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1.
Rachel Pope Prakash Ganesh Chisomo Chalamanda William Nundwe Jeffrey Wilkinson 《The journal of sexual medicine》2018,15(8):1125-1132
Introduction
Women with vesicovaginal fistulas often experience a disruption in their normal lives, including sexual relationships, because of urinary incontinence.Aim
Although surgery repairs the urinary leakage, it is not known how surgery might affect sexual function positively or negatively.Methods
119 women were enrolled before surgery and interviewed including a revised Female Sexual Distress Scale (FSDS-R) score and examined for vaginal length, caliber, and pelvic floor strength.Main Outcome Measures
Approximately one third of women return to normal sexual function after repair, although a minority experience de novo dysfunction.Results
115 women completed follow-up 6 to 12 months after surgery. Approximately one third (35.6%, n = 41) stated that intercourse had returned to the way it was before a fistula. Forty-four women (40%) report sexual problems after the fistula developed; 15% due to incontinence and 23.5% due to pain. Fourteen women (12.2%) stated that they experienced problems with intercourse since surgery; 50% due to incontinence during intercourse and 50% due to pain. Nineteen of the participants (16.5%) scored in the range of dysfunction as assessed by the FSDS-R tool after surgery. Fibrosis did not significantly change and was not found to be associated with sexual function. Vaginal length was found to decrease on average by 5 mm. Of the variables examined, the factors statistically significantly associated with dysfunction included a larger-size fistula as determined by the Goh classification (> 3 cm diameter) and decreased vaginal caliber. FSDS-R scores drastically decreased from before to after surgery and the reason for problems with intercourse changed from leaking urine before surgery to lack of partner and concern for HIV infection.Clinical Implications
Women with large fistulas and decreased vaginal calibers are at high risk for sexual dysfunction and should be counseled appropriately preoperatively and offered surgical and medical interventions.Strengths & Limitations
Physical parameters were combined with qualitative interviews and FSDS-R scores to contextualize sexual health before and after surgery. Limitation is the brief follow-up of 6-12 months after surgery as many women were still abstaining from sexual activity.Conclusion
Sexual dysfunction is a complex issue for women with obstetric fistulas; although many women do not continue to experience problems, several need ongoing counseling and treatment.Pope R, Ganesh P, Chalamanda C, et al. Sexual Function Before and After Vesicovaginal Fistula Repair. J Sex Med 2018;15:1125–1132. 相似文献2.
Tsia-Shu Lo Sukanda Bin Jaili Rami Ibrahim 《Taiwanese journal of obstetrics & gynecology》2017,56(4):534-537
Objective
Urethral diverticulum is uncommon, therefore appropriate evaluation, preoperative planning and counseling must be done in order to make correct diagnosis and prevent complications.Materials and methods
A case of anterior vaginal wall mass was treated elsewhere by a gynecologist as periurethral cyst abscess; incision and drainage were done but a symptom of pus discharge was observed after 2 weeks. Therefore, exploration, cyst wall excision and primary closure were done though histopathological examination surprisingly confirmed the presence of urethral tissue suggestive of diverticulum.Results
Subsequently, she developed persistent urinary leakage along with urethrovaginal fistula for which they again performed pervaginal multilayer closure. Patient was later referred to us with recurrent urethrovaginal fistula. We performed posterior urethral fistulectomy with anterior vaginal wall flap and multilayer closure. Three years follow up reveals complete recovery.Conclusion
Even urethral diverticulum is a rare condition, should be kept in mind as early diagnosis and management. 相似文献3.
Christa Aubrey Jeanelle Sabourin 《Journal d'obstetrique et gynecologie du Canada》2018,40(10):1333-1336
Background
The loop electrosurgical excision procedure (LEEP) is commonly used to treat cervical dysplasia and has few procedural risks. We report a rare complication: vesicovaginal fistula (VFF).Case
A 47-year-old G3P1 woman with a previous LEEP underwent a second procedure 9 years later and was diagnosed as having microinvasive cervical cancer. Subsequently, at the time of her scheduled robotic-assisted laparoscopic total hysterectomy, examination under anaesthesia revealed a VFF, confirmed with cystoscopy. A joint VFF repair and total abdominal hysterectomy bilateral salpigo-oophorectomy subsequently ensued with an uncomplicated postoperative course.Conclusion
VFF is a rare but recognized complication of LEEP, particularly in women with risk factors, such as a prior LEEP. Examination under anesthesia prior to commencing surgery facilitated recognition and appropriate management of this case. 相似文献4.
