, Rodrigo; García-Benítez, Carlos Quesnel; Vieyra Cortés, Edmundo Alejandro

    2013-01-01

    The ectopic location of endometrial glands and stroma may cause the formation of a tumor known as endometrioma. It almost always occurs in the ovary, and due to its characteristic appearance has been called "chocolate cyst". Cervical localization of this disease is extremely rare, and when it occurs, tends to be an exocervical and/or endocervical injury, as a result of cervical procedures. We communicate the case of a patient with cystic endometriosis in the cervix after a subtotal abdominal hysterectomy, performed by obstetric hemorrhage. Even though there have been reports about cases of cervical endometriosis, most of them have been reported as superficial cervical endometriosis and as a discovery after a total hysterectomy or cervical biopsy, in some cases even with original diagnosis ofAGUS (atypical glandular cells of undetermined significance). We concluded that in this case, instrumented uterine curettage and subtotal hysterectomy by obstetric indication are a possible origin of cervical endometriosis, due to "seeding" endometrial tissue during the curettage in a friable cervix.

  2. Frequency of adenomyosis in hysterectomy specimens performed for benign indications

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    bulent cakmak

    2012-09-01

    Results: Adenomyosis frequency was determined as 11.7% (17 of 149 patients received for the elavuation for this study. There was no statistically significance in terms of ages among the cases with or without adenomyosis (49.4+/-8.3 vs 50.5+/-9.7 (p>0.05. Similarly there was no statistically significance between two groups in the number of pregnancy and parous (p>0.05. Adenomyosis was determined as 13.2% in hysterectomy specimens performed for leiomyoma and again it was determined as 17.8% in hysterectomy specimens performed for refracter menorrhagia. There was no statistically significance between two indication groups for the sake of being determined of adenomyosis hystopathologically in hysterectomy specimens (p>0.05. Conclusion: Adenomyosis can be seen in patients with leiomyoma and menorrhagia. So the possibility of adenomyosis detection should not be forgotten when the treatment is planned for the cases with leiomyoma and menorrhagia. [J Contemp Med 2012; 2(3.000: 158-161

  3. Arteriovenous malformations of the uterus: an uncommon cause of vaginal bleeding.

    Science.gov (United States)

    Hoffman, M K; Meilstrup, J W; Shackelford, D P; Kaminski, P F

    1997-12-01

    Arteriovenous malformations (AVM) are rare entities in gynecology, with only 73 cases reported in the literature. Most commonly they present with vaginal hemorrhage, but other presentations such as congestive heart failure, postmenopausal bleeding, and an asymptomatic mass have been described. These lesions may be congenital or acquired. Acquired lesions are believed to follow trauma or may arise after choriocarcinoma or other gynecologic malignancies. Diagnosis can rapidly be made with color flow Doppler ultrasound or angiography. Additionally, they have been detected using hysteroscopy, hysterosalpingogram, and computerized tomography. Acute management consists of hemodynamic stabilization and possibly placement of a Foley bulb in the uterus or methylergonovine injection. Ultimate treatment depends on the patients desire for fertility. Embolization therapy is variably successful and may allow the preservation of reproductive capacity. To date, five pregnancies after embolization have been reported with varying outcomes. If pregnancy is not desired or embolization fails, hysterectomy remains the treatment of choice.

  4. Systematic review of the limited evidence for different surgical techniques at benign hysterectomy

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Schroll, Jeppe Bennekou; Settnes, Annette

    2017-01-01

    Hysterectomy for benign gynecological conditions is a common operation that has developed extensively through the last 20 years. Methods and surgical techniques vary throughout the regions in Denmark as well as internationally. Consequently, the Danish Health Authority initiated a national clinical...... laparoscopic hysterectomy for non-prolapsed uteri when feasible (⊕ΟΟΟ). ↓ Robot-assisted laparoscopic hysterectomy should only be preferred over conventional laparoscopic hysterectomy after careful consideration because the beneficial effect is uncertain and because of the longer operating time (⊕⊕ΟΟ...

  5. Laparoscopic compared with open radical hysterectomy in obese women with early-stage cervical cancer.

    Science.gov (United States)

    Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun

    2012-06-01

    To compare the surgical and oncological outcomes of laparoscopic radical hysterectomy and open radical hysterectomy in obese women with early-stage cervical cancer. The medical records of 166 patients with stage IA2-IIA2 cervical cancer and a body mass index of at least 30 who underwent laparoscopic radical hysterectomy (n=54) or open radical hysterectomy (n=112) at the Asan Medical Center between 1998 and 2011 were reviewed. None of the patients in the laparoscopic radical hysterectomy group required conversion to laparotomy. The resection margin was negative in 98.1% of the laparoscopic radical hysterectomy group and 98.2% of the open radical hysterectomy group (P=.976). No difference between the two groups was observed in terms of operating time, perioperative hemoglobin level change, transfusion requirement, or the number of retrieved lymph nodes. Compared with open radical hysterectomy, laparoscopic radical hysterectomy was associated with a significant reduction in the following: interval to return of bowel movements (2 days compared with 2.7 days, Pobese women with early-stage cervical cancer because it is associated with a more favorable surgical outcome without compromising survival outcomes. II.

  6. HYSTERECTOMY IN THE PERINATAL AND POSTPARTUM PERIOD IN THE 17-YEAR CLINICAL MATERIAL

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    Dobrosława L. Sikora-Szczęśniak

    2013-11-01

    Full Text Available Intruduction: Hysterectomy is one of major surgeries. Pregnancy, delivery and postpartum period make the operation even more difficult as it is forced and complicated by various pathological conditions that develop over that time. Objective: The purpose of study was to analyze the frequency of hysterectomy, indications to undertake it and complications associated with the removal of the uterus in pregnancy and during perinatal and postpartum period. The study analyzed the cases of hysterectomies in perinatal and postpartum period performed over the 17-year clinical material from the Department of Gynaecology and Obstetrics, SZOZ, Lipsko in the years 1985–2001. Material and methods : The material for analysis were medical records of 15 women who developed complications in pregnancy, perinatal and postpartum period, which were absolute indication to perform hysterectomy. The following parameters were analyzed: patient’s age, number of deliveries, the way pregnancies were terminated, the way present pregnancy was terminated, complications, indications to Caesarean section and perinatal and postpartum hysterectomy, type of hysterectomy performed, other associated procedures and complications. Results : In total 15 hysterectomies were performed in the period of study which accounts for 0.10% all deliveries. The material revealed the following causes for hysterectomy: placental pathologies (46.7%, inflammatory conditions of internal sex organs (20.0%, uterine atonia after delivery (13.3%, injuries of sex organs (13.3%. Elective hysterectomy in that period was performed in one patient (6.7%. The risk factors predisposing to complications resulting in hysterectomy were history of Caesarean sections in 10 patients (66.7% and multiple spontaneous deliveries. Complications associated with hysterectomy which enforced additional operations were noted in two cases (13.3%. Total hysterectomy was performed in 8 patients (53.3% including hysterectomy with

  7. C.I.S.H. Laparoscopic Hysterectomy: The Experience at the "Centro Materno Infantil"

    Science.gov (United States)

    Decunto; Traverso; Gibelli; Harpe

    1994-08-01

    Laparoscopic hysterectomy has been established firmly as a surgical alternative to standard abdominal hysterectomy around the world. In Argentina, we had introduced operative laparoscopy at the Hospital Aleman in May 1993, with a major change from basic diagnostic laparoscopy to advanced operative laparoscopy. A total of 180 major laparoscopic cases have been performed from May 1993 to January 1994, including laparoscopic hysterectomies. Of our first five C.I.S.H. laparoscopic hysterectomies, all had excellent outcomes, with greatly diminished hospital stay and less usage of analgesics postoperatively. The average length of stay was 2.5 days. No major complications occurred.

  8. The Role of Vaginal Brachytherapy in the Treatment of Surgical Stage I Papillary Serous or Clear Cell Endometrial Cancer

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    Barney, Brandon M., E-mail: barney.brandon@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Mariani, Andrea; Dowdy, Sean C.; Bakkum-Gamez, Jamie N. [Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota (United States); Haddock, Michael G. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2013-01-01

    Objectives: The optimal adjuvant therapy for International Federation of Gynecology and Obstetrics (FIGO) stage I papillary serous (UPSC) or clear cell (CC) endometrial cancer is unknown. We report on the largest single-institution experience using adjuvant high-dose-rate vaginal brachytherapy (VBT) for surgically staged women with FIGO stage I UPSC or CC endometrial cancer. Methods and Materials: From 1998-2011, 103 women with FIGO 2009 stage I UPSC (n=74), CC (n=21), or mixed UPSC/CC (n=8) endometrial cancer underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjuvant high-dose-rate VBT. Nearly all patients (n=98, 95%) also underwent extended lymph node dissection of pelvic and paraortic lymph nodes. All VBT was performed with a vaginal cylinder, treating to a dose of 2100 cGy in 3 fractions. Thirty-five patients (34%) also received adjuvant chemotherapy. Results: At a median follow-up time of 36 months (range, 1-146 months), 2 patients had experienced vaginal recurrence, and the 5-year Kaplan Meier estimate of vaginal recurrence was 3%. The rates of isolated pelvic recurrence, locoregional recurrence (vaginal + pelvic), and extrapelvic recurrence (including intraabdominal) were similarly low, with 5-year Kaplan-Meier estimates of 4%, 7%, and 10%, respectively. The estimated 5-year overall survival was 84%. On univariate analysis, delivery of chemotherapy did not affect recurrence or survival. Conclusions: VBT is effective at preventing vaginal relapse in women with surgical stage I UPSC or CC endometrial cancer. In this cohort of patients who underwent comprehensive surgical staging, the risk of isolated pelvic or extrapelvic relapse was low, implying that more extensive adjuvant radiation therapy is likely unnecessary.

  9. Clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer.

    Science.gov (United States)

    Li, Fengshuang; Wu, Yumei; Kong, Weimin; Wang, Jiandong; Hao, Xia; Niu, Juwei; Bai, Laifu

    2017-01-01

    The purpose of this study was to evaluate the clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer. From June 2008 to June 2014, data from 78 Stage Ib2 and IIa cervical cancer patients (age ≤75 years) with a diameter of local lesions >4 cm were collected in our hospital. Before treatment, all cases were confirmed by biopsy. The patients' general state was good, Karnofsky Performance Score ≥90, heart and lung functioning was normal, and patients were able to tolerate the surgery. The 78 patients were randomly divided into two groups: neoadjuvant radiotherapy group (NRG) (n = 38) and radical surgery group (n = 40). Patients in NRG received 2000~3000 cGy192 Ir irradiation of preoperatively intracavitary brachytherapy (radioactive source at 1 cm distance). After a rest of 10-14 days, radical hysterectomy with pelvic lymphadenectomy was performed. Surgery alone group (SAG) (n = 40) underwent radical surgery directly. The treatment outcomes between these two groups were compared, and the effect of preoperative intracavitary brachytherapy and presence of postoperative complications were evaluated. The total clinical efficacy for intracavitary brachytherapy was 94.7% (36/38) with complete response 13 (34.2%), partial response 23 (60.5%), and stable disease 2 (5.3%). Moreover, no patients developed progression disease; for SAG patients, 32 cases successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time treatment for Stage Ib2 and IIa cervical cancer and can significantly improve the locoregional control rate.

  10. Dexmedetomidine in Postoperative Analgesia in Patients Undergoing Hysterectomy

    Science.gov (United States)

    Ren, Chunguang; Chi, Meiying; Zhang, Yanwei; Zhang, Zongwang; Qi, Feng; Liu, Zhong

    2015-01-01

    Abstract Both dexmedetomidine and sufentanil modulate spinal analgesia by different mechanisms, and yet no human studies are available on their combination for analgesia during the first 72 hours after abdominal hysterectomy. This CONSORT-prospective, randomized, double-blinded, controlled trial sought to evaluate the safety and efficacy of the combination of dexmedetomidine and sufentanil in intravenous patient-controlled analgesia (PCA) for 72 hours after abdominal hysterectomy. Ninety women undergoing total abdominal hysterectomy were divided into 3 equal groups that received sufentanil (Group C; 0.02 μg/kg/h), sufentanil plus dexmedetomidine (Group D1; 0.02 μg/kg/h, each), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.05 μg/kg/h) (Group D2) for 72 hours after surgery in this double-blinded, randomized study. The primary outcome measure was the postoperative sufentanil consumption, whereas the secondary outcome measures were pain intensity (visual analogue scale), requirement of narcotic drugs during the operation, level of sedation, Bruggrmann comfort scale, and concerning adverse effects. The postoperative sufentanil consumption was significantly lower in Groups D1 and D2 than in Group C during the observation period (P < 0.05), but lower in Group D2 than in Group D1 at 24, 48, and 72 hours after surgery (P < 0.05). The heart rate after intubation and incision was lower in Groups D1 and D2 than in Group C (P < 0.05). On arrival at the recovery room, Groups D1 and D2 had lower mean blood pressure than Group C (P < 0.05). The intraoperative requirement of sevoflurane was 30% lesser in Groups D1 and D2 than in Group C. The sedation levels were greater in Groups D1 and D2 during the first hour (P < 0.05). Compared with Groups C and D1, Group D2 showed lower levels of the overall incidence of nausea and vomiting (P < 0.05). Among the tested PCA options, the addition of dexmedetomidine (0.05 μg/kg/h) and sufentanil (0

  11. Robotic single site radical hysterectomy plus pelvic lymphadenectomy in gynecological cancers.

    Science.gov (United States)

    Vizza, Enrico; Chiofalo, Benito; Cutillo, Giuseppe; Mancini, Emanuela; Baiocco, Ermelinda; Zampa, Ashanti; Bufalo, Arabella; Corrado, Giacomo

    2018-01-01

    To evaluate the feasibility and the safety of robotic single-site radical hysterectomy (RSSRH) plus pelvic lymphadenectomy (PL) in endometrial or cervical cancer. Patients with endometrial cancer (EC) International Federation of Gynecology and Obstetrics (FIGO) stage II, early cervical cancer (ECC) FIGO stage IB1 or locally advanced cervical cancer (LACC) FIGO stage IB2-IIB with clinical response ≥50% after neo-adjuvant chemotherapy (NACT) were enrolled in a prospective cohort trial. All cases were performed using the da Vinci Si Surgical Single Site System®. Between April 2014 and November 2016, twenty patients were included in our pilot study. Three and 17 patients underwent type B1 or C1 RSSRH plus PL, respectively. The median age of patients was 46 years (range, 36-68 years) and the median body mass index was 23.5 kg/m² (range, 19.1-36.3 kg/m²). The median total operative time was 190 minutes (range, 90-310 minutes). The median blood loss was 75 mL (range, 20-700 mL) and the median number of pelvic lymph nodes removed was 16 (range, 5-27). No laparoscopic/laparotomic conversions were reported and the median time to discharge was 6 days (range, 4-16 days). No intra-operative complications occurred while 4 (20%) post-operative complications were reported: one pelvic abscess, one lymphorrea, one bowel perforation, and one vaginal dehiscence. RSSRH plus PL is technically feasible in patients affected by gynecological cancer.

  12. RADICAL HYSTERECTOMY IN SURGICAL TREATMENT OF INVASIVE CERVICAL CANCER AT THE DEPARTMENT OF GYNECOLOGY AND OBSTETRICS IN NOVI SAD IN THE PERIOD 1993-2013.

    Science.gov (United States)

    Đurđević, Srđan; Stojanović, Sanja; Pantelić, Miloš; Nikolić, Dragan; Basta Nikolić, Marijana; Mocko Kaćanski, Mihaela

    2015-01-01

    During the period from 1993 - 2013, 175 women with invasive cervical cancer underwent radical hysterectomy sec. Wertheim-Meigs at the Department of Gynecology and Obstetrics, Clinical Center of Vojvodina in Novi Sad. Indications for radical hysterectomy comprise histopathologically confirmed invasive cervical cancer in stages I B 1- II B according to the International Federation of Gynecology and Obstetrics. Stage ofthe disease or extent of the disease spread to the adjacent structures was assessed in accordance with the International Federation of Gynecology and Obstetrics staging system from 2009. Exclusion criteria were all other stages of this disease: I A and stages higher than II B, as well as the absence of definite histological confirmation of the cervical cancer (primary endometrial or vaginal cancer which infiltrates the uterine cervix). Prior the operation, the following had to be done: the imaging of pelvis and abdomen, chest X-ray in two directions, electrocardiography, internist and anesthesiological examination. The patients' age ranged from 24-79 years (x : 46 years), and the operation duration was 120-300 minutes (x : 210 min.). Stage I B 1 was found in 64.6% of operated patients, 14.8% of the patients were in stage I B 2, 9.1% were in stage II A and 11.4% were in stage II B. Blood loss during the operation ranged from 50-800 ml (on average 300 ml), and the number ofremoved lymph nodes per operation was 14-75 (x : 32). Intraoperative and postoperative complications developed in 6.8% of and 17.7% of patients, respectively. Recurrence was reported in 22(12.5%) patients, most often in paraaortic lymph nodes (3.4%) and parametria (2.8%), while the overall 5-year survival rate was 87% until 2008. Wertheim-Meigs radical hysterectomy is a basic surgical technique for the treatment of initial stages of invasive cervical cancer.

  13. Profilaxis antibiótica en histerectomía abdominal y vaginal

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    Joaquín Hernández Torres

    1998-12-01

    Full Text Available Se estudiaron retrospectivamente los expedientes clínicos de 155 pacientes a las que se les realizó histerectomía por vía abdominal o vaginal, en el Servicio de Cirugía General durante un período de 30 meses. Las pacientes se dividieron en 3 grupos según: a recibieron antibioticoterapia perioperatoria, b recibieron antibioticoterapia en el posoperatorio inmediato y c no recibieron tratamiento antibiótico. Se analizó la tasa de infección de la herida quirúrgica, además de la relación de ésta con algunos factores, entre ellos el tiempo quirúrgico y la antisepsia vaginal. Se llevaron los resultados a tratamiento estadístico (chi cuadrado y test de Fisher y se concluyó en que existe diferencia significativa entre la tasa de infección de la herida cuando se utiliza profilaxis perioperatoria (4,7 % si se compara con las pacientes que no recibieron tratamiento antibióticoA retrospective study of the medical histories of 155 patients who underwent vaginal of abdominal hysterectomy at the General Surgery Service during 30 months was conducted. Patients were divided into 3 groups: a patients who received perioperative antibiotic therapy, b patients that were administered antibiotics theraphy in the immediate postoperative and c those under no antibiotics treatment. The surgical wound infection rate was analyzed as well as its relation with some factors, such as surgical time and vaginal antisepsis. The results were statistically treated (chi square and Fisher’s test and it was concluded that there is a significant difference between the wound infection rate of patients receiving perioperative prophylaxis (4.7 % and those without antibiotics treatment

  14. Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer.

    Science.gov (United States)

    Higgs, Peta; Janda, Monika; Asher, Rebecca; Gebski, Val; Forder, Peta; Obermair, Andreas

    2018-01-02

    Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195; total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17; 95% confidence interval, -17.11 to -5.24; total laparoscopic hysterectomy: mean change -10.25; 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  15. Lactobacillus for Vaginal Microflora Correction

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    Saule Saduakhasova

    2014-12-01

    Full Text Available Introduction. Despite the significant progress made in prevention, diagnosis, and treatment, there is still a high rate of vaginal dysbiosis in Kazakh women. The use of antibiotics in the treatment of vaginal dysbiosis contributes to the elimination of pathogens as well as microflora, which can lead to a decrease in local immunity and more favorable conditions for infection spread. The most physiologically safe and promising method for the restoration of vaginal biocenosis is the use of probiotics administered by a vaginal route.Methods. We have allocated 64 of cultures of Lactobacillus from the vaginal epithelium of healthy women of reproductive age and women with diagnosed bacterial vaginosis (BV. Identification of cultures was performed by PCR analysis of 16S ribosomal RNA.  Evaluation of biological significance was determined by the following criteria: high antagonistic activity against Candida albicans, Escherichia coli, Serratia marcescens, Proteus mirabilis, Klebsiella ozaenae, and Staphylococcus aureus; and production of hydrogen peroxide, resistance to antibiotics, adhesive activity. We studied the symbiotic relationship of selected biologically active of cultures to each other and received options for consortiums with  properties of  probiotics through co-cultivation.Results. Results of genotyping  showed that the isolated lactobacilli belong to the seven species: L. fermentum, L. salivarius, L. gasseri, L. crispatus, L. jensenii, L. plantarum, and L. delbrueskii. L. fermentum, L. salivarius, L. gasseri, and L. jensenii occur in women with suspected BV. The highest percentage of occurrence in the vagina of healthy women was L. fermentum (28%. Most strains of lactobacilli possess high inhibitory activity for all test-strains, except Candida albicans (37.5%. 56% of studied cultures revealed high adhesion to human erythrocytes. All lactobacillus strains were resistant to metronidazole, 80% to kanamycin, 57%  to vancomycin, and

  16. Concurrent chemoradiation for vaginal cancer.

    Directory of Open Access Journals (Sweden)

    David T Miyamoto

    Full Text Available BACKGROUND: It is not known whether the addition of chemotherapy to radiation therapy improves outcomes in primary vaginal cancer. Here, we review clinical outcomes in patients with primary vaginal cancer treated with radiation therapy (RT or concurrent chemoradiation therapy (CRT. METHODS: Seventy-one patients with primary vaginal cancer treated with definitive RT with or without concurrent chemotherapy at a single institution were identified and their records reviewed. A total of 51 patients were treated with RT alone; 20 patients were treated with CRT. Recurrences were analyzed. Overall survival (OS and disease-free survival (DFS rates were estimated using the Kaplan-Meier method. Cox regression analysis was performed. RESULTS: The median age at diagnosis was 61 years (range, 18-92 years and the median follow-up time among survivors was 3.0 years. Kaplan-Meier estimates for OS and DFS differed significantly between the RT and CRT groups (3-yr OS = 56% vs. 79%, log-rank p = 0.037; 3-yr DFS = 43% vs. 73%, log-rank p = 0.011. Twenty-three patients (45% in the RT group had a relapse at any site compared to 3 (15% in the CRT group (p = 0.027. With regard to the sites of first relapse, 10 patients (14% had local only, 4 (6% had local and regional, 9 (13% had regional only, 1 (1% had regional and distant, and 2 (3% had distant only relapse. On univariate analysis, the use of concurrent chemotherapy, FIGO stage, tumor size, and date of diagnosis were significant predictors of DFS. On multivariate analysis, the use of concurrent chemotherapy remained a significant predictor of DFS (hazard ratio 0.31 (95% CI, 0.10-0.97; p = 0.04. CONCLUSIONS: Vaginal cancer results in poor outcomes. Adequate radiation dose is essential to ensure curative management. Concurrent chemotherapy should be considered for vaginal cancer patients.

  17. Vaginal delivery of breech presentation.

    Science.gov (United States)

    Kotaska, Andrew; Menticoglou, Savas; Gagnon, Robert

    2009-06-01

    To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth. Trial of labour in an appropriate setting or delivery by pre-emptive Caesarean section for women with a singleton breech fetus at term. Reduced perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short- and long-term maternal morbidity and mortality. Medline was searched for randomized trials, prospective cohort studies, and selected retrospective cohort studies comparing planned Caesarean section with a planned trial of labour; selected epidemiological studies comparing delivery by Caesarean section with vaginal breech delivery; and studies comparing long-term outcomes in breech infants born vaginally or by Caesarean section. Additional articles were identified through bibliography tracing up to June 1, 2008. The evidence collected was reviewed by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care. This guideline was compared with the 2006 American College of Obstetrician's Committee Opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery. The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Vaginal breech birth can be associated with a higher risk of perinatal mortality and short-term neonatal morbidity than

  18. Use of vaginal estrogen in Danish women

    DEFF Research Database (Denmark)

    Meaidi, Amani; Goukasian, Irina; Lidegaard, Oejvind

    2016-01-01

    INTRODUCTION: We know little about the use of vaginal estrogen in perimenopausal and postmenopausal women. We aimed to assess the prevalence of vaginal estrogen use in Denmark. MATERIAL AND METHODS: The study was designed as a nationwide cross-sectional study of all Danish women aged 40-79 years......, living in Denmark during the period 2007-2013. The Danish Prescription Register delivered data permitting us to assess the prevalence, age and regional geographical belonging of women purchasing prescribed vaginal estradiol. The number of women using over-the-counter vaginal estriol products...... was estimated from sale statistics from the same register. RESULTS: In 2013, 10.2% of all Danish women between 40 and 79 years of age used vaginal estradiol. The prevalence of women using this type of vaginal estrogen increased from 8.5% in year 2007 to 10.2% in 2013. The use peaked at 16.5% in women aged 60...

  19. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    LENUS (Irish Health Repository)

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  20. Age at hysterectomy as a predictor for subsequent pelvic organ prolapse repair

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, Jan; Ottesen, Bent

    2016-01-01

    INTRODUCTION AND HYPOTHESIS: The aim of this study was to investigate the association between patient age at the time of hysterectomy and subsequent pelvic organ prolapse (POP) surgery. METHODS: We gathered data on all benign hysterectomies and POP surgeries performed in Denmark on Danish women...

  1. Hysterectomy on benign indication in Denmark 1988-1998. A register based trend analysis

    DEFF Research Database (Denmark)

    Gimbel, H; Settnes, A; Tabor, A

    2001-01-01

    BACKGROUND: The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication. METHODS: Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data...

  2. Audit of hysterectomies in a group of private hospitals in Kaduna ...

    African Journals Online (AJOL)

    Conclusion: The indications for hysterectomy are varied and the operation appears to be safe in private hospitals in Kaduna. Quality assurance could be improved by simple supply of operation registers to hospitals. Keywords: hysterectomy, indications, medical audit, Nigeria Tropical Journal of Obstetrics and Gynaecology ...

  3. Urinary tract injuries in laparoscopic hysterectomy: a systematic review.

    Science.gov (United States)

    Adelman, Marisa R; Bardsley, Tyler R; Sharp, Howard T

    2014-01-01

    The aim of this review was to estimate the incidence of urinary tract injuries associated with laparoscopic hysterectomy and describe the long-term sequelae of these injuries and the impact of early recognition. Studies were identified by searching the PubMed database, spanning the last 10 years. The key words "ureter" or "ureteral" or "urethra" or "urethral" or "bladder" or "urinary tract" and "injury" and "laparoscopy" or "robotic" and "gynecology" were used. Additionally, a separate search was done for "routine cystoscopy" and "gynecology." The inclusion criteria were published articles of original research referring to urologic injuries occurring during either laparoscopic or robotic surgery for gynecologic indications. Only English language articles from the past 10 years were included. Studies with less than 100 patients and no injuries reported were excluded. No robotic series met these criteria. A primary search of the database yielded 104 articles, and secondary cross-reference yielded 6 articles. After reviewing the abstracts, 40 articles met inclusion criteria and were reviewed in their entirety. Of those 40 articles, 3 were excluded because of an inability to extract urinary tract injuries from total injuries. Statistical analysis was performed using a generalized linear mixed effects model. The overall urinary tract injury rate for laparoscopic hysterectomy was 0.73%. The bladder injury rate ranged from 0.05% to 0.66% across procedure types, and the ureteral injury rate ranged from 0.02% to 0.4% across procedure type. In contrast to earlier publications, which cited unacceptably high urinary tract injury rates, laparoscopic hysterectomy appears to be safe regarding the bladder and ureter. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Fascial Anatomy and Its Relevance in Safe Laparoscopic Hysterectomy.

