Abstract Background Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life. Objectives To identify factors that lead to the ...occurrence of severe perineal lacerations. Search strategy We searched MEDLINE, Scopus, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Google Scholar and reference lists from all included studies. Selection criteria We included prospective and retrospective observational studies. Data collection and analysis Predetermined data were collected and analyzed with the Mantel–Haenszel fixed-effects model or the DerSimonian–Laird random-effects model. Main results The meta-analysis included 22 studies (n = 651 934). Women with severe perineal tears were more likely to have had heavier infants (mean difference 192.88 g 95% CI, 139.80–245.96 g), an episiotomy (OR 3.82 95% CI, 1.96–7.42), or an operative vaginal delivery (OR 5.10 95% CI, 3.33–7.83). Epidural anesthesia (OR 1.95 95% CI, 1.63–2.32), labor induction (OR 1.08 95% CI, 1.02–1.14), and labor augmentation (OR 1.95 95% CI, 1.56–2.44) were also more common among women with perineal lacerations. Conclusions Various factors contribute to the occurrence of perineal lacerations. Future studies should consistently evaluate all examined parameters to determine their possible interrelation.
Background: The first modern cystoscope was developed with the invention of rod lens and optical fibers in the 1960s. Since then, many advances have been made in functionality and camera image ...analysis. The cost of purchasing equipment and volume of the endoscopic tower remains a challenge and a barrier to the spread of cystoscopy. Urinary tract injury is a significant complication in women undergoing gynecologic surgery. Selective intraoperative cystoscopy at laparoscopic hysterectomy or complex pelvic surgery is valuable for recognizing lower urinary tract injuries. We have developed a novel wireless cystoscope for performing diagnostic and operative cystoscopy. Methods: The new wireless cystoscopic setup consists of a rigid cystoscope 4 mm, 30° that joins a modified action camera to a c-mount adapter f 18-35 mm and a portable led light source. Results: The new setup has so far been effectively used in more than 50 diagnostic cystoscopies and pigtail catheter replacements without complications. Two cases performed with the new setup are presented in the video. Conclusions: The new cystoscopic setup has the advantage of a wireless video camera, 4K ultraHD, and is easy setup. Due to its low cost and portability, the wireless cystoscope is easy to obtain and use. Also, it is invaluable and ergonomic in managing the integrity or pathology of the bladder, urethra, and ureters.
Introduction and hypothesis
In this video we present the surgical management of a 58-year-old woman presenting with a large prolapsed myomatous uterus treated with vaginal hysterectomy (VH) and ...pelvic floor repair (PFR) (uterosacral ligament suspension and posterior colporraphy) under local anesthesia and conscious sedation.
Methods
The patient underwent VH and PFR by using an infiltration of a local anesthetic solution of lidocaine, ropivacaine and adrenaline in combination with intravenous (iv) conscious sedation. Debulking techniques, such as intramyometrial coring, uterine bisection, myomectomy and wedge resection, were used to facilitate VH. The final weight of the removed uterus was 870 g.
Results
This video demonstrates that performing a surgically challenging VH under local anesthesia is feasible.
Conclusions
Vaginal uterine morcellation can be performed to debulk the enlarged uterus so that hysterectomy can be accomplished under local anesthesia. The use of local anesthesia may safely be offered as an alternative to patients undergoing a complex vaginal hysterectomy and reconstructive surgery.
Aim of the video
In this video we present the surgical management of a 59-year-old woman with stress urinary incontinece (SUI) and pelvic organ prolapse (POP) who had a history of rheumatoid ...arthritis and endometrial hyperplasia with atypia.
Methods
A concomitant laparoscopic hysterectomy with bilateral oophorectomy and a multi-compartment laparoscopic native tissue repair of the POP, combined with a Burch urethropexy, was performed to restore pelvic floor defects and treat the underlying endometrial pathology.
Conclusion
Total laparoscopic multi-compartment repair of POP and/or SUI using native tissue appears to be a viable alternative to both laparoscopic procedures using synthetic meshes and vaginal native tissue repairs. Although not a routine option for the majority of patients with POP and SUI, this procedure may be offered in selected cases, where native tissue repair of the pelvic floor is preferred.
Endometriosis is a benign, estrogen-dependent gynecological condition with an uncertain exact pathogenetic mechanism. The aim of this study was to evaluate the potential differential expression of ...Insulin Growth Factor 1 (IGF-1) isoforms in deeply infiltrating endometriotic (DIE) lesions, in ovarian endometriomas, and in the eutopic endometrium of the same endometriosis patients and to compare their expression with that in the eutopic endometrium of women without endometriosis. A total of 39 patients were included: 28 with endometriosis, of whom 15 had endometriomas only, 7 had DIE nodules only, and 6 had both DIE and endometriomas, and 11 without endometriosis served as controls. We noticed a similar pattern of expression between IGF-1Ea and IGF-1Ec, which differed from that of the IGF-1Eb isoform, possibly implying differential biological actions of different isoforms in DIE subtypes. We observed a tendency of lower expression of IGF-1Ea and IGF-1Ec in endometriomas without DIE compared to endometriomas with concurrent DIE or in DIE nodules. In conclusion, differential expression of IGF-1 isoforms may indicate that DIE with its associated ovarian lesions and simple ovarian endometriosis should be considered as two forms of the disease developing under different molecular pathways.