Hiroshi Kaneda Yasuhisa Terao Yuko Matsuda Kazunari Fujino Takafumi Ujihira Soshi Kusunoki Miki Kimura Akihiko Shiraishi Ryohei Kuwatsuru Satoru Takeda 《Taiwanese journal of obstetrics & gynecology》2017,56(4):502-507
Objective
Surgery for uterine cervical fibroids is difficult because of restricted surgical access and risks such as intraoperative bleeding or injury to other organs. The internal iliac artery balloon occlusion catheter (IIABOC) provides effective hemostasis for placenta previa and atonic hemorrhage, and is increasingly used in surgery for uterine fibroids for controlling intraoperative hemorrhage. We investigated the efficacy and safety of the IIABOC for controlling intraoperative bleeding in total abdominal hysterectomies (TAH) and abdominal myomectomies (AM) for large cervical fibroids.Material and methods
From 2007 to 2014, the IIABOC was used in 22 cases (12 for TAH and 10 for AM) in which cervical fibroids fully occupied the pelvic cavity. Intraoperative blood loss, operating time, sample weight, use of blood transfusion, and injury to other organs were assessed.Result
Mean blood loss, operative time, and sample weight in the IIABOC cases were 510 mL, 178 min, and 2550 g for TAH; and 727.5 mL, 157.5 min, and 1850 g for AM. Blood loss divided by sample weight in IIABOC cases was significantly lower than that in non-IIABOC cases during the same time period, for both TAH and AM. Allogeneic blood transfusion was not necessary, and complications of injury to other organs did not occur in any of the 22 cases.Conclusions
For large cervical fibroids with limited operating space, surgery was performed under bleeding control by occlusion of the internal iliac artery with an IIABOC. This technique enables control of hemorrhage and safe operative management in gynecological surgery. 相似文献5.
Szu-Yu Chen Bor-Ching Sheu Su-Cheng Huang Wen-Chun Chang 《Taiwanese journal of obstetrics & gynecology》2017,56(4):467-471
Objective
To report a single surgeon's experience with 109 laparoendoscopic single-site myomectomy (LESS-M) using conventional laparoscopic instruments and a homemade glove port system.Materials and methods
A total of 109 consecutive women who underwent LESS-M between March 2011 and April 2015 were reviewed.Results
The mean age and body mass index were 38.3 ± 6.5 years and 22.1 ± 3.0 kg/m2. The mean diameter of the largest myoma and the mean number of myomas were 8.1 ± 2.4 cm and 1.6 ± 0.7. The mean weight of the myomas was 223.2 ± 159.7 g. The most common type of myoma was intramural (61%), followed by subserosal (23%), submucosal (9%), and intraligamental (7%). The most common site of the myomas was anterior (39%), followed by posterior (38%), lateral (15%), and fundal (9%). The mean operative time and estimated blood loss were 138.5 ± 43.8 min and 104.9 ± 270.1 mL. Two patients (1.8%) required intraoperative transfusion. The mean hospital stay was 2.5 ± 0.6days. There were no conversions to laparotomy, but three patients(2.8%) were converted to two-port laparoscopic myomectomy. No patient experienced any major complication, including bowel, ureter, bladder injuries, or incisional hernia. Six women became pregnant after the operation, and five of these patients delivered their babies at full term by cesarean section. One patient delivered her baby at a gestational age at 32 weeks due to idiopathic polyhydramnios by cesarean section. One patient had the second pregnancy and delivery after LESS-M. Fourteen patients (12.8%) had small recurrent myomas that did not require treatment.Conclusion
LESS-M is a feasible alternative for patients with symptomatic myomas, and this technique can provide cosmetic advantages compared to conventional laparoscopic surgery. 相似文献6.