    Science.gov (United States)

    Puntambekar, Shailesh P; Puntambekar, Seema P; Gadkari, Yamini; Naval, Suyash

    2015-01-01

    To demonstrate the importance of being familiar with the anatomy of the endopelvic fascia as seen by laparoscopy to perform safe laparoscopic hysterectomies. Combination of surgical videos and design diagrams. Compiled high-definition surgical videos from the Galaxy Care Laparoscopy Institute, Pune, India. These videos clearly demonstrate the anatomy of the endopelvic fascia and describe tips to avoid damage to the major structures, including the major vessels, ureter, bowel, bladder, and endopelvic fascia. The laparoscopic view of the anatomy with the current camera system is an excellent tool to demonstrate and teach pelvic anatomy, which can be applied to surgical principles in difficult benign and oncological cases. We used a total laparoscopic approach to demonstrate the fasciae that were seen during various types of hysterectomies. The video shows the following: (1) the posterior leaf of the broad ligament was opened until it reached the apex of the uterosacral ligament; (2) the anterior leaf of broad ligament was opened until it reached the vesico-uterine peritoneal reflection; (3) the principles of bladder dissection; (4) the pubocervico-vesical fascia and its relevance to bladder dissection; (5) the relevance of the anatomy of the uterine artery, vein, and ureter with endopelvic fascia within the leaves of the broad ligament; (6) Denonvillier's fascia dissection technique for dissection of the rectum away from the vagina; (7) the anatomy of the vesicocervical ligaments, forming the ureteric tunnel; (8) the dissection principles of lateralizing the ureter in the retrovesical region; (9) the endopelvic fascia reflection, which continued caudally, covering the pelvic floor; and (10) the relevance of the anatomy of the endopelvic fascia and the stress urinary incontinence treatment technique. Understanding the anatomy of the fasciae of the pelvis helps to create avascular planes and is crucial for performing safe hysterectomies. Copyright © 2015 AAGL

  5. Dynamic Clinical Measurements of Voluntary Vaginal Contractions and Autonomic Vaginal Reflexes

    NARCIS (Netherlands)

    Broens, Paul M. A.; Spoelstra, Symen K.; Weijmar Schultz, Willibrord C. M.

    2014-01-01

    IntroductionThe vaginal canal is an active and responsive canal. It has pressure variations along its length and shows reflex activity. At present, the prevailing idea is that the vaginal canal does not have a sphincter mechanism. It is hypothesized that an active vaginal muscular mechanism exists

  6. Single port robotic hysterectomy technique improving on multiport procedure

    Directory of Open Access Journals (Sweden)

    John R Lue

    2012-01-01

    Full Text Available The benefits of laparoscopic surgery over conventional abdominal surgery have been well documented. Reducing postoperative pain, decreasing postoperative morbidity, hospital stay duration, and postoperative recovery time have all been demonstrated in recent peer-review literature. Robotic laparoscopy provides the added dimension of increased fine mobility and surgical control. With new single port surgical techniques, we have the added benefit of minimally invasive surgery and greater patient aesthetic satisfaction, as well as all the other benefits laparoscopic surgery offers. In this paper, we report a successful single port robotic hysterectomy and the simple process by which this technique is performed.

  7. Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer

    DEFF Research Database (Denmark)

    Herling, Suzanne Forsyth; Møller, Ann M; Palle, Connie

    2017-01-01

    INTRODUCTION: Robotic-assisted laparoscopic hysterectomy (RALH) has become a widely used approach for women with endometrial cancer and has replaced laparotomy. It has been questioned if the increased costs are justified by superior surgical outcomes. The aim of the present study was to examine......-anaesthesia care unit was shorter for patients undergoing RALH. CONCLUSIONS: RALH appears advantageous for women treated for endometrial cancer in terms of post-operative complications. We recommend the use of the Clavien-Dindo classification of surgical outcomes for quality assessment. FUNDING: departmental only...

  8. Surgical treatment: Myomectomy and hysterectomy; Endoscopy: A major advancement.

    Science.gov (United States)

    Thubert, Thibault; Foulot, Hervé; Vinchant, Marie; Santulli, Pietro; Marzouk, Paul; Borghese, Bruno; Chapron, Charles

    2016-07-01

    Uterine fibroids affect 25% of women worldwide. Symptomatic women can be treated by either medical or surgical treatment. Development of endoscopic surgery has widely changed the management of myoma. Currently, although laparoscopic or laparoscopic robot-assisted myomectomies or hysterectomies are common, there has been no consensual guideline concerning the surgical techniques, operative route, and usefulness of preoperative treatment. Hysteroscopy management is a major advancement avoiding invasive surgery. This study deals with a literature review concerning surgical management of fibroids. Copyright © 2016. Published by Elsevier Ltd.

  9. Hysterectomy in Denmark 1977-2011: Changes in rate, indications, and hospitalization

    DEFF Research Database (Denmark)

    Lykke, Rune; Blaakær, J.; Ottesen, B.

    2013-01-01

    . The indication of pelvic organ prolapse and abnormal uterine bleeding increased while the indication of fibroids decreased. The average age of women at time of hysterectomy increased from 46 years in 1977-1981 to 50 years in 2006-2011. The mean number of hospitalization days was reduced by 75%. Regional......OBJECTIVE: To describe conditions regarding hysterectomy for benign indications during the past 35 years in Denmark. STUDY DESIGN: Population-based register study of 167,802 women who underwent hysterectomy for benign conditions in the period 1977-2011. Patient data regarding operative techniques...... differences were detected regarding route of hysterectomy and hospitalization. CONCLUSIONS: This study demonstrates a change in the pattern of indications for hysterectomy, increased age of the affected women, reduced length of stay in the hospital, and a rise in the percentage of minimal invasive surgical...

  10. Objective comparison of subtotal vs. total abdominal hysterectomy regarding pelvic organ prolapse and urinary incontinence

    DEFF Research Database (Denmark)

    Andersen, Lea Laird; Møller, Lars Alling; Gimbel, Helga Margrethe Elisabeth

    2015-01-01

    prolapse, 3 day voiding diary and also filled out the pelvic floor distress inventory (PFDI-20) questionnaire. RESULTS: We included 100/304 (32.9%) women (subtotal hysterectomy: 53, total hysterectomy: 47) in the clinical examinations. The study questionnaire was answered by 197 (64.8%) (subtotal: 97......OBJECTIVE: To compare subtotal and total abdominal hysterectomy regarding objective assessment of pelvic organ prolapse, urinary incontinence and voiding function 14 years after hysterectomy for benign diseases. STUDY DESIGN: Long-term follow-up of a randomized clinical trial of subtotal vs. total...... abdominal hysterectomy with objective outcomes. All randomized women still alive and living in Denmark (n=304) were invited to answer a questionnaire and come for clinical examination consisting of 20-min pad weighing test, urinary flow, measurement of residual urine, POP-Q measurement for pelvic organ...

  11. [Correlation of subjective and objective assessment of vaginal prolapse surgery - secondary analysis of randomized controlled study in patients with pelvic floor injury treated with vaginal mesh or with sacrospinous ligament fixation].

    Science.gov (United States)

    Švabík, K; El Haddad, R; Mašata, J; Hubka, P; Martan, A

    2015-10-01

    We had provided secondary analysis of our randomized controlled study comparing vaginal mesh with sacrospinous fixation for vaginal prolapse. We correlated data from subjective and objective assessment. Secondly we had provided correlations results of subjective and objective assessment between patient with anatomical failure and those without. The aim of this analysis was to provide correlation between objective and subjective outcome measures. Subanalysis of randomized controlled study. Obstetric Gynecology Department, First Faculty of Medicine of Charles University and General University Hospital in Prague. This is secondary analysis of single center randomized controlled study comparing two standard procedures for vaginal prolapse after hysterectomy in patients with levator avulsion injury. We had analyzed pre- and postoperative subjective POPDI score (Pelvic Organ Prolapse Distress Inventory) and correlated this score with most prolapsed portion of vaginal wall. We had compared all vaginal compartments using POPQ (Pelvic Organ Prolapse Quantification): anterior wall with point Ba, apical with point C, and posterior with point Bp. Subsequently we compared subjective POPDI score in group of patients with anatomical failure and those without. We had included in randomized study 70 women. Mean preoperative POPDI score was 65.25 (3.57-200). We didnt found any correlation between subjective score and objective assessment in preoperative data: POPDI vs. Ba (p = 0.75) POPDI vs. C (p = 0.57) a POPDI vs. Bp (p = 0.22) and no correlation in postoperative assessment. Postoperative POPDI score decreased to 26.1, but there was no difference in POPDI score in woman with anatomical failure and no failure - 17.4 vs. 23.3 (p = 0.64)CONCLUSION: Secondary analysis of randomized controlled study had shown that objective and subjective assessment have poor correlation. We didnt found any correlation between degree of prolapse and intensity of complains. The large inter

  12. A randomised trial comparing endometrial resection and abdominal hysterectomy for the treatment of menorrhagia.

    Science.gov (United States)

    Gannon, M J; Holt, E M; Fairbank, J; Fitzgerald, M; Milne, M A; Crystal, A M; Greenhalf, J O

    1991-01-01

    OBJECTIVE--To determine the advantages and disadvantages of endometrial resection and abdominal hysterectomy for the surgical treatment of women with menorrhagia. DESIGN--Randomised study of two treatment groups with a minimum follow up of nine months. SETTING--Royal Berkshire Hospital, Reading. SUBJECTS--51 of 78 menorrhagic women without pelvic pathology who were on the waiting list for abdominal hysterectomy. TREATMENT--Endometrial resection or abdominal hysterectomy (according to randomisation). Endometrial resections were performed by an experienced hysteroscopic surgeon; hysterectomies were performed by two other gynaecological surgeons. MAIN OUTCOME MEASURES--Length of operating time, hospitalisation, recovery; cost of surgery; short term results of endometrial resection. RESULTS--Operating time was shorter for endometrial resection (median 30 (range 20-47) minutes) than for hysterectomy (50 (39-74) minutes). The hospital stay for endometrial resection (median 1 (range 1-3) days) was less than for hysterectomy (7 (5-12) days). Recovery after endometrial resection (median 16 (range 5-62) days) was shorter than after hysterectomy (58 (11-125) days). The cost was 407 pounds for endometrial resection and 1270 pounds for abdominal hysterectomy. Four women (16%) who did not have an acceptable improvement in symptoms after endometrial resection had repeat resections. No woman has required hysterectomy during a mean follow up of one year. CONCLUSION--For women with menorrhagia who have no pelvic pathology endometrial resection is a useful alternative to abdominal hysterectomy, with many short term benefits. Larger numbers and a longer follow up are needed to estimate the incidence of complications and the long term efficacy of endometrial resection. PMID:1760601

  13. Body mass index following natural menopause and hysterectomy with and without bilateral oophorectomy.

    Science.gov (United States)

    Gibson, C J; Thurston, R C; El Khoudary, S R; Sutton-Tyrrell, K; Matthews, K A

    2013-06-01

    The directional and temporal nature of relationships between overweight and obesity and hysterectomy with or without oophorectomy is not well understood. Overweight and obesity may be both a risk factor for the indications for these surgeries and a possible consequence of the procedure. We used prospective data to examine whether body mass index (BMI) increased more following hysterectomy with and without bilateral oophorectomy compared with natural menopause among middle-aged women. BMI was assessed annually for up to 10 years in the Study of Women's Health Across the Nation (SWAN (n=1962)). Piecewise linear mixed growth models were used to examine changes in BMI before and after natural menopause, hysterectomy with ovarian conservation and hysterectomy with bilateral oophorectomy. Covariates included education, race/ethnicity, menopausal status, physical activity, self-rated health, hormone therapy use, antidepressant use, age and visit before the final menstrual period (FMP; for natural menopause) or surgery (for hysterectomy/oophorectomy). By visit 10, 1780 (90.6%) women reached natural menopause, 106 (5.5%) reported hysterectomy with bilateral oophorectomy and 76 (3.9%) reported hysterectomy with ovarian conservation. In fully adjusted models, BMI increased for all women from baseline to FMP or surgery (annual rate of change=0.19 kg m(-2) per year), with no significant differences in BMI change between groups. BMI also increased for all women following FMP, but increased more rapidly in women following hysterectomy with bilateral oophorectomy (annual rate of change=0.21 kg m(-2) per year) as compared with following natural menopause (annual rate of change=0.08 kg m(-2) per year, P=0.03). In this prospective examination, hysterectomy with bilateral oophorectomy was associated with greater increases in BMI in the years following surgery than following hysterectomy with ovarian conservation or natural menopause. This suggests that accelerated weight

  14. More frequent vaginal orgasm is associated with experiencing greater excitement from deep vaginal stimulation.

    Science.gov (United States)

    Brody, Stuart; Klapilova, Katerina; Krejčová, Lucie

    2013-07-01

    Research indicated that: (i) vaginal orgasm (induced by penile-vaginal intercourse [PVI] without concurrent clitoral masturbation) consistency (vaginal orgasm consistency [VOC]; percentage of PVI occasions resulting in vaginal orgasm) is associated with mental attention to vaginal sensations during PVI, preference for a longer penis, and indices of psychological and physiological functioning, and (ii) clitoral, distal vaginal, and deep vaginal/cervical stimulation project via different peripheral nerves to different brain regions. The aim of this study is to examine the association of VOC with: (i) sexual arousability perceived from deep vaginal stimulation (compared with middle and shallow vaginal stimulation and clitoral stimulation), and (ii) whether vaginal stimulation was present during the woman's first masturbation. A sample of 75 Czech women (aged 18-36), provided details of recent VOC, site of genital stimulation during first masturbation, and their recent sexual arousability from the four genital sites. The association of VOC with: (i) sexual arousability perceived from the four genital sites and (ii) involvement of vaginal stimulation in first-ever masturbation. VOC was associated with greater sexual arousability from deep vaginal stimulation but not with sexual arousability from other genital sites. VOC was also associated with women's first masturbation incorporating (or being exclusively) vaginal stimulation. The findings suggest (i) stimulating the vagina during early life masturbation might indicate individual readiness for developing greater vaginal responsiveness, leading to adult greater VOC, and (ii) current sensitivity of deep vaginal and cervical regions is associated with VOC, which might be due to some combination of different neurophysiological projections of the deep regions and their greater responsiveness to penile stimulation. © 2013 International Society for Sexual Medicine.

  15. Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: A novel approach in difficult laparoscopic hysterectomy

    OpenAIRE

    Mun-Kun Hong; Tang-Yuan Chu; Dah-Ching Ding

    2016-01-01

    Objective: To proposed a novel method for a difficult laparoscopic hysterectomy that spares the cervical ligaments and eliminates the cervical canal and transformation zone of the cervix. Case report: A 40-year-old women, gravida 3 para 3, who had had a cesarean delivery previously, was referred to the gynecology clinic due to adenomyosis with menorrhagia and severe anemia. Ultrasonography showed that the uterus was enlarged to 13.5 cm × 10.7 cm × 8.8 cm. After obtaining informed consent, ...

  16. Pelvic packing with vaginal traction for the management of intractable hemorrhage.

    Science.gov (United States)

    Naranjo-Gutiérrez, Leonardo A; Oliva-Cristerna, Joaquín; Ramírez-Montiel, Martha L; Ortiz, Mario I

    2014-10-01

    To present clinical cases examining the effectiveness and safety of pelvic packing with vaginal traction for inhibiting obstetric hemorrhage among women receiving treatment at a public obstetrics and gynecology tertiary care hospital in Mexico. In a retrospective observational descriptive study, eight cases of obstetric hemorrhage treated by pelvic packing with vaginal traction between January 2012 and December 2013 at Hospital de la Mujer, Mexico City, Mexico, were reviewed. The mean patient age was 28.8±6.8 years. The average blood loss was 4535±897 mL. Uterine atony was the cause of bleeding among six patients: histopathologic examination revealed two cases of placenta accreta, one case of placenta percreta, two cases of uteroplacental apoplexy, and one case of myomatosis. For two patients, placental separation was difficult and required surgical management. The packing technique was effective for all patients. No patients presented with infection or required re-operation for bleeding management. No deaths occurred. For management of bleeding among patients with underlying coagulation disorders, pelvic packing can be useful when standard techniques such as hysterectomy, tubal hypogastric ligation, and/or pharmacologic therapy are unsuccessful. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. A Case of Malignant Melanoma of the Uterine Cervix with Disseminated Metastases throughout the Vaginal Wall

    Directory of Open Access Journals (Sweden)

    Tomoko Noguchi

    2017-01-01

    Full Text Available Malignant melanoma (MM in the female genital tract accounts for less than 2% of all melanomas, and the vast majority associated occur in the vulva and vagina. Primary MM of the uterine cervix is extremely rare and its prognosis is very poor. We report a case of primary MM of the cervix with dissemination throughout the vaginal wall. A 66-year-old woman presented with postmenopausal bleeding. Gynecologic examination demonstrated a 2 cm polypoid blackish-pigmented tumor on the cervix with multiple small blackish-pigmented lesions throughout the vaginal wall. Cervical Pap smear cytology showed malignant melanoma. MRI and PET/CT did not detect any distant or lymph node metastases. She underwent radical hysterectomy, pelvic lymphadenectomy, and total vaginectomy. The pathological diagnosis was FIGO stage IIIA primary cervical MM. She received adjuvant chemotherapy with 6 courses of dacarbazine, but 6 months later, multiple lung metastases were detected. Despite 4 courses of anti-PD-1 antibody (nivolumab treatment, she died of the disease 13 months after surgery.

  18. A Case of Malignant Melanoma of the Uterine Cervix with Disseminated Metastases throughout the Vaginal Wall.

    Science.gov (United States)

    Noguchi, Tomoko; Ota, Nami; Mabuchi, Yasushi; Yagi, Shigetaka; Minami, Sawako; Okuhira, Hisako; Yamamoto, Yuki; Nakamura, Yasushi; Ino, Kazuhiko

    2017-01-01

    Malignant melanoma (MM) in the female genital tract accounts for less than 2% of all melanomas, and the vast majority associated occur in the vulva and vagina. Primary MM of the uterine cervix is extremely rare and its prognosis is very poor. We report a case of primary MM of the cervix with dissemination throughout the vaginal wall. A 66-year-old woman presented with postmenopausal bleeding. Gynecologic examination demonstrated a 2 cm polypoid blackish-pigmented tumor on the cervix with multiple small blackish-pigmented lesions throughout the vaginal wall. Cervical Pap smear cytology showed malignant melanoma. MRI and PET/CT did not detect any distant or lymph node metastases. She underwent radical hysterectomy, pelvic lymphadenectomy, and total vaginectomy. The pathological diagnosis was FIGO stage IIIA primary cervical MM. She received adjuvant chemotherapy with 6 courses of dacarbazine, but 6 months later, multiple lung metastases were detected. Despite 4 courses of anti-PD-1 antibody (nivolumab) treatment, she died of the disease 13 months after surgery.

  19. Vaginitis

    Science.gov (United States)

    ... vagina as a cream or gel. What is trichomoniasis? Trichomoniasis is a condition caused by the microscopic ... transmitted infections (STIs) . What are the symptoms of trichomoniasis? Signs of trichomoniasis may include a yellow-gray ...

  20. [Has ketamine preemptive analgesic effect in patients undergoing abdominal hysterectomy?].

    Science.gov (United States)

    Karaman, Semra; Kocabaş, Seden; Zincircioğlu, Ciler; Firat, Vicdan

    2006-07-01

    The aim of this study was to determine if preemptive use of the NMDA receptor antogonist ketamine decreases postoperative pain in patients undergoing abdominal hystrectomy. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. After standart general anaesthesia, before or after incision patients received bolus saline or ketamine. Group S received only saline while Group Kpre received ketamine 0.4 mg/kg before incision and saline after incision, and Group Kpost received saline before incision and 0.4 mg/kg ketamine after incision. Postoperatif analgesia was maintained with i.v. PCA morphine. Pain scores were assessed with Vizüal Analog Scale (VAS), Verbal Rating Scale (VRS) at 1., 2, 3., 4., 8., 12. ve 24. hours postoperatively. First analgesic requirement time, morphine consumption and side effects were recorded. There were no significant differences between groups with respect to VAS / VRS scores, the time for first analgesic dose, and morphine consumption ( p>0.05). Patients in Group S had significantly lower sedation scores than either of the ketamine treated groups ( pketamin had no preemptive analgesic effect in patients undergoing abdominal hysterectomy, but further investigation is needed for different operation types and dose regimens.

  1. VULVO-VAGINAL CANDIDIASIS ASSOCIATED WITH ACITRETIN

    NARCIS (Netherlands)

    STURKENBOOM, MCJM; MIDDELBEEK, A; VANDENBERG, LTWD; VANDENBERG, PB; STRICKER, BHC; WESSELING, H

    The aim of this study was to estimate the risk of vulvo-vaginal candidiasis among the users of acitretin. The incidence rate ratio of vulvo-vaginal candidiasis was estimated in a cohort of acitretin users by using prescription sequence analysis. Study subjects were 196 women between 15 and 45 years

  2. Value of bacterial culture of vaginal swabs in diagnosis of vaginal infections

    Directory of Open Access Journals (Sweden)

    Nenadić Dane

    2015-01-01

    Full Text Available Bacground/Aim. Vaginal and cervical swab culture is still very common procedure in our country’s everyday practice whereas simple and rapid diagnostic methods have been very rarely used. The aim of this study was to show that the employment of simple and rapid diagnostic tools [vaginal fluid wet mount microscopy (VFWMM, vaginal pH and potassium hydroxide (KOH test] offers better assessment of vaginal environment than standard microbiologic culture commonly used in Serbia. Methods. This prospective study included 505 asymptomatic pregnant women undergoing VFWMM, test with 10% KOH, determination of vaginal pH and standard culture of cervicovaginal swabs. Combining findings from the procedures was used to make diagnoses of bacterial vaginosis (BV and vaginitis. In addition, the number of polymorphonuclear leukocytes (PMN was determined in each sample and analyzed along with other findings. Infections with Candida albicans and Trichomonas vaginalis were confirmed or excluded by microscopic examination. Results. In 36 (6% patients cervicovaginal swab cultures retrieved several aerobes and facultative anaerobes, whereas in 52 (11% women Candida albicans was isolated. Based on VFWMM findings and clinical criteria 96 (19% women had BV, 19 (4% vaginitis, and 72 (14% candidiasis. Of 115 women with BV and vaginitis, pH 4.5 was found in 5, and of 390 with normal findings 83 (21% had vaginal pH 4.5. Elevated numbers of PMN were found in 154 (30% women - in 83 (54% of them VFWMM was normal. Specificity and sensitivity of KOH test and vaginal pH determination in defining pathological vaginal flora were 95% and 81%, and 79% and 91%, respectively. Conclusion. Cervicovaginal swab culture is expensive but almost non-informative test in clinical practice. The use of simpler and rapid methods as vaginal fluid wet mount microscopy, KOH test and vaginal pH offers better results in diagnosis, and probably in the treatment and prevention of sequels of vaginal

  3. Health Care Disparities in Hysterectomy for Gynecologic Cancers: Data From the 2012 National Inpatient Sample.

    Science.gov (United States)

    Esselen, Katharine M; Vitonis, Allison; Einarsson, Jon; Muto, Michael G; Cohen, Sarah

    2015-11-01

    To examine hysterectomies in the United States performed for gynecologic malignancies and identify factors associated with the use of minimally invasive techniques. This is a cross-sectional analysis of the 2012 National Inpatient Sample, the largest national all-payer database of hospital discharges. International Classification of Diseases, 9th Revision, Clinical Modification codes for any type of hysterectomy performed for gynecologic malignancy were used to abstract pertinent observations. Weighted multivariable logistic regression models were used to examine the associations between demographic and clinical factors and mode of hysterectomy by cancer diagnosis. In 2012, there were an estimated 46,450 hysterectomies for gynecologic malignancy in the United States. Of these, 28,285 (61%) were performed for uterine, 4,275 (9%) for cervical, 12,370 (27%) for ovarian cancer, and 1,520 (3%) for other gynecologic malignancies. Minimally invasive hysterectomy was used in 50% of uterine, 43% of cervical, and 8.5% of ovarian cancer cases. Black women had decreased odds of undergoing minimally invasive hysterectomy for uterine (adjusted odds ratio [OR] 0.50, 95% confidence interval [CI] 0.40-0.0.63, Pgynecologic malignancies remained underused in 2012; there were striking racial disparities associated with use of minimally invasive hysterectomy for uterine and cervical cancers. III.

  4. Expression and significance of aquaporin-2 in human ectocervical-vaginal epithelial cells.

    Science.gov (United States)

    Zhao, Yurong; Lai, Ailuan; Dong, Wenbing

    2014-01-01

    To observe the expression of aquaporin-2 (AQP2) in human ectocervical-vaginal epithelial cells (hECEs). The study included 75 females who underwent hysterectomy for benign pelvic lesions. They were divided into three groups according to menstrual states: 28 cases in the normal menstrual group, 24 cases in the perimenopausal group, and 23 cases in the postmenopausal group. Specimens were obtained from the posterior vaginal wall. AQP2 mRNA and protein expression were detected using quantitative real-time polymerase chain reaction and immunohistochemistry, respectively. Estrogen (E2), follicle-stimulating hormone (FSH) and plasma osmolality were assayed by blood routine test. Linear regression analysis was used for data analysis. AQP2 mRNA and protein expression were detected in all hECE tissues. AQP2 mRNA and protein expression in the normal menstrual group were significantly higher than those in the peri- and menopausal groups (p < 0.05). AQP2 mRNA was negatively correlated with FSH level (R = -0.537, p < 0.05), age (R = -0.508, p < 0.05) and plasma osmolality (R = -0.214, p < 0.05), but positively correlated with E2 (R = 0.511, p < 0.05). AQP2 protein expression was negatively correlated with FSH (R = -0.419, p < 0.05) and age (R = -0.034, p < 0.05), but positively correlated with E2 (R = 0.367, p < 0.05). The downregulation of AQP2 might be a causative factor for decreased vaginal secretions during the menopausal period. © 2014 S. Karger AG, Basel.

  5. Risk factors for major depressive disorder and the psychological impact of hysterectomy: a prospective investigation.

    Science.gov (United States)

    Yen, Ju-Yu; Chen, Yung-Hung; Long, Cheng-Yu; Chang, Yu; Yen, Cheng-Fang; Chen, Cheng-Chung; Ko, Chih-Hung

    2008-01-01

    The authors prospectively evaluated the risk of major depressive disorder and the psychological impact of recent hysterectomy in 68 women who underwent hysterectomy for non-malignant conditions. Depression, anxiety, body image, sexual functioning, family support, life stress, and subjective gynecological symptoms were assessed 2 weeks before surgery and at 1 month and 4 months after surgery. Depression, anxiety, body image, and subjective gynecological symptoms improved after surgery; however, sexual functioning worsened after surgery. Previous emotional problems and poorer body image, sexual functioning, and higher stress 1 month after surgery are risk factors for post-hysterectomy major depressive disorder.

