共查询到20条相似文献,搜索用时 15 毫秒
1.
Ron Schonman Zohar Dotan Adi Y. Weintraub Mordechai Goldenberg Daniel S. Seidman Eyal Schiff David Soriano 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To investigate the intraoperative features and long-term postoperative results of patients with ureteral endometriosis who underwent ureteral reimplantation.Study design
In this retrospective study, we reviewed records of all patients with ureteral endometriosis treated by ureteral reimplantation. Pre-, intra- and post-operative information was collected.Results
Of patients operated for endometriosis, seven were diagnosed with severe ureteral endometriosis and underwent ureteral reimplantation. Psoas hitch was the preferred technique for the ureteral reimplantation. During a mean postoperative follow up of 42.3 ± 20.0 months, all but one patient reported significant symptomatic improvement. None of the patients needed additional medical or surgical treatment and no recurrence was noted.Conclusion
Ureteral reimplantation performed by a multidisciplinary surgical team is a suitable technique in selected cases, gives good long-term results and has no need for repeated surgical treatment. 相似文献2.
Ureteral endometriosis is associated with deep endometriosis and is relatively uncommon. In some patients, progressive obstruction of the lower part of the ureter may occur, with silent loss of renal function as a consequence. We report on three patients with loss of renal function, in whom different pathogenic mechanisms probably were the decisive cause. Failure to diagnose deep endometriosis with ureteral involvement, misinterpretation of hydroureter at magnetic resonance imaging and lack of typical symptoms may all be reasons for development of loss of renal function. With only one functional kidney, these patients should be followed closely with renal function tests and ultrasound, and in certain cases also by magnetic resonance imaging or renal scintigraphy. 相似文献
3.
Objective
to gain insight into the experiences and perspectives of pregnant women diagnosed antenatally with fetal lower urinary tract obstruction (LUTO) participating in an interventional fetal medicine randomised controlled trial (RCT).Design
a qualitative study using semi-structured interviews. Interviews were analysed using Riessman's narrative analysis.Setting
fetal medicine clinics within the United Kingdom National Health Service (NHS).Participants
five pregnant women who were recruited as part of an RCT and two additional women who were recruited after the trial was terminated before completion.Findings
three themes were identified and form the basis of this article: the use of technology in pregnancy, the loss of a normal pregnancy, and decision making in uncertainty.Implications and conclusions
undertaking qualitative research within an RCT can illuminate the experience of the condition being studied. Women's experience of a pregnancy where LUTO was diagnosed in the fetus entailed an emotional journey following the visualisation of the abnormality through the use of routine ultrasound screening. Women tried to make sense of the diagnosis in order to make the best, albeit less than ideal, decisions for themselves, their baby, and their family. Midwives are in a good position to support women through the emotional distress of diagnosis and to help them negotiate the uncertain terrain in which they make decisions. 相似文献4.
Zaid M. Tabbaa Jo Marie T. Janco Andrea Mariani Sean C. Dowdy Michaela E. McGree Amy L. Weaver William A. Cliby 《Gynecologic oncology》2014
Objective
The aim of this study is to estimate the overall rates of significant incontinent conduit-related complications and compare rates between conduit types.Methods
This was a retrospective review of 166 patients who underwent incontinent urinary diversion from April 1993 through April 2013.Patients were categorized by conduit type—ileal, sigmoid colon, and transverse colon. Significant conduit-related complications were assessed at 30 and 90 days after surgery. Significant conduit-related complication was defined as any of the following: ureteral stricture, conduit leak, conduit obstruction, conduit ischemia, ureteral anastomotic leak, stent obstruction requiring intervention via interventional radiology procedure or reoperation, and renal failure.Results
A total of 166 patients underwent formation of an incontinent urinary conduit, most commonly during exenteration for gynecologic malignancy. There were 129 ileal, 11 transverse colon, and 26 sigmoid conduits. The overall significant conduit-related complication rate within 30 days was 15.1%. Complication rates for ileal, transverse and sigmoid conduits were 14.7%, 0%, and 23.1%, respectively (Fisher's exact test, p = 0.24). By 90 days, the Kaplan–Meier estimated rates of significant complications were 21.8% overall, and 22.3%, 0%, and 28.9%, respectively, by conduit type (log-rank test, p = 0.19). The most common significant conduit-related complications were conduit or ureteral anastomotic leaks and conduit obstructions. By 1 and 2 years following surgery, the Kaplan–Meier estimated overall rate of significant conduit-related complication increased to 26.5% and 30.1%, respectively.Conclusions
Our study suggests that there are multiple appropriate tissue sites for use in incontinent conduit formation, and surgical approach should be individualized. Most significant conduit-related complications occur within 90 days after surgery. 相似文献5.
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7.