Amanda Marie Hill K. Meryl Davis Lindsay Clark-Donat Lee Marvin Hammons Masoud Azodi Dan-Arin Silasi 《Journal of minimally invasive gynecology》2017,24(1):108-113
Study Objective
To determine whether vertical versus horizontal closure of the vaginal cuff during laparoscopic hysterectomy has an effect on postoperative vaginal length and pelvic organ prolapse.Design
A prospective randomized controlled trial. Subjects were randomly assigned to vertical or horizontal vaginal cuff closure at the time of total laparoscopic hysterectomy. Pelvic organ prolapse quantization (POP-Q) tests were performed before surgery, 2 to 4 weeks after surgery, and 3 to 4 months after surgery (Canadian Task Force classification I).Setting
An academic university-affiliated community hospital.Patients
Patients undergoing laparoscopic or robotic-assisted laparoscopic total hysterectomy for benign or malignant disease, excluding those undergoing radical hysterectomy or concomitant pelvic floor procedure.Interventions
Subjects were randomized into the vertical or horizontal vaginal cuff closure group. Total hysterectomy was completed with traditional laparoscopic techniques or with robotic assistance. A colpotomy ring was used in each subject. Vaginal cuff closure was performed with barbed suture in a running fashion according to the group assignment.Measurements and Main Results
A total of 43 subjects were enrolled and randomized. One patient was excluded because the vaginal cuff was closed vaginally, 1 cancelled surgery, and 1 was completed without a uterine manipulator. The mean change in vaginal length was ?0.89 cm (standard deviation [SD] = 1.03) in the horizontal group and ?0.86 cm (SD = 1.19) in the vertical group (p = .57). POP-Q evaluation revealed no differences between groups and an overall trend toward improved POP-Q measurements. The average duration of vaginal cuff closure did not differ (p = .45), and there were no intraoperative complications related to vaginal cuff closure.Conclusion
Horizontal and vertical laparoscopic closure of the vaginal cuff after laparoscopic hysterectomy results in similar changes in vaginal length and other POP-Q scores. 相似文献7.
Background
Vesicovaginal fistula (VVF) is an epithelium-lined communication between the urinary bladder and vagina. Most of VVFs are repaired by conventional open surgery. Laparoscopic repair of VVFs is rare and so far no report is available about laparoscopic repair of persistent VVF using fleece-bound sealing system as a tissue barrier in the literature. Here we describe the operative technique and briefly review the literature.Case
We present the case of a 37-year-old woman with recurring VVF in two times after abdominal and transvaginal repairs caused by a massive bleeding during caesarian-section due to placenta previa and underwent hysterectomy. During the laparoscopic repair of the fistula and excision of the vaginal cuff, fleece-bound sealing system (TachoSil®) was used as tissue barrier. Laparoscopic transperitoneal transvesical repair was successfully performed by suturing the defects and fixing two TachoSil between the bladder and vagina. The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found.Conclusion
We believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity. Whilst proper identification of tissue planes and good laparoscopic suturing technique are required, using fleece-bound sealing system might be convenient especially for persistent VVF.8.
Antonino Ditto Giorgio Bogani Fabio Martinelli Mauro Signorelli Valentina Chiappa Cono Scaffa Alice Indini Umberto Leone Roberti Maggiore Domenica Lorusso Francesco Raspagliesi 《Journal of minimally invasive gynecology》2017,24(1):98-102
Study Objective
Growing evidence supports the safety of a laparoscopic approach for patients affected by apparent early-stage ovarian cancer. However, no well-designed studies comparing laparoscopic and open surgical staging are available. In the present investigation we aimed to provide a balanced long-term comparison between these 2 approaches.Design
Retrospective study (Canadian Task Force classification II-2).Setting
Tertiary center.Patients
Data of consecutive patients affected by early-stage ovarian cancer who had laparoscopic staging were matched 1:1 with a cohort of patients undergoing open surgical staging. The matching was conducted by a propensity-score comparison.Intervention
Laparoscopic and open surgical staging.Measurements and Main Results
Fifty patient pairs (100 patients: 50 undergoing laparoscopic staging vs 50 undergoing open surgical staging) were included. Demographic and baseline oncologic characteristics were balanced between groups (p > .2). We observed that patients undergoing laparoscopic staging experienced longer operative time (207.2 [71.6] minutes vs 180.7 [47.0] minutes; p = .04), lower blood loss (150 [52.7] mL vs 339.8 [225.9] mL; p < .001), and shorter length of hospital stay (4.0 [2.6] days vs 6.1 [1.6] days; p < .001) compared with patients undergoing open surgical staging. No conversion to open surgery occurred. Complication rate was similar between groups. No difference in survival outcomes were observed, after a mean (SD) follow-up of 49.5 (64) and 52.6 (31.7) months after laparoscopic and open surgical staging, respectively.Conclusions
Our findings suggest that the implementation of minimally invasive staging does not influence survival outcomes of patients affected by early-stage ovarian cancer. Laparoscopic staging improved patient outcomes, reducing length of hospital stay. Further large prospective studies are warranted. 相似文献9.