  6. Mexican beliefs and attitudes toward hysterectomy and gender-role ideology in marriage.

    Science.gov (United States)

    Marván, Ma Luisa; Quiros, Vanessa; López-Vázquez, Esperanza; Ehrenzweig, Yamilet

    2012-01-01

    One hundred and sixty-one Mexican respondents completed a questionnaire that measured beliefs and attitudes toward hysterectomy and another that measured gender-role ideology in marriage (GRIMQ). The participants were divided into two groups according to the GRIMQ: "high machismo/marianismo" and "low machismo/marianismo" groups. The participants belonging to the first group showed the most negative attitudes toward hysterectomy. In this group, men showed more negative attitudes toward hysterctomy and were less likely than women to believe that hysterectomy has positive aspects. The findings are discussed in light of male dominance and female subordination that prevail in certain cultural groups of Mexico.xs.

  7. An innovative approach to treating vaginal mesh exposure after abdominal sacral colpopexy: endoscopic resection of mesh and platelet-rich plasma; initial experience in three women.

    Science.gov (United States)

    Castellani, Daniele; Valloni, Alessandra; Piccirilli, Angela; Paradiso Galatioto, Giuseppe; Vicentini, Carlo

    2017-02-01

    Polypropylene mesh exposure is uncommon after abdominal sacral colpopexy (ASC), but in case of symptomatic vaginal mesh exposure, surgery is needed. When treating it, care must be taken to completely remove the exposed mesh (EM), saving as much vaginal tissue as possible to avoid a subsequent shortened and narrowed vagina. In this video, we present a minimally invasive technique for treating EM after ASC using endoscopic mesh resection and autologous platelet-rich plasma (PRP) technology. Three women were referred to our outpatient clinic for vaginal vault mesh exposure after laparoscopic ASC with concomitant hysterectomy. All women underwent endoscopic bipolar PlasmaKinetic resection (BPR) of EM, and PRP gel was delivered in the surgical site to cover the gap left by the resection. Mean operative time was 39.6 min. Surgery was uneventful in all cases. All women recovered sexual function, and nobody experienced relapsed pelvic organ prolapse at 1-year follow-up. Our preliminary results show that BPR and PRP are safe, effective, and feasible for treating vaginal mesh exposure with conservation of anatomy and sexual function.

  8. Prolapso vaginal e uterino em ovelhas

    OpenAIRE

    Maíra Bianchi R. Alves; Benesi,Fernando J.; Lilian Gregory; Della Libera, Alice M.M.P.; Sucupira,Maria Cláudia A.; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    O presente trabalho objetivou realizar um estudo retrospectivo sobre os prolapsos vaginal e uterino em ovelhas atendidas no Serviço de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6%). O prolapso vaginal total foi o de maior frequência (72%). As ovelhas acometidas, em sua maioria, possuíam idade sup...

  9. Deep neuromuscular blockade and low insufflation pressure during laparoscopic hysterectomy.

    Science.gov (United States)

    Madsen, Matias Vested; Istre, Olav; Springborg, Henrik Halvor; Staehr-Rye, Anne Kathrine; Rosenberg, Jacob; Lund, Jørgen; Gätke, Mona Ring

    2017-05-01

    Establishment of sufficient muscle relaxation is essential in laparoscopic surgery. During laparoscopy, surgeons can experience abdominal contractions in their patients. Deep neuromuscular block (NMB) has the potential to prevent such episodes. In this study, we explored if deep NMB reduces the incidence of sudden abdominal contractions as compared with standard NMB. This was a pre-planned secondary analysis of a randomized, controlled study. A total of 110 patients scheduled for laparoscopic hysterectomy were randomized to either deep NMB and 8 mmHg pneumoperitoneum (deep NMB group) or single-bolus NMB and 12 mmHg pneumoperitoneum (standard NMB group). NMB was established with rocuronium and reversed with sugammadex. Two gynaecologists registered episodes of sudden abdominal contractions, alarms from the insufflator due to increased intraabdominal pressure and incidences with tightness of the abdominal wall. No sudden abdominal contractions were detected in the deep NMB group as compared with 12 episodes in the standard NMB group (p deep and standard NMB group, respectively. The gynaecologists registered increasing abdominal tensions in no versus eight procedures (p = 0.006) in the deep and standard NMB group, respectively. Deep NMB in combination with 8 mmHg pneumoperitoneum prevented sudden abdominal contractions during laparoscopic hysterectomy. This work was funded in part by a research grant from the Investigator Initiated Studies Program of Merck Sharp & Dohme Corp, USA. The opinions expressed in this paper are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. The study was assigned with EudraCT number 2012-003787-51 and registered with clinicaltrials.gov (NCT01722097). Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any

  10. Women's Intention to Prevent Vesico Vaginal Fistula Recurrence in ...

    African Journals Online (AJOL)

    Objective: The study purpose was to determine the association between intention to prevent Vesico-Vaginal Fistula recurrence and knowledge of the risk factors of Vesico Vaginal Fistula recurrence, attitude towards Vesico Vaginal Fistula prevention and self esteem among women with Vesico-Vaginal Fistula in two repair ...

  11. Endometrial safety of ultra-low-dose estradiol vaginal tablets

    DEFF Research Database (Denmark)

    Simon, James; Nachtigall, Lila; Ulrich, Lian G

    2010-01-01

    To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17β-estradiol vaginal tablets in postmenopausal women with vaginal atrophy.......To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17β-estradiol vaginal tablets in postmenopausal women with vaginal atrophy....

  12. Endometrial safety of ultra-low-dose estradiol vaginal tablets

    DEFF Research Database (Denmark)

    Simon, James; Nachtigall, Lila; Ulrich, Lian G

    2010-01-01

    To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17ß-estradiol vaginal tablets in postmenopausal women with vaginal atrophy.......To evaluate the endometrial hyperplasia and carcinoma rate after 52-week treatment with ultra-low-dose 10-microgram 17ß-estradiol vaginal tablets in postmenopausal women with vaginal atrophy....

  13. Surgical removal of a large vaginal calculus formed after a tension-free vaginal tape procedure.

    Science.gov (United States)

    Zilberlicht, Ariel; Feiner, Benjamin; Haya, Nir; Auslender, Ron; Abramov, Yoram

    2016-11-01

    Vaginal calculus is a rare disorder which has been reported in association with urethral diverticulum, urogenital sinus anomaly, bladder exstrophy and the tension-free vaginal tape (TVT) procedure. We report a 42-year-old woman who presented with persistent, intractable urinary tract infection (UTI) following a TVT procedure. Cystoscopy demonstrated an eroded tape with the formation of a bladder calculus, and the patient underwent laser cystolithotripsy and cystoscopic resection of the tape. Following this procedure, her UTI completely resolved and she remained asymptomatic for several years. Seven years later she presented with a solid vaginal mass. Pelvic examination followed by transvaginal ultrasonography and magnetic resonance imaging demonstrated a large vaginal calculus located at the lower third of the anterior vaginal wall adjacent to the bladder neck. This video presents the transvaginal excision and removal of the vaginal calculus.

  14. Vaginal Calculus in a Woman With Mixed Urinary Incontinence and Vaginal Mesh Exposure.

    Science.gov (United States)

    Winkelman, William D; Rabban, Joseph T; Korn, Abner P

    2016-01-01

    Vaginal calculi are extremely rare and are most commonly encountered in the setting of an urethrovaginal or vesicovaginal fistula. We present a case of a 72-year-old woman with mixed urinary incontinence and vaginal mesh exposure incidentally found to have a large vaginal calculus. We removed the calculus surgically and analyzed the components. Results demonstrated the presence of ammonium-magnesium phosphate hexahydrate and carbonate apatite.

  15. Quality of life, urogynecological morbidity, and lymphedema after radical vaginal trachelectomy for early-stage cervical cancer

    DEFF Research Database (Denmark)

    Frøding, Ligita Paskeviciute; Ottosen, Christian; Mosgaard, Berit Jul

    2015-01-01

    OBJECTIVE: Radical vaginal trachelectomy (RVT) offers a possibility for future childbearing for young women with early-stage cervical cancer. However, the literature on quality of life and self-reported morbidity in patients undergoing RVT is scarce. The aim of this study was to prospectively...... assess quality of life after RVT with focus on urogynecological morbidity and lymphedema. Furthermore, the aim of this study was to compare results with those in women treated with radical abdominal hysterectomy (RAH) and with age-matched control women from the general population. METHODS AND MATERIALS...... severe lymphedema of the legs as assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module. The Global Health Status scores of the RVT patients improved over time but were significantly lower than in the healthy controls during...

  16. Determination of Prognostic Factors for Vaginal Mucosal Toxicity Associated With Intravaginal High-Dose Rate Brachytherapy in Patients With Endometrial Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bahng, Agnes Y.; Dagan, Avner [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States); Bruner, Deborah W. [University of Pennsylvania School of Nursing, Philadelphia, PA (United States); Lin, Lilie L., E-mail: lin@xrt.upenn.edu [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA (United States)

    2012-02-01

    Purpose: The objective of this study was to determine the patient- and treatment-related prognostic factors associated with vaginal toxicity in patients who received intravaginal high dose rate (HDR) brachytherapy alone as adjuvant treatment for endometrial cancer. Secondary goals of this study included a quantitative assessment of optimal dilator use frequency and a crude assessment of clinical predictors for compliant dilator use. Methods and Materials: We retrospectively reviewed the charts of 100 patients with histologically confirmed endometrial cancer who underwent total hysterectomy and bilateral salpingo-oophorectomy with or without lymph node dissection and adjuvant intravaginal brachytherapy between 1995 and 2009 at the Hospital of University of Pennsylvania. The most common treatment regimen used was 21 Gy in three fractions (71 patients). Symptoms of vaginal mucosal toxicity were taken from the history and physical exams noted in the patients' charts and were graded according to the Common Toxicity Criteria for Adverse Events v. 4.02. Results: The incidence of Grade 1 or asymptomatic vaginal toxicity was 33% and Grade 2-3 or symptomatic vaginal toxicity was 14%. Multivariate analysis of age, active length, and dilator use two to three times a week revealed odds ratios of 0.93 (p = 0.013), 3.96 (p = 0.008), and 0.17 (p = 0.032) respectively. Conclusion: Increasing age, vaginal dilator use of at least two to three times a week, and shorter active length were found to be significantly associated with a decreased risk of vaginal stenosis. Future prospective studies are necessary to validate our findings.

  17. A prospective study of risk factors for pain persisting 4 months after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, Birgitte; Dueholm, Margit; Nikolajsen, Lone

    2009-01-01

    OBJECTIVES: Chronic pain after hysterectomy is reported by 5% to 32% of women, but it is unknown whether the pain is a result of surgery or can be attributable to other factors such as preoperative and postoperative pain, physical, and psychosocial status. The aim of this prospective study.......004 and P = 0.034). A similar tendency was seen for preoperative "pelvic pain" (P = 0.059). Women with pain at 4 months reported lower quality of life in 4 Short Form-36 subscales and less control of pain preoperatively (P Pain persisting 4 months after hysterectomy...... was therefore to study the role of surgery and other possible predictors for pain 4 months after hysterectomy. METHODS: Ninety women referred for hysterectomy for benign conditions completed the study. The women were interviewed and completed pain questionnaires before surgery and after 3 weeks and 4 months...

  18. Danish gynecologists' opinion about hysterectomy on benign indication: results of a survey

    DEFF Research Database (Denmark)

    Gimbel, Helga; Ottesen, Bent; Tabor, Ann

    2002-01-01

    WAS: 73%. For women aged > or = 50 years meno-metrorrhagia and symptomatic fibroids seemed to be important for hysterectomy recommendations, and for those aged fibroids and unexplained pelvic pain seemed important for recommendation of other treatments. Employment, gender...

  19. Application of da Vinci(®) Robot in simple or radical hysterectomy: Tips and tricks.

    Science.gov (United States)

    Iavazzo, Christos; Gkegkes, Ioannis D

    2016-01-01

    The first robotic simple hysterectomy was performed more than 10 years ago. These days, robotic-assisted hysterectomy is accepted as an alternative surgical approach and is applied both in benign and malignant surgical entities. The two important points that should be taken into account to optimize postoperative outcomes in the early period of a surgeon's training are how to achieve optimal oncological and functional results. Overcoming any technical challenge, as with any innovative surgical method, leads to an improved surgical operation timewise as well as for patients' safety. The standardization of the technique and recognition of critical anatomical landmarks are essential for optimal oncological and clinical outcomes on both simple and radical robotic-assisted hysterectomy. Based on our experience, our intention is to present user-friendly tips and tricks to optimize the application of a da Vinci® robot in simple or radical hysterectomies.

  20. Is Previous Tubal Ligation a Risk Factor for Hysterectomy because of Abnormal Uterine Bleeding?

    Directory of Open Access Journals (Sweden)

    Sanam Moradan

    2012-07-01

    Full Text Available Objectives: Post tubal ligation syndrome (PTLS is a term used to describe a variety of post tubal ligation side effects or symptoms. These include increased menstrual bleeding and hysterectomy. Whether or not post tubal syndrome is a real entity, it has been a subject of controversy in the medical literature for decades. Numerous studies have reported conflicting conclusions about these symptoms. In this study the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among non-sterilized female population of the same age.Methods: This study was carried out on 160 women, 38-52 years, who underwent hysterectomy in Amir University Hospital, Semnan, Iran, from September 2008 to September 2011. After gathering of data from medical records, in this study, the incidence of hysterectomy for bleeding disorders among sterilized women was compared with the incidence of hysterectomy for bleeding disorders among nonsterilized female population for the same age.Results: The mean age of the study group was 44/4±5/7 and the mean age of the control group was 45/2±5/3, (p=0.424.The mean parity of the study group was 3/8±1/8 and the mean parity of the control group was 3/5±1/4, (p=0.220. So, in regard to age and parity, two groups were matched. Hysterectomies were performed for 160 cases and abnormal uterine bleeding was the cause of hysterectomy in 67 cases. Among 67 cases, 19 cases (37.3% had previous tubal sterilization + hysterectomy (study group and 48 cases (44% were not undergoing tubal sterilization but had hysterectomy for abnormal bleeding causes (control group. Statistical analyses showed that there were not significant differences between two groups, (RR=0.85; 95% CI: 0.56-1.28; p=0.418.Conclusion: The result of this study showed that previous tubal sterilization is not a risk factor for undergoing hysterectomy because of abnormal uterine bleeding.

  1. Prevalence of vaginal candidiasis among pregnant women with abnormal vaginal discharge in Maiduguri.

    Science.gov (United States)

    Ibrahim, S M; Bukar, M; Mohammed, Y; Mohammed, B; Yahaya, M; Audu, B M; Ibrahim, H M; Ibrahim, H A

    2013-01-01

    Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women. High vaginal swab samples and data on epidemiological characteristics were collected from 400 pregnant women with complaints of abnormal vaginal discharge at booking clinic of University of Maiduguri Teaching Hospital. The data was analysed using SPSS 16.0 statistical software. The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-24 years, 291 (72.8%) in multipara, 223 (55.8%) in those with Primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P vaginal discharge in pregnancy was high in this study and C. albicans was the commonest cause. It is recommended that a pregnant woman complaining of abnormal vaginal discharge be assessed and Laboratory diagnosis done in order to give appropriate treatment.

  2. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

    National Research Council Canada - National Science Library

    Pereira, Vanessa S; Hirakawa, Humberto S; Oliveira, Ana B; Driusso, Patricia

    2014-01-01

    .... PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement...

  3. Do vaginal lactobacilli prevent preterm labour?

    African Journals Online (AJOL)

    % before 34 weeks (obstetric database - Tygerberg Hospital). Therefore, it is not surprising that preterm labour is the main cause of perinatal mortality.1According to recent information, infection and particularly vaginal bacteriosis play a major ...

  4. Vaginal Discharge: What's Normal, What's Not

    Science.gov (United States)

    ... School Has a Weapon. What Should I Do? School Counselors Kidney Stones Brain and Nervous System ... the vagina, and helping to prevent and fight infections. Although it's normal for the color, texture, and amount of vaginal fluids to vary ...

  5. VBAC (Vaginal Birth After C-Section)

    Science.gov (United States)

    ... www.uptodate.com/home. Accessed May 19, 2015. Lang CT, et al. Uterine dehiscence and rupture after ... Health Letter PRC-20395237 Patient Care & Health Information Tests & Procedures Vaginal birth after C-section (VBAC) Request ...

  6. Vaginal itching and discharge - adult and adolescent

    Science.gov (United States)

    ... other symptoms ( atrophic vaginitis ). Forgotten tampon or foreign body, which may cause a foul odor. Chemicals found in detergents, fabric softeners, feminine sprays, ointments, creams, douches, and contraceptive foams or jellies or creams, ...

  7. Microbes on the Human Vaginal Epithelium

    National Research Council Canada - National Science Library

    Richard W. Hyman; Marilyn Fukushima; Lisa Diamond; Jochen Kumm; Linda C. Giudice; Ronald W. Davis

    2005-01-01

    Using solely a gene-based procedure, PCR amplification of the 16S ribosomal RNA gene coupled with very deep sequencing of the amplified products, the microbes on 20 human vaginal epithelia of healthy...

  8. CHANGING TRENDS OF VARIOUS ROUTES OF HYSTERECTOMY IN BENIGN UTERINE PATHOLOGIES - A COMPARATIVE STUDY

    OpenAIRE

    Sharma; Chanchlani

    2014-01-01

    BACKGROUND : Hysterectomy is one of the most commonly performed obstetrics and gynecology surgical procedure worldwide, second only to cesarean section. Even with use of conservative therapies, approximately 6 lakh hysterectomies are performed each year in United States. MATERIAL AND METHODS : This was a comparative cross sectional study conducted in the Department of Obstetrics and Gynecology of Chirayu Medical College and H ospital, Bhopal from Jan 201...

  9. Lack of influence of simple premenopausal hysterectomy on bone mass and bone metabolism

    DEFF Research Database (Denmark)

    Ravn, Pernille; Lind, C; Nilas, L

    1995-01-01

    urinary calcium corrected for creatinine excretion. RESULTS: Women who had undergone premenopausal hysterectomy had similar bone mineral densities compared with women with an intact uterus in all compartments, apart from a 6% to 11% higher bone mineral density (p ....07). This bone mineral density difference could thus be explained by extragonadal sex hormone production. CONCLUSION: Premenopausal hysterectomy did not reduce ovarian function and increase bone turnover and bone loss....

  10. The added value of hysterectomy in the management of gestational trophoblastic neoplasia.

    Science.gov (United States)

    Eysbouts, Y K; Massuger, L F A G; IntHout, J; Lok, C A R; Sweep, F C G J; Ottevanger, P B

    2017-06-01

    Despite the undoubted effectiveness of chemotherapeutic treatment in gestational trophoblastic neoplasia (GTN), problems related to toxicity of chemotherapy and chemo-resistant disease have led to reconsideration of the use of hysterectomy. Aim of the present study was to evaluate indications for and outcome of hysterectomy in patients with GTN in a nation-wide cohort. Between 1977 and 2012, we identified all patients diagnosed with GTN and treated with hysterectomy from the Dutch national databases. Demographics, clinical characteristics and follow-up were recorded retrospectively. One hundred and nine patients (16.5% of all registered patients with GTN) underwent hysterectomy as part of their management for GTN. The majority of patients was classified as low-risk disease (74.3%), post-molar GTN (73.5%) and disease confined to the uterus (65.1%). After hysterectomy, complete remission was achieved in 66.2% of patients with localized disease and in 15.8% of patients with metastatic disease. For patients with localized disease, treated with primary hysterectomy, treatment duration was significantly shorter (mean 3.2weeks and 8.0weeks respectively, p=0.01) with lower number of administered chemotherapy cycles (mean 1.5 and 5.8 respectively, pdisease and no desire to preserve fertility, whereas patients with chemotherapy-resistant disease may benefit from additional hysterectomy, especially when disease is localized. For patients with widespread metastatic disease, the benefit of hysterectomy lies in the removal of chemotherapy-resistant tumor bulk with subsequent effect on survival. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy.

    Science.gov (United States)

    Deffieux, Xavier; Vinchant, Marie; Wigniolle, Ingrid; Goffinet, François; Sentilhes, Loïc

    2017-01-01

    Intra-abdominal packing is a possible option for persistent bleeding following hysterectomy for postpartum hemorrhage. However, to date, only very limited data about maternal outcome after intra-abdominal packing for surgically uncontrolled hemorrhage following hysterectomy are available. The objective of the current study was to estimate maternal outcome after intra-abdominal packing following unsuccessful peripartum hysterectomy for postpartum hemorrhage. A questionnaire was mailed to all maternity units performing more than 850 deliveries per year. Inclusion criteria were: all cases of abdominal packing performed following unsuccessful peripartum hysterectomy for postpartum hemorrhage between 2003 and 2013. The primary outcome was success of intra-abdominal packing, defined as the arrest of hemorrhage with no need of additional procedure. The total number of deliveries during the study period that occurred in the 51 participating centers was 1,430,142. The centers reported a total of 718 (1 per 2000 deliveries) peripartum hysterectomies for PPH and 53 abdominal packings performed after unsuccessful peripartum hysterectomy (about 1 per 14 hysterectomies). A median of 5 [IQR 3-7] pads were used for packing. Abdominal packing was removed after a median of 39.5 hours [IQR 24-48]. The success rate of abdominal packing was 62% (33/53). Among the 20 (38%) women in whom bleeding did not stop following the use of abdominal packing, 6 required a second surgical intervention, 6 a pelvic artery embolization and the 8 other women had "only" further intensive resuscitation and pharmacological treatments. Finally, mortality rate was 24% (13/53). Our results suggest that abdominal packing, used for duration of 24 to 48 hours, seems to be an option as an ultimate procedure to control persistent life-threatening postpartum hemorrhage following peripartum hysterectomy.

  12. The Effect of Hysterectomy on Women?s Sexual Function: a Narrative Review

    OpenAIRE

    Danesh, Mahmonier; Hamzehgardeshi, Zeinab; Moosazadeh, Mahmood; Shabani-Asrami, Fereshteh

    2015-01-01

    Background: Regarding the contradictions about positive and negative effects of hysterectomy on women?s sexual functioning, this study was conducted to review the studies on the effect of hysterectomy on postoperative women?s sexual function. Method: This study was a narrative review and performed in 5 steps: a) Determining the research questions, b) Search methods for identification of relevant studies, c) Choosing the studies, d) Classifying, sorting out, and summarizing the data, and e) re...

  13. Can radical parametrectomy be omitted in occult cervical cancer after extrafascial hysterectomy?

    OpenAIRE

    Lu, Huai-wu; Li, Jing; Liu, Yun-yun; Liu, Chang-hao; Xu, Guo-Cai; Xie, Ling-Ling; Wu,Miao-fang; Lin, Zhong-qiu

    2015-01-01

    Background Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parametrectomy (RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early-stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avo...

  14. Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormones

    DEFF Research Database (Denmark)

    Kølsen-Petersen, Jens Aage; Bendtzen, Klaus; Tønnesen, Else Kirstine

    2008-01-01

    with the other groups (Psaline before hysterectomy appears to have limited effect on the postoperative concentration of selected plasma cytokines and the hormonal stress......BACKGROUND: Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery. METHODS: Sixty-two women undergoing abdominal hysterectomy were randomized...

  15. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse.

    Science.gov (United States)

    Korbly, Nicole B; Kassis, Nadine C; Good, Meadow M; Richardson, Monica L; Book, Nicole M; Yip, Sallis; Saguan, Docile; Gross, Carey; Evans, Janelle; Lopes, Vrishali V; Harvie, Heidi S; Sung, Vivian W

    2013-11-01

    The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation. This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression. Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation. A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for

  16. The outcome of transobturator anterior vaginal wall prolapse repair using porcine dermis graft: intermediate term follow-up

    Directory of Open Access Journals (Sweden)

    Ayman Mahdy

    2013-07-01

    Full Text Available Introduction and Hypothesis We evaluated the anatomical success and complications of Perigee® with porcine dermis Graft in the repair of anterior vaginal wall prolapse (AVWP Materials and Methods After Institutional Review Board (IRB approval, the charts of all patients who underwent AVWP repair using the Perigee/InteXen® kit from July 2005 to July 2009 were reviewed. Patients who had less than 6-month follow-up were excluded. Preoperative data including patient age, previous AVWP repairs, hysterectomy status, preoperative dyspareunia and pertinent physical findings were collected and recorded. Postoperative success was defined as anatomical stage 0 or I using the Pelvic Organ Prolapse Quantification (POP-Q scoring system. Graft related complications were also recorded. Results Out of 89 patients, 69 completed at least 6-month follow-up. Median follow-up was 13 (6-48 months. Seventeen patients (25% had previous AVWP repair and 32 (46% had previous hysterectomy. Preoperatively, AVWP stage II was found in 9 (13%, stage III in 27 (39% and stage IV in 33 (48% patients. Anatomic success was found in 48 (69% patients, with 23 (33% having stage 0 and 25 (36% stage I AVWP. Intraoperative complications included incidental cystotomy in one patient and bladder perforation in one. Postoperative complications included vaginal exposure and dyspareunia in one case, wound dehiscence in one and tenderness over the graft arm with dyspareunia in one. conclusions The use of porcine dermis in AVWP repair is safe with minimal graft related complications; however, anatomical success is lower than that reported with the use of synthetic grafts.

  17. Twin vaginal delivery: innovate or abdicate.

    Science.gov (United States)

    Easter, Sarah Rae; Taouk, Laura; Schulkin, Jay; Robinson, Julian N

    2017-05-01

    Neonatal safety data along with national guidelines have prompted renewed interest in vaginal delivery of twins, particularly in the case of the noncephalic second twin. Yet, the rising rate of twin cesarean deliveries, coupled with the national decline in operative obstetrics, raises concerns about the availability of providers who are skilled in twin vaginal birth. Providers are key stakeholders for increasing rates of twin vaginal delivery. We surveyed a group of practicing obstetricians to explore potential barriers to the vaginal birth of twins with a focus on delivery of the noncephalic second twin. Among 107 responding providers, only 57% would deliver a noncephalic second twin by breech extraction. Providers who preferred breech extraction had a higher rate of maternal-fetal medicine subspecialty training (26.2% vs 4.3%; P30 sets of twins annually (57.4% vs 34.8%; P=.02). Most providers (54.2%) were familiar with the findings from the recent randomized trial that demonstrated the safety of twin vaginal birth. However, knowledge of the trial was not associated statistically with a preference for breech extraction (62.3% vs 43.5%; P=.05). Providers who preferred breech extraction were more likely to agree with recent society guidelines that encourage the vaginal birth of twins (86.9% vs 63.0%; Pinnovation. Without novel provider-focused strategies, we may relinquish passively the requisite skills for not only our patients but also for future generations of obstetricians. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. [Frequency of epidural analgesia for vaginal delivery].