Shicheng Yu Haiyang WuLiwei Xu Gonghui LiZhigen Zhang 《International journal of gynaecology and obstetrics》2013
Objective
To describe the early surgical repair of iatrogenic ureterovaginal fistula (UVF) secondary to gynecologic surgery, and evaluate the efficacy and feasibility of early surgical intervention.Methods
Data were retrospectively reviewed for 52 patients with iatrogenic UVF who underwent early surgical repair between January 1996 and January 2011 at the Sir Run Run Shaw Hospital, Hangzhou, China. Preoperative patient characteristics and postoperative endpoints, including type of index procedure, repair technique, operative time, perioperative complications, and postoperative follow-up data were assessed.Results
All early surgical repairs were uneventful. The mean time from diagnosis to surgery was 15.7 days (range, 14–21 days). The mean operative time was 73.4 min (range, 51–110 min) for ureteroneocystostomy, and 104 min (range, 91.5–153 min) for Boari flap procedure. The mean estimated blood loss was 57.8 mL (range, 35–80 mL). No major intraoperative complications occurred, although 5 patients had postoperative surgical site infections. Forty-three patients were followed for a mean of 18.4 months (range, 10.5–24.0 months). Ureteral stricture with asymptomatic hydronephrosis occurred in 2 (4.7%) patients. Ipsilateral renal function was preserved in all patients.Conclusion
Early surgical repair of UVF secondary to gynecologic surgery was safe and effective, and preserved ipsilateral renal function. 相似文献8.
Roman H 《Journal de gynecologie, obstetrique et biologie de la reproduction》2007,36(2):141-150
Objectives
To establish guidelines for the medical and surgical management of painful endometriosis.Material and Methods
An exhaustive review on Medline and Cochrane Database between 1980 and 2006 was performed.Results
GnRH agonists, progestins, continuous monophasic oral contraceptives and danazol have a suppressive effect on dysmenorrhoea, nonmenstrual pain and dyspareunia (grade A). Surgical treatment is effective in painful endometriosis (grade B). Complete surgical excision of deep endometriotic lesions with conservation of uterus and ovaries has a limited term efficacy on pain relief (grade C). A multidisciplinary approach is recommended (grade C). The use of the psychotherapy improves the management of chronic pain (grade A). There is a lack of information concerning the therapeutic strategy able to prevent recurrences. Whether endometriosis recurrences occur, medical treatment should be the first line approach (expert opinion). A hysterectomy with salpingo-oophorectomy and complete excision of the lesions is efficient in women with pain recurrence who no longer desire pregnancy (grade C).Conclusion
Medical and surgical treatments have a limited term efficacy on painful endometriosis (grade A). The benefit/risk relationship, depending on secondary effect therapy, should be assessed on a case to case basis. 相似文献9.
Karina E. Hansen Ulrik S. Kesmodel Einar B. Baldursson Rikke Schultz Axel Forman 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
Little is known about the implications of endometriosis on women's work life. This study aimed at examining the relation between endometriosis-related symptoms and work ability in employed women with endometriosis.Study design
In a cohort study, 610 patients with diagnosed endometriosis and 751 reference women completed an electronic survey based on the Endometriosis Health Profile 30-questionnaire and the Work Ability Index (short form). Percentages were reported for all data. Binary and multivariate logistic regression analyses were used to assess risk factors for low work ability. The level of statistical significance was set at p < 0.025 in all analyses.Results
In binary analyses a diagnosis of endometriosis was associated with more sick days, work disturbances due to symptoms, lower work ability and a wide number of other implications on work life in employed women. Moreover, a higher pain level and degree of symptoms were associated with low work ability. Full regression analysis indicated that tiredness, frequent pain, a higher daily pain level, a higher number of sick days and feeling depressed at work were associated with low work ability. A long delay from symptom onset to diagnosis was associated with low work ability.Conclusions
These data indicate a severe impact of endometriosis on the work ability of employed women with endometriosis and add to the evidence that this disease represents a significant socio-economic burden. 相似文献10.
Dos Santos AR Lopes-Costa PV Gontijo JA da Silva BB 《European journal of obstetrics, gynecology, and reproductive biology》2012,161(1):102-104
Objective
To explore the role of primary physicians in the diagnostic delay of lower urinary tract and pelvic organ prolapse symptoms in parous women.Study design
Prospective cohort study of women referred to the Urogynecology Outpatient Clinic of a major medical center by primary physicians in the community for initial assessment of lower urinary tract and pelvic organ prolapse symptoms.Results
Most of the women blamed themselves for the delay. However, the primary physicians were considered responsible for 33.5% of the delays. There was no between-group differences in self-blame (p = 0.438). Women with pelvic organ prolapse blamed the gynecologist significantly more often than women with lower urinary tract symptoms (p = 0.043); 38.6% of the physicians considered the symptoms not sufficiently severe or a natural part of aging.Conclusion
Patients need to receive more information on the availability of specific evaluations and treatments for pelvic floor dysfunction. 相似文献11.