Gery Lamblin Gil Dubernard Pierre de Saint Hilaire Franck Jacquot Philippe Chabert Gautier Chene François Golfier 《Journal of minimally invasive gynecology》2017,24(1):41-47
Study Objective
To assess the anatomic efficacy and safety of synthetic glue to fix prosthetic material in laparoscopic sacrocolpopexy.Design
A 1-year follow-up in a prospective multicenter pilot study between November 2013 and November 2014 (Canadian Task Force Classification II-2).Setting
An academic urogynecology research hospital.Patients
Seventy consecutive patients with Pelvic Organ Prolapse Quantification stage ≥3 anterior and/or medial prolapse underwent laparoscopic sacrocolpopexy.Interventions
All women underwent laparoscopic sacrocolpopexy with the same standardized technique using a synthetic surgical glue to fix anterior and posterior meshes.Measurements and Main Results
Patients were followed up at 1 month and 1 year, with anatomic and functional assessment (Pelvic Floor Distress Inventory-20, Pelvic Floor Impact Questionnaire-7, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12). Anatomic success was defined as 1-year Pelvic Organ Prolapse Quantification stage ≤1. Sixty-six patients were included; the mean age was 56.7 ± 1.2 years. The mean operative time was 145 ± 5 minutes. The mean glue fixation time was less than 2 minutes for both anterior and posterior meshes. The 1-year anatomic success rate was 87.5% in the anterior compartment (Ba at ?2.3 cm, p < .0001) and 95.3% in the medial compartment (point C at ?6.1 cm, p < .0001). There were no intra- or postoperative complications and no cases of mesh exposure; 5 cases of mesh shrinkage (7.8%) were observed at 1 year. The postoperative urinary stress incontinence rate was 29.7% at 1 year. Eight patients (12.1%) underwent revision surgery with transobturator tape. All quality of life scores showed significant improvement (p < .0001) at 1 year.Conclusion
Synthetic glue attachment of prosthetic material in laparoscopic sacrocolpopexy proved straightforward, safe, time-saving, and effective at 1 year. Prospective randomized studies will be needed to confirm the long-term benefit. 相似文献10.
Soo Yoon Lee Mi-La Kim Seok Ju Seong Jong Woon Bae Yeon Jean Cho 《Journal of pediatric and adolescent gynecology》2017,30(2):228-233
Study Objective
To evaluate the cumulative recurrence rate of endometriomas after a laparoscopic endometriotic cyst enucleation in adolescents and to find the factors associated with recurrence.Design
A multicenter retrospective cohort study.Setting
Three university hospitals.Participants
One hundred five patients surgically treated with laparoscopic enucleation of endometriotic cysts younger than 20 years of age were selected.Interventions
None.Main Outcome Measures
Endometrioma recurrence was considered when transvaginal or transrectal sonography indicated a cystic mass with a diameter of 20 mm or greater. Recurrence rate of endometrioma and median time to recurrence were evaluated.Results
In total, 105 patients were followed for 47.3 (±44.3) months (range, 3-161 months). Seventeen patients (16.2%) experienced recurrence after the first-line surgery and 8 patients (7%) underwent a second surgery. The median time to recurrence was 53.0 (±8.5) months (range, 8-111 months). Using Kaplan-Meier method, the cumulative recurrence rates of endometrioma per patient at 24, 36, 60, and 96 months after the first-line surgery were 6.4%, 10%, 19.9% and 30.9%, respectively. Surgical characteristics, such as the diameter of the cyst, revised American Society for Reproductive Medicine stage, unilateral or bilateral involvement, and coexistence of deep endometriosis were not associated with recurrence in this age group.Conclusion
Although the short-term recurrence rate in adolescents after first-line surgery is relatively low, the recurrence rate appears to be higher according to the follow-up duration. Long-term and continuous follow-up is needed for patients who have undergone surgical treatment for endometriosis in the adolescent period. 相似文献11.
