Abstract Objective To evaluate surgical, long-term anatomic and functional results of the laparoscopic Vecchietti procedure to treat women with vaginal agenesis. Methods Retrospective analysis of 86 ...women treated at the Department of Gynecology and Obstetrics at the University of Verona, Italy. Data were analyzed based on surgical results and postoperative sexual satisfaction. Depth and diameter of the neo-vagina was determined. The characteristics of the neo-vaginal mucosa were investigated by vaginoscopy. Patients reported frequency, satisfaction, and any difficulties found at intercourse. Results Functional success was obtained in 98.1% and anatomic success in 100%. In all patients, at 1 year, the mucosa was pink, trophic, and moist. Two fingers were introduced easily into the neo-vagina in all cases. All patients, which decided to have sexual intercourse, defined these as satisfying within 6 months. Conclusions Laparoscopic procedure used in this study is simple, safe, and effective. Anatomical and functional results obtained suggest this laparoscopic procedure as the treatment of choice for this syndrome.
To evaluate the validity of transrectal ultrasonography in the assessment of rectovaginal endometriosis.
We compared the findings of transrectal ultrasonographic examination performed before surgery ...with the operative and pathologic findings in 140 women who underwent laparoscopy or laparotomy for suspected endometriosis. The ultrasonographer was asked to investigate whether any deep endometriotic lesions were present in the rectovaginal septum and to define the lateral extension on the basis of involvement of the uterosacral ligaments. In addition, infiltration of the rectal and vaginal walls was evaluated.
Thirty-four women had endometriosis infiltrating the rectovaginal septum confirmed by combined operative and pathologic findings. Ultrasonography showed a sensitivity and specificity of 97% and 96%, respectively, in the diagnosis of the presence of rectovaginal endometriosis. The sonographer identified infiltration of the rectal and vaginal walls correctly in all cases in whom it was present, but also reported rectal infiltration in three cases not confirmed by the surgeon and pathologist. The sensitivity and specificity in the diagnosis of uterosacral ligament infiltration were 80% and 97%, respectively.
If our preliminary results are confirmed by a larger series, transrectal ultrasonography will be considered a valid diagnostic tool in the evaluation of rectovaginal endometriosis.
Studies on umbilical cord blood for determination of lactate indicate that high levels seem to be correlated to foetal metabolism for anaerobic glycolysis taking place in oxygen-deprived tissues of ...the foetus. These findings may be of particular-deprived clinical importance when foetal distress or foetal hypoxemia is caused by perinatal events.
The maternal and foetal heart rates, acid-base values measured and the outcome of 94 pregnancies complicated by intrapartum foetal asphyxia have been reviewed, and the maternal and foetal acid-base and lactate levels during the course of labour and at delivery were studied in patients with evidence of metabolic acidosis. Lactate concentrations were measured during labour and at delivery in blood samples obtained from the foetal presenting part and from the umbilical cord with the use of a rapid electrochemical technique. The foetuses were evaluated by means of the Apgar score, intrapartum cardiotocography, observation of the presence of meconium stained amniotic fluid, and clinical features of distress at birth.
Evidence of clinical foetal distress was not related to the severity of the asphyxia. An increased lactate level was found in asphyctic infants and a clear correlation between lactic acidosis and foetal distress was documented. Low Apgar scores were observed in infants with moderate or severe asphyxia at delivery. Scalp lactate correlated significantly with umbilical artery lactate, but not with 1-min or 5-min Apgar scores. The lactate concentration was higher in cases of instrumental delivery compared to spontaneous delivery. No perfect correlation was found between lactate level and neonatal outcome but there were not a significant number of neonates with immediate complications. The rate of forceps delivery in the distress group was significantly higher than that of the healthy foetuses, so spontaneous labour was less frequently associated with foetal distress than instrumental delivery. In the distress group, severe variable decelerations were generally recorded in the second stage of labour. The incidence of neonatal Apgar score < or = 7 in neonates with abnormal baseline foetal heart rate (FHR) was higher than in those with severe variable decelerations, mild variable decelerations, and transient tachycardia. Duration of the active second stage of labour was significantly with the presence of foetal lactate at the time of crowning of the foetal head and the presence of lactate in umbilical arterial and vein blood at delivery. Expulsion time > or = 45 minutes, compared with shorter active second stage, and acidaemia at birth implied larger arterial-venous lactate differences. The presence of foetal lactate at crowning was also significantly associated with the level of umbilical arterial-venous lactate difference.