Mandy Mangler Julia HerbstlebSylvia Mechsner Julia BartleyAchim Schneider Christhardt Köhler 《International journal of gynaecology and obstetrics》2014
Objective
To demonstrate the quality of a combined vaginal–abdominal surgical approach to rectovaginal endometriosis by analyzing long-term outcome and recurrence rates.Methods
In a prospective cohort study in Berlin, Germany, women with endometriosis of the rectovaginal septum were enrolled between September 2004 and December 2012. Bowel infiltration was verified intraoperatively and treated by a nerve-sparing, mesentery-preserving vaginal–abdominal operative approach. Operative results were evaluated by assessing short- and long-term complications and recurrence rates.Results
During the study period, 110 women underwent surgery. For 71 (64.5%) patients, bowel infiltration was confirmed intraoperatively. Overall, 15% of the patients had peri- or postoperative complications. No long-term complications occurred. After a median follow-up of 64 months, no recurrence in the rectovaginal septum was observed among the study patients. The recurrence of pelvic endometriosis was 15%.Conclusion
The surgical nerve-sparing approach to rectovaginal endometriosis was confirmed to facilitate precise diagnosis and treatment with minimal morbidity and a long-term complication rate of 0%. 相似文献12.
Ana López Carrasco Alicia Hernández Gutiérrez Paula A. Hidalgo Gutiérrez Roberto Rodríguez González José L. Marijuán Martín Ignacio Zapardiel Javier de Santiago García 《Taiwanese journal of obstetrics & gynecology》2017,56(2):243-246
Objective
Ileocecal endometriosis is rare. Symptoms range from no symptoms, cramps, vomiting, to acute intestinal obstruction. Our objective was to review our cases, clarify, and resume its most appropriate management focusing on the factors to determine diagnosis. This is a retrospective study by revision of medical charts of all ileal endometriosis cases of our unit from 2006 to 2014.Case Report
Seven cases were found; three (43%) had previous endometriosis laparoscopic diagnosis, four (57%) had partial bowel obstruction episodes, three (43%) had chronic pelvic pain, and one developed acute intestinal obstruction in postoperative ileostomy closure. In three (43%), the diagnosis was made with magnetic resonance imaging (MRI) and double contrast barium enema, in one (14%) only with MRI, and the other three (43%) during surgery. All patients underwent resection of the ileum and evolved favorably.Conclusion
Variability in symptoms hinders diagnosis. The gold standard for diagnosis is MRI, but clinical suspicion optimizes imaging test diagnosis. Segmental resection should be indicated in the majority of the cases. 相似文献13.
Karsten Krüger Kai Behrendt Gesine Niedobitek-Kreuter Katharina Koltermann Andreas D. Ebert 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objectives
To investigate the value of magnetic resonance imaging (MRI) in the preoperative diagnosis of specific anatomical locations of endometriosis.Study design
Between July 2008 and April 2011, 152 women (mean age 33.5 ± 6.1 years) with clinical and sonographic suspicion of endometriosis underwent pelvic MRI using T2 and unenhanced T1 sequences with and without fat saturation. Two radiologists interpreted the following regions by consensus according to a standardized protocol: ovaries, vagina, pouch of Douglas, rectosigmoid colon, uterosacral ligament (USL), bladder, peritoneum, and other pelvic regions. The results of MRI were retrospectively correlated with the laparoscopic and histopathologic findings. The main outcome parameters, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and the negative likelihood ratio (LR−), were determined.Results
Sensitivity, specificity, PPV, NPV, accuracy, positive and the negative likelihood ratio were 87.6%, 84.6%, 94.3%, 70.2%, 86.8%, 5.69 and 0.15 for the pouch of Douglas (vagina: 81.4%, 81.7%, 79.2%, 83.8%, 81.6%, 4.45, 0.23; rectosigmoid colon: 80.2%, 77.5%, 80.2%, 77.5%, 78.9%, 3.56, 0.25; USL: 77.5%, 68.2%, 77.5%, 68.2%, 73.7%, 2.44, 0.33; ovaries: 86.3%, 73.6%, 78.4%, 82.8%, 80.3%, 3.27, 0.19; urinary bladder: 81.0%, 94.7%, 70.8%, 96.9%, 92.8%, 15.15, 0.20; peritoneum: 35.3%, 88.1%, 60.0%, 73.0%, 70.4%, 2.97, 0.73). All endometriotic implants at other localization were detected (abdominal wall in 4, groin in one patient).Conclusions
The value of MRI in preoperative diagnosis of endometriosis is dependent on the location of endometriosis. The highest accuracy was found in bladder endometriosis and the lowest in peritoneal endometriosis. 相似文献14.