Ozlem Dural Cenk Yasa Ercan Bastu Funda Gungor Ugurlucan Gamze Yilmaz Bahar Yuksel Suleyman Engin Akhan Faruk Buyru 《Journal of pediatric and adolescent gynecology》2017,30(1):128-131
Study Objective
To evaluate the outcomes of laparoscopic surgery for the treatment of adnexal pathology in older children and adolescents.Design
A retrospective cohort review.Setting
A tertiary academic center in Istanbul, Turkey.Participants
Pediatric and adolescent patients aged between 9 and 19 years (n = 69) who underwent laparoscopic surgery for adnexal pathology from January 2005 through September 2015. The patients who were pregnant or with non-gynecologic pathology detected during surgery were excluded from the study.Interventions
Patients were divided into 2 groups according to their age. Group 1 consisted of 31 patients aged between 9 and 16 years and group 2 included 38 patients aged between 17 and 19 years.Main Outcome Measures
The indication for surgery, procedures performed, anesthesia time, length of hospital stay, pathology findings, and complication rates were evaluated.Results
Ovarian cystectomy and adnexal detorsion with or without cystectomy were the most frequently performed. Ovary-sparing conservative surgery was possible for all patients, except those with gonadal dysgenesis and testicular feminization (n = 6), who underwent laparoscopic gonadectomy. The most common pathologic finding was mature cystic teratoma (30.2%), followed by benign paratubal cyst, and simple cysts of the ovary. Anesthesia time was shorter in group 2 (P = .018). The procedures performed, length of hospital stay, complication rate, and pathology findings were not significantly different between the 2 groups.Conclusions
Laparoscopic surgery can be successfully performed as an efficient, safe, and well tolerated procedure for treating a wide variety of adnexal pathology among children and young adolescents without any significant variation between different age groups. 相似文献12.
Natasha L. Orr Heather Noga Christina Williams Catherine Allaire Mohamed A. Bedaiwy Sarka Lisonkova Kelly B. Smith Paul J. Yong 《The journal of sexual medicine》2018,15(8):1158-1166
Introduction
The etiology of endometriosis-associated deep dyspareunia may include direct endometriosis-specific factors (eg, stage or invasiveness of disease) and/or indirect contributors such as bladder/pelvic floor dysfunction (eg, related to myofascial mechanisms or nervous system sensitization).Aim
This study aimed to determine whether bladder/pelvic floor tenderness and painful bladder syndrome were associated with severity of deep dyspareunia in women with endometriosis, regardless of Stage (I/II vs III/IV) or other endometriosis-specific factors.Methods
Observational study from a prospective patient registry (January 2014 to December 2016) at a tertiary centre for endometriosis. Included were women aged 18 to 49 years who had surgical removal and histopathologic confirmation of endometriosis at the centre. Cases with Stage I/II vs Stage III/IV endometriosis were analyzed separately. Bivariate associations with the primary outcome (severity of deep dyspareunia) were tested for bladder/pelvic floor tenderness, painful bladder syndrome, as well as endometriosis-specific factors identified at the time of laparoscopic surgery (eg, deep infiltrating endometriosis) and demographic factors (eg, age). Multivariable ordinal logistic regression was carried out to adjust for factors associated with the primary outcome.Main Outcome Measure
Primary outcome was severity of deep dyspareunia on an 11-point numeric rating scale, categorized as none/mild (0–3), moderate (4–6), and severe (7–10), from a preoperative self-reported questionnaire.Results
Overall, 411 women had surgically confirmed endometriosis: 263 had Stage I/II and 148 had Stage III/IV endometriosis. Among women with Stage I/II endometriosis, severity of deep dyspareunia was associated with both bladder/pelvic floor tenderness and painful bladder syndrome (AOR = 1.94, 95% CI: 1.11–3.38, P = .019 and AOR = 1.99, 95% CI: 1.15–3.44, P = .013, respectively), independent of endometriosis-specific factors or other factors associated with deep dyspareunia severity. Similar associations were found in women with Stage III/IV endometriosis (bladder/pelvic floor tenderness AOR =2.51, 95% CI: 1.25–5.02, P = .01, painful bladder syndrome: AOR = 1.90, 95% CI: 1.01–3.57, P = .048).Clinical Implications
Myofascial or nervous system mechanisms may be important for deep dyspareunia in women with endometriosis, even in those with moderate-to-severe disease (Stage III/IV).Strengths & Limitations
Strengths include the prospective registry, and histological confirmation of endometriosis and staging by experienced endometriosis surgeons. Limitations include assessment of only one pelvic floor muscle (levator ani).Conclusion
In women with Stage I/II or Stage III/IV endometriosis, severity of deep dyspareunia was strongly associated with bladder/pelvic floor tenderness and painful bladder syndrome, independent of endometriosis-specific factors, which suggests the role of myofascial or sensitization pain mechanisms in some women with deep dyspareunia.Orr NL, Noga H, Williams C, et al. Deep Dyspareunia in Endometriosis: Role of the Bladder and Pelvic Floor. J Sex Med 2018;15:1158–1166. 相似文献13.