Introduction and hypothesis
Surgical outcomes of elderly women who have been treated using midurethral slings could be influenced by confounding factors, such as age-related comorbidities. Aim of ...this study is to assess elderly patients (>75 years) who underwent a transobturator sling procedure with a follow-up of at least 13 years.
Methods
This is a prospective follow-up observational study including elderly women of current age ≥ 75 years old who underwent TVT-O placement at least 13 years prior to the study period. Main outcome measures were the objective and subjective cure rates at the follow-up visit. Secondary outcome measures included: patient-reported success rate, de novo urgency symptoms rate, evaluation of other subjective parameters related to the lower urinary tract function, and assessment of the health-related quality of life.
Results
Seventy-two out of 85 women (84.7%) meeting the inclusion and exclusion criteria were assessed at the follow-up visit. The mean follow-up period was 13.7 years (SD = 0.8). The overall objective and subjective cure rates were 80.5% (58 out of 72) and 84.7% (61 out of 72) respectively, whereas 9.7% of the patients (7 out of 72) reported being subjectively improved. The patient-reported success rate was 91.7% (66 out of 72). De novo urgency rate was 23.7% (9 out of 38), whereas 26.5% of the patients (9 out of 34) reported aggravation of preexisting urgency.
Conclusions
In women of advanced age, the TVT-O procedure is a highly effective and long-lasting treatment. The safety profile of the TVT-O was not influenced by geriatric conditions, whereas the long-term presence of a polypropylene sling did not appear to trigger the onset of medical disorders.
Radical excision of a complicated transobturator tape Grigoriadis, Themos; Zacharakis, Dimitrios; Kontogeorgakos, Vasileios ...
International Urogynecology Journal,
04/2020, Letnik:
31, Številka:
4
Journal Article
Recenzirano
Aim of the video
In this video, we present the case of a late-detected sinus formation 4 years after a TOT placement.
Method
A combined surgical approach (transvaginal and transcutaneous routes) ...performed by a urogynecologist and an orthopaedic surgeon was chosen to carry out a radical en bloc excision of the sinus tract with the right half of the tape. This combined approach has the advantage of completely removing the biofilm adhered to the surface of the tape and the surrounding tissues, thus making antibiotic therapy more effective.
Conclusion
Surgical removal of these microbial commmunities is very important for the resolution of device-related infections. Severe infectious complications of transobturator slings should be managed by a tertiary multidisciplinary team to optimize patient care.
Tubal endometriosis (EM) refers to the detection of ectopic endometrial implants on tubes. It may cause a significant defect of the tubes, translating into dysmenorrhea, pelvic pain, and infertility. ...We aimed to evaluate the disease characteristics, prevalence, histopathological findings and genetic profile of patients with tubal EM. A thorough search of three electronic databases was performed for studies that presented outcomes of patients with tubal EM. Thirteen studies (four observational, seven case reports, two genetic) were considered eligible for inclusion. The prevalence of tubal EM ranged from 6.9% to 69%. The predominant symptoms for referral of patients were infertility and abdominal pain. Women of reproductive age underwent salpingectomy for the management of the disease. Only one case of malignant transformation was recorded in a 60-year-old patient. The prevalence of tubal EM ranges depending on the indication for surgery, the presence of concomitant pelvic EM and the type of diagnosis and treatment. Further, more extensive, larger studies are warranted to evaluate the impact of tubal EM in the progression and prognosis of EM, the effect of salpingectomy in the improvement of disease-related symptoms and to designate the group of patients that could benefit from risk-reducing salpingectomy based on the risk of developing ovarian malignancy.
We describe a rare case of a pedunculated myoma receiving multiple de‐novo developed parasitic collateral blood supply from the adjacent organs. The main feeding vessels arise from the omentum and ...the bladder.
Primary parasitic blood supply on myomas is a rare pathological entity that make laparoscopic myomectomy a demanding operation.
We describe a useful technique, in laparoscopic cystectomy in‐a‐bag, for suspension and stabilization of endobag and adnexa using temporary sutures. It intends to create an isolated field to avoid ...spillage of the cyst content into the abdomen in case of rupture, thereby allowing the safe laparoscopic removal of ovarian masses.
This simple technique permits simultaneous suspension and stabilization of endobag and adnexa, facilitating the surgeon's work and making the operation safer for the patient.
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