Objectives
To identify, critically evaluate and describe the available scientific evidence on the efficacy and safety of oral or vaginal administration of probiotics in preventing recurrent urinary tract infections and microbial or fungal vaginal infections.Methods
An electronic search was performed in PubMed Central, the Cochrane Library and the meta-searcher TRIP databases using the terms: “Lactobacillus”, “probiotics”, “female urogenital diseases”, “urinary tract infections” and “genitourinary infections”.Results
Of 20 studies that met the selection criteria for this review, a tendency to favor the use of probiotics was observed, especially in the population at high risk of bacterial vaginosis and fungal vulvovaginitis.Conclusions
Probiotics are a promising option in the prevention of recurrences of lower urinary tract infections. Their use can be recommended as a safe and cost effective option especially in high risk subgroups. 相似文献15.
输尿管子宫内膜异位症临床少见,症状隐匿,易漏诊而导致肾功能损害。治疗原则为切除病灶,解除梗阻,保护肾功能,防止复发。手术治疗是首选治疗方法,并配合以围手术期药物治疗。目前对于适宜的输尿管术式尚无定论,腹腔镜手术是今后输尿管子宫内膜异位症手术治疗的趋势。 相似文献
16.
Simone Ferrero Giovanni Camerini Nicola Ragni Pier L. Venturini Ennio Biscaldi Renato Seracchioli Valentino Remorgida 《European journal of obstetrics, gynecology, and reproductive biology》2010
Objective
Up to now limited attention has been given to the medical treatment of bowel endometriosis. This study evaluates the efficacy of aromatase inhibitors and norethisterone acetate in treating pain and gastrointestinal symptoms caused by bowel endometriosis.Study design
This prospective pilot study included six women with colorectal endometriosis; all women had intestinal nodules infiltrating at least the muscularis propria of the bowel and did not have a stenosis of the bowel lumen >60%; the patients suffered from pain and intestinal symptoms. The study subjects received letrozole (2.5 mg/day) and norethisterone acetate (2.5 mg/day) continuously for 6 months. The presence and intensity of symptoms were evaluated before starting the treatment, and after 3 and 6 months of treatment.Results
The double-drug regimen improved pain, non-menstrual pelvic pain, deep dyspareunia, dyschezia, symptoms mimicking diarrhoea-predominant irritable bowel syndrome, intestinal cramping, abdominal bloating and passage of mucus in the stools, and 67% of the patients declared that the treatment improved their gastrointestinal symptoms.Conclusions
The administration of letrozole and norethisterone acetate reduces pain and gastrointestinal symptoms of women with colorectal endometriosis, particularly when patients suffer from symptoms mimicking diarrhoea-predominant irritable bowel syndrome. 相似文献17.
Josep Lluis Carbonell i Esteve Orlando Perera Boza Ana María Riverón Cobo Jesús González Giuseppe Tomasi 《Progresos de Obstetricia y Ginecología》2012
Objectives
To evaluate the safety and efficacy of 5 mg and 25 mg doses of mifepristone for the treatment of endometriosis.Design
Randomized double-blind study.Setting
Eusebio Hernández Hospital, Havana, Cuba.Subjects
Twenty-six women laparoscopically diagnosed with endometriosis were included.Treatment
Group I received one tablet of 25 mg mifepristone daily and group II received one tablet of 5 mg mifepristone daily for 6 months. Laparoscopy and endometrial biopsy were performed before and after treatment.Variable to evaluate efficacy
Reduction in the intensity of dysmenorrhea measured by a visual analogue scale.Results
In both groups reductions in the intensity of dysmenorrhea and dyspareunia were highly significant compared with initial values (P <.001). All the women were amenorrheic after 45 days of treatment.Conclusions
At doses of 5 mg or 25 mg, mifepristone could be an alternative for the treatment of endometriosis. 相似文献18.
Esther Pilar García-Santos Virginia Muñoz-Atienza Susana Sánchez-García Alejandro Puerto-Puerto Francisco Javier Ruescas-García María del Carmen Manzanares-Campillo Fernando Martínez-de Paz David Padilla-Valverde Rebeca Vitón-Herrero Lucía González-López Jesús Martín-Fernández 《Progresos de Obstetricia y Ginecología》2014
19.
Pedro González Ramos Cristina Pastor Oliver Cristina González Pastor Francisco Javier Manero Ruiz Ángela Pecondón Español Pedro Royo Manero Juan Luis Alcázar Zambrano Ernesto Fabre González 《Progresos de Obstetricia y Ginecología》2012