    Science.gov (United States)

    Atanassova, M; Nikolov, A

    2011-01-01

    To establish the frequency of epidural analgesia for vaginal delivery. The research includes 51 632 deliveries for 16 years period. Total frequency of vaginal delivery with EA, compared to total number of vaginal deliveries for period is 11.77%. The frequency shows tendency to slowly increase in the beginning of the period, probably because of getting experienced among some of the obstetricians, after then frequency stay relatively constant. Except care of somatic health of mother and foetus, modern obstetrics requires to ensure maximum comfort of parturient, to satisfy requirements of modern women for "painless" delivery and leave a positive memory of birth. That is why more frequently use of EA for vaginal delivery is necessary. EA is an approved method for anesthetizing vaginal delivery. It is established slowly increasing frequency of EA for anesthetizing vaginal delivery. The frequency of EA in University hospital "Maichin dom" is relatively low in comparison with mentioned in literature values, which raises the question of finding ways to further promote and increase the application of EA.

  19. Vaginal fold histology reduces the variability introduced by vaginal exfoliative cytology in the classification of mouse estrous cycle stages

    OpenAIRE

    Arnon, Gal; Po-Ching, Lin; Anne M, Barger; Amy L, MacNeill; CheMyong, Ko

    2014-01-01

    Vaginal exfoliative cytology is commonly used in biomedical and toxicological research to classify the stages of the rodent estrous cycle. However, mouse vaginal exfoliative cytology is commonly used as a stand-alone tool and has not been evaluated in reference to vaginal histology and serum sex hormone levels. In this study, the direct and Giemsa-stained methods of vaginal exfoliative cytology were compared in reference to vaginal fold histology and serum sex hormone levels. Both methods pre...

  20. Cost analysis of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery.

    Science.gov (United States)

    Fanning, James; Fenton, Bradford; Jean, Geraldine Marie; Chae, Clara

    2011-12-01

    Prophylactic intraoperative ureteral stent placement is performed to decrease operative ureteric injury, though few data are available on the effectiveness of this procedure, and no data are available on its cost. To analyze the cost of prophylactic intraoperative cystoscopic ureteral stents in gynecologic surgery. All cases of prophylactic ureteral stent placement performed in gynecologic surgery during a 1-year period were identified and retrospectively reviewed through the electronic medical records database of Summa Health System. Costs were obtained through the Healthcare Cost Accounting System. The principles of cost-effective analysis were used (ie, explicit and detailed descriptions of costs and cost-effectiveness statistics). Importantly, we evaluated cost and not charges or financial model estimates. In addition, we obtained the contribution margins (ie, the hospital's net profit or loss) for prophylactic ureteral stent placement. Other gynecologic procedures were also analyzed. Among 792 major inpatient gynecologic procedures, 18 cases of prophylactic intraoperative ureteral stents were identified. Median costs were as follows: additional cost of prophylactic intraoperative ureteral stenting, $1580; additional cost of surgical resources, $770; cost of ureteral catheters, $427; cost of surgeons, $383. The contribution margins per case for various gynecologic surgical procedures were as follows: oophorectomy, $2804 profit; abdominal hysterectomy, $2649 profit; laparoscopically assisted vaginal hysterectomy (LAVH), $1760 profit. When intraoperative ureteral stenting was added, the contribution margins changed to the following: oophorectomy, $782 profit; abdominal hysterectomy, $627 profit; LAVH, $262 loss. Overall, the contribution margin profit was decreased by about 85%, from $2400 to $380. Prophylactic intraoperative ureteral stenting in gynecologic surgery decreases a hospital's contribution margin. Because of the expense of this procedure, as well as

  1. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis.

    Science.gov (United States)

    Brody, Stuart; Weiss, Petr

    2010-08-01

    Evidence was recently provided for vaginal orgasm, orgasm triggered purely by penile-vaginal intercourse (PVI), being associated with better psychological functioning. Common sex education and sexual medicine approaches might undermine vaginal orgasm benefits. To examine the extent to which women's vaginal orgasm consistency is associated with (i) being told in childhood or adolescence that the vagina was the important zone for inducing female orgasm; (ii) how well they focus mentally on vaginal sensations during PVI; (iii) greater PVI duration; and (iv) preference for above-average penis length.   In a representative sample of the Czech population, 1,000 women reported their vaginal orgasm consistency (from never to almost every time; only 21.9% never had a vaginal orgasm), estimates of their typical foreplay and PVI durations, what they were told in childhood and adolescence was the important zone for inducing female orgasm, their degree of focus on vaginal sensations during PVI, and whether they were more likely to orgasm with a longer than average penis. The association of vaginal orgasm consistency with the predictors noted above. Vaginal orgasm consistency was associated with all hypothesized correlates. Multivariate analysis indicated the most important predictors were being educated that the vagina is important for female orgasm, being mentally focused on vaginal sensations during PVI, and in some analyses duration of PVI (but not foreplay) and preferring a longer than average penis. Focusing attention on penile-vaginal sensation supports vaginal orgasm and the myriad benefits thereof. Brody S, and Weiss P. Vaginal orgasm is associated with vaginal (not clitoral) sex education, focusing mental attention on vaginal sensations, intercourse duration, and a preference for a longer penis. © 2009 International Society for Sexual Medicine.

  2. Incidence and determinants of hysterectomy in a low-income setting in Gujarat, India.

    Science.gov (United States)

    Desai, Sapna; Campbell, Oona Mr; Sinha, Tara; Mahal, Ajay; Cousens, Simon

    2017-02-01

    Hysterectomy is a leading reason for use of health insurance amongst low-income women in India, but there are limited population-level data available to inform policy. This paper reports on the findings of a mixed-methods study to estimate incidence and identify predictors of hysterectomy in a low-income setting in Gujarat, India. The estimated incidence of hysterectomy, 20.7/1000 woman- years (95% CI: 14.0, 30.8), was considerably higher than reported from other countries, at a relatively low mean age of 36 years. There was strong evidence that among women of reproductive age, those with lower income and at least two children underwent hysterectomy at higher rates. Nearly two-thirds of women undergoing hysterectomy utilized private hospitals, while the remainder used government or other non-profit facilities. Qualitative research suggested that weak sexual and reproductive health services, a widespread perception that the post-reproductive uterus is dispensable and lack of knowledge of side effects have resulted in the normalization of hysterectomy. Hysterectomy appears to be promoted as a first or second-line treatment for menstrual and gynaecological disorders that are actually amenable to less invasive procedures. Most women sought at least two medical opinions prior to hysterectomy, but both public and private providers lacked equipment, skills and motivation to offer alternatives. Profit and training benefits also appeared to play a role in some providers' behaviour. Although women with insecure employment underwent the procedure knowing the financial and physical implications of undergoing a major surgery, the future health and work security afforded by hysterectomy appeared to them to outweigh risks. Findings suggest that sterilization may be associated with an increased risk of hysterectomy, potentially through biological or attitudinal links. Health policy interventions require improved access to sexual and reproductive health services and health

  3. Semaphorin 4D induces vaginal epithelial cell apoptosis to control mouse postnatal vaginal tissue remodeling.

    Science.gov (United States)

    Ito, Takuji; Bai, Tao; Tanaka, Tetsuji; Yoshida, Kenji; Ueyama, Takashi; Miyajima, Masayasu; Negishi, Takayuki; Kawasaki, Takahiko; Takamatsu, Hyota; Kikutani, Hitoshi; Kumanogoh, Atsushi; Yukawa, Kazunori

    2015-02-01

    The opening of the mouse vaginal cavity to the skin is a postnatal tissue remodeling process that occurs at approximately five weeks of age for the completion of female genital tract maturation at puberty. The tissue remodeling process is primarily composed of a hormonally triggered apoptotic process predominantly occurring in the epithelium of the distal section of the vaginal cavity. However, the detailed mechanism underlying the apoptotic induction remains to be elucidated. In the present study, it was observed that the majority of BALB/c mice lacking the class 4 semaphorin, semaphorin 4D (Sema4D), developed imperforate vagina and hydrometrocolpos resulting in a perpetually unopened vaginal cavity regardless of a normal estrogen level comparable with that in wild‑type (WT) mice. Administration of β‑estradiol to infant Sema4D‑deficient (Sema4D‑/‑) mice did not induce precocious vaginal opening, which was observed in WT mice subjected to the same β‑estradiol administration, excluding the possibility that the closed vaginal phenotype was due to insufficient estrogen secretion at the time of vaginal opening. In order to assess the role of Sema4D in the postnatal vaginal tissue remodeling process, the expression of Sema4D and its receptor, plexin‑B1, was examined as well as the level of apoptosis in the vaginal epithelia of five‑week‑old WT and Sema4D‑/‑ mice. Immunohistochemical analyses confirmed the localization of Sema4D and plexin‑B1 in the mouse vaginal epithelia. Terminal deoxynucleotidyl transferase dUTP nick end labeling assay and immunohistochemistry detecting activated caspase‑3 revealed significantly fewer apoptotic cells in situ in the vaginal mucosa of five‑week‑old Sema4D‑/‑ mice compared with WT mice. The addition of recombinant Sema4D to Sema4D‑/‑ vaginal epithelial cells in culture significantly enhanced apoptosis of the vaginal epithelial cells, demonstrating the apoptosis‑inducing activity of Sema4D. The

  4. Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Damast, Shari, E-mail: shari.damast@yale.edu [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Alektiar, Kaled M. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Goldfarb, Shari [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Eaton, Anne; Patil, Sujata [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Mosenkis, Jeffrey [Department of Comparative Human Development, University of Chicago, Chicago, Illinois (United States); Bennett, Antonia [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Atkinson, Thomas [Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Jewell, Elizabeth; Leitao, Mario; Barakat, Richard; Carter, Jeanne [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Basch, Ethan [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2012-10-01

    Purpose: We used the Female Sexual Function Index (FSFI) to investigate the prevalence of sexual dysfunction (SD) and factors associated with diminished sexual functioning in early stage endometrial cancer (EC) patients treated with simple hysterectomy and adjuvant brachytherapy. Methods and Materials: A cohort of 104 patients followed in a radiation oncology clinic completed questionnaires to quantify current levels of sexual functioning. The time interval between hysterectomy and questionnaire completion ranged from <6 months to >5 years. Multivariate regression was performed using the FSFI as a continuous variable (score range, 1.2-35.4). SD was defined as an FSFI score of <26, based on the published validation study. Results: SD was reported by 81% of respondents. The mean ({+-} standard deviation) domain scores in order of highest-to-lowest functioning were: satisfaction, 2.9 ({+-}2.0); orgasm, 2.5 ({+-}2.4); desire, 2.4 ({+-}1.3); arousal, 2.2 ({+-}2.0); dryness, 2.1 ({+-}2.1); and pain, 1.9 ({+-}2.3). Compared to the index population in which the FSFI cut-score was validated (healthy women ages 18-74), all scores were low. Compared to published scores of a postmenopausal population, scores were not statistically different. Multivariate analysis isolated factors associated with lower FSFI scores, including having laparotomy as opposed to minimally invasive surgery (effect size, -7.1 points; 95% CI, -11.2 to -3.1; P<.001), lack of vaginal lubricant use (effect size, -4.4 points; 95% CI, -8.7 to -0.2, P=.040), and short time interval (<6 months) from hysterectomy to questionnaire completion (effect size, -4.6 points; 95% CI, -9.3-0.2; P=.059). Conclusions: The rate of SD, as defined by an FSFI score <26, was prevalent. The postmenopausal status of EC patients alone is a known risk factor for SD. Additional factors associated with poor sexual functioning following treatment for EC included receipt of laparotomy and lack of vaginal lubricant use.

  5. Does vaginal estrogen treatment with support pessaries in vaginal prolapse reduce complications?

    Science.gov (United States)

    Bulchandani, Supriya; Toozs-Hobson, Philip; Verghese, Tina; Latthe, Pallavi

    2015-12-01

    Pelvic organ prolapse is often co-existant with atrophy of the genital tract in older women who tend to prefer vaginal pessaries for prolapse. Vaginal estrogen therapy is used by some along with a support pessary for prolapse with no robust evidence to back this practice. We aimed to evaluate differences in complications of support pessaries for vaginal prolapse in postmenopausal women, with and without vaginal estrogen use. We prospectively assessed postmenopausal women attending the urogynaecology clinic for a pessary change. We asked them about the level of discomfort during pessary change (visual analogue scale for pain), discharge, bleeding and infection. Ethics approval was not required as this was a service evaluation project. Statistical analysis for relative risk was performed, including sub-group analysis for 'ring pessary' and 'non-ring group' (Shelf, Gellhorn, Shaatz). Between July 2013 and December 2014, we assessed 120 postmenopausal women using support pessaries for prolapse. The mean age was 70 years; 45% of the patients used vaginal estrogen. There were no statistically significant differences in complications with or without vaginal estrogen use, although the trend was higher amongst non-users. The 'non-ring' sub-group not using vaginal estrogen had a higher risk of vaginal ulceration, bleeding and discharge. Postmenopausal women may have lesser complications when using vaginal estrogen with a support pessary for prolapse, particularly with pessaries other than the ring. An adequately powered randomised controlled trial is needed to assess conclusively whether vaginal estrogen enhances comfort and reduces complications of support pessaries for prolapse. © The Author(s) 2015.

  6. Pragmatic prevention, permanent solution: Women's experiences with hysterectomy in rural India.

    Science.gov (United States)

    Desai, Sapna

    2016-02-01

    Hysterectomy appears to be on the rise amongst low-income, rural women in India as routine treatment for gynaecological ailments. This paper explores the individual, household, socio-economic and health system factors that influenced women's decisions to undergo hysterectomy in rural Gujarat, with a focus on women's perspectives. Interviews were conducted with 35 rural, low-income women who had undergone hysterectomy, local gynaecologists and other key informants, alongside observation of daily life and health-related activities. Inductive, open coding was conducted within a framework analysis to identify thematic influences on the decision to undergo hysterectomy. Women underwent hysterectomy at an average age of 36, as treatment for typically severe gynaecological ailments. I argue that women, faced with embedded social inequality in the form of gender biases, lack of labour security and a maternal-centric health system, demonstrated pragmatic agency in their decision to remove the uterus. When they experienced gynaecological ailments, most sought two to three opinions and negotiated financial and logistical concerns. The health system offered few non-invasive services for non-maternal health issues. Moreover, women and health care providers believed there is limited utility of the uterus beyond childbearing. Women's responsibilities as caretakers, workers and producers drove them to seek permanent solutions that would secure their long-term work and health security. Thus, hysterectomy emerged as a normalised treatment for gynaecological ailments, particularly for low-income women with limited resources or awareness of potential side effects. In this setting, hysterectomy reflects the power structures and social inequalities in which women negotiated medical treatment--and the need to reverse a culture of permanent solutions for low-income women. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Pregabalin can decrease acute pain and postoperative nausea and vomiting in hysterectomy: A meta-analysis.

    Science.gov (United States)

    Wang, Yi-Ming; Xia, Min; Shan, Nan; Yuan, Ping; Wang, Dong-Lin; Shao, Jiang-He; Ma, Hui-Wen; Wang, Lu-Lu; Zhang, Yuan

    2017-08-01

    Whether the preoperative administration of pregabalin plays a beneficial role in controlling acute pain after hysterectomy is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of pregabalin to treat acute postoperative pain following hysterectomy. In April 2017, a systematic computer-based search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing pregabalin with placebo in patients undergoing hysterectomy were retrieved. The primary endpoint was the visual analog scale (VAS) score with rest or mobilization at 2 h, 4 and 24 hours and cumulative morphine consumption at 2, 4, 24, and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, and dizziness. After tests for publication bias and heterogeneity among studies were performed, the data were aggregated for random-effects models when necessary. Ten clinical studies with 1207 patients (pregabalin = 760, control = 447) were finally included in this meta-analysis. Preoperative administration of pregabalin was associated with a significant reduction of VAS with rest or mobilization at 2, 4, and 24 hours after hysterectomy. Further, the preoperative administration of pregabalin was associated with a reduction in total morphine consumption at 2, 4, 24, and 48 hours after hysterectomy. The occurrence of morphine-related complications (nausea and vomiting) was also reduced in the pregabalin group. However, the preoperative administration of pregabalin was associated with an increase in the occurrence of dizziness. There was no significant difference in the occurrence of sedation. The preoperative use of pregabalin reduced postoperative pain, total morphine consumption, and morphine-related complications following hysterectomy. The doses of pregabalin were different, and large heterogeneity was the limitation of

  8. Pregabalin can decrease acute pain and postoperative nausea and vomiting in hysterectomy

    Science.gov (United States)

    Wang, Yi-ming; Xia, Min; Shan, Nan; Yuan, Ping; Wang, Dong-lin; Shao, Jiang-he; Ma, Hui-wen; Wang, Lu-lu; Zhang, Yuan

    2017-01-01

    Abstract Background: Whether the preoperative administration of pregabalin plays a beneficial role in controlling acute pain after hysterectomy is unknown. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine the efficacy and safety of the preoperative use of pregabalin to treat acute postoperative pain following hysterectomy. Methods: In April 2017, a systematic computer-based search was conducted in the PubMed, EMBASE, Web of Science, Cochrane Library, and Google databases. RCTs comparing pregabalin with placebo in patients undergoing hysterectomy were retrieved. The primary endpoint was the visual analog scale (VAS) score with rest or mobilization at 2 h, 4 and 24 hours and cumulative morphine consumption at 2, 4, 24, and 48 hours. The secondary outcomes were complications of nausea, vomiting, sedation, and dizziness. After tests for publication bias and heterogeneity among studies were performed, the data were aggregated for random-effects models when necessary. Results: Ten clinical studies with 1207 patients (pregabalin = 760, control = 447) were finally included in this meta-analysis. Preoperative administration of pregabalin was associated with a significant reduction of VAS with rest or mobilization at 2, 4, and 24 hours after hysterectomy. Further, the preoperative administration of pregabalin was associated with a reduction in total morphine consumption at 2, 4, 24, and 48 hours after hysterectomy. The occurrence of morphine-related complications (nausea and vomiting) was also reduced in the pregabalin group. However, the preoperative administration of pregabalin was associated with an increase in the occurrence of dizziness. There was no significant difference in the occurrence of sedation. Conclusions: The preoperative use of pregabalin reduced postoperative pain, total morphine consumption, and morphine-related complications following hysterectomy. The doses of pregabalin were

  9. Aerobic vaginal pathogens and their sensitivity pattern.

    Science.gov (United States)

    Mumtaz, Shamim; Ahmad, Mumtaz; Aftab, Irum; Akhtar, Naeem; ul Hassan, Masood; Hamid, Abdul

    2008-01-01

    The vaginal flora is a complicated environment, containing dozens of microbiological species in variable quantities and relative proportions. The frequent cause of vaginal discharge is an infection or colonization with different microorganisms. Some pathologic conditions causing vaginitis are well defined yet, 7-72% of women with vaginitis may remain undiagnosed and such forms of abnormal vaginal flora neither considered as normal, nor can be called bacterial vaginosis have been termed as 'intermediate flora' and its management probably differ from that of bacterial vaginosis. It is of crucial importance in pregnant females at risk of preterm delivery. The present study has been conducted especially to elucidate this type of aerobic vaginal isolates and their culture and sensitivity towards currently used antibiotics. This study was conducted at the Microbiology Department of Fauji Foundation Hospital, Rawalpindi over a period of two years (April 2004-March 2006). One thousand, nine hundred and twenty three high vaginal swabs, both from indoor and outdoor patients were collected, cultured and their susceptibility to various antibiotics was determined. Significant growth was obtained in 731 samples. The highest frequency of infection (39.5%) was observed at 31-40 years followed by 41-50 years (35.8%). About 76% were from outdoor and 24% were from indoor patients. Staphylococcus aureus was the most prevalent vaginal pathogen at 11-60 yrs & with highest prevalence at 31-40 years followed by 41-50 years. It was a predominant pathogen in both indoor (35%) as well as outdoor (41.6%) patients, followed by enteric gram-negative bacilli and other gram-positive cocci. There were very few antibiotics among the conventionally available aminoglycosides, third generation cephalosporins, penicillin, quinolones, sulfonamides and tetracyclines possessing good sensitivity (> 80%) against any one the common aerobic vaginal pathogens. The effective chemotherapeutics agents belong to

  10. Screening of mucoadhesive vaginal gel formulations

    Directory of Open Access Journals (Sweden)

    Ana Ochoa Andrade

    2014-12-01

    Full Text Available Rational design of vaginal drug delivery formulations requires special attention to vehicle properties that optimize vaginal coating and retention. The aim of the present work was to perform a screening of mucoadhesive vaginal gels formulated with carbomer or carrageenan in binary combination with a second polymer (carbomer, guar or xanthan gum. The gels were characterised using in vitroadhesion, spreadability and leakage potential studies, as well as rheological measurements (stress and frequency sweep tests and the effect of dilution with simulated vaginal fluid (SVF on spreadability. Results were analysed using analysis of variance and multiple factor analysis. The combination of polymers enhanced adhesion of both primary gelling agents, carbomer and carrageenan. From the rheological point of view all formulations presented a similar behaviour, prevalently elastic and characterised by loss tangent values well below 1. No correlation between rheological and adhesion behaviour was found. Carbomer and carrageenan gels containing the highest percentage of xanthan gum displayed good in vitro mucoadhesion and spreadability, minimal leakage potential and high resistance to dilution. The positive results obtained with carrageenan-xanthan gum-based gels can encourage the use of natural biocompatible adjuvants in the composition of vaginal products, a formulation field that is currently under the synthetic domain.

  11. Changing trends in peripartum hysterectomy over the last 4 decades.

    LENUS (Irish Health Repository)

    Flood, Karen M

    2012-02-01

    OBJECTIVE: The purpose of this study was to identify changing trends in peripartum hysterectomy (PH) in a single large obstetric population over the last 40 years. STUDY DESIGN: A retrospective cohort study was performed from 1966-2005 of patients who had PH in any of the 3 Dublin obstetric hospitals. Cases were identified, and details were obtained from the combined patient databases of each hospital. RESULTS: There were 872,379 deliveries during the study period, among which 358 women underwent PH (0.4\\/1000 deliveries). In a comparison of the study decades 1966-1975 with 1996-2005, PH decreased from 0.9 per 1000 deliveries to 0.2 of 1000 deliveries. Although the overall cesarean delivery rate has increased from 6-19% during these 2 decades, the percentage of PH that occurs in the setting of a previous cesarean delivery has increased from 27-57% (P < .00001). Indications for PH have changed significantly in this time period, with "uterine rupture" as the indication for PH decreasing from 40.5-9.3% (P < .0001) and placenta accreta as the indication increasing significantly from 5.4-46.5% (P < .00001). CONCLUSION: PH has decreased over the last 4 decades. However, alongside the rising cesarean delivery rate, there has been a marked increase in the incidence of placenta accreta.

  12. Fasciocutaneous flap for vaginal and perineal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Wang, T.N.; Whetzel, T.; Mathes, S.J.; Vasconez, L.O.

    1987-07-01

    A skin and fascia flap from the medial thigh is proposed for vaginal and perineal reconstruction. Dissection, vascular injection, and radiographs of 20 fresh cadaver limbs uniformly demonstrated the presence of a communicating suprafascial vascular plexus in the medial thigh. Three to four nonaxial vessels were consistently found to enter the proximal plexus from within 5 cm of the perineum. Preservation of these vessels permitted reliable elevation of a 9 X 20 cm fasciocutaneous flap without using the gracilis muscle as a vascular carrier. Fifteen flaps in 13 patients were used for vaginal replacement and coverage of vulvectomy, groin, and ischial defects. Depending on the magnitude of the defect, simultaneous and independent elevation of the gracilis muscle provided additional vascularized coverage as needed. Our experience indicates that the medial thigh fasciocutaneous flap is a durable, less bulky, and potentially sensate alternative to the gracilis musculocutaneous flap for vaginal and perineal reconstruction.

  13. Vaginal Biogenic Amines: Biomarkers of Bacterial Vaginosis or Precursors to Vaginal Dysbiosis?

    Directory of Open Access Journals (Sweden)

    Tiffanie Maree Nelson

    2015-09-01

    Full Text Available Bacterial vaginosis (BV is the most common vaginal disorder among reproductive age women. One clinical indicator of BV is a ‘fishy’ odor. This odor has been associated with increases in several biogenic amines (BAs that may serve as important biomarkers. Within the vagina, BA production has been linked to various vaginal taxa, yet their genetic capability to synthesize BAs is unknown. Using a bioinformatics approach, we show that relatively few vaginal taxa are predicted to be capable of producing BAs. Many of these taxa (Dialister, Prevotella, Parvimonas, Megasphaera, Peptostreptococcus, and Veillonella spp. are more abundant in the vaginal microbial community state type (CST IV, which is depleted in lactobacilli. Several of the major Lactobacillus species (L. crispatus, L. jensenii, and L. gasseri were identified as possessing gene sequences for proteins predicted to be capable of putrescine production. Finally, we show in a small cross sectional study of 37 women that the BAs putrescine, cadaverine and tyramine are significantly higher in CST IV over CSTs I and III. These data support the hypothesis that BA production is conducted by few vaginal taxa and may be important to the outgrowth of BV-associated (vaginal dysbiosis vaginal bacteria.

  14. A Novel Technique for Anterior Vaginal Wall Prolapse Repair: Anterior Vaginal Wall Darn

    Directory of Open Access Journals (Sweden)

    Osman Köse

    2013-01-01

    Full Text Available Aim. The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD, which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. Materials and Methods. Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1 cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. Results. Data were collected six months after operation. Cough stress test (CST, Pelvic Organ Prolapse Quantification (POP-Q evaluation, Incontinence Impact Questionnaire (IIQ-7, and Urogenital Distress Inventory (UDI-6 scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. Conclusion. In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method.

  15. Clinical research of effects of retaining the uterine blood supply hysterectomy on ovarian function

    Directory of Open Access Journals (Sweden)

    Cai Yufei

    2017-01-01

    Full Text Available Objective To evaluate the effect of hysterectomy for reserving the uterine blood supply on ovarian endocrine function and on symptoms of menopausal transition. Methods Uterine benign lesions should be line the uterus times total resection in 100 patients were randomly divided into hysterectomy group of retaining uterus vascular supply group(research group,n = 50 and traditional total hysterectomy group (the control group, n = 50, comparing two groups in operation time, intraoperative bleeding ,postoperative fever and residual polyp, blood tests were taken to check the serum sex hormone levels change and clinical observation for perimenopausal symptoms before and postoperative three months, six months, one year and two years at the same time respectively. Results There was no significant difference between two groups in operation time, intraoperative blood loss, postoperative fever and residual polyp (P0.05,the symptoms of the menopausal transition hardly appear; postoperative FSH, LH increased significantly in control group (P<0.05,E2 decrease (P<0.05, perimenopausal symptoms appeared more often. Conclusion The effect of uterus hysterectomy for retaining vascular supply on ovarian endocrine function is less than the traditional total hysterectomy, this operation has a certain importance to preserve ovarian function and delay the occurrence of premature ovarian aging.

