ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo review the results of the authors' technique for performing abdominal sacral colpopexy using polyester mesh in the treatment of women with posthysterectomy vaginal vault prolapse and enterocele.MethodsData were obtained from clinical examination, retrospective review of clinical records, and independent standardized telephone interview of patients who had undergone abdominal sacral colpopexy between 1991 and 1994 at Emory University Hospital in Atlanta, Georgia.ResultsA total of 49 patients underwent abdominal sacral colpopexy using polyester mesh. At the time of clinical review, one patient had died of a malignancy and one patient had moved without giving a forwarding address, leaving 47 patients available for interview. The mean follow-up time was 16 months (range, 2–36 months; median, 17 months). Physical examination revealed excellent support of the vaginal apex in all patients, and 85% of patients reported being satisfied with the results of their surgery. Patient dissatisfaction was related mainly to persistent urinary tract complaints after correction of vaginal prolapse. Sexual function was unchanged (30%) or improved (50%) in 80% of the sexually active women who underwent vaginal vault suspension.ConclusionsAbdominal sacral colpopexy with polyester mesh is an effective procedure for correcting posthysterectomy vaginal vault prolapse.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveGynecologic surgery for benign disease in contrast to oncologic surgery rarely includes significant dissection of the retroperitoneum. Because early ovarian cancer may be found incidentally at the time of benign surgery or during pathologic evaluation without having obtained a preoperative CA-125 value, the purpose of this study was to quantify the change in CA-125 during the current average duration of stay after benign gynecologic surgery.MethodsPreoperative and postoperative (day 2) serum CA-125 values were obtained on women who underwent laparotomy for a benign gynecologic condition.ResultsTwenty-five patients had preoperative and postoperative CA-125 values obtained. An unexpected yet statistically significant decrease in the postoperative CA-125 value was noted (P < 0.05).ConclusionsBenign gynecologic surgery alone results in a decrease in CA-125 in the period 36–48 hours postoperatively. Therefore, in a patient found to have an ovarian malignancy at benign surgery, and therefore not staged, a significantly elevated (> 50 U/mL) postoperative CA-125 value should not be attributed to the operation, but rather should raise suspicion of residual ovarian cancer.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThis report describes an innovative approach for the repair of large cystoceles.MethodsThe procedure was performed on 12 patients with grade 3 or 4 cystoceles. The technique used autologous rectus fascia graft placed underneath the bladder. Follow-up examinations were performed regularly for a mean of 15 months.ResultsThere was one asymptomatic recurrence of cystocele among the 12 patients. Additionally, one patient had significant urinary retention after the procedure. The remaining patients have excellent vaginal support.ConclusionThe autologous rectus fascia graft procedure is an extensive operation for the repair of large cystoceles. The initial results are encouraging and the authors hope to submit a larger series of patients in the future.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine the success rate of planned prophylactic adnexectomy at the time of vaginal hysterectomy.MethodsThe same gynecologic surgeon attempted adnexectomy for ovarian cancer prophylaxis in 60 women aged 40 years and older undergoing vaginal hysterectomy between January 1996 and January 1998. A simple vaginal clamp technique was used for salpingo-oophorectomy. Factors such as age and uterine weight and complications were analyzed in this prospective study and compared between women for whom the procedure was successful and for whom it was not.ResultsFifty-three of 60 women (88.3%) underwent successful prophylactic oophorectomy as planned. Women for whom oophorectomy could not be safely performed were significantly older (59.0 years of age vs. 75.3 years of age; 95% confidence interval, −25.0 to −7.7; P = 0.0004) compared to women for whom it was completed as planned. These older women also had significantly smaller uteri (129.6 g vs. 58.6 g; 95% confidence interval, +3.3 to + 138.8; P = 0.04) than their younger counterparts. Complications were rare in each group.ConclusionWith a simple and safe clamp technique the majority of prophylactic oophorectomies can be successfully performed at the time of vaginal hysterectomy. The surgeon must exercise considerable caution when approaching oophorectomy in very elderly women in which severe gonadal atrophy may make oophorectomy too dangerous to perform.