Jong-Wook Seo Dong-Yun Lee Byung-Koo Yoon DooSeok Choi 《Journal of pediatric and adolescent gynecology》2017,30(2):223-227
Study Objective
Young age is a possible risk factor of endometriosis recurrence after surgery. However, the efficacy of postoperative medical treatment has not been well addressed in adolescents. The purpose of this study was to evaluate whether postoperative medical treatment is as effective in adolescents as it is in adults in the prevention of endometrioma recurrence.Design
A retrospective cohort study.Setting
Samsung Medical Center, Seoul, Korea.Participants
This study included 176 reproductive-aged women who underwent conservative laparoscopic surgery for pathology-confirmed endometrioma. Women were classified into 2 groups according to age: adolescents (20 years of age and younger, n = 34; group I) and reproductive-aged women (aged 25-35 years, n = 142; group II).Interventions
The same surgeon performed all of the surgeries for uniformity. Postoperatively, patients were treated monthly with a gonadotropin-releasing hormone agonist depot for 3-6 months, followed by cyclic oral contraceptives.Main Outcome Measures
Endometrioma recurrence was determined using ultrasonography. The recurrence rate of endometrioma was compared between the 2 groups.Results
During the treatment period (median, 41.0 months; range, 6-159 months), recurrence was noted in 8 cases (4.5%). After adjusting for confounders (which were statistically different between the groups), the cumulative proportion of recurrent endometriomas after 60 months was comparable between the 2 groups (5.3% in group I and 8.5% in group II).Conclusion
Long-term postoperative medical treatment with cyclic oral contraceptives after a gonadotropin-releasing hormone agonist can be as effective in adolescents as it is in adults in the prevention of endometrioma recurrence. 相似文献14.
Mirko Bertozzi Ciro Esposito Claudio Vella Vito Briganti Nicola Zampieri Daniela Codrich Michele Ubertazzi Alessandro Trucchi Elisa Magrini Sonia Battaglia Vittorio Bini Maria Luisa Conighi Caterina Gulia Alessandra Farina Francesco Saverio Camoglio Waifro Rigamonti Piergiorgio Gamba Giovanna Riccipetitoni Antonino Appignani 《Journal of pediatric and adolescent gynecology》2017,30(3):413-417
Study Objective
To report results of a retrospective multicentric Italian survey concerning the management of pediatric ovarian torsion (OT) and its recurrence.Design
Multicenter retrospective cohort study.Setting
Italian Units of Pediatric Surgery.Participants
Participants were female aged 1-14 years of age with surgically diagnosed OT between 2004 and 2014.Interventions
Adnexal detorsion, adnexectomy, mass excision using laparoscopy or laparotomy. Different kinds of oophoropexy (OPY) for OT or recurrence, respectively.Main Outcome Measures
A total of 124 questionnaires were returned and analyzed to understand the current management of pediatric OT and its recurrence. The questionnaires concerned patient age, presence of menarche, OT site, presence and type of mass, performed procedure, OPY technique adopted, intra- and postoperative complications, recurrence and site, procedure performed for recurrence, OPY technique for recurrence, and 1 year follow-up of detorsed ovaries.Results
Mean age at surgery was 9.79 ± 3.54 years. Performed procedures were open adnexectomy (52 of 125; 41.6%), laparoscopic adnexectomy (25 of 125; 20%), open detorsion (10 of 125; 8%), and laparoscopic detorsion (38 of 125; 30.4%). Recurrence occurred in 15 of 125 cases (12%) and resulted as significant (P = .012) if associated with a normal ovary at the first episode of torsion. Recurrence occurred only in 1 of 19 cases after OPY (5.2%). Ultrasonographic results of detorsed ovaries were not significant whether an OPY was performed or not (P = 1.00).Conclusion
Unfortunately, oophorectomy and open technique are still widely adopted even if not advised. Recurrence is not rare and the risk is greater in patients without ovarian masses. OPY does not adversely affect ultrasonographic results at 1 year. When possible OPY should be performed at the first episode of OT. 相似文献15.