  16. Systematic review of same-day discharge after minimally invasive hysterectomy.

    Science.gov (United States)

    Korsholm, Malene; Mogensen, Ole; Jeppesen, Mette M; Lysdal, Vibeke K; Traen, Koen; Jensen, Pernille T

    2017-02-01

    Same-day discharge has been suggested to safe and acceptable following minimally invasive hysterectomy. To evaluate the feasibility of same-day discharge following minimally invasive hysterectomy and to identify associated factors. Medline, Embase and the Cochrane Central Register of Controlled Trials were systematically searched using the terms "same day discharge", "minimally invasive surgery", and "hysterectomy" between October 1 and October 31, 2015. No language or publication date restrictions were included. Randomized controlled trials and observational studies evaluating same-day discharge before midnight on the day of minimally invasive hysterectomy were included. Study characteristics, pre-operative selection criteria, and predictive factors for same-day discharge were analyzed. There were 15 observational studies with 11 992 patients included. Significant heterogeneity was observed in the studies, and publication and selection bias could have potentially affected the results. All the studies concluded that same-day discharge was feasible. However, some factors were associated with a decreased possibility of same-day discharge; these were older age, beginning surgery later than 1:00 pm and completing surgery later than 6:00 pm, longer duration of operation, and high estimated blood loss. Same-day discharge appears feasible for a majority of patients who undergo minimally invasive hysterectomies if adequate emphasis is placed on pre-surgical planning and careful patient selection. © 2016 The Authors International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  17. Optimal timing for performing hysterectomy according to different phase of menstrual cycle: Which is best?

    Science.gov (United States)

    Kim, Jeong Jin; Kang, Jun Hyeok; Lee, Kyo Won; Kim, Kye Hyun; Song, Taejong

    2017-05-01

    The aim of this study was to determine whether the different phases of the menstrual cycle could affect operative bleeding in women undergoing laparoscopic hysterectomy. This was a retrospective comparative study. Based on the adjusted day of menstrual cycle, 212 women who underwent laparoscopic hysterectomy were classified into three groups: the follicular phase (n = 51), luteal phase group (n = 125), and menstruation group (n = 36). The primary outcome measure was the operative bleeding. There was no difference in the baseline characteristics of the patients belonging to the three groups. For the groups, there were no significant differences in operative bleeding (p = .469) and change in haemoglobin (p = .330), including operative time, length of hospital stay and complications. The menstrual cycle did not affect the operative bleeding and other parameters. Therefore, no phase of the menstrual cycle could be considered as an optimal timing for performing laparoscopic hysterectomy with minimal operative bleeding. Impact statement What is already known on this subject: the menstrual cycle results in periodic changes in haemostasis and blood flow in the reproductive organs. What the results of this study add: the menstrual cycle did not affect the operative bleeding and other operative parameters during laparoscopic hysterectomy. What the implications are of these findings for clinical practice and/or further research: no phase of the menstrual cycle could be considered as an optimal timing for performing laparoscopic hysterectomy with minimal operative bleeding.

  18. A prospective randomized study of the inflammatory responses to multiport and singleport laparoscopic hysterectomies.

    Science.gov (United States)

    Tormena, Renata Assef; Ribeiro, Sérgio Conti; Soares, José Maria; Maciel, Gustavo Arantes Rosa; Baracat, Edmund Chada

    2017-07-01

    To evaluate the inflammatory responses induced by laparoscopic hysterectomies with multiport and singleport approaches. This was a pilot prospective randomized study that included 42 women candidates for hysterectomy at School of Medicine, Hospital das Clínicas, USP. The patients were randomized to two groups: MP-TLH (total laparoscopic hysterectomy with 3 abdominal incisions), and SP-TLH (total laparoscopic hysterectomy with a single umbilical incision).We evaluated the inflammatory response (via CRP, IL-6, IL-10, TNFα, VEGF and leukogram assessments), surgical time, postoperative pain, blood loss and surgical complications in both groups. Both techniques were similar regarding C-reactive protein (p=.666), IL-6 (p=.833), IL-10 (p=.420), TNF-α(p=.098), VEGF (p=.092) and the leukogram (p=.712) measures. The operative time was significantly longer in the SP-TLH group than in the MP-TLH group (p=.001). The pain evaluation was similar in both groups (p=.170). Hemoglobin variation and the aspirated blood volume were similar in both groups (p=.493 and p=.347). There were no major complications. Multiport and singleport laparoscopic approaches are both safe methods for hysterectomy. Although SP-TLH resulted in a significantly longer operative time than MP-TLH, no differences were observed between the groups in inflammatory responses, blood loss and postoperative pain.

  19. Pregnancy's stronghold on the vaginal microbiome.

    Directory of Open Access Journals (Sweden)

    Marina R S Walther-António

    Full Text Available To assess the vaginal microbiome throughout full-term uncomplicated pregnancy.Vaginal swabs were obtained from twelve pregnant women at 8-week intervals throughout their uncomplicated pregnancies. Patients with symptoms of vaginal infection or with recent antibiotic use were excluded. Swabs were obtained from the posterior fornix and cervix at 8-12, 17-21, 27-31, and 36-38 weeks of gestation. The microbial community was profiled using hypervariable tag sequencing of the V3-V5 region of the 16S rRNA gene, producing approximately 8 million reads on the Illumina MiSeq.Samples were dominated by a single genus, Lactobacillus, and exhibited low species diversity. For a majority of the patients (n = 8, the vaginal microbiome was dominated by Lactobacillus crispatus throughout pregnancy. Two patients showed Lactobacillus iners dominance during the course of pregnancy, and two showed a shift between the first and second trimester from L. crispatus to L. iners dominance. In all of the samples only these two species were identified, and were found at an abundance of higher than 1% in this study. Comparative analyses also showed that the vaginal microbiome during pregnancy is characterized by a marked dominance of Lactobacillus species in both Caucasian and African-American subjects. In addition, our Caucasian subject population clustered by trimester and progressed towards a common attractor while African-American women clustered by subject instead and did not progress towards a common attractor.Our analyses indicate normal pregnancy is characterized by a microbiome that has low diversity and high stability. While Lactobacillus species strongly dominate the vaginal environment during pregnancy across the two studied ethnicities, observed differences between the longitudinal dynamics of the analyzed populations may contribute to divergent risk for pregnancy complications. This helps establish a baseline for investigating the role of the microbiome in

  20. Fanconi anemia and vaginal squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Jesus Paula Carvalho

    2012-01-01

    Full Text Available Fanconi Anemia (FA is an autosomal recessive disease characterized by chromosome instability, cellular hypersensitivity to DNA cross-linking agents, and increased predisposition to malignancies. We describe here a 28 year-old female with FA and vaginal squamous cell carcinoma treated by radiation therapy alone. The patient developed arm phlebitis, pulmonary fungal infection, and severe rectal bleeding, followed by hypocalcaemia, hypokalemia, vaginal bacterial and fungal infection, with subsequent leg and arm phlebitis, perineal abscess, and sepsis. The patient died 12 weeks later.

  1. Directed shift of vaginal microbiota induced by vaginal application of sucrose gel in rhesus macaques.

    Science.gov (United States)

    Hu, Kai-tao; Zheng, Jin-xin; Yu, Zhi-jian; Chen, Zhong; Cheng, Hang; Pan, Wei-guang; Yang, Wei-zhi; Wang, Hong-yan; Deng, Qi-wen; Zeng, Zhong-ming

    2015-04-01

    Sucrose gel was used to treat bacterial vaginosis in a phase III clinical trial. However, the changes of vaginal flora after treatment were only examined by Nugent score in that clinical trial, While the vaginal microbiota of rhesus macaques is characterized by anaerobic, Gram-negative bacteria, few lactobacilli, and pH levels above 4.6, similar to the microbiota of patients with bacterial vaginosis. This study is aimed to investigate the change of the vaginal microbiota of rehsus macaques after topical use of sucrose gel to reveal more precisely the bacterial population shift after the topical application of sucrose gel. Sixteen rhesus macaques were treated with 0.5 g sucrose gel vaginally and three with 0.5 g of placebo gel. Vaginal swabs were collected daily following treatment. Vaginal pH levels and Nugent scores were recorded. The composition of the vaginal micotbiota was tested by V3∼V4 16S rDNA metagenomic sequencing. Dynamic changes in the Lactobacillus genus were analyzed by qPCR. The vaginal microbiota of rhesus macaques are dominated by anaerobic Gram-negative bacteria, with few lactobacilli and high pH levels above 4.6. After five days' treatment with topical sucrose gel, the component percentage of Lactobacillus in vaginal microbiota increased from 1.31% to 81.59%, while the component percentage of Porphyromonas decreased from 18.60% to 0.43%, Sneathia decreased from 15.09% to 0.89%, Mobiluncus decreased from 8.23% to 0.12%, etc.. The average vaginal pH values of 16 rhesus macaques of the sucrose gel group decreased from 5.4 to 3.89. There were no significant changes in microbiota and vaginal pH observed in the placebo group. Rhesus macaques can be used as animal models of bacterial vaginosis to develop drugs and test treatment efficacy. Furthermore, the topical application of sucrose gel induced the shifting of vaginal flora of rhesus macaques from a BV kind of flora to a lactobacilli-dominating flora. Copyright © 2015 The Authors. Published by

  2. Prolapso vaginal e uterino em ovelhas Uterine and vaginal prolapse in ewes

    OpenAIRE

    Maíra Bianchi R. Alves; Benesi,Fernando J.; Lilian Gregory; Della Libera, Alice M.M.P.; Sucupira,Maria Cláudia A.; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    O presente trabalho objetivou realizar um estudo retrospectivo sobre os prolapsos vaginal e uterino em ovelhas atendidas no Serviço de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6%). O prolapso vaginal total foi o de maior frequência (72%). As ovelhas acometidas, em sua maioria, possuíam idade sup...

  3. Preliminary findings on vaginal epithelial cells and body ...

    African Journals Online (AJOL)

    sahelian zone of Cameroon, in order to assess vaginal cytology and body temperature variations during oestrous cycle. Swabbing was done daily in the vagina, and vaginal smears were stained according to Romanowski method.

  4. Vaginitis: How Many Women Are Affected/at Risk?

    Science.gov (United States)

    ... About 3% of women of childbearing age have trichomoniasis. 4 Many women with vaginal infections have no ... a yeast infection. 15 to 20 women have trichomoniasis. Who gets vaginitis and who is at risk? ...

  5. Characterisation of probiotic properties in human vaginal lactobacilli strains

    OpenAIRE

    Hütt, Pirje; Lapp, Eleri; Štšepetova, Jelena; Smidt, Imbi; Taelma, Heleri; Borovkova, Natalja; Oopkaup, Helen; Ahelik, Ave; Rööp, Tiiu; Hoidmets, Dagmar; Samuel, Külli; Salumets, Andreas; Mändar, Reet

    2016-01-01

    Background: Vaginal lactobacilli offer protection against recurrent urinary infections, bacterial vaginosis, and vaginal candidiasis.Objective: To characterise the isolated vaginal lactobacilli strains for their probiotic properties and to compare their probiotic potential.Methods: The Lactobacillus strains were isolated from vaginal samples by conventional culturing and identified by sequencing of the 16S rDNA fragment. Several functional properties were detected (production of hydrogen pero...

  6. OUTCOME OF INSTRUMENTAL VAGINAL DELIVERIES IN REFERRED CASES

    OpenAIRE

    Prameela; Asha; Prajwal

    2015-01-01

    INTRODUCTION: Instrumental vaginal deliveries are important procedures. Performed in indicated cases and attending to the well laid criterias will reduce the fetal and maternal morbidity. These assisted instrumental vaginal deliveries help in reducing the caesarean sec tion rate. AIMS AND OBJECTIVES: To determine the incidence and indications of instrumental vaginal deliveries. To know the maternal and fetal outcome in ventouse (vaccum assisted vaginal delivery) and...

  7. Variety of Candida in Women with Abnormal Vaginal Discharge

    OpenAIRE

    Guevara Duncan, José; Instituto de Medicina Tropical "Daniel A. Carrión" Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima, Perú; Béjar, Vilma; Instituto de Medicina Tropical "Daniel A. Carrión" Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima, Perú; Cáceres, Alfredo; Hospital Arzobispo Loayza Lima, Perú; Valencia, Esther; Instituto de Medicina Tropical "Daniel A. Carrión" Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima, Perú

    2014-01-01

    OBJECTIVES: Vaginal discharge and related aymptoms are frequent complaints among young women. The aim of this study was to describe Candida species isolated from vaginal discharge samples, as well as the relationship between Candida species and some of these symptoms. MATERIAL AND METHODS: A survey of consecutive patients presenting with vaginal discharge in the course of normal consultations was conducted at the Hospital Loayza. One hundred women with vaginal discharge were surveyed, with ma...

  8. Changes and Factors Influencing Health-related Quality of Life After Hysterectomy in Premenopausal Women with Benign Gynecologic Conditions

    Directory of Open Access Journals (Sweden)

    Ya-Ling Yang

    2006-01-01

    Conclusion: The overall self-rated health status and PCS showed significant improvements after hysterectomy. Having had a blood transfusion, being educated and employed were positively associated with MCS score after surgery. These findings are vital for preoperative counseling for women undergoing hysterectomy.

  9. Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese

    NARCIS (Netherlands)

    Bijen, Claudia B. M.; de Bock, Geertruida H.; Vermeulen, Karin M.; Arts, Henriette J. G.; ter Brugge, Henk G.; van der Sijde, Rob; Kraayenbrink, Arjen. A.; Bongers, Marlies Y.; van der Zee, Ate G. J.; Mourits, Marian I. E.; van der, Sijde R.

    Background: Total laparoscopic hysterectomy (TLH) is safe and cost effective in early stage endometrial cancer when compared to total abdominal hysterectomy (TAH). In non-randomised data it is often hypothesised that older and obese patients benefit most from TLH. Aim of this study is to analyse

  10. Quality of life and sexual function after type C2/type III radical hysterectomy for locally advanced cervical cancer: a prospective study.

    Science.gov (United States)

    Plotti, Francesco; Sansone, Milena; Di Donato, Violante; Antonelli, Elena; Altavilla, Tiziana; Angioli, Roberto; Panici, Pierluigi Benedetti

    2011-03-01

    The introduction of screening programs have made cervical cancer detectable at earlier stages and in younger patients. Nevertheless, only a few studies have examined the QoL and sexual function in disease-free cervical cancer survivors. The objective of this study is to evaluate the sexual function in a cervical cancer patient's group treated with neoadjuvant chemotherapy (NACT) plus type C2/type III radical hysterectomy (RH). We have enrolled in the oncologic group (OG) sexually active patients affected by cervical cancer (stage IB2 to IIIB) treated with NACT followed by RH. Included subjects were interviewed with the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CX24 Questionnaire. Two consecutive assessments were recorded: at the first evaluation postoperatively (T1) and at the 12-month follow-up visit (T2). Results were compared with a benign gynecological disease group (BG) and with a healthy control group (HG). A total of 33 patients for OG, 37 for BG, and 35 women for HG were recruited. After surgery, sexual activity has been resumed by 76% of the OG patients and 83.7% of the BG patients (P = not significant). Cancer survivors had clinically worse problems with symptom experience, body image, and sexual/vaginal functioning than controls (P cancer survivors and women with benign gynecological disease is not statically significant. Concerning sexual enjoyment assessment, our study shows comparable results for OG and BG. Nevertheless, the worsening of symptom experience, body image, and sexual/vaginal functioning, OG patients have same sexual activity and sexual enjoyment data compared with those of BG patients. Thus, NACT followed by RH could be a valid therapeutic strategy to treat and improve well-being especially in young cervical cancer patients. © 2010 International Society for Sexual Medicine.

  11. Total Robotic Hysterectomy: Thailand’s First Case Report of Gynecologic Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Korakot Sirimai

    2016-01-01

    Full Text Available Objective: This study aimed to report the feasibility, trouble shooting and surgical technique in the total robotic hysterectomy for the patient with adenomyoma uteri. Methods: A 51 year-old patient was diagnosed with adenomyosis. Total robotic hysterectomy was performed. Results: Total operating time was 350 min, estimated blood loss was 50 ml, and length of hospitalization was 6 days. The pathologic section revealed adenomyosis with myoma uteri. The intraoperative and post-operative complications were unremarkable. The patient was in good conditions at 6th week, 3rd, 6th, 12th and 24th month. Conclusion: Total robotic hysterectomy for benign gynecologic condition, such as adenomyosis, is safe and feasible. However, the sustained high consuming cost must be weighted with the patient’s advantages.

  12. Complications after hysterectomy. A Danish population based study 1978-1983

    DEFF Research Database (Denmark)

    Andersen, T F; Loft, A; Brønnum-Hansen, Henrik

    1993-01-01

    years after the operation were 3.7% and 9.4%. The most frequently observed complications were post operative wound infections and bleeding, each affecting about 2% of all operated women. Logistic regression and Cox regression were used to identify prognostic indicators of readmission with complications......We studied complications after hysterectomy among all women in the Danish population who had a simple hysterectomy in the period 1978-81 based on data obtained from the Danish National Hospital Registry. Among patients, with neither diagnosed cancer nor major co-surgery (n = 23,386), we identified....... The probability of readmission with complications within six years after hysterectomy was estimated at 8% among low risk patients. The most pronounced increase in risk of readmission with complication occurred among women who had been admitted to psychiatric or somatic hospitals 0-12 months before they had...

  13. Hysterectomy and its impact on the calculated incidence of cervical cancer and screening coverage in Denmark

    DEFF Research Database (Denmark)

    Lam, Janni Uyen Hoa; Lynge, Elsebeth; Njor, Sisse Helle

    2015-01-01

    , the incidence rate of cervical cancer and the screening coverage for women aged 23-64 years on 31 December 2010 were calculated with and without adjustments for hysterectomies undertaken for reasons other than cervical cancer. They were calculated as the number of cases divided by 1) the total number of woman......BACKGROUND: The incidence rates of cervical cancer and the coverage in cervical cancer screening are usually reported by including in the denominator all women from the general population. However, after hysterectomy women are not at risk anymore of developing cervical cancer. Therefore, it makes...... sense to determine the indicators also for the true at-risk populations. We described the frequency of total hysterectomy in Denmark and its impact on the calculated incidence of cervical cancer and the screening coverage. MATERIAL AND METHODS: With data from five Danish population-based registries...

  14. An audit of instrumental vaginal delivery in Aminu Kano Teaching ...

    African Journals Online (AJOL)

    Context: Operative vaginal delivery is used to shorten the second stage of labour. Objective: The aim of this study is to determine the incidence of instrumental vaginal deliveries in a large teaching hospital. Study design and setting: Descriptive study involving 354 women, who either had forceps or vacuum operative vaginal ...

  15. Prevalence of Vaginal Candidiasis among Pregnant Women with ...

    African Journals Online (AJOL)

    BACKGROUND: Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. OBJECTIVES: To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women. METHODS: High vaginal swab samples and data on epidemiological ...

  16. Tension-Free Vaginal Taping in Pakistani Women with Stress Urinary Incontinence.

    Science.gov (United States)

    Saleem, Ayesha

    2017-06-01

    To evaluate the effectiveness and determine the peroperative and postoperative complications of tension-free vaginal tape (TVT) sling for urinary stress incontinence (USI) and contributing factors to complications. Descriptive study. Kidney Centre Postgraduate Institute, Karachi, from January 2009 to December 2010. One hundred consecutive patients underwent TVT as per Ulmsten Technique for urinary stress incontinence and patients were followed for 3 years. The subjective cure rate and improvement rate was based on the international consultation on incontinence questionnaire for evaluating female lower urinary tract symptoms (ICIQ - FLUS). The subjective cure was defined as the statement of the woman not experiencing any loss of urine upon physical stress and improvement rate was defined as occasional leakage during stress. Patients at 1- and 3-year up follow-up showed subjective cure rate and improvement rate of 98% and 2%, and 95% and 5%, respectively. Mean operative time was 32 minutes. UTI was the commonest complication observed in 7 (7%) patients. Women with voiding dysfunction preoperatively had 9-fold odds of difficulty postoperatively (0incontinence. Bladder perforation, voiding dysfunction, supra-pubic discomfort and UTI are the commonest complications. Risk factors for perforation include preoperative hysterectomy. Pre-existing voiding dysfunction and UTI lead to persistent similar postoperative problems.

  17. The impact of socioeconomic and clinical factors on purchase of prescribed analgesics before and after hysterectomy on benign indication

    DEFF Research Database (Denmark)

    Daugbjerg, Signe Bennedbæk; Brandsborg, Birgitte; Ottesen, Bent Smedegaard

    2014-01-01

    OBJECTIVE:: Pelvic pain is a primary symptom of women referred for hysterectomy. This study identified risk factors for purchase of prescribed analgesics before and after hysterectomy and examined purchase changes after hysterectomy, specifically focusing on socioeconomic effects. METHODS:: Nearly...... socioeconomic factors and changes in analgesic purchase were assessed. RESULTS:: Analgesic purchase after hysterectomy was independently predicted by age below 35 or above 65 years, body mass index >29.9, high American Society of Anesthesiologists (ASA) score, uterus weight...... all Danish women (n=13,420) with a hysterectomy on benign indication between 2004 and 2006 were included in a registry-based follow-up study. Information on prescription analgesic purchase was from the Danish National Prescription Registry. Factors associated with a purchase and associations between...

  18. Peripartum hysterectomy: an economic analysis of direct healthcare costs using routinely collected data.

    Science.gov (United States)

    Achana, F A; Fleming, K M; Tata, L J; Sultan, A A; Petrou, S

    2017-10-03

    To estimate resource use and costs associated with peripartum hysterectomy for the English National Health Service. Analysis of linked Clinical Practice Research Datalink and Hospital Episodes Statistics (CPRD-HES) data. Women undergoing peripartum hysterectomy between 1997 and 2013 and matched controls. Inverse probability weighted generalised estimating equations were used to model the non-linear trend in healthcare service use and costs over time, accounting for missing data, adjusting for maternal age, body mass index, delivery year, smoking and socio-economic indicators. Primary care, hospital outpatient and inpatient attendances and costs (UK 2015 prices). The study sample included 1362 women (192 cases and 1170 controls) who gave birth between 1997 and 2013; 1088 (153 cases and 935 controls) of these were deliveries between 2003 and 2013 when all categories of hospital resource use were available. Based on the 2003-2013 delivery cohort, peripartum hysterectomy was associated with a mean adjusted additional total cost of £5380 (95% CI £4436-6687) and a cost ratio of 1.76 (95% CI 1.61-1.98) over 5 years of follow up compared with controls. Inpatient costs, mostly incurred during the first year following surgery, accounted for 78% excluding or 92% including delivery-related costs. Peripartum hysterectomy is associated with increased healthcare costs driven largely by increased post-surgery hospitalisation rates. To reduce healthcare costs and improve outcomes for women who undergo hysterectomy, interventions that reduce avoidable repeat hospitalisations following surgery such as providing active follow up, treatment and support in the community should be considered. A large amount of NHS data on peripartum hysterectomy suggests active community follow up could reduce costs, #HealthEconomics. © 2017 Royal College of Obstetricians and Gynaecologists.

  19. Tubal ligation, hysterectomy and epithelial ovarian cancer in the New England Case-Control Study.

    Science.gov (United States)

    Rice, Megan S; Murphy, Megan A; Vitonis, Allison F; Cramer, Daniel W; Titus, Linda J; Tworoger, Shelley S; Terry, Kathryn L

    2013-11-15

    Previous studies have observed that tubal ligation and hysterectomy are associated with a decreased risk of ovarian cancer; however, little is known about whether these associations vary by surgical characteristics, individual characteristics or tumor histology. We used logistic regression to examine tubal ligation, simple hysterectomy and hysterectomy with unilateral oophorectomy in relation to risk of epithelial ovarian cancer in the New England Case-Control Study. Our primary analysis included 2,265 cases and 2,333 controls. Overall, tubal ligation was associated with a lower risk of epithelial ovarian cancer [odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.68-0.97], especially for endometrioid tumors (OR = 0.45, 95% CI: 0.29-0.69). The inverse association between tubal ligation and ovarian cancer risk was stronger for women who had undergone the procedure at the time of last delivery (OR = 0.60, 95% CI: 0.42-0.84) rather than at a later time (OR = 0.93, 95% CI: 0.75-1.15). Overall, simple hysterectomy was not associated with ovarian cancer risk (OR: 1.09, 95% CI: 0.83-1.42), although it was associated with a nonsignificant decreased risk of ovarian cancer among women who underwent the procedure at age 45 or older (RR: 0.64, 95% CI: 0.40-1.02) or within the last 10 years (OR = 0.65, 95% CI: 0.38-1.13). Overall, women who had a hysterectomy with a unilateral oophorectomy had significantly lower risk of ovarian cancer (OR = 0.65, 95% CI: 0.45-0.94). In summary, tubal ligation and hysterectomy with unilateral oophorectomy were inversely associated with ovarian cancer risk in a large population-based case-control study. Additional research is necessary to understand the potential biologic mechanisms by which these procedures may reduce ovarian cancer risk. Copyright © 2013 UICC.

  20. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles.

    Science.gov (United States)

    Pereira, Vanessa S; Hirakawa, Humberto S; Oliveira, Ana B; Driusso, Patricia

    2014-01-01

    The proper evaluation of the pelvic floor muscles (PFM) is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (ppalpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.

  1. [Prolapse surgery. With abdominal or vaginal meshes?].

    Science.gov (United States)

    Loertzer, H; Schneider, P; Thelen, P; Ringert, R H; Strauß, A

    2012-09-01

    In prolapse surgery several surgical techniques are available. The different open, laparoscopic and vaginal approaches are distinguished by distinct success and relapse rates and operation-specific complications. A safe and optimal therapeutic pelvic floor surgery should be based on the three support levels according to DeLancy and be individually adjusted for every patient. The vaginal approach may be used for all kinds of female genital prolapse and is a comparatively less invasive technique with a short time of convalescence. Apart from stress incontinence there is no need for synthetic meshes in primary approaches and excellent results with low complication and relapse rates can be achieved. An uncritical application of synthetic material is to be avoided in vaginal repair at all times. Abdominal surgical techniques, both open and laparoscopic, present their strengths in the therapeutic approach to level 1 defects or stress incontinence. They provide excellent functional and anatomical corrections and low relapse rates. Abdominally inserted meshes have lower complication rates than vaginal ones.

  2. Predictors of vaginal delivery in nulliparous mothers

    African Journals Online (AJOL)

    Background: Nulliparity is an obstetric high-risk group whose labor, compared with multiparae, are more likely to develop labor abnormalities that requires intervention. The aim of this report is todetermine factors that influence vaginal delivery in nulliparae. Materials and Methods: A prospective cross-sectional study was ...

  3. Vaginal plethysmography in women with dyspareunia

    NARCIS (Netherlands)

    Wouda, JC; Hartman, Petra M; Bakker, Riksta M; Bakker, JO; van de Wiel, HBM; Schultz, WCMW

    We investigated by means of vaginal plethysmography the extent to which the genital reactions of women with dyspareunia (N = 18) differed from those of women without dyspareunia (N = 16) during sexual arousal. In addition, we used questionnaires to investigate whether the genital reaction was

  4. Vaginal Lacerations from Consensual Intercourse in Adolescents

    Science.gov (United States)

    Frioux, Sarah M.; Blinman, Thane; Christian, Cindy W.

    2011-01-01

    Objective: (1) To describe lacerations of the vaginal fornices, an injury known to be associated with consensual sexual intercourse, including known complications and treatment course, (2) to contrast these injuries with injuries sustained during sexual assault, and (3) to discuss the assessment of adolescent patients for sexual injuries. Methods:…

  5. Vaginal yeast infections in diabetic women

    African Journals Online (AJOL)

    The overall vaginal prevalence of C. albicans was 12,8% (26/203 patients). This yeast was associated with genital symp- toms in 84,6% (22/26) ofthe patients from whom it was isolated. Only 4 patients without symptoms yielded C. albicans. One of these had classic candidiasis on clinical grounds, while the other 3 patients ...

