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Ob-Gyn AND Prolapse, genital [keywords]
- Post void dribbling: incidence and risk factors. [Journal Article]
- Neurourol Urodyn 2010 Mar; 29(3):432-6.
The primary aim of this study was to determine the incidence of post void dribbling (PVD) in women being evaluated for pelvic floor dysfunction. The secondary aim was to identify other conditions present in women with symptoms of PVD.163 consecutive women with complaints of PVD who underwent urodynamic testing were studied. Testing was performed to evaluate women scheduled for surgery for incontinence, irritative bladder, urinary retention and pelvic organ prolapse. Subjects completed a medical history and voiding diary. A complete pelvic exam was performed. Patients were questioned regarding symptoms of PVD, stress incontinence, urge incontinence and insensible urine loss. Menopausal status, hormone replacement therapy status, age, body mass index, residual urine volume, genital hiatus length, and evidence of pelvic organ prolapse were recorded. Maximal urethral closure pressure, urethral length, pressure transmission ratio, and documentation of detrusor overactivity or urodynamic stress incontinence were determined by urodynamic testing.42% of patients had symptoms of PVD. The incidence of PVD decreased with age. In pre- and peri-menopausal women, there was an association between PVD and urge incontinence. In post-menopausal women, there was an association between age, body mass index, and genital hiatus length.There was a significant correlation between PVD and urge incontinence in pre-menopausal patients. The overall incidence and causes of PVD relative to age require further study. Body mass index and genital hiatus length may play an important role in PVD, especially in post-menopausal women.
- Advanced laparoscopic gynecologic surgery. [Comparative Study, Journal Article, Review]
- Surg Clin North Am 2000 Oct; 80(5):1443-64.
What is the future for laparoscopy? Any procedure thought to be impossible to perform by laparoscopy or procedures that, based on conventional wisdom, should not be done laparoscopically are being performed or developed as the reader peruses this article. Technical advances in the endoscopic equipment and development of laparoscopic instruments have allowed for performance of sophisticated procedures with laparoscopic assistance. Appropriate laparoscopic skills allow surgeons to perform these procedures in a fashion nearly identical to an open procedure; however, modifications of historically proven techniques are controversial regarding the expenses generated, equipment necessary to perform the procedure, training necessary, and potential for complications. Has the obituary of laparotomy been written? The benefits of laparoscopically assisted or performed procedures are continuing to be analyzed. LAVH has been touted as a way to reduce the number of abdominal hysterectomies while increasing the number of vaginal hysterectomies. Therefore, indications for LAVH would ideally more resemble indications for abdominal hysterectomy than vaginal hysterectomy; however, LAVH does not seem to have increased the total number of vaginal hysterectomies. Conversely, the number of abdominal hysterectomies seems to be roughly the same, whereas the number of vaginal hysterectomies has decreased and the number of LAVHs has increased. Therefore, surgeons seem to be substituting LAVH for vaginal hysterectomy. Studies comparing laparoscopic Burch procedures and open Burch procedures are just now being reported. Many early reports described procedures that are not classic Burch colposuspensions. These changes make it impossible to assume that overall success and rate of complications are the same. The same can be said for techniques for correction of pelvic organ prolapse. Although laparoscopic performance and laparoscopic assistance are increasing in popularity, most cases are not handled in this way. Clearly, not every surgeon has embraced using the laparoscope to treat patients who would otherwise have undergone abdominal or vaginal surgery.