ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe purpose of this paper is to define the complication rates of hysterectomy using a minilaparotomy technique.MethodsThe hospital and outpatient records of 228 patients who underwent hysterectomy using a minimally invasive abdominal technique were reviewed. The complication rates from hysterectomy were compared to those from the Collaborative Review of Sterilization, published in 1982.ResultsThe average length of stay was 1.9 days. Significant morbidity occurred in 6.6% of patients. The rate of wound infection/hematoma was 3.5%. The rate of pelvic infection was 0.4%. The rate of unintended major surgical procedures was 1.3%. There was a statistically significant decrease in operative site infection, nonoperative site infection, and rate of transfusion when the current study was compared to the Collaborative Review of Sterilization. Early postoperative fever as an indicator of postoperative infection showed a positive predictive value of 4.7% and a negative predictive value of 95.1%.ConclusionThe complication rates of hysterectomy were lower in this study than those from the Collaborative Review of Sterilization. Commonly used definitions for febrile morbidity were inapplicable because of reduction in hospital stay. The presence of early postoperative fever was a poor indicator for development of postoperative infection.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveThe purpose of this study is to describe the Doderlein-Kronig (Doderlein) technique of vaginal hysterectomy and to compare this method to the “standard” approach, by reviewing the Madigan Army Medical Center experience.MethodsA retrospective chart review of 302 cases of vaginal hysterectomy between 1992 and 1997 was performed. Standard vaginal hysterectomy and Doderlein procedures were grouped according to indication and other procedures performed concurrently. These groups were then compared with respect to blood loss, hematocrit change, operating time, hospital stay, and complications.ResultsThe authors found most outcome parameters to be similar between the standard technique and the Doderlein technique. Considering mean blood loss and mean operating time, the authors’ data demonstrated statistically significant advantages to using the Doderlein technique when the hysterectomy was performed for pelvic relaxation.ConclusionThis study supports the Doderlein hysterectomy as an excellent alternative to standard vaginal hysterectomy. In the authors’ opinion, it has a number of advantages compared to standard techniques when performing an laparoscopically assisted vaginal hysterectomy or hysterectomy for pelvic relaxation.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo describe a transvaginal bladder neck suspension using the in-line needle driver.MethodsThe transvaginally exposed endopelvic fascia is sutured at the bladder neck with three helical bites bilaterally. A 2-cm skin incision is made bilaterally, parallel to the inguinal ligament and midway between the pubic symphysis and the anterior superior iliac spine, and carried down to the space of Retzius. The sutures are passed suprapubically. One end of each suture is anchored to the Cooper ligament using the in-line needle driver, which is guided by palpation. The sutures are tied bilaterally to suspend the bladder neck.ResultsAll 15 patients were subjectively cured after a mean follow-up of 12 months. All patients had improvement to less than 30° cotton-swab test on follow-up examinations.ConclusionThe use of the in-line needle driver for transvaginal bladder neck suspension provides access to the relevant anatomic structures and simulates the modified Burch colposuspension in the anatomic effect it accomplishes.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess the basic knowledge of primary care providers regarding pelvic anatomy and pelvic floor dysfunction and to determine referral patterns of primary care providers for patients with pelvic floor dysfunction.MethodsMilitary primary care providers at three military teaching hospitals in the Washington-National Capital Region were invited to participate in our study. Forty-seven subjects were then randomized into one of two groups. Questionnaires designed to determine basic knowledge of pelvic anatomy and pelvic floor dysfunction and assessment of referral patterns for these patients were administered to all subjects. Group 1 (N = 18) participated in a half-day lecture series covering pelvic anatomy and pelvic floor dysfunction. Participants in group 2 (N = 29) did not attend the lecture series.ResultsThe mean basic knowledge score improved after the lecture series from 10.83/19 (57%) to 13.83/19 (73%) (P= 0.001). Similarly, a statistically significant difference was detected in appropriate referral patterns in pre- and post-lecture questionnaires, 7.56/14 (54%) correct to 9.33/14 (67%), respectively (P= 0.001). The Wilcoxon signed rank test was used for statistical analysis.ConclusionThe basic knowledge of primary care providers was improved in the experimental cohort (group 1) after receiving a standardized lecture series in pelvic anatomy and pelvic floor dysfunction. Appropriate specialty referrals of patients with pelvic floor dysfunction also improved in group 1. This study demonstrates that providing standardized lectures to primary care physicians may be an excellent means for urogynecologists to enhance their referral base in the military healthcare system.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BackgroundUreteroscopy is an important technique for the evaluation, diagnosis, and management of urologic problems in the ureter and renal pelvis. Advances in ureteroscope design and improved intraureteral lithotripsy, balloon dilation devices, guidewires, and retrieval systems have made ureteroscopy safer and easier to perform.Preoperative EvaluationA formal urologic evaluation should be completed in preparation for the surgical procedure. Given the broad spectrum of urologic problems that require ureteroscopy, the preoperative evaluation must be tailored to the individual patient.Surgical ProcedureAll patients receive prophylactic antibiotics at surgery. During the cystoscopic portion of the procedure, the surgeon performs gentle retrograde pyelography typically under fluoroscopy to localize pathology, assess ureteral tortuosity, and gauge ureteral obstruction. Because most complications of ureteroscopy are related in some form or other to ureteral access, surgical anatomy of the ureter is important.ComplicationsPerioperative complications such as mucosal trauma, bleeding, perforation, failure to visualize or access pathology, problems with extraction and with fragmentation and ablation procedures, and ureteral avulsion are outlined, as are early and late postoperative complications.ConclusionsUreteroscopy can be performed safely and reliably in most cases as an outpatient procedure, and the incidence and severity of complications currently reported has decreased. Whereas technologic advances and surgical experience have permitted ureteroscopy to flourish, ureteroscopy can be a very tedious procedure and requires patience and a careful surgical plan.

ISSN:1077-2847    

出版商:OVID    

年代:2001

数据来源: OVID