  6. Red alert – Infant vaginal bleeding

    Directory of Open Access Journals (Sweden)

    Veerabhadra Radhakrishna

    2015-02-01

    Full Text Available Infant vaginal bleeding is an alarming symptom in an infant. Although several causes can be listed, the possibility of malignancy still needs to be ruled out in view of the guarded prognosis of these uncommon infantile tumors. This case report aims to raise the awareness towards the workup and management of infantile malignancies in a baby girl

  7. The vaginal microflora in relation to gingivitis

    Science.gov (United States)

    2009-01-01

    Background Gingivitis has been linked to adverse pregnancy outcome (APO). Bacterial vaginosis (BV) has been associated with APO. We assessed if bacterial counts in BV is associated with gingivitis suggesting a systemic infectious susceptibilty. Methods Vaginal samples were collected from 180 women (mean age 29.4 years, SD ± 6.8, range: 18 to 46), and at least six months after delivery, and assessed by semi-quantitative DNA-DNA checkerboard hybridization assay (74 bacterial species). BV was defined by Gram stain (Nugent criteria). Gingivitis was defined as bleeding on probing at ≥ 20% of tooth sites. Results A Nugent score of 0–3 (normal vaginal microflora) was found in 83 women (46.1%), and a score of > 7 (BV) in 49 women (27.2%). Gingivitis was diagnosed in 114 women (63.3%). Women with a diagnosis of BV were more likely to have gingivitis (p = 0.01). Independent of gingival conditions, vaginal bacterial counts were higher (p gingivitis had higher counts of Prevotella bivia (p 1.0 × 104 cells) and a diagnosis of gingivitis was 3.9 for P. bivia (95% CI 1.5–5.7, p gingivitis in comparison to women with BV but not gingivitis. P. bivia and P. disiens may be of specific significance in a relationship between vaginal and gingival infections. PMID:19161595

  8. Prolapso vaginal e uterino em ovelhas

    National Research Council Canada - National Science Library

    Maíra Bianchi R. Alves; Fernando J. Benesi; Lilian Gregory; Alice M.M.P. Della Libera; Maria Cláudia A. Sucupira; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    ... de Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6...

  9. vaginal histological changes of the baboon

    African Journals Online (AJOL)

    2009-04-04

    Apr 4, 2009 ... VAGINAL HISTOLOGICAL CHANGES OF THE BABOON DURING THE NORMAL MENSTRUAL CYCLE AND. PREGNANCY. A. Nyachieo ... During the luteal phase, menstrual phase and pregnancy the squamous epithelium was ... point, an endoscopic cup (Karl Storz, GmbH & Co. KG, Germany) was used ...

  10. Lactobacilli Dominance and Vaginal pH: Why is the Human Vaginal Microbiome Unique?

    Directory of Open Access Journals (Sweden)

    Elizabeth A. Miller

    2016-12-01

    Full Text Available The human vaginal microbiome is dominated by bacteria from the genus Lactobacillus, which create an acidic environment thought to protect women against sexually transmitted pathogens and opportunistic infections. Strikingly, lactobacilli dominance appears to be unique to humans; while the relative abundance of lactobacilli in the human vagina is typically >70%, in other mammals lactobacilli rarely comprise more than 1% of vaginal microbiota. Several hypotheses have been proposed to explain humans' unique vaginal microbiota, including humans' distinct reproductive physiology, high risk of STDs, and high risk of microbial complications linked to pregnancy and birth. Here, we test these hypotheses using comparative data on vaginal pH and the relative abundance of lactobacilli in 26 mammalian species and 50 studies (N=21 mammals for pH and 14 mammals for lactobacilli abundance. We found that non-human mammals, like humans, exhibit the lowest vaginal pH during the period of highest estrogen. However, the vaginal pH of non-human mammals is never as low as is typical for humans (median vaginal pH in humans = 4.5; range of pH across all 21 non-human mammals = 5.4 to 7.8. Contrary to disease and obstetric risk hypotheses, we found no significant relationship between vaginal pH or lactobacilli abundance and multiple metrics of STD or birth injury risk (P-values ranged from 0.13 to 0.99. Given the lack of evidence for these hypotheses, we discuss two alternative explanations: the common function hypothesis and a novel hypothesis related to the diet of agricultural humans. Specifically, with regard to diet we propose that high levels of starch in human diets have led to increased levels of glycogen in the vaginal tract, which, in turn, promotes the proliferation of lactobacilli. If true, human diet may have paved the way for a novel, protective microbiome in human vaginal tracts. Overall, our results highlight the need for continuing research on non

  11. Laparoscopic Hemi-hysterectomy and Trachelectomy in a Case of Herlyn-Werner-Wunderlich Syndrome.

    Science.gov (United States)

    Al Sawah, Entidhar; Plosker, Shayne M; Mikhail, Emad

    2016-10-26

    Herlyn-Werner-Wunderlich Syndrome (HWWS) is a rare Müllerian anomaly characterized by uterus didelphys coexisting with an obstructed hemivagina and ipsilateral renal agenesis. A 13-year-old female presented one-year after menarche with severe dysmenorrhea and a right-sided pelvic mass. Imaging identified a right uterus with hematometra, hematocolpos, absent right kidney, normal left kidney, ureter, left uterus, and vagina compressed to the left by right hematocolpos. We performed laparoscopic hemi-hysterectomy of the non-communicating hemi-uterus, and laparoscopic trachelectomy. Laparoscopic hemi-hysterectomy and trachelecotmy is a minimally invasive surgical option for patients with Herlyn-Werner-Wunderlich Syndrome.

  12. Early postoperative mortality following hysterectomy. A Danish population based study, 1977-1981

    DEFF Research Database (Denmark)

    Loft, Anne; Andersen, T F; Brønnum-Hansen, Henrik

    1991-01-01

    The main objective of this cohort study was to analyse the early postoperative mortality after 'simple' hysterectomy for benign indications and to compare it with that of a randomly selected reference group of women matched for age. Registry data covering the entire Danish female population were ...... prospective studies of survival and morbidity, including quality of life for longer periods of time following operations.......The main objective of this cohort study was to analyse the early postoperative mortality after 'simple' hysterectomy for benign indications and to compare it with that of a randomly selected reference group of women matched for age. Registry data covering the entire Danish female population were...

  13. Effect of simple and radical hysterectomy on quality of life - analysis of all aspects of pelvic floor dysfunction.

    Science.gov (United States)

    Selcuk, Selcuk; Cam, Cetin; Asoglu, Mehmet Resit; Kucukbas, Mehmet; Arinkan, Arzu; Cikman, Muzaffer Seyhan; Karateke, Ates

    2016-03-01

    The impact of simple and radical hysterectomy on all aspects of pelvic floor dysfunctions was evaluated in current study. This retrospective cohort study included 142 patients; 58 women (40.8%) who have undergone simple, 41 (28.8%) radical hysterectomy, and 43 (30.2%) women without any surgical intervention to serve as the control group. The validated versions of the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), Pelvic Floor and Incontinence Sexual Impact Questionnaire (PISQ-12), Wexner Incontinence Scale score and pelvic organ prolapse quantification (POP-Q) system were used in detailed evaluation of pelvic floor dysfunction. One-way ANOVA and Pearson's chi square tests were performed in statistical analysis. It was found that there were significant differences in irritative and obstructive scores of UDI-6 between Type III hysterectomy group and Type I hysterectomy group. In addition, patients of Type I hysterectomy had significant higher irritative and obstructive scores than the control group. Type III hysterectomy had the most significant deteriorating effect on sexual life, based on scores of PISQ-12 compared to both Type I hysterectomy group and control group. Hysterectomy results in detrimental effects on the quality of life (QoL) regarding all aspects of pelvic floor functions especially in women of radical hysterectomy. Urinary dysfunctional symptoms like urgency, obstruction and especially sexual problems are more bothersome and difficult to overcome. The impact of hysterectomy on QoL should be investigated as a whole and may be more profound than previously thought. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Atrophic Vaginitis in Breast Cancer Survivors: A Difficult Survivorship Issue

    Directory of Open Access Journals (Sweden)

    Joanne Lester

    2015-03-01

    Full Text Available Management of breast cancer includes systematic therapies including chemotherapy and endocrine therapy can lead to a variety of symptoms that can impair the quality of life of many breast cancer survivors. Atrophic vaginitis, caused by decreased levels of circulating estrogen to urinary and vaginal receptors, is commonly experienced by this group. Chemotherapy induced ovarian failure and endocrine therapies including aromatase inhibitors and selective estrogen receptor modulators can trigger the onset of atrophic vaginitis or exacerbate existing symptoms. Symptoms of atrophic vaginitis include vaginal dryness, dyspareunia, and irritation of genital skin, pruritus, burning, vaginal discharge, and soreness. The diagnosis of atrophic vaginitis is confirmed through patient-reported symptoms and gynecological examination of external structures, introitus, and vaginal mucosa. Lifestyle modifications can be helpful but are usually insufficient to significantly improve symptoms. Non-hormonal vaginal therapies may provide additional relief by increasing vaginal moisture and fluid. Systemic estrogen therapy is contraindicated in breast cancer survivors. Continued investigations of various treatments for atrophic vaginitis are necessary. Local estrogen-based therapies, DHEA, testosterone, and pH-balanced gels continue to be evaluated in ongoing studies. Definitive results are needed pertaining to the safety of topical estrogens in breast cancer survivors.

  15. The Comparison of vaginal cream of mixing yogurt, honey and clotrimazole on symptoms of vaginal candidiasis.

    Science.gov (United States)

    Darvishi, Maryam; Jahdi, Fereshteh; Hamzegardeshi, Zeinab; Goodarzi, Saied; Vahedi, Mohsen

    2015-04-03

    Vulvovaginal candidiasis is known as one of the most common fungal infection among women of reproductive age and considered as an important public health problem. In recent years, due to resistance to common antifungal medication, the use of traditional medicine of anti-fungal and herbal treatment increased. Therefore the objective of this study was to determine the effects of vaginal cream, mixture of yogurt and honey and comparing it with clotrimazole vaginal cream on symptoms of Vulvovaginal candidiasis in patients. In this randomized, triple blind clinical trial of 70 non-pregnant women infected with Candidal vulvovaginitis were placed in two groups of Vaginal cream mixed of yogurt and honey recipients (N=35) and clotrimazole vaginal cream (N=35). Both groups were treated for 7 days. At the beginning of study, Clinical and laboratory signs and symptoms were registered 7 and 14 days after treatment by questionnaire, observation form and secretions culture results. Data by chi-square test, t test, McNemar tests were analyzed by SPSS version 21. Significance level of 0.05 was considered. The result of present study reveals the significant differences in symptom improvement of ' yogurt and honey, than clotrimazole group (Pyogurt and honey" and clotrimazole (20% versus 8.6%) and second time cultivation (14 days after treatment) (17/1% versus 8.6%) were similar and there was no significant differences between the two groups. (P>0.05) CONCLUSION: This study indicated that he therapeutic effects of vaginal cream, yogurt and honey is not only similar with clotrimazole vaginal cream but more effective in relieving some symptoms of vaginal candidiasis. Therefore, the use of this product can be suggested as an herbal remedy for candida infection treatment.

  16. Peripartum hysterectomy in the first decade of the 21st century.

    LENUS (Irish Health Repository)

    Tadesse, W

    2012-02-01

    We reviewed the role of peripartum hysterectomy (PH) in the first decade of the 21st century. The study was confined to women who delivered a baby weighing 500 g or more between 2000 and 2009, and who required a hysterectomy within 72 h of delivery for obstetric reasons. Individual case records were reviewed. There were 19 cases of PH in 78,961 deliveries giving an incidence of 1 in 4,156 (0.02%). Of the 19 cases, 95% were delivered by caesarean section and 89% had one or more prior sections. The indications were placental bed pathology (79%), uterine atony (16%) and uterine trauma (5%). Of the 19 hysterectomies, 16 (84%) were total and a gynaecological oncologist was involved in nine (56%) of these cases. There were no maternal or fetal deaths, but a mother required an average blood transfusion of 10 units. The overall rate of PH was remarkably low compared with other studies but it is likely to increase in the future because of the strong association between increasing caesarean section rates and placental bed pathology. The potential involvement of the cervix and other pelvic structures by placental pathology means that PH in the future will be more challenging, and the hysterectomy will need to be total rather than subtotal.

  17. More Wounding Than Wounds: Hysterectomy, Phenomenology, and the Pain(s of Excorporation

    Directory of Open Access Journals (Sweden)

    Heather Hill-Vásquez

    2016-06-01

    Full Text Available Focusing on the pain experience of hysterectomy, this article applies and interrogates the foundational descriptive process on which phenomenology is based and suggests that feminism and phenomenology are more compatible than previously asserted. Building upon the work of feminist philosophers who have also explored how feminist and phenomenological approaches share similar methods and intentions—especially in connection with the former’s significant attention to lived experience as a source for the theory feminism employs—the article engages with the philosophies of Maurice Merleau-Ponty and Samuel Mallin who maintain a consistent attention to the body in their phenomenological approaches. Arguing that Mallin’s method of “body hermeneutics” is especially valuable for constructing a feminist phenomenological approach, the article applies Mallin’s theories to the hysterectomy experience, thus revealing how other female-coded experiences of pain, intrusion, shame, and vulnerability are intertwined with hysterectomy. Moreover, the article posits the pain experience of hysterectomy as a particularly emphatic form of phenomenological excorporation in which hidden and habituated assumptions—in this case, the previously unnoticed and unexamined association of a woman’s womb with what it means to be a woman—are painfully brought to light. As the womb becomes more present in the notion and reality of its absence, what does this mean for the many women who experience the shared phenomenon of hysterectomy—including feminist women who enter the experience with a more explicit understanding of themselves as gendered subjects?

  18. The added value of hysterectomy in the management of gestational trophoblastic neoplasia

    NARCIS (Netherlands)

    Eysbouts, Y.K.; Massuger, L.F.A.G.; Hout, J. in't; Lok, C.A.; Sweep, F.C.; Ottevanger, P.B.

    2017-01-01

    BACKGROUND: Despite the undoubted effectiveness of chemotherapeutic treatment in gestational trophoblastic neoplasia (GTN), problems related to toxicity of chemotherapy and chemo-resistant disease have led to reconsideration of the use of hysterectomy. Aim of the present study was to evaluate

  19. Uterine Fundectomy in Patients With Benign Etiology Undergoing Hysterectomy: New Surgical Technique.

    Science.gov (United States)

    Saremi, AboTaleb; Bahrami, Homa; Feizy, Fariba

    2017-10-10

    Hysterectomy is the most common surgical procedure in gynecology, not only in cases of malignancies but also in many benign cases. Many uterine preservation techniques have been introduced as alternatives to hysterectomy. We aimed to propose a new uterine surgical procedure. In this paper, we compare the utility of this new technique to the limitations of current procedures. Uterine fundectomy may be considered as a subtotal hysterectomy. In this new technique, the uterine fundus including all pathologic tissue is cut as a reverse trapezoid by monopolar cautery. The upper side of the trapezoid, which includes the whole uterine fundus, is removed, but the fallopian tubes and cornual segment are preserved. A small uterine cavity remains, as well as the endometrial tissue lining it. Patient recruitment for this study began in April 2017 and is expected to end approximately 12 months later. Assessment of the primary outcomes is expected to take place in April 2018. Uterine preservation is particularly critical in developing new surgical approaches that can lead to a positive impact on patient satisfaction. This protocol outlines the first attempt to prospectively test surgical fundectomy in candidates for hysterectomy for benign indications.

  20. Factors Related to Hysterectomy in Women with Physical and Mobility Disabilities

    Science.gov (United States)

    Lin, Lan-Ping; Hsieh, Molly; Chen, Si-Fan; Wu, Chia-Ling; Hsu, Shang-Wei; Lin, Jin-Ding

    2012-01-01

    This paper aims to identify self-report data for hysterectomy prevalence and to explore its correlated factors among women with physical and mobility disabilities in Taiwan. This paper was part of a larger study, "Survey on Preventive Health Utilizations of People with Physical and Mobility Disability in Taiwan," which is a…

  1. Prediction of peripartum hysterectomy and end organ dysfunction in major obstetric haemorrhage.

    LENUS (Irish Health Repository)

    O'Brien, D

    2010-12-01

    The aims of this study are to determine the incidence and aetiology of major obstetric haemorrhage (MOH) in our population, to examine the success rates of medical and surgical interventions and to identify risk factors for peripartum hysterectomy and end organ dysfunction (EOD).

  2. Radical (Wertheim) hysterectomy for early stages (1B and 2A ...

    African Journals Online (AJOL)

    A review of cases of early stages (1B & 2A) cancer of the cervix, managed by radical hysterectomy at Olabisi Onabanjo University Teaching Hospital Sagamu Nigeria between 1997 and 2004 was carried out to appraise the outcome in terms of the success and safety of the operation. Seventeen cases were so treated, and ...

  3. Inflammatory response in patients undergoing uterine artery embolization as compared to patients undergoing conventional hysterectomy

    DEFF Research Database (Denmark)

    Brøchner, A C; Mygil, B; Elle, B

    2009-01-01

    BACKGROUND: Uterine fibroids are benign tumors seen in 20-40% of women of childbearing age, and these fibroids are usually treated by hysterectomy. During the last decade, embolization of the uterine arteries with polyvinyl alcohol microparticles has become an alternative treatment. PURPOSE...

  4. Enterobius vermicularis infestation of a hysterectomy specimen in a patient with a colonic reservoir.

    Science.gov (United States)

    Worley, Michael J; Slomovitz, Brian M; Pirog, Edyta C; Caputo, Thomas A; Ledger, William J

    2009-06-01

    A 43-year-old woman (gravida 2, para 1011) with a history of uterine leiomyomata and a Barnett colonic reservoir underwent a supracervical hysterectomy. Final pathology revealed Enterobius vermicularis within the myometrium and adnexal vasculature. Infection may have occurred through a modified mode given the presence of a Barnett colonic reservoir and absence of an anus.

  5. The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms

    NARCIS (Netherlands)

    van der Vaart, C. H.; van der Bom, J. G.; de Leeuw, J. R. J.; Roovers, J. P. W.; Heintz, A. P. M.

    2002-01-01

    OBJECTIVE: To study the contribution of hysterectomy to the occurrence of urge-or stress urinary incontinence symptoms. DESIGN: A population-based, cross-sectional cohort study conducted in 1999. SETTING: A university medical centre in The Netherlands. POPULATION: Random sample of 2322 women,

  6. Profound bilateral visual loss after hysterectomy indicated for severe postpartum haemorrhage

    DEFF Research Database (Denmark)

    Ostri, Christoffer; Zibrandtsen, Nathalie; Larsen, Michael

    2014-01-01

    We present a case of a patient with bilateral posterior ischaemic optic neuropathy in the previously unreported setting of hysterectomy indicated for severe postpartum haemorrhage. The diagnosis was based on clinical and paraclinical examinations, including MRI of the head, electroretinography (ERG...

  7. Longitudinal study of uro-gynecological morbidity and quality of life after radical hysterectomy

    DEFF Research Database (Denmark)

    Jensen, Pernille Tine

    Background: Radical hysterectomy (RH) and pelvic lymphadenectomy is widely used as the primary treatment for lymph node negative early stage cervical cancer. Little knowledge exists concerning the impact of RH on self-assessed urological and gynecological adverse effects as well as the impact of RH...

  8. Effect of Total Laparoscopic Hysterectomy vs Total Abdominal Hysterectomy on Disease-Free Survival Among Women With Stage I Endometrial Cancer: A Randomized Clinical Trial.

    Science.gov (United States)

    Janda, Monika; Gebski, Val; Davies, Lucy C; Forder, Peta; Brand, Alison; Hogg, Russell; Jobling, Thomas W; Land, Russell; Manolitsas, Tom; Nascimento, Marcelo; Neesham, Deborah; Nicklin, James L; Oehler, Martin K; Otton, Geoff; Perrin, Lewis; Salfinger, Stuart; Hammond, Ian; Leung, Yee; Sykes, Peter; Ngan, Hextan; Garrett, Andrea; Laney, Michael; Ng, Tong Yow; Tam, Karfai; Chan, Karen; Wrede, C David; Pather, Selvan; Simcock, Bryony; Farrell, Rhonda; Robertson, Gregory; Walker, Graeme; Armfield, Nigel R; Graves, Nick; McCartney, Anthony J; Obermair, Andreas

    2017-03-28

    Standard treatment for endometrial cancer involves removal of the uterus, tubes, ovaries, and lymph nodes. Few randomized trials have compared disease-free survival outcomes for surgical approaches. To investigate whether total laparoscopic hysterectomy (TLH) is equivalent to total abdominal hysterectomy (TAH) in women with treatment-naive endometrial cancer. The Laparoscopic Approach to Cancer of the Endometrium (LACE) trial was a multinational, randomized equivalence trial conducted between October 7, 2005, and June 30, 2010, in which 27 surgeons from 20 tertiary gynecological cancer centers in Australia, New Zealand, and Hong Kong randomized 760 women with stage I endometrioid endometrial cancer to either TLH or TAH. Follow-up ended on March 3, 2016. Patients were randomly assigned to undergo TAH (n = 353) or TLH (n = 407). The primary outcome was disease-free survival, which was measured as the interval between surgery and the date of first recurrence, including disease progression or the development of a new primary cancer or death assessed at 4.5 years after randomization. The prespecified equivalence margin was 7% or less. Secondary outcomes included recurrence of endometrial cancer and overall survival. Patients were followed up for a median of 4.5 years. Of 760 patients who were randomized (mean age, 63 years), 679 (89%) completed the trial. At 4.5 years of follow-up, disease-free survival was 81.3% in the TAH group and 81.6% in the TLH group. The disease-free survival rate difference was 0.3% (favoring TLH; 95% CI, -5.5% to 6.1%; P = .007), meeting criteria for equivalence. There was no statistically significant between-group difference in recurrence of endometrial cancer (28/353 in TAH group [7.9%] vs 33/407 in TLH group [8.1%]; risk difference, 0.2% [95% CI, -3.7% to 4.0%]; P = .93) or in overall survival (24/353 in TAH group [6.8%] vs 30/407 in TLH group [7.4%]; risk difference, 0.6% [95% CI, -3.0% to 4.2%]; P = .76). Among women

  9. Biofilms of vaginal Lactobacillus in vitro test.

    Science.gov (United States)

    Wei, Xiao-Yu; Zhang, Rui; Xiao, Bing-Bing; Liao, Qin-Ping

    2017-01-01

    This paper focuses on biofilms of Lactobacillus spp. - a type of normal flora isolated from healthy human vaginas of women of childbearing age; thereupon, it broadens the research scope of investigation of vaginal normal flora. The static slide culture method was adopted to foster biofilms, marked by specific fluorescence staining. Laser scanning confocal and scanning electron microscopy were used to observe the microstructure of the biofilms. Photographs taken from the microstructure were analysed to calculate the density of the biofilms. The body of Lactobacillus spp., though red, turned yellow when interacting with the green extracellular polysaccharides. The structure of the biofilm and aquaporin within the biofilm were imaged. Lactobacillus density increases over time. This study provides convincing evidence that Lactobacillus can form biofilms and grow over time in vitro. This finding establishes an important and necessary condition for selecting proper strains for the pharmaceutics of vaginal ecology.

  10. Adolescent Experiences with the Vaginal Ring

    Science.gov (United States)

    Epstein, Laura B.; Sokal-Gutierrez, Karen; Ivey, Susan L.; Raine, Tina; Auerswald, Colette

    2011-01-01

    Purpose To understand racial/ethnic minority adolescent females’ experiences with the vaginal ring. Methods We conducted in-depth interviews with a clinic-based sample of 32 young women aged 15–24 years who had used the vaginal ring. Results Qualitative analysis using grounded theory revealed that adolescents undergo a multi-stage process when trying the ring and adopting ring use. These stages include hearing about the ring, initial reactions, first experiences with insertion and removal, and first sexual experiences. Adolescents subsequently enter an assessment and adjustment stage in which they decide whether to adopt or discontinue ring use. Ultimately they share their experiences with friends. Conclusions The model developed provides a context within which providers may advise adolescents as they begin use of the ring. Some specific recommendations are offered. PMID:18565439

  11. [Morphogenesis of vaginal aplasia. Therapeutic deductions].

    Science.gov (United States)

    Minh, H N; Smadja, A; Belaisch, J

    1985-01-01

    On the basis of the studies of the embryogenesis of the vagina, the authors consider that malformations classically described as being partial aplasia should not be separated from the total absence of the vagina. The important feature is the association of a functioning or non functioning uterus with the absence of the vagina. They believe that it is incorrect to describe the pouch of menstrual retention associated with a functioning uterus as "haematocolpos" and that is not justified to describe the cup-shaped vestibular depression as "hemi-vagina". According to the authors, although vaginal aplasia with a functioning uterus forming a pouch of menstrual retention constitutes an absolute indication for surgery, surgery is not justified in cases of vaginal aplasia with a non functioning uterus. If Frank's method fails in these cases, the patient or the couple should be referred to a sexologist, as women with this anomaly retain a perfect femininity, although unable to conceive.

  12. Vaginal fibrosarcoma in bitch: a case report

    Directory of Open Access Journals (Sweden)

    E.R. Al-Kenanny

    2013-12-01

    Full Text Available A nine year–old wolf bitch was admitted to the surgical section of veterinary clinic teaching hospital in Mosul with abnormal mass occupying relatively the vulvar opening. According to the case history of owner, the bitch was suffered from varying degree of difficulty during parturition due to presence of this mass that showed during and after parturition. Appetite and all body health condition were normal. Clinical examination revealed presence of mass like tumor attached to the vaginal wall with numerous nodules or small growths originated also from wall of vulva near to large mass. The large growth was protruded completely through the vagina without any vaginal prolapse. After general anesthesia with ketamine and xylazine, the mass was surgically removed. Histopathological sections were revealed presence of fibrosarcoma which represented by arrangement of cells that have features of malignancy like darkly staining nuclei (hyperchromasia. The mass was diagnosed as a well-differentiated fibrosarcoma.