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThe objective of this study was to evaluate the pubic bone suburethral stabilization sling procedure as a treatment for recurrent urinary incontinence.MethodsThe procedure was performed from August 1990 through August 1994 in 105 patients with recurrent stress incontinence after ineffective previous surgery for incontinence. The patients were followed for 4 to 8 years. The technique involved placing a suburethral inorganic mesh patch at the junction of the upper one third and the lower two thirds of the urethra and securing it with titanium bone screws to the posteroinferior pubis transvaginally for site-specific urethral support and stabilization of normally positioned continence anatomy.ResultsOne hundred percent of patients fulfilled the subjective criteria that were determined for treatment success.ConclusionThe pubic bone suburethral stabilization sling operation can be performed with minimum morbidity. Gynecologists familiar with transvaginal anterior colporrhaphy should have little problem learning this technique.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveThe purpose of this study was to assess the results of the sacrospinous ligament fixation for the treatment of vaginal vault prolapse after hysterectomy.DesignBetween 1979 and 1996, 63 women underwent a reconstructive operation because of vaginal prolapse after abdominal or vaginal hysterectomy. Sacrospinous ligament fixation was performed in all women in combination with operative correction of either cystocele or rectocele, or both.ResultsRecurrent vaginal prolapse occurred in only one woman 3 years after the operation. Temporary nerve damage was observed in two patients. Six women reported urine loss because of stress incontinence after sacrospinous ligament fixation.ConclusionVaginal vault suspension to the sacrospinous ligament avoids major abdominal surgery and allows the surgeon to correct coexistent cystocele and rectocele. Sacrospinous ligament fixation of the prolapsed vaginal vault should be performed with colposuspension if masked urinary stress incontinence is preoperatively detected.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundSentinel lymph node biopsy has been used for nodal staging of patients with melanoma and breast cancer. Initial studies suggest that this technique may be useful for selected pelvic tumors as well. The application of sentinel lymph node biopsy to vulvar, penile, endometrial, and colorectal cancers is discussed in this review.MethodsReview of the current literature regarding sentinel lymph node biopsy was performed.DiscussionRecent studies suggest that sentinel lymph node biopsy may provide accurate nodal staging information for a variety of pelvic malignancies and at the same time avoid the morbidity of complete lymphadenectomy for the majority of patients.ConclusionFurther study is necessary to document the accuracy of sentinel lymph node biopsy in vulvar, penile, endometrial, and colorectal cancers.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundCervical adenosquamous carcinomas are rare until the fourth decade of life. According to some large epidemiologic studies, they share risk factors with squamous cell carcinoma.MethodsWe report a 25-year-old virgin who underwent radical hysterectomy with preservation of both ovaries for treatment of a large cauliflower-like cervical adenosquamous carcinoma. Challenges in the pre- and postoperative management are presented. Immunostaining and polymerase chain reaction were used to analyze the tumor for the presence of human papillomavirus. DNA sequencing was used to evaluate the p53 gene for mutations.DiscussionThe delay in diagnosis in this case highlights the overriding importance of the pelvic examination in the evaluation of patients with gynecologic complaints. This tumor was not associated with known oncogenic or nononcogenic human papillomavirus types. In the p53 gene a single base pair deletion results in a frame shift and a premature stop codon in exon 7. Therefore, on the basis of the most sensitive assays available, this tumor displays the human papillomavirus-negative, p53 mutation-positive combination initially described in cervix cancer cell lines. Although the simple notation of a reciprocal relation between p53 mutations and human papillomavirus has been abandoned on the basis of clinical studies, this case offers substantial evidence of an alternative pathway for human papillomavirus-negative cervical carcinomas.ConclusionAlthough the simple notion of a reciprocal relation between p53 mutations and human papillomavirus has been abandoned on the basis of clinical studies, this case offers substantial evidence of an alternative pathway for human papillomavirus-negative cervical carcinomas.

ISSN:1077-2847    

出版商:OVID    

年代:1999

数据来源: OVID