Lactate and pH values provide the best parameters to distinguish between asphyctic and normal newborns, with lactate having the most discriminating power. The prospective value of the discrimination functions derived from lactate and pH data is good when the foetuses are allocated into normal parameters but poor when an attempt is made to allocate the foetuses into pathologic ones, with a high false-negative rate. However, the discriminating ability is improved when pathologic foetuses are included into one single abnormal group. These results confirm the potential use of rapid foetal blood lactate measurements for the early diagnosis of intrapartum foetal distress.
An animal model of female Wistar species of rats was developed to study the early effects of ileocystoplasty.
Bladder augmentation using ileum and a sham operation (cistostomy) were performed in 14 ...and 6 female Wistar rats, rispectively. Urine was obtained for culture and urinalysis in all rats at the time of operation and at the time of the sacrifice. Seven rats underwent ileocystoplasty and three shams were sacrificed after one and three months. In all rats sacrificed three months after ileocystoplasty, blood sample drawn for serum electrolytes, blood urea, nitrogen creatine and bicarbonate was performed. Post mortem histopathological examination of the ileal patch and of kidneys was performed.
The cultures of the urine were positive in 1 out 7 (14.3%) and in 4 out 7 (57%) after one and three months after ileocystoplasty, respectively. Urinary pH of the augmented group was significantly higher in treated rats than in shams (p < 0.05). At sacrifice three months post operatively, the serum chloride concentration was significantly higher in augmented than shams (p < 0.05). Bladder calculi were formed in 28.6% of ileocystoplasty. Histopathological examination of the enteropatch showed urothelialization of the graft and kidneys showed a significant glomerular depletion.
Our data confirm an early significant enhancement of urinary pH in rats underwent ileocystoplasty and the stone formation is a frequent event. Already three months after ileocystoplasty urothelialization extended from the side of anastomosis towards the central portion of the ileal graft. Moreover, a significant improvement of serum creatine, sign of glomerular overload and progressive glomerular depletion were recorded in treated rats, probably as a consequence of water and electrolyte resoption through the intestinal graft.
Objective: Our goal was to describe the outcomes of women with vaginal agenesis who had surgical creation of a neovagina using the Vecchietti technique over a 20-year period. We also sought to ...determine whether the laparoscopic approach would result in similar outcomes as laparotomy.
Method: Retrospective analysis of 76 women with vaginal agenesis treated at the University of Verona Hospital between 1976 and 1996 with the Vecchietti procedure. Operative and postoperative records were reviewed, and sexual histories were obtained. Data were analyzed based on surgical approach and postoperative sexual satisfaction. Continuous data were analyzed with student's
t-test, and categoric data were analyzed using Fisher's exact test.
Result: Those who underwent the Vecchietti procedure with a laparoscopic approach (
N=7) had similar complication rates (0% vs. 13.0%,
P=0.59) and postoperative neovaginal depth (74.9 mm vs. 73.7 mm,
P=0.93) as those with laparotomy (
N=69). Similar proportions of women reported inadequate vaginal lubrication (28.6% vs. 17.4%,
P=0.61) and sexual satisfaction (100% vs. 78.3%) in the laparoscopy and laparotomy groups as well. Operative complications, neovaginal depth, or degree of lubrication were not good predictors of sexual satisfaction.
Conclusion: Outcomes in those women who underwent the Vecchietti technique via the laparoscopic approach are comparable to those who underwent laparotomy.
The management of fetal ovarian cysts is still controversial despite the improvement in prenatal diagnosis with ultrasonography. Some studies suggest an aggressive management, while others opt for a ...conservative one. The prognosis of the majority of congenital ovarian cysts is good since they have a benign origin. Sometimes, however, complications such as torsion or rupture can occur which often require surgical intervention after delivery. In this paper we report our experience and a brief review of the literature.
The authors report on 32 pregnant women in whom ultrasonography revealed the presence of an echo-rare or echo-free area in the fetal abdomen suggestive of an ovarian cyst. All women were followed-up during pregnancy with serial ultrasound examinations. Postnatal ultrasound controls confirmed the prenatal diagnosis in all cases. The diameters of the cysts ranged from 2.7 to 7.5 cm.