  13. Secretory Aspartyl Proteinases Cause Vaginitis and Can Mediate Vaginitis Caused by Candida albicans in Mice.

    Science.gov (United States)

    Pericolini, Eva; Gabrielli, Elena; Amacker, Mario; Kasper, Lydia; Roselletti, Elena; Luciano, Eugenio; Sabbatini, Samuele; Kaeser, Matthias; Moser, Christian; Hube, Bernhard; Vecchiarelli, Anna; Cassone, Antonio

    2015-06-02

    Vaginal inflammation (vaginitis) is the most common disease caused by the human-pathogenic fungus Candida albicans. Secretory aspartyl proteinases (Sap) are major virulence traits of C. albicans that have been suggested to play a role in vaginitis. To dissect the mechanisms by which Sap play this role, Sap2, a dominantly expressed member of the Sap family and a putative constituent of an anti-Candida vaccine, was used. Injection of full-length Sap2 into the mouse vagina caused local neutrophil influx and accumulation of the inflammasome-dependent interleukin-1β (IL-1β) but not of inflammasome-independent tumor necrosis factor alpha. Sap2 could be replaced by other Sap, while no inflammation was induced by the vaccine antigen, the N-terminal-truncated, enzymatically inactive tSap2. Anti-Sap2 antibodies, in particular Fab from a human combinatorial antibody library, inhibited or abolished the inflammatory response, provided the antibodies were able, like the Sap inhibitor Pepstatin A, to inhibit Sap enzyme activity. The same antibodies and Pepstatin A also inhibited neutrophil influx and cytokine production stimulated by C. albicans intravaginal injection, and a mutant strain lacking SAP1, SAP2, and SAP3 was unable to cause vaginal inflammation. Sap2 induced expression of activated caspase-1 in murine and human vaginal epithelial cells. Caspase-1 inhibition downregulated IL-1β and IL-18 production by vaginal epithelial cells, and blockade of the IL-1β receptor strongly reduced neutrophil influx. Overall, the data suggest that some Sap, particularly Sap2, are proinflammatory proteins in vivo and can mediate the inflammasome-dependent, acute inflammatory response of vaginal epithelial cells to C. albicans. These findings support the notion that vaccine-induced or passively administered anti-Sap antibodies could contribute to control vaginitis. Candidal vaginitis is an acute inflammatory disease that affects many women of fertile age, with no definitive cure and, in

  14. Pregnancy and Vaginal Delivery after Sacrohysteropexy

    Directory of Open Access Journals (Sweden)

    Deniz Balsak

    2015-01-01

    Full Text Available Pregnancy and birth after a Pelvic Organ Prolapse (POP surgery is a rare condition and less is known about the method for delivery. A 31-year-old women with gravida 3 para 3 underwent abdominal sacrohysteropexy and transobturatuar tape (TOT procedures for stage III prolapse who delivered via vaginal birth and showed no relapse. Sacrohysteropexy is a good option for women with POP who desire fertility with a long term follow-up period.

  15. Bakri balloon in vaginal-perineal hematomas complicating vaginal delivery: a new therapeutic approach.

    Science.gov (United States)

    Gizzo, Salvatore; Saccardi, Carlo; Patrelli, Tito Silvio; Di Gangi, Stefania; D'Antona, Donato; Battista Nardelli, Giovanni

    2013-04-01

    The study aimed to evaluate the effectiveness of Bakri balloon as a hemostatic device in severe postpartum hemorrhage due to complicated vaginal-perineal hematoma not responsive to standard surgical treatments. The article discusses an effective and minimally invasive technique for resolving a case of massive vaginal-perineal bleeding after vaginal delivery complicated by ischiorectal fossa hematoma. A 36-year-old primipara white woman, 41 weeks 1 day pregnant, was admitted to our unit for beginning of labor. She experienced a precipitous delivery of a healthy male baby (3.72 kg, 51 cm in length), and spontaneous complete afterbirth of placenta and membranes. The intervention involved positioning of an hemostatic Bakri balloon device in the vagina, to compress the vaginal wall, ensuring that the draining apex was well positioned into the uterine cervix. The patient was discharged after having a puerperal course without further complications. Vaginal hemostatic Bakri balloon device shows hemostatic efficacy immediately assessable, is promptly removable, not interfering with subsequent surgical or radiological procedures, does not increase the risk of infections as other compressive procedures, allows flow of lochia, does not cause pain or discomfort in women, and permits adjustable compression when a drainage is placed during surgery. Despite the high cost, it does not show disadvantages.

  16. Relationship among vaginal palpation, vaginal squeeze pressure, electromyographic and ultrasonographic variables of female pelvic floor muscles

    Directory of Open Access Journals (Sweden)

    Vanessa S. Pereira

    2014-10-01

    Full Text Available Background: The proper evaluation of the pelvic floor muscles (PFM is essential for choosing the correct treatment. Currently, there is no gold standard for the assessment of female PFM function. Objective: To determine the correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the female PFM. Method: This cross-sectional study evaluated 80 women between 18 and 35 years of age who were nulliparous and had no pelvic floor dysfunction. PFM function was assessed based on digital palpation, vaginal squeeze pressure, electromyographic activity, bilateral diameter of the bulbocavernosus muscles and the amount of bladder neck movement during voluntary PFM contraction using transperineal bi-dimensional ultrasound. The Pearson correlation was used for statistical analysis (p<0.05. Results: There was a strong positive correlation between PFM function and PFM contraction pressure (0.90. In addition, there was a moderate positive correlation between these two variables and PFM electromyographic activity (0.59 and 0.63, respectively and movement of the bladder neck in relation to the pubic symphysis (0.51 and 0.60, respectively. Conclusions: This study showed that there was a correlation between vaginal palpation, vaginal squeeze pressure, and electromyographic and ultrasonographic variables of the PFM in nulliparous women. The strong correlation between digital palpation and PFM contraction pressure indicated that perineometry could easily be replaced by PFM digital palpation in the absence of equipment.

  17. EFFECTIVENESS OF SCHEDULED AMBULATION ON EARLY POSTOPERATIVE OUTCOME AMONG PATIENTS WHO HAVE UNDERGONE ABDOMINAL HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Rinku Girija

    2017-01-01

    Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis

  18. Pattern of mental ill health morbidities following hysterectomy for benign gynaecological disorders among Nigerian women

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    Morhason-Bello Imran O

    2009-07-01

    Full Text Available Abstract Objective to compare the pre and post hysterectomy mental ill health (MIH status and also, to determine whether there is any association with the surgical indication. Methodology An observational study, conducted among women scheduled for hysterectomy at the University College Hospital, Ibadan from January till June 2005. The MIH morbidities were assessed using a validated general health questionnaire (GHQ before and after the surgery by trained research assistant. The score of 4 and above was used as the cut off. Cross tabulations were performed to detect any association and also to compare pre and post hysterectomy mental health status. The level of statistical significance was set at P Results Of the 50 women recruited, 45 participated in the study. The age range of the participants was 35 to 63 years with a mean of 48.6 (SD = 0.6 years. Anxiety related disorder was present in 20 (44.4%, and depression in 3 (6.7% before hysterectomy. Post surgery, there was significant increase in those with anxiety by 6.8% and a reduction in the proportion of depressive illness by 2.3%. Uterine fibroid as a preoperative diagnosis, had significant association among those with anxiety related disorder (68.4% and depression (10.5%. Conclusion This study suggests that mental ill health may complicates hysterectomy for benign uterine pathology among Nigerian women, and that anxiety related disorders increases after operation with the highest proportion in those with clinical diagnosis of Uterine Fibroid. We recommend adequate preoperative counseling using properly trained psychologists when affordable to minimize these morbidities.

  19. Clinical Outcomes in International Federation of Gynecology and Obstetrics Stage IA Endometrial Cancer With Myometrial Invasion Treated With or Without Postoperative Vaginal Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Diavolitsis, V. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Rademaker, A. [Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Lurain, J.; Hoekstra, A. [Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Strauss, J. [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States); Small, W., E-mail: wsmall@nmff.org [Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL (United States)

    2012-10-01

    Purpose: To assess the clinical outcomes of patients with Stage IA endometrial cancer with myometrial invasion treated with postoperative vaginal brachytherapy (VBT) with those who received no adjuvant therapy (NAT). Methods and Materials: All patients treated with hysterectomy for endometrial cancer at Northwestern Memorial Hospital between 1978 and 2005 were identified. Those patients with Stage IA disease with myometrial invasion who were treated with VBT alone or NAT were identified and included in the present analysis. Results: Of 252 patients with Stage IA endometrial cancer with superficial (<50%) myometrial invasion who met the inclusion criteria, 169 underwent VBT and 83 received NAT. The median follow-up in the VBT and NAT groups was 103 and 61 months, respectively. In the VBT group, 56.8% had Grade 1, 37.9% had Grade 2, and 5.3% had Grade 3 tumors. In the NAT group, 75.9%, 20.5%, and 3.6% had Grade 1, 2, and 3 tumors, respectively. Lymphatic or vascular space invasion was noted in 12.4% of the VBT patients and 5.6% of the NAT patients. The 5-year overall survival rate was 95.5%. The 5-year recurrence-free survival rate was 92.4% for all patients, 94.4% for the VBT group, and 87.4% for the NAT group (p = NS). Of the 169 VBT patients and 83 NAT patients, 8 (4.7%) and 6 (7.2%) developed recurrent disease. One vaginal recurrence occurred in the VBT group (0.6%) and three in the NAT group (3.8%). Recurrences developed 2-102 months after surgical treatment. Two of the four vaginal recurrences were salvaged. No Grade 3 or higher acute or late radiation toxicity was noted. Conclusions: The use of postoperative VBT in patients with Stage I endometrial cancer with <50% myometrial invasion yielded excellent vaginal disease control and disease-free survival, with minimal toxicity.

  20. Magnetic resonance imaging of primary vaginal carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, M.B. [Department of Diagnostic Radiology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom)]. E-mail: ben.taylor@christie-tr.nwest.nhs.uk; Dugar, N. [Department of Diagnostic Radiology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom); Davidson, S.E. [Radiation Oncology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom); Carrington, B.M. [Department of Diagnostic Radiology, Christie Hospital NHS Trust, Withington, Manchester (United Kingdom)

    2007-06-15

    Aims: To describe the magnetic resonance imaging (MRI) features of vaginal carcinoma and to suggest a role for MRI in its management. Materials and methods: Twenty-five patients with primary vaginal carcinoma treated at our institution between 1996 and 2005 were included in the study. The MRI examinations were reviewed and tumour dimensions, signal characteristics and involvement of pelvic structures were documented, as were sites of enlarged lymph nodes and metastases. Details of patient treatment and outcome were obtained from the clinical notes. Results: The median patient age was 54 years (range 31-86 years). Tumour maximum diameter ranged from 1.6-11.3 cm (mean 3.7 cm). Most tumours were of iso-intense signal to muscle on T1-weighted images and hyper-intense to muscle on T2-weighted images. Eighty-eight percent of patients had tumour extending beyond the vagina and 56% of patients had Figo stage III or above tumours. Sixteen patients were treated with radiotherapy (two with chemoradiotherapy), five with surgery and four with supportive care. Ten patients (40%) died of their disease during the study period. The MRI stage of the tumour correlated with survival. Conclusion: MRI identified over 95% of primary vaginal tumours in the present study, enabled radiological staging, which correlated with outcome, and provided information of use in treatment planning.

  1. Antibiotic Susceptibility of Potentially Probiotic Vaginal Lactobacilli

    Directory of Open Access Journals (Sweden)

    Virginia Ocaña

    2006-01-01

    Full Text Available Objective. To study the antimicrobial susceptibility of six vaginal probiotic lactobacilli. Methods. The disc diffusion method in Müeller Hinton, LAPTg and MRS agars by the NCCLS (National Committee for Clinical Laboratory Standards procedure was performed. Due to the absence of a Lactobacillus reference strains, the results were compared to those of Staphylococcus aureus ATCC29213. Minimal Inhibitory Concentration (MIC with 21 different antibiotics in LAPTg agar and broth was also determined. Results. LAPTg and MRS agars are suitable media to study antimicrobial susceptibility of lactobacilli. However, the NCCLS procedure needs to be standardized for this genus. The MICs have shown that all Lactobacillus strains grew at concentrations above 10 μg/mL of chloramphenicol, aztreonam, norfloxacin, ciprofloxacin, ceftazidime, ceftriaxone, streptomycin and kanamycin. Four lactobacilli were sensitive to 1 μg/mL vancomycin and all of them were resistant to 1000 μg/mL of metronidazole. Sensitivity to other antibiotics depended on each particular strain. Conclusions. The NCCLS method needs to be standardized in an appropriate medium to determine the antimicrobial susceptibility of Lactobacillus. Vaginal probiotic lactobacilli do not display uniform susceptibility to antibiotics. Resistance to high concentrations of metronidazole suggests that lactobacilli could be simultaneously used with a bacterial vaginosis treatment to restore the vaginal normal flora.

  2. Antibiotic Susceptibility of Potentially Probiotic Vaginal Lactobacilli

    Science.gov (United States)

    Ocaña, Virginia; Silva, Clara; Nader-Macías, María Elena

    2006-01-01

    Objective. To study the antimicrobial susceptibility of six vaginal probiotic lactobacilli. Methods. The disc diffusion method in Müeller Hinton, LAPTg and MRS agars by the NCCLS (National Committee for Clinical Laboratory Standards) procedure was performed. Due to the absence of a Lactobacillus reference strains, the results were compared to those of Staphylococcus aureus ATCC29213. Minimal Inhibitory Concentration (MIC) with 21 different antibiotics in LAPTg agar and broth was also determined. Results. LAPTg and MRS agars are suitable media to study antimicrobial susceptibility of lactobacilli. However, the NCCLS procedure needs to be standardized for this genus. The MICs have shown that all Lactobacillus strains grew at concentrations above 10 μg/mL of chloramphenicol, aztreonam, norfloxacin, ciprofloxacin, ceftazidime, ceftriaxone, streptomycin and kanamycin. Four lactobacilli were sensitive to 1 μg/mL vancomycin and all of them were resistant to 1000 μg/mL of metronidazole. Sensitivity to other antibiotics depended on each particular strain. Conclusions. The NCCLS method needs to be standardized in an appropriate medium to determine the antimicrobial susceptibility of Lactobacillus. Vaginal probiotic lactobacilli do not display uniform susceptibility to antibiotics. Resistance to high concentrations of metronidazole suggests that lactobacilli could be simultaneously used with a bacterial vaginosis treatment to restore the vaginal normal flora. PMID:17485797

  3. Stereophotogrammetry of the perineum during vaginal delivery.

    Science.gov (United States)

    Zemčík, Robert; Karbanova, Jaroslava; Kalis, Vladimir; Lobovský, Libor; Jansová, Magdalena; Rusavy, Zdenek

    2012-10-01

    To analyze deformation of the perineum during normal vaginal delivery in order to identify clinical steps that might be beneficial when executing manual perineal protection. The present prospective study at Charles University Hospital, Pilsen, Czech Republic, enrolled 10 primiparous women at term undergoing non-instrumental vaginal delivery assisted by the same obstetrician between September 2009 and September 2010. A modified hands-poised technique performed concurrently with stereophotogrammetry was used to analyze and quantify perineal deformation and strain at the final stage of delivery. The highest tissue strain (mean, 177%; 95% confidence interval [CI], 106.3-248.5) was in a transverse direction and occurred at the level of the fourchette (i.e. 1cm was transversely stretched and deformed to 2.77 cm during the final stage of vaginal delivery). This strain was more than 4 times higher than the maximum anteroposterior strain (mean, 43%; 95% CI, 28.6-57.4). On the basis of these stereophotogrammetry data, a technique of perineal protection executed by fingers of the posterior (right) hand can be proposed. Further experimental and clinical studies are needed to evaluate whether this technique might assist in reducing obstetric perineal trauma. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Postmenopausal Vaginal Endometriotic Cyst: A Case Report

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    Esengul Turkyilmaz

    2016-07-01

    Full Text Available A seventy-three-year-old patient%u2019s vaginal examination revealed a semi-mobile cystic structure visualised at the middle third portion of the posterior vaginal wall. The cyst was excised and the cyst wall was sent for pathological examination. The histopathological examination of the cyst with CD10 staining and tests for nuclear estrogen receptor positivity and nuclear progesteron receptor positivity revealed that the cyst wall contained endometrial stromal cells, endometrial surface epithelial cells, and hemosiderin-laden macrophages. Endometriosis externa was diagnosed based on the above findings. The case we report here, of an isolated vaginal endometriotic cyst, is unique because of its presentation in a postmenopausal woman without any history of infertility, any gynecologic surgery, or hormone replacement therapy. The reasonable explanation for this case might include certain mechanisms such as the self-sustaining existence of endometriotic cells that were implanted during the premenopausal period to the vagina and that maintain local estrogen production. No single hypothesis can explain the pathophysiology of endometriosis, given all of its various forms and presentations.

  5. Effects of intrauterine contraception on the vaginal microbiota.

    Science.gov (United States)

    Bassis, Christine M; Allsworth, Jenifer E; Wahl, Heather N; Sack, Daniel E; Young, Vincent B; Bell, Jason D

    2017-09-01

    There have been conflicting reports of altered vaginal microbiota and infection susceptibility associated with contraception use. The objectives of this study were to determine if intrauterine contraception altered the vaginal microbiota and to compare the effects of a copper intrauterine device (Cu-IUD) and a levonorgestrel intrauterine system (LNG-IUS) on the vaginal microbiota. DNA was isolated from the vaginal swab samples of 76 women using Cu-IUD (n=36) or LNG-IUS (n=40) collected prior to insertion of intrauterine contraception (baseline) and at 6 months. A third swab from approximately 12 months following insertion was available for 69 (Cu-IUD, n=33; LNG-IUS, n=36) of these women. The V4 region of the bacterial 16S rRNA-encoding gene was amplified from the vaginal swab DNA and sequenced. The 16S rRNA gene sequences were processed and analyzed using the software package mothur to compare the structure and dynamics of the vaginal bacterial communities. The vaginal microbiota from individuals in this study clustered into 3 major vaginal bacterial community types: one dominated by Lactobacillus iners, one dominated by Lactobacillus crispatus and one community type that was not dominated by a single Lactobacillus species. Changes in the vaginal bacterial community composition were not associated with the use of Cu-IUD or LNG-IUS. Additionally, we did not observe a clear difference in vaginal microbiota stability with Cu-IUD versus LNG-IUS use. Although the vaginal microbiota can be highly dynamic, alterations in the community associated with the use of intrauterine contraception (Cu-IUD or LNG-IUS) were not detected over 12 months. We found no evidence that intrauterine contraception (Cu-IUD or LNG-IUS) altered the vaginal microbiota composition. Therefore, the use of intrauterine contraception is unlikely to shift the composition of the vaginal microbiota such that infection susceptibility is altered. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Spectrum of vaginal discharge in a tertiary care setting

    Science.gov (United States)

    Sivaranjini, R; Jaisankar, TJ; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, SC; Habeebullah, S

    2013-01-01

    Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. PMID:24470998

  7. Thermosensitive hydrogels a versatile concept adapted to vaginal drug delivery.

    Science.gov (United States)

    Taurin, Sebastien; Almomen, Aliyah A; Pollak, Tatianna; Kim, Sun Jin; Maxwell, John; Peterson, C Matthew; Owen, Shawn C; Janát-Amsbury, Margit M

    2017-11-15

    Vaginal drug delivery represents an attractive strategy for local and systemic delivery of drugs otherwise poorly absorbed after oral administration. The rather dense vascular network, mucus permeability and the physiological phenomenon of the uterine first-pass effect can all be exploited for therapeutic benefit. However, several physiological factors such as an acidic pH, constant secretion, and turnover of mucus as well as varying thickness of the vaginal epithelium can impact sustained drug delivery. In recent years, polymers have been designed to tackle challenges mentioned above. In particular, thermosensitive hydrogels hold great promise due to their stability, biocompatibility, adhesion properties and adjustable drug release kinetics. Here, we discuss the physiological and anatomical uniqueness of the vaginal environment and how it impacts the safe and efficient vaginal delivery and also reviewed several thermosensitive hydrogels deemed suitable for vaginal drug delivery by addressing specific characteristics, which are essential to engage the vaginal environment successfully.

  8. Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial

    DEFF Research Database (Denmark)

    Rasmussen, M L; Dierking, G; Lech, K

    2008-01-01

    BACKGROUND: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy. METHODS: One hundred a...

  9. Cost and Distribution of Hysterectomy and Uterine Artery Embolization in the United States: Regional/Rural/Urban Disparities

    National Research Council Canada - National Science Library

    Marquisette Glass Lewis; Olúgbemiga T Ekúndayò

    2017-01-01

    ..., accessibility and physical availability. The purpose of this study was to determine and compare the cost of UAE and classical abdominal hysterectomy with regard to race/ethnicity, region, and location...

  10. Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids : 10-year outcomes from the randomized EMMY trial

    NARCIS (Netherlands)

    de Bruijn, Annefleur M.; Ankum, Willem M.; Reekers, Jim A.; Birnie, Erwin; van der Kooij, Sanne M.; Volkers, Nicole A.; Hehenkamp, Wouter J. K.

    2016-01-01

    BACKGROUND: Since 1995 uterine artery embolization has been described as an alternative for hysterectomy in patients with symptomatic fibroids. Many studies including several randomized controlled trials established uterine artery embolization as a valuable treatment. These randomized controlled

  11. Thirty-day postoperative mortality after hysterectomy in women with liver cirrhosis: a Danish population-based cohort study.

    DEFF Research Database (Denmark)

    Lesnikova, Iana

    2002-01-01

    , Building 260, 8000 Aarhus C, Denmark.BACKGROUND: Women with liver cirrhosis have a higher incidence of hysterectomy than the general population, generally because of abnormal bleeding. They may also have an increased risk of postoperative mortality and morbidity. METHODS: In the nationwide Danish National......Thirty-day postoperative mortality after hysterectomy in women with liver cirrhosis: a Danish population-based cohort study.Nielsen IL, Thulstrup AM, Nielsen GL, Larsen H, Vilstrup H, Sorensen HT.Department of Clinical Epidemiology, Aarhus and Aalborg University Hospitals, Vennelyst Boulevard 6...... Patients Register (NPR) we identified all women diagnosed with liver cirrhosis from 1977 to 1993. From this cohort we selected all women undergoing hysterectomy. A random sample of women without liver cirrhosis undergoing hysterectomy was selected as controls. Outcome was defined as mortality within...

  12. Posterior pelvic exenteration and retrograde total hysterectomy in patients with locally advanced ovarian cancer: Clinical and functional outcome

    Directory of Open Access Journals (Sweden)

    Roberto Berretta

    2016-06-01

    Conclusion: Our study confirmed that pelvic posterior exenteration associated with retrograde radical hysterectomy represents the safest radical surgical approach to advanced ovarian cancer, which permits preservation of the pelvic autonomic nerve plexus and, therefore, bladder and colorectal functions.

  13. Supporting Women Planning a Vaginal Breech Birth: An International Survey.

    Science.gov (United States)

    Petrovska, Karolina; Watts, Nicole P; Catling, Christine; Bisits, Andrew; Homer, Caroline S E

    2016-12-01

    The aim of this study was to explore the experiences of women who planned a vaginal breech birth. An online survey was developed consisting of questions regarding women's experiences surrounding planned vaginal breech birth. The survey was distributed between April 2014 and January 2015 to closed membership Facebook groups that had a consumer focus on vaginal breech birth. In total, 204 unique responses to the survey were obtained from women who had sought the option of a vaginal breech birth in a previous pregnancy. Most women (80.8%) stated that they were happy with the birth choices they made, and a significant proportion (89.4%) would attempt a vaginal breech birth in subsequent pregnancies. Less than half of women were formally referred to a clinician skilled in vaginal breech birth when their baby was diagnosed breech (41.8%), while the remainder sourced a clinician themselves. Half of the women felt supported by their care provider (56.7%) and less than half (42.3%) felt supported by family and friends. The women who responded to this international survey sought the option of a vaginal breech birth, were subsequently happy with this decision, and would attempt a vaginal breech birth in their next pregnancy. Access to vaginal breech birth is important for some women; however, this choice may be challenging to achieve. Consistent information and support from clinicians is important to assist decision-making. © 2016 Wiley Periodicals, Inc.

  14. Human vaginal pH and microbiota: an update.

    Science.gov (United States)

    Godha, Keshav; Tucker, Kelly M; Biehl, Colton; Archer, David F; Mirkin, Sebastian

    2017-12-22

    A woman's vaginal pH has many implications on her health and it can be a useful tool in disease diagnosis and prevention. For that reason, the further examination of the relationship between the human vaginal pH and microbiota is imperative. In the past several decades, much has been learned about the physiological mechanisms modulating the vaginal pH, and exogenous/genetic factors that may influence it. A unified, coherent understanding of these concepts is presented to comprehend their interrelationships and their cumulative effect on a woman's health. In this review, we explore research on vaginal pH and microbiota throughout a woman's life, vaginal intermediate cell anaerobic metabolism and net proton secretion by the vaginal epithelial, and the way these factors interact to acidify the vaginal pH. This review provides foundational information about what a microbiota is and its relationship with human physiology and vaginal pH. We then evaluate the influence of physiological mechanisms, demographic factors, and propose ideas for the mechanisms behind their action on the vaginal pH.

  15. A simplified classification for describing colposcopic vaginal patterns.

    Science.gov (United States)

    Indraccolo, Ugo; Baldoni, Angelo

    2012-04-01

    This study aimed to highlight that colposcopic vaginal patterns are not specific, unlike cervical colposcopic patterns, and to provide a simpler classification of vaginal colposcopic patterns. A total of 223 patients who underwent colposcopy with Schiller test were assessed (hierarchical log-linear model) retrospectively. The greatest predictability for histologically confirmed warts and cancers is represented by colposcopic patterns of wart and cancer. Lugol-negative area is strongly predictive of koilocytosis, even if it is found in other vaginal lesions. Thickened epithelium seems to better predict a severe vaginal lesion, whereas thin white epithelium better suggests a mild vaginal lesion. Colposcopic patterns were simplified as follows: Lugol-negative area, white epithelia (thin white epithelium and white thickened epithelium), vascular lesions (regular and irregular mosaicisms and punctations), wart, and cancer. Thus, koilocytosis is predicted by the Lugol-negative area, whereas white epithelia patterns and vascular patterns are not specific, suggesting overall vaginal intraepithelial neoplasias. Wart and cancer patterns are pathognomonic for histologically confirmed warts and cancers. Vaginal colposcopy poorly predicts the severity of vaginal lesions. By including each type of white epithelium within a new category called "white epithelia patterns" and each type of vascular pattern within a new category called "vascular patterns," it is possible to simplify vaginal colposcopy without compromising its accuracy.

  16. Minilaparoscopic radical hysterectomy (mLPS-RH) vs laparoendoscopic single-site radical hysterectomy (LESS-RH) in early stage cervical cancer: a multicenter retrospective study.