Xianlan Zhao Ya Tao Yingying Du Lei Zhao Cai Liu Yan Zhou Peng Wei 《Taiwanese journal of obstetrics & gynecology》2018,57(2):276-282
Objective
We aimed to evaluate our experience with the application of uterine wall local resection and reconstruction to preserve the uterus in patients with morbidly adherent placenta.Materials and methods
In a retrospective study, data from patients with morbidly adherent placenta who delivered by cesarean section between January 1, 2013 and May 31, 2016 were analyzed. Prophylactic abdominal aorta balloon occlusion and tourniquet were used to prevent massive hemorrhage in all 62 cases, followed by uterine wall local resection and reconstruction to preserve the uterus. The quantity of estimated blood loss (EBL), operation time, and complications were analyzed.Results
The placenta penetrated to the myometrium in 10 cases, involved the posterior bladder wall in 46 cases, and penetrated the posterior bladder wall in six cases. For all cases, the mean EBL in the surgery was 1377.3 ± 605.2 mL, the mean EBL in the initial postoperative 24 h was 140.6 ± 66.3 mL, the mean operation time was 72.3 ± 24.5 min, and the mean postoperative hospital stay was 5.8 ± 1.6 days. The six cases of placenta penetrating the bladder underwent bladder repair. Sixty-one cases had preserved uterus, and only one case had a hysterectomy due to amniotic fluid embolism (AFE).Conclusion
Combined with prophylactic abdominal aorta balloon occlusion and tourniquet, uterine wall local resection and reconstruction is highly effective to reduce the intraoperative blood loss and hysterectomy in morbidly adherent placenta. 相似文献16.
Tsia-Shu Lo Sukanda Bin Jaili Rami Ibrahim Chuan Chi Kao Ma Clarissa Uy-Patrimonio 《Taiwanese journal of obstetrics & gynecology》2018,57(1):150-152
Objective
To know the diagnostic tools and proper management of ureterovaginal fistula following neglected vaginal foreign body in order to achieve optimal outcome.Case report
A case of ureterovaginal fistula associated with a neglected vaginal foreign body. The patient was complaining of a foul-smelling vaginal discharge and lower abdominal pain. On vaginal examination, a hard and large foreign body was found. Examination under anesthesia was performed, and an aerosol cap was removed from her vagina. The patient developed urinary incontinence after removal of the foreign body. Subsequent work-up demonstrated the presence of a right ureterovaginal fistula. The patient underwent an abdominal ureteroneocystostomy. At one year follow up, the patient had fully recovered.Conclusion
Ureterovaginal fistula following neglected vaginal foreign body is a serious condition. Early diagnosis, treatment of infection and proper surgical management can improve the outcome and decrease complications. 相似文献17.
Shun-Jen Tan Chi-Huang Chen Shauh-Der Yeh Yun-Ho Lin Chii-Ruey Tzeng 《Taiwanese journal of obstetrics & gynecology》2018,57(1):153-156
Objective
To report an infertility case of deep-infiltrating bladder endometriosis conceiving following robot-assisted surgery and modified gonadotropin-releasing hormone agonist (GnRHa) treatment.Case report
A 33 year-old infertile female presenting with dysmenorrhea was found to have a bladder mass by pelvic ultrasound. Cystoscopy revealed a protruding tumor from the posterior bladder wall, and endometriosis was highly suspected. Robot-assisted laparoscopic partial cystectomy was performed for the deep-infiltrating bladder endometriosis. With postoperative half-dose GnRHa treatment and timed intercourse, she got pregnant within 3 months.Conclusion
Robot-assisted complete resection of deep-infiltrating endometriosis and bladder repair immediately followed by GnRHa therapy and medical assistance improves reproductive outcomes efficiently in women with endometriosis-associated infertility. 相似文献18.
