ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesAnterior flap hemipelvectomy is an unusual procedure used to treat tumors from the buttock and proximal posterior thigh. This study reviews the technique and analyzes 8 such operations.MethodsCharts from 1973 to 2001 were reviewed. The technique is described and demographics, histology, symptomatology, tumor status, blood transfusion, operative time, ICU time, use of neo- or adjuvant therapy, complications, patterns of recurrence and outcome were recorded.ResultsThe ratio male:female was 6:2. Seven patients were Caucasian, one was Asian. Median age was 47.5 years. Pain and swelling were the major complaints. Two patients had previous manipulation before referral. Most tumors were sarcomas. All patients had regional disease at diagnosis. All procedures had curative intent. Median operative time was 427 minutes. Median blood transfusion was 1200 mL. Maximum ICU permanence was 48 hours. Six patients received neo-or adjuvant therapy. The most frequent complication was phantom pain. Recurrences were local in 1 case and pulmonary in 4 cases. Median follow up was 10.5 months. Median survival was 21 months. There was no operative mortality.ConclusionsThe anterior flap hemipelvectomy is a safe and effective procedure to treat gluteal or high posterior thigh tumors. It has a low rate of complications, and should be the reconstructive procedure of choice in such cases.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo determine the effectiveness and safety of vaginal hysterectomy compared with abdominal and laparoscopic vaginal hysterectomy.MethodsA total of 615 women underwent abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy. Operating time, route of hysterectomy, need of blood transfusion, operative and postoperative complications, route conversion to laparotomy, and length of hospital stay were recorded for each case.ResultsVaginal hysterectomy was successfully performed in 413 women (67%), abdominal hysterectomy in 182 (30%), and laparoscopically assisted vaginal hysterectomy in 20 (3%). In 8 cases (2%), vaginal hysterectomy failed and was converted to abdominal hysterectomy. Vaginal hysterectomy was associated with shorter operating time and hospital stay than abdominal hysterectomy. The vaginal approach was used in 292 women with nonprolapsed uterus, a number of whom had uterine fragmentation (74 cases). The average operating time was 92 minutes (range, 30–290 minutes), the average postoperative hospitalization was 96 hours, and the average uterine weight was 199 g (range, 20–2020 g), considering all types of hysterectomy.ConclusionsVaginal hysterectomy is an effective and safe procedure, even for nonprolapsed uterus. This route of hysterectomy is associated with fewer complications and a shorter length of hospital stay when compared with abdominal hysterectomy, with subjacent health and economic benefits. The lack of training in vaginal surgery is one of the principal reasons that vaginal hysterectomy is not the predominant procedure. Teaching skills in vaginal surgery will increase the number performed by this route compared with the abdominal approach.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo determine the effectiveness of tension-free vaginal tape (TVT) in cases of urodynamic stress incontinence, with or without intrinsic sphincter deficiency, associated with a nonhypermobile urethra.MethodsThe medical records of consecutive patients who underwent TVT as an isolated procedure during a 32-month period were subject to retrospective review. Preoperative physical examination findings, urodynamic results, and cotton swab test values were recorded. A nonhypermobile (fixed) urethra was defined as a maximum straining angle less than 30°. Patients had TVT performed under local anesthesia with intravenous sedation. Operations were considered successful if the patients were free of stress incontinence by both subjective and objective criteria. Categorical data were compared using the Fisher exact test. The median values of continuous data were compared using the Wilcoxon rank sum test.ResultsOne hundred fifty-three patients were included, of whom 139 had urethral hypermobility and 14 did not. Median follow-up was 6 months (range, 0.5–26) in the hypermobile patients and 6 months (range, 1.5–17 months) in the nonhypermobile patients. The success rate of TVT was 92% (137/149) in the patients with urethral hypermobility and 79% (11/14) in the nonhypermobile patients (&Dgr; = −13%; 95% confidence interval, −35, 8).ConclusionsThe success rates of TVT in the presence or absence of preoperative urethral hypermobility appear to be comparable. This result includes the subset of patients with intrinsic sphincter deficiency. TVT may be a viable option for the treatment of stress incontinence in patients with a nonhypermobile urethra.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectivesTo evaluate the efficacy of Le Fort colpocleisis on bladder, bowel function, and quality of life (QOL) in elderly women with advanced genital prolapse.MethodsWomen with severe genital prolapse who were unable to satisfactorily wear a vaginal pessary underwent a Le Fort colpocleisis with concomitant anti-incontinence procedure, if required. During 2-week, 6-week, and 6-month postoperative visits, patients were examined and questioned about irritative voiding symptoms (voids > 10/day, nocturia > 2/night, urgency), incontinence, constipation, and overall well-being. Quality-of-life impact was evaluated with an instrument for pelvic prolapse, which was sent to all patients at least 12 weeks after operation. Follow-up by telephone was attempted to encourage completion of the questionnaire.ResultsForty-five women underwent a Le Fort colpocleisis and high perineoplasty. Thirty-one (69%) also had a tension-free vaginal tape procedure. Mean age was 83 ± 5.2 years. Ninety-three percent (42/45) of the women had failed previous pessary use. One patient (2%) had recurrence of her prolapse. There were no significant differences in preoperative and postoperative incidence of irritative voiding and constipation symptoms. Eighty-two percent (37/45) of the QOL questionnaires were returned for analysis. The possible range of total score on the questionnaire is 15 to 75. Mean QOL score for the population was 24.8 ± 8.6. Patients with postoperative irritative voiding symptoms, constipation, or SUI symptoms had a mean score of 25.8 ± 9.1, and patients without these symptoms had a mean score of 21.4 ± 6.0 (P= 0.19).ConclusionsLe Fort colpocleisis is a feasible treatment option for severe vaginal prolapse in the elderly patient. Low QOL impact scores after operation, despite irritative bladder symptoms and constipation, demonstrate the beneficial outcome of colpocleisis in elderly women who have advanced genital prolapse and are not sexually active.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Urinary incontinence has a detrimental effect on a patient's quality of life. The problem is even more devastating when patients experience fecal incontinence and other disabilities that prevent them from managing their incontinence independently.Numerous techniques have been used in the effort to achieve urinary continence, such as indwelling urethral catheters or suprapubic tubes, penile clamps, external catheters, pads, and diapers; all harbor their own complications and limit quality of life. Initially, most patients with neurologic disorder and a neurogenic bladder are treated pharmacologically. The adjunct of clean intermittent catheterization (CIC) helps many patients with neurogenic bladders. Despite the immediate objection, nearly all patients with hand function are able to learn and perform CIC. Subpopulations that are unable to perform CIC are tetraplegic patients with poor manual dexterity, cognitive impairment, or body posture that prevents easy access to the urethra and patients with damaged or scarred urethras not suitable for urethral reconstruction. Caretakers rather than the patient may perform CIC.Simon described the first urinary diversion, ureterosigmoidostomy, in 1852. Since then numerous solutions have been proposed, all of them with the same intent of providing a low-pressure manageable diversion. The Mitrofanoff procedure and the Indiana pouch with its modification for an ileocystoplasty have gained great popularity in the last 10 to 15 years. In this article, we review patient selection, operative goals, and surgical technique to obtain better bladder management for these chronically disabled patients.

ISSN:1542-5983    

出版商:OVID    

年代:2003

数据来源: OVID