    Science.gov (United States)

    Fagotti, Anna; Ghezzi, Fabio; Boruta, David M; Scambia, Giovanni; Escobar, Pedro; Fader, Amanda N; Malzoni, Mario; Fanfani, Francesco

    2014-01-01

    To compare the perioperative outcomes of laparoendoscopic single-site radical hysterectomy (LESS-RH) and minilaparoscopic radical hysterectomy (mLPS-RH). Retrospective study (Canadian Task Force classification II-2). Seven institutions in Italy. Forty-six patents with early cervical cancer (FIGO stage IA2-IB1/IIA1) were included in the study. Nineteen patients (41.3%) underwent LESS-RH, and 27 (58.7%) underwent mLPS-RH. Pelvic lymph node dissection was performed in all patients. In the LESS-RH group, all surgical procedures were performed through a single umbilical multichannel port. In the mLPS-RH group, the procedure was completed using a 5-mm umbilical optical trocar and 3 additional 3-mm ancillary trocars, placed suprapubically and in the left and right lower abdominal regions. There was no difference in clinicopathologic characteristics at the time of diagnosis between the LESS-RH and mLPS-RH groups. Median operative time was 270 minutes (range, 149-380 minutes) for LESS-RH, and was 180 minutes (range, 90-240 minutes) for mLPS-RH (p = .001). No further differences were detected between the 2 groups insofar as type of radical hysterectomy, number of lymph nodes removed, or perioperative outcomes. In the LESS-RH group, conversion to laparotomy was necessary in 1 patient (5.3%) because of external iliac vein injury, and in another patient, conversion to standard laparoscopy was required because of truncal obesity. In the mLPS-RH group, no conversions were observed; however, a repeat operation was performed to repair a ureteral injury. The percentage of patients discharged 1 day after surgery was significantly higher in the LESS-RH group (57.9%) compared with the mLPS-RH group (25.0%) (p = .03). After a median follow-up of 27 months (range, 9-73 months), only 1 patient, who had undergone mLPS-RH, experienced pelvic recurrence and died of the disease. Both LESS-RH and mLPS-RH are feasible ultra-minimally invasive approaches for performance of radical hysterectomy

  17. Induced vaginal birth after previous caesarean section

    Directory of Open Access Journals (Sweden)

    Akylbek Tussupkaliyev

    2016-11-01

    Full Text Available Introduction The rate of operative birth by Caesarean section is constantly rising. In Kazakhstan, it reaches 27 per cent. Research data confirm that the percentage of successful vaginal births after previous Caesarean section is 50–70 per cent. How safe the induction of vaginal birth after Caesarean (VBAC remains unclear. Methodology The studied techniques of labour induction were amniotomy of the foetal bladder with the vulsellum ramus, intravaginal administration of E1 prostaglandin (Misoprostol, and intravenous infusion of Oxytocin-Richter. The assessment of rediness of parturient canals was conducted by Bishop’s score; the labour course was assessed by a partogram. The effectiveness of labour induction techniques was assessed by the number of administered doses, the time of onset of regular labour, the course of labour and the postpartum period and the presence of complications, and the course of the early neonatal period, which implied the assessment of the child’s condition, described in the newborn development record. The foetus was assessed by medical ultrasound and antenatal and intranatal cardiotocography (CTG. Obtained results were analysed with SAS statistical processing software. Results The overall percentage of successful births with intravaginal administration of Misoprostol was 93 per cent (83 of cases. This percentage was higher than in the amniotomy group (relative risk (RR 11.7 and was similar to the oxytocin group (RR 0.83. Amniotomy was effective in 54 per cent (39 of cases, when it induced regular labour. Intravenous oxytocin infusion was effective in 94 per cent (89 of cases. This percentage was higher than that with amniotomy (RR 12.5. Conclusions The success of vaginal delivery after previous Caesarean section can be achieved in almost 70 per cent of cases. At that, labour induction does not decrease this indicator and remains within population boundaries.

  18. Prolapso vaginal e uterino em ovelhas Uterine and vaginal prolapse in ewes

    National Research Council Canada - National Science Library

    Maíra Bianchi R. Alves; Fernando J. Benesi; Lilian Gregory; Alice M.M.P. Della Libera; Maria Cláudia A. Sucupira; Fábio C. Pogliani; Viviani Gomes

    2013-01-01

    ... Clínica de Bovinos e Pequenos Ruminantes (CBPR) da FMVZ/USP no período compreendido entre 2000 a 2010, no qual, foram atendidas 56 ovinos com problemas inerentes ao sistema reprodutivo, dessas, 25 apresentaram prolapso vaginal ou uterino (44,6...

  19. Directed shift of vaginal microbiota induced by vaginal application of sucrose gel in rhesus macaques

    Directory of Open Access Journals (Sweden)

    Kai-tao Hu

    2015-04-01

    Conclusions: Rhesus macaques can be used as animal models of bacterial vaginosis to develop drugs and test treatment efficacy. Furthermore, the topical application of sucrose gel induced the shifting of vaginal flora of rhesus macaques from a BV kind of flora to a lactobacilli-dominating flora.

  20. Vaginal fold histology reduces the variability introduced by vaginal exfoliative cytology in the classification of mouse estrous cycle stages.

    Science.gov (United States)

    Gal, Arnon; Lin, Po-Ching; Barger, Anne M; MacNeill, Amy L; Ko, CheMyong

    2014-12-01

    Vaginal exfoliative cytology is commonly used in biomedical and toxicological research to classify the stages of the rodent estrous cycle. However, mouse vaginal exfoliative cytology is commonly used as a stand-alone tool and has not been evaluated in reference to vaginal histology and serum sex hormone levels. In this study, the direct and Giemsa-stained methods of vaginal exfoliative cytology were compared in reference to vaginal fold histology and serum sex hormone levels. Both methods predicted the estrous stages similarly with mean discordance rates of 55%, 77%, 46%, and 31%, for diestrus, proestrus, estrus, and metestrus, respectively. From these results, we conclude that vaginal exfoliative cytology may be used as a general guide to determine the desired estrous stage end point and that a definitive confirmation of the estrous stage should be obtained from evaluation of vaginal fold histology. Confirmation of the stage of the estrous cycle by vaginal fold histology will decrease the variability otherwise introduced by misclassification of estrous cycle stages with vaginal exfoliative cytology. © 2014 by The Author(s).

  1. The trends of minimally invasive surgery for benign gynecologic lesions, 1997-2007 in Taiwan

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    Ming-Ping Wu

    2012-11-01

    Full Text Available The use of minimally invasive surgery (MIS has grown over the past two decades in Taiwan and worldwide. Laparoscopic surgery has been applied to manage the adnexal mass, and ectopic pregnancy since 1989, followed by the first case series of laparoscopic-assisted vaginal hysterectomy (LAVH in 1992 in Taiwan. These cases successfully advanced the development of the laparoscopic field. The most significant finding for hysterectomy is the significant increase of laparoscopic hysterectomy (LH from 5.75% to 37.50%, which is accompanied by the decrease of total abdominal hysterectomies (TAH from 77.93% to 48.12%, in 1997 and 2007, respectively. Laparoscopic surgery increased significantly from 35.78% to 71.66% for benign ovarian tumor; laparoscopic procedures significantly increased from 18.9% in 1997 to 73.95% in 2007 for ectopic pregnancy. Surgeon acceptance and a rapid evolution of instrumentation have enabled the use of laparoscopy to flourish in recent years. Based on nationwide population-based studies, the choices of surgical procedures are found to be dependent on patient factors, surgeon factors, and hospital factors. The academic activities launched by the MIS-related medical associations significantly lower the threshold for entering the field of endoscopy for gynecologists. This review demonstrates a considerable shift in the use of laparoscopic surgery as MIS in the approaches of benign gynecologic conditions, hysterectomy, ovarian tumor, and ectopic pregnancy, during the past 15 years in Taiwan. As a minimally invasive approach, laparoscopic surgery represents a profound change in patients, surgeons, and hospitals where the surgeries were performed.

  2. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

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    Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp; Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp; Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp; Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp; Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp; Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan); Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp [Kurume University School of Medicine, Department of Obstetrics and Gynecology (Japan); Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp; Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan)

    2016-08-15

    PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

  3. Perceptions of alternative therapies available for women facing hysterectomy or menopause.

    Science.gov (United States)

    Richter, D L; Corwin, S J; Rheaume, C E; McKeown, R E

    2001-01-01

    Women's perceptions of alternative therapies available for managing symptoms related to menopause and to the need for hysterectomy were explored. Data are reported from 17 focus groups of peri- and menopausal aged women (n = 82) living in two southern U.S. coastal counties. Analysis showed that emergent themes did not vary by race or surgery experience. Herbal preparations, vitamin supplements, "healthy living" (diet & exercise), and mind/body practices (prayer & "mental healing") were mentioned as possible alternatives for managing symptoms. Participants more frequently identified "other" conventional medical approaches--prescription medication, laser surgery, dilation and curettage, and "watchful waiting"--as alternatives to hysterectomy. Alternative therapies are linked to women's desire to gain control over their own health care decisions and practices.

  4. The value of random biopsies, omentectomy, and hysterectomy in operations for borderline ovarian tumors

    DEFF Research Database (Denmark)

    Kristensen, Gitte Schultz; Schledermann, Doris; Mogensen, Ole

    2014-01-01

    OBJECTIVE: Borderline ovarian tumors (BOTs) are treated surgically like malignant ovarian tumors with hysterectomy, salpingectomy, omentectomy, and multiple random peritoneal biopsies in addition to removal of the ovaries. It is, however, unknown how often removal of macroscopically normal......-appearing tissues leads to the finding of microscopic disease. To evaluate the value of random biopsies, omentectomy, and hysterectomy in operations for BOT, the macroscopic and microscopic findings in a cohort of these patients were reviewed retrospectively. MATERIALS: Women treated for BOT at Odense University.......7%) in International Federation of Gynecology and Obstetrics stage I, 9 (12%) in stage II, and 7 (9.3%) in stage III. The histologic subtypes were serous (68%), mucinous (30.7%), and Brenner type (1.3%). Macroscopically radical surgery was performed in 62 patients (82.7%), and 46 (61.3%) received complete staging...

  5. Minimally invasive treatment of iatrogenic complete left ureter obstruction after hysterectomy

    Directory of Open Access Journals (Sweden)

    Yigit Akin

    2012-09-01

    Full Text Available The iatrogenic ureter injuries are rare complications and may have serious consequences. The treatment options depend on situations. Pelvic surgeons, keep in mind that this kinds of complications, is very important for diagnosis and treatment, during the surgery. This report presents a case of a patient with iatrogenic left ureteral injury during hysterectomy. The patient visited emergency department of our hospital with the chief complaints of left lomber pain on the 17th day of hysterectomy. After evaluation in emergency clinic, the patient had an endoscopic treatment for iatrogenic ureter injury. The patient is still in follow-up period. We also review the literature and discuss diagnose, treatment, prognosis of iatrogenic ureter injuries. The treatmentoptions are still developing by technology.

  6. Association of previous Cesarean delivery with surgical complications after a hysterectomy later in life

    DEFF Research Database (Denmark)

    Lindquist, Sofie A. I.; Shah, Neel; Overgaard, Charlotte

    2017-01-01

    Importance: In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied. Objective: To investigate whether previous cesarean delivery increases the risk......, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016. Exposure: Cesarean delivery. Main Outcomes and Measures: Reoperation, perioperative and postoperative complications, and blood...... transfusion within 30 days of a hysterectomy. Results: Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714...

  7. Transversus abdominis plane (TAP) block after robot-assisted laparoscopic hysterectomy

    DEFF Research Database (Denmark)

    Torup, H; Bøgeskov, M; Hansen, E G

    2015-01-01

    completed the study, 34 receiving TAP block with ropivacaine and 31 receiving sham block with isotonic saline. We found no differences in median (interquartile range) morphine consumption the first 24 h between the TAP block group [17.5 mg (6.9-36.0 mg)] and the placebo group [17.5 mg (2.9-38.0 mg)] (95......BACKGROUND: Transversus abdominis plane (TAP) block is widely used as a part of pain management after various abdominal surgeries. We evaluated the effect of TAP block as an add-on to the routine analgesic regimen in patients undergoing robot-assisted laparoscopic hysterectomy. METHODS......: In a prospective blinded study, 70 patients scheduled for elective robot-assisted laparoscopic hysterectomy were randomised to receive either TAP block (ropivacaine 0.5%, 20 ml on each side) or sham block (isotonic saline 0.9%, 20 ml on each side). All patients had patient-controlled analgesia (PCA) with morphine...

  8. Radical hysterectomy in obese and morbidly obese women with cervical cancer.

    Science.gov (United States)

    Frumovitz, Michael; Sun, Charlotte C; Jhingran, Anuja; Schmeler, Kathleen M; Dos Reis, Ricardo; Milam, Michael R; Soliman, Pamela T; Taylor, Kristal; Ramirez, Pedro T

    2008-10-01

    To compare intraoperative and postoperative outcomes, pathologic findings, cancer recurrence, and death rates in normal-weight, overweight, obese, and morbidly obese women undergoing radical hysterectomy and pelvic lymphadenectomy for early-stage cervical cancer. A review of patients who underwent radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer between 1990 and 2006 was performed. On the basis of body mass index (BMI) (calculated as weight [kg]/[height (m)](2)), women were categorized as normal weight (BMI 18.5-24.9), overweight (BMI 25.0-29.9), obese (BMI 30.0-34.9), or morbidly obese (BMI at least 35.0). Four hundred eight women met the inclusion criteria. Of these, 155 (38%) were normal weight, 126 (31%) were overweight, 77 (19%) were obese, and 50 (12%) were morbidly obese. There were no statistically significant differences between these four groups in age, Charlson comorbidity score, smoking history, stage, histologic grade or subtype, tumor size, depth of invasion, transfusion rate, operative time, or intraoperative complications. Higher BMI was significantly correlated with higher estimated operative blood loss (P=.001). There were no statistically significant differences between the groups in pathologic findings, length of postoperative hospital stay, postoperative complications, readmission rate, or proportion of women receiving adjuvant radiotherapy. At a median follow-up time of 64 months, there were no differences between groups in rates of recurrence or death from disease. Radical hysterectomy and pelvic lymphadenectomy is feasible for obese and morbidly obese women with cervical cancer. Obesity alone should not be a contraindication to radical hysterectomy in women with cervical cancer.

  9. Prophylactic Antibiotic Choice and Risk of Surgical Site Infection After Hysterectomy.

    Science.gov (United States)

    Uppal, Shitanshu; Harris, John; Al-Niaimi, Ahmed; Swenson, Carolyn W; Pearlman, Mark D; Reynolds, R Kevin; Kamdar, Neil; Bazzi, Ali; Campbell, Darrell A; Morgan, Daniel M

    2016-02-01

    To evaluate associations between prophylactic preoperative antibiotic choice and surgical site infection rates after hysterectomy. A retrospective cohort study was performed of patients in the Michigan Surgical Quality Collaborative undergoing hysterectomy from July 2012 to February 2015. The primary outcome was a composite outcome of any surgical site infection (superficial surgical site infections or combined deep organ space surgical site infections). Preoperative antibiotics were categorized based on the recommendations set forth by the American College of Obstetricians and Gynecologists and the Surgical Care Improvement Project. Patients receiving a recommended antibiotic regimen were categorized into those receiving β-lactam antibiotics and those receiving alternatives to β-lactam antibiotics. Patients receiving nonrecommended antibiotics were categorized into those receiving overtreatment (excluded from further analysis) and those receiving nonstandard antibiotics. Multivariable logistic regression models were developed to estimate the independent effect of antibiotic choice. Propensity score matching analysis was performed to validate the results. The study included 21,358 hysterectomies. The overall rate of any surgical site infection was 2.06% (n=441). Unadjusted rates of "any surgical site infection" were 1.8%, 3.1%, and 3.7% for β-lactam, β-lactam alternatives, and nonstandard groups, respectively. After adjusting for patient and operative factors within clusters of hospitals, compared with the β-lactam antibiotics (reference group), the risk of "any surgical site infection" was higher for the group receiving β-lactam alternatives (odds ratio [OR] 1.7, confidence interval [CI] 1.27-2.07) or the nonstandard antibiotics (OR 2.0, CI 1.31-3.1). Compared with women receiving β-lactam antibiotic regimens, there is a higher risk of surgical site infection after hysterectomy among those receiving a recommended β-lactam alternative or nonstandard regimen.

  10. Prophylactic salpingectomy in women undergoing hysterectomy for benign gynaecological disease - a new Danish recommendation

    DEFF Research Database (Denmark)

    Sloth, Sigurd Beier; Gimbel, Helga; Jørgensen, Annemette

    Background In May 2015 we published a national clinical guideline on hysterectomy for benign gynaecological conditions in cooperation with the Danish Health and Medicines Authority. One of nine investigated areas of interest was whether or not to remove the fallopian tubes in women undergoing...... Network, the National Institute for Health and Care Excellence, the National Guideline Clearinghouse, the Scottish Intercollegiate Guidelines Network, the Health Technology Assessment Database, the Cochrane Library, MEDLINE, EMBASE, CINAHL and Danish, Swedish and Norwegian national directorates of health...

  11. PEER GROUP SUPPORT INCREASE SELF CONCEPT ON POST-RADICAL HYSTERECTOMY PATIENTS

    Directory of Open Access Journals (Sweden)

    Esti Yunitasari

    2017-07-01

    Full Text Available Introduction: Cervical cancer is one of the disease that can be found among women in all over the world, including in Indonesia. This disease remains a significant problem as the primary cause of death among other cancer diseases in women. Cervical cancer may influence all aspects of human life, whether it is physiological, psychological or social. Stress in patients with cervical cancer is generally increasing due to the rejection of their degrading health condition. The aimed of this study was to analyze the influence of peer group support on the improvement of self concept in patients with post-radical hysterectomy cervical cancer in Obstetric Wards, Dr Soetomo Hospital, Surabaya. Method: A quasy experimental with static group comparison and consecutive sampling design was used in this study. Population in this study was patients with post radical hysterectomy cervical cancer treated in Obstetric Wards, Dr Soetomo Hospital, Surabaya. There were 20 respondents divided into each 10 respondents for control group and treatment group. The independent variable was peer group support and the dependent variable was self concept. Data for self concept were collected by using questionaire then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The results revealed that peer group support had significance influence to the improvement of self concept in post-radical hysterectomy patients (p=0.000. Discussion: It,s can be concluded that peer group support increase of self concept in post-radical hysterectomy patients.

  12. Development of Transvaginal Uterus Amputation Device for Laparoscopic Hysterectomies in Gynecologic Surgeries

    Directory of Open Access Journals (Sweden)

    Serkan DİKİCİ

    2015-01-01

    Full Text Available Hysterectomy, that is removal of uterus, is one of the most common major operations in gynecologic surgeries. Laparoscopy technique is preferred in hysterectomy because of its advantages such as lower intra-operative blood loss, decreased surrounding tissue/organ damage, less operating time, lower postoperative infection and frequency of fever, shorter duration of hospitalization and post-operative returning time to normal activity. During total laparoscopic hysterectomy, first uterine vessels and ligaments are cauterized respectively, and then cervicovaginal connections are cauterized and coagulated to remove uterus completely. Uterine manipulators are used during laparoscopy to maximize the endoscopic vision of surgeons by moving related organs. However, conventional uterine manipulators have important drawbacks particularly to move uterus in three dimensions and to show cervicovaginal landmark during laparoscopic circular cauterization and amputation of the uterine cervix. A new transvaginal uterine manipulator may overcome these two important drawbacks of these currently available devices. For this reason, a3D scanned technique was used to get uterus sizes and computer aided design software is used in designing of the new manipulator and then 3D printer was used in prototyping. Special light emitting diodes (LEDs were mounted on the cervical cap of the manipulator to guide light beams from inside of cervicovaginal tissue to abdominal cavity to facilitate the visualization of tissue landmarks. Moreover, performances of different caps and LED systems will be evaluated. Furthermore, after integration of self-cutting and self-suturing mechanisms into our system, final prototype will be produced by using titanium which is biologically and mechanically appropriate. Therefore, aim of this study was to design and produce a new uterine manipulator with three dimensional movements, LED illumination, self-cutting and self-suturing systems to facilitate

  13. Analgesic effect of ultrasound-guided transversus abdominis plane block after total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Røjskjaer, Jesper O; Gade, Erik; Kiel, Louise B

    2015-01-01

    OBJECTIVE: To assess the effect of bilateral ultrasound-guided transversus abdominis plane block with ropivacaine compared with placebo as part of a multimodal analgesic regimen. DESIGN: A randomized, double-blind, placebo-controlled trial following the CONSORT criteria. SETTING: Hvidovre...... an ultrasound-guided transversus abdominis plane block in women undergoing total abdominal hysterectomy. As part of a multimodal regimen the transversus abdominis plane block showed some effect on pain scores at rest only in the early postoperative period....

  14. Physician opinions regarding elective bilateral salpingectomy with hysterectomy and for sterilization.

    Science.gov (United States)

    Gill, Sarah E; Mills, Benjie B

    2013-01-01

    To gather opinions about the benefits and concerns of performing bilateral salpingectomy without oophorectomy during hysterectomy for benign indications and as a sterilization procedure. Survey study (Canadian Task Force classification III). Practicing physicians in US institutions that have obstetrics and gynecology residency programs listed on the FREIDA website were surveyed electronically. A validated, standardized questionnaire designed to gather opinions about bilateral salpingectomy performed during hysterectomy or for sterilization was administered via SurveyMonkey to practitioners of obstetrics and gynecology. Results were compiled and presented as percentages of total responders. A total of 234 surveys were returned. Fifty-four percent of physicians perform bilateral salpingectomy during hysterectomy, most commonly to reduce the risks of cancer (75%) and repeat operation (49.1%). Of the 45.5% of physicians who do not perform bilateral salpingectomy during hysterectomy, most (69.4%) believe there is no benefit. Fifty-eight percent of practitioners believe that bilateral salpingectomy is the most effective method of sterilization after age 35 years but choose this method only in patients in whom one sterilization procedure has failed or because of tubal disease. Only 7.2% of surgeons prefer it as an interval sterilization procedure. Most practitioners believe that bilateral salpingectomy is beneficial. Most also believe that bilateral salpingectomy is the most effective sterilization procedure; however, only 7.2% use this method as an interval procedure. More data are needed to evaluate the prophylactic effect of bilateral salpingectomy against postoperative sequelae. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

  15. Internal hernia through the pouch of douglas after hysterectomy: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Jin; Cho, Seung Hyun; Shin, Hyun Woong; Kim, Tae Eun; Kim, Byung Young; Kim, Hee Jin [Daegu Fatima Hospital, Daegu (Korea, Republic of)

    2012-05-15

    Internal hernia is a rare cause of small bowel obstruction. Among the different types of internal hernias, the pelvic hernia is extremely rare. We report the radiographic findings of a patient with a Douglas pouch hernia presenting with closed loop obstruction at the anterior aspect of the distal rectum. The patient was a 60 year old female, who had undergone a hysterectomy 20 years prior, for treatment of a uterine myoma.

  16. Laparoscopic Radical Hysterectomy in Early Stage Cervical Cancer: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Zhao, Yue; Hang, Bo; Xiong, Guang-Wu; Zhang, Xiao-Wei

    2017-11-01

    To investigate the value of laparoscopic radical hysterectomy (LRH) in the treatment of early stage cervical cancer by comparing intraoperative and postoperative outcomes with abdominal radical hysterectomy (ARH). We searched the Medline, Web of Knowledge, Cochrane Library, and Chinese National Knowledge Infrastructure, through February 2, 2016 with keywords of "laparoscopic OR laparoscopy" AND "radical hysterectomy OR early cervical cancer OR stage IB, stage IB1, stage IB2, stage IIA, stage IIA1, stage IIA2, stage IIA cervical cancer" to identify all relevant studies that compared LRH with ARH in treating early cervical cancer. Two reviewers evaluated the quality of literature independently. Standardized tables were used to extract data (study or participant details and results) from the texts, tables, figures, or any other attachments of eligible publications. Weighted mean differences (MDs) and odds ratios (ORs) were pooled with the random effects model. Then we conducted meta-analysis using the RevMan5.3 software. A total of 615 studies were initially identified. After screening, 23 studies, including 4205 patients were recruited. LRH was associated with lower estimated blood loss (mL) (MD = -178.41, 95% confidence interval [CI] = -214.89 to -141.94, P early stage cervical cancer in most essential aspects, which should arouse sufficient attention.

  17. Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy

    Directory of Open Access Journals (Sweden)

    A. Anagnostopoulos

    2017-01-01

    Full Text Available Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL and longer postoperative hospital stay (2.3 versus 4.1 days. Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes, lower lymph node harvest (12.6 versus 16.9, and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.

  18. Perioperative surgical outcome of conventional and robot-assisted total laparoscopic hysterectomy.

    Science.gov (United States)

    van Weelden, W J; Gordon, B B M; Roovers, E A; Kraayenbrink, A A; Aalders, C I M; Hartog, F; Dijkhuizen, F P H L J

    2017-01-01

    To evaluate surgical outcome in a consecutive series of patients with conventional and robot assisted total laparoscopic hysterectomy. A retrospective cohort study was performed among patients with benign and malignant indications for a laparoscopic hysterectomy. Main surgical outcomes were operation room time and skin to skin operating time, complications, conversions, rehospitalisation and reoperation, estimated blood loss and length of hospital stay. A total of 294 patients were evaluated: 123 in the conventional total laparoscopic hysterectomy (TLH) group and 171 in the robot TLH group. After correction for differences in basic demographics with a multivariate linear regression analysis, the skin to skin operating time was a significant 18 minutes shorter in robot assisted TLH compared to conventional TLH (robot assisted TLH 92m, conventional TLH 110m, p0.001). The presence or absence of previous abdominal surgery had a significant influence on the skin to skin operating time as did the body mass index and the weight of the uterus. Complications were not significantly different. The robot TLH group had significantly less blood loss and lower rehospitalisation and reoperation rates. This study compares conventional TLH with robot assisted TLH and shows shorter operating times, less blood loss and lower rehospitalisation and reoperation rates in the robot TLH group.

  19. [Assessment of factors with possible influence over the duration of laparoscopic hysterectomy].

    Science.gov (United States)

    Tomov, S; Gorchev, G; Tanchev, L; Popovska, S; Nikolova, M

    2012-01-01

    The duration of an operative intervention is directly related to the seriousness of the operative trauma. A group of 14 factors with possible influence over operative time was investigated on the basis of the analysis of 635 laparoscopic hysterectomies accomplished over a six-year period (2004-2010) at the Oncogynecological Clinic at "Georgi Stranski" University Hospital for Active Treatment, and "St. Marina" Specialized Hospital for Active Treatment in Obstetrics and Gynecology, Pleven, Bulgaria. The factors which prolong the operative time statistically significant are uterine prolapse, as an: indication for operation, emergence of complications, hemotransfusion, enlarged uterus to the size of m. l. IV-V and increase in the body mass index by 1 kappag/m2, while previous conization and every following year of accomplishment of a laparoscopic hysterectomy significant shorten operative time. The fact that previous abdominal operations do not affect the duration of laparoscopic hysterectomy significant, indirectly supports the proposition that they are not a contraindication for the given operative procedure.

  20. Analysis of the learning curve for robotic hysterectomy for benign gynaecological disease.

    Science.gov (United States)

    Sendag, Fatih; Zeybek, Burak; Akdemir, Ali; Ozgurel, Banu; Oztekin, Kemal

    2014-09-01

    The objective was to evaluate the learning curve for performing a robotic hysterectomy to treat benign gynaecological disease. Thirty-six patients underwent robotic hysterectomy for benign indications. A systematic chart review of consecutive cases was conducted. The collected data included age, BMI, operating time, set-up time, docking time, uterine weight, blood loss, intraoperative complications, postoperative complications, conversions to laparotomy and length of hospital stay. The mean operating, set-up and docking times were 169 ± 54.5, 52.9 ± 12.4 and 7.8 ± 7.6 min, respectively. The learning curve analysis revealed a decrease in both docking and operating times, with both curves plateauing after case 9. The learning curve analysis revealed a decrease in docking time and operating time after case 9, suggesting that there might be a fast, learning curve for experienced laparoscopic surgeons to master robotic hysterectomy, and that the docking process does not have a significant negative influence on the overall operating time. Copyright © 2013 John Wiley & Sons, Ltd.