Objective
Although laparoscopic hysterectomy, a worldwide popular surgery, ensures faster recovery and less postoperative pain than with laparotomic hysterectomy, immediate pain control still improving postoperative care. We introduce an effective method, intraoperative injection of ropivacaine into both uterosacral ligaments, to control immediate postoperative pain.Materials and methods
We performed a prospective, double-blind, and randomized study. We analyzed 40 cases of laparoscopic vaginal hysterectomy performed between July 2015 and November 2016 by a single surgeon (Y.S.K.). We randomized the enrolled patients into the ropivacaine injection group and the saline injection group. Before the vaginal stump was closed, 7.5% ropivacaine or saline (10 mL) was administered into both uterosacral ligaments, 5 mL each. In all cases, the medicine was injected transvaginally before the vaginal stump was closed. The primary outcome was the postoperative pain intensity expressed by numeric ranking scale (NRS) scores at 2, 6, 12, and 24 h after injection. The secondary outcome was the amount of analgesics demanded for pain control during the 24 h after the surgery.Results
The pain intensity at 2 h after injection was significantly lower in the ropivacaine-injected group (p = .0234). There was no difference in pain intensity at 6, 12, and 24 h after injection and the amount of analgesics used. However, the total amount of opioid analgesic used was lower in the ropivacaine-injected group than in the placebo-injected group. (p = .0251).Conclusion
Intraoperative ropivacaine injection into both uterosacral ligaments during laparoscopic hysterectomy can reduce early postoperative pain and consumption of analgesics to improve postoperative care. 相似文献19.
Harneet Gujral Annmarie Vilkins Nisse V. Clark Alison B. Vogell Kelly N. Wright 《Journal of minimally invasive gynecology》2017,24(1):103-107
Study Objective
To compare the operative time of contained hand tissue extraction with power morcellation and to quantify the learning curve required to develop this skill.Design
A retrospective cohort study (Canadian Task Force classification II-3).Setting
Lahey Hospital and Medical Center, a suburban academic tertiary care center serving a broad base of patients.Patients
Eighty-eight women undergoing laparoscopic hysterectomy requiring morcellation or tissue extraction from 2012 through 2015.Interventions
Power morcellation before the institution's ban on power morcellation and contained hand tissue extraction instituted in a response to the ban.Measurements and Main Results
Data were collected to compare the operative time and perioperative outcomes of morcellation before discontinuation of the power morcellator and after adaptation of a contained hand tissue extraction protocol. The data were then used to determine a learning curve for the new procedure. Eighty-eight consecutive cases of laparoscopic hysterectomy requiring morcellation were identified during the study duration, with 46 patients undergoing power morcellation and 42 undergoing hand tissue extraction. The 2 groups were similar overall in body mass index (28.9 vs 29.5, p = .70), prior laparoscopy (28% vs 21%, p = .46) or laparotomy (39% vs 21%, p = .07), removal of the cervix (56% vs 86%, p < .01), and uterine weight (581 vs 628 g, p = .56). The hand tissue extraction group had an average operating room time of 170 minutes compared with 154 minutes (p = .08) for the power morcellation group. The 2 surgeons performed 32 and 10 hand tissue extractions, respectively, with a decrease in 0.7 and 3 minutes per case, respectively, over the course of 7 months (p = .3 and .6, respectively).Conclusion
Contained hand tissue extraction was similar to power morcellation in the total operative time. The learning curve of surgeons performing contained hand tissue extraction showed a nonsignificant trend toward improvement in the operative time with an increasing number of cases. 相似文献20.
Jennifer M. Hebert-Beirne Rachel O&#x;Conor Jeni Donatelli Ihm Molly Kirk Parlier Missy D. Lavender Linda Brubaker 《Journal of pediatric and adolescent gynecology》2017,30(2):188-192