In the 16 cases (50%) in which the cyst diameter was below 4 cm, periodic ultrasound examinations revealed a tendency towards spontaneous regression of the cysts. In the other 16 cases (50%) in which the cyst diameter exceeded 4 cm, cystectomy was necessary due to subsequent complications (torsion in 6 cases, 37.5%, and intracystic hemorrhage in the other 10, 62.5%).
The most appropriate clinical approach in the management of benign feto-neonatal ovarian cysts is to adopt a wait-and-see policy, assessing the course of the condition by means of periodic ultrasound monitoring. Only when tumefactions measure more than 4 cm in diameter with attendant complications is surgical therapy indicated. Without complications, however, aspiration of the cystic contents is possible even in ovarian cysts exceeding 4 cm in diameter.
The purpose of this study was to compare the outcome of standard extrafascial hysterectomy and tailored radical hysterectomy as a definitive treatment of recurrent deep endometriosis.
This was a ...descriptive study that comprised 38 patients who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy between 1989 and 2002 for symptomatic recurrences of deep endometriosis, after ≥1 previous surgical procedures and ovarian suppressive medical treatments. After the operation, all of the patients were given transdermal estradiol. The minimum follow-up time was 24 months.
Twenty-six patients underwent standard extra-fascial hysterectomy (group A), and 12 patients underwent modified radical hysterectomy that included the removal of all deeply infiltrating endometriotic lesions (group B). The recurrence of pain caused by endometriosis occurred in 8 women (31%) of group A and in no patients of group B.
Definitive surgery for deep endometriosis should include the removal of the uterus, adnexa, and all surgically accessible deep lesions. As a consequence, the surgeon must be familiar with radical pelvic surgery.
To evaluate the results of a new laparoscopic technique for the creation of a neovagina in women with Rokitansky syndrome.
Open noncomparative clinical study.
Tertiary care center.
Fourteen patients ...with Rokitansky syndrome, aged 15 to 34years, desiring to have sexual relations.
The patients underwent creation of a neovagina at laparoscopy by a modification of Vecchietti’s technique.
At the clinical examinations performed during the follow up (ranging from 6 to 24months), the patients reported the frequency, satisfaction, and any difficulties found at intercourse. At each examination, the depth and diameter of the neovagina was determined. The characteristics of the neovaginal mucosa were investigated by vaginoscopy.
No intraoperative and postoperative complications were observed. The patients considered the discomfort caused by the Vecchietti’s device and the daily tractions acceptable. In all the patients the mucosa was pink, trophic, and moist 3months after the operation. Two fingers were introduced easily into the neovagina in all cases, and the mean length was 8.1±1.1cm. All but one patient defined their sexual intercourse as satisfying within 6months from the intervention.
In light of the results obtained in the present series, we consider that, because of its efficacy, rapidity, and safety, the laparoscopic surgical method used by us may be suggested as the treatment of choice to correct Rokitansky syndrome.
To evaluate how many women required the so-called "emergency contraception" at our outpatient service and what the actual role is of this kind of pharmacological administration in interfering with ...ovulation and pregnancy, paying particular attention to the ethical and medico-legal aspects of this subject.
During the period from 1 December 1998 to 30 November 2003, emergency contraception was prescribed to a total of 1,160 women. With regard to the contraceptives used, in most cases (1,132, 97.6%) a combined oral estrogen-progestogen pill (ethinyloestradiol 0.05 mg plus levonorgestrel 0.25 mg) was prescribed; in some cases (20 patients, 1.8%) danazol (400 mg), in four women (0.3%) a progestin-only pill (levonorgestrel 0.75 mg), and in four other women (0.3%) an intrauterine device.
It does not come out that there were any pregnancies in our study patients since none of them, who were told to come back for follow-up, were seen at our termination of pregnancy service or delivery room.
The "Yuzpe regimen" of a combined oral estrogen-progestogen pill has been the most commonly used method for emergency contraception. A new method recently proposed, a progestin-only pill with levonorgestrel 0.75 mg, is having better results than the previous one, with a lower incidence of side-effects and higher efficacy. Moreover, the treatment with this method does not interfere in case of a pregnancy already being carried and cannot interrupt it.
