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Uterine Prolapse [keywords]
- Long-term Clinical Outcomes Following Resectoscopic Endometrial Ablation of Non-Atypical Endometrial Hyperplasia in Women with Abnormal Uterine Bleeding. [JOURNAL ARTICLE]
- J Minim Invasive Gynecol 2014 Jul 15.
To determine the feasibility, efficacy, and long-term clinical outcomes of resectoscopic endometrial ablation as primary treatment of simple and complex endometrial hyperplasia without atypia in women with abnormal uterine bleeding.From January 1990 through December 2012, the senior author (GAV) performed 4 729 primary resectoscopic endometrial ablations to treat women with abnormal uterine bleeding. This group included 161 women with endometrial hyperplasia, identified either by office biopsy (n = 62) or incidentally during routine hysteroscopic endometrial ablation (n =99). Endometrial tissue by D&C and/or resected during resectoscopic surgery identified 6 women with atypical hyperplasia (4 complex, 2 simple) and 1 with adenosarcoma. One atypical complex hyperplasia and the adenosarcoma received hysterectomy. The remaining 159 women, including 5 with atypical hyperplasia (3 complex, 2 simple), received resectoscopic endometrial ablation (102 simple, 52 complex) as primary treatment. The median (range) age and BMI was 50 years (30-87) and 32 kg/m(2) (17-59), respectively. Comorbidities included, hypertension in 25, diabetes in 14, cerebrovascular disease in 3, cardiovascular disease in 7 and hypothyroidism in 8 women. Office biopsy was proliferative endometrium in 68, simple hyperplasia in 43, complex hyperplasia in 19 and inadequate in13 women. In 18 women, we were unable to perform biopsy due to cervical stenosis, morbid obesity or patient intolerance. Endometrium was resected in 120 women, electrocoagulated in 34 and combination in 5 women, using a 9 mm (26F) resectoscope, 1.5% glycine and 120 w of power. Patients were followed up annually. Three patients were lost to follow up and one died from unrelated cause 5 years after surgery.There was one uterine perforation requiring no additional treatment. Simple and complex endometrial hyperplasia was identified in 70 and 35 women after endometrial ablation, respectively. At a median follow up of 7 years (1.5-18), 12 patients had hysterectomy for; persistent bleeding-6, benign ovarian cyst-2, pelvic organ prolapse-1, chronic pelvic pain-2, fibroids-1. Uterine histopathology in 11 patients indicated no residual endometrial hyperplasia. We were unable to obtain pathology report in one. The remaining 138 women were very satisfied with their treatment with no further bleeding or pain in 132 (95.7%). Six patients (4.3%) had monthly spotting.Resectoscopic endometrial ablation is feasible, safe and effective treatment of simple and complex endometrial hyperplasia without atypia in women with abnormal uterine bleeding by experienced hysteroscopic surgeons.
- Vaginal hysterectomy: past, present, and future. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Jul 16.
Vaginal hysterectomy is the oldest and least invasive of the hysterectomy techniques and fulfills the evidence-based requirements as the preferred route of hysterectomy for benign gynecologic disease. Currently, vaginal hysterectomy is commonly utilized for treating uterine prolapse, but despite proven safety and effectiveness, the use of vaginal hysterectomy for treating non-prolapse conditions has been and remains underutilized in surgical practice. Improving the use of vaginal hysterectomy in the future will likely depend on addressing the key issues of training and maintaining skills in the technique and increasing awareness of the scientific evidence supporting its use.
- PLD.23 Management of transverse and unstable lie at term. [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A112-3.
To determine current practice and outcomes in women admitted to antenatal ward with diagnosis of transverse or unstable lie.Fetal lie (other than longitudinal) at term may predispose to prolapse of cord or fetal arm and uterine rupture. Local guidelines recommend admission at 37+0 (RCOG guidelines after 37+6 weeks) but give no specific recommendations regarding further management.A retrospective study was conducted at St Thomas' Hospital, London from 2009-2012 of all women admitted with unstable/transverse lie. The diagnosis was based on ultrasound examination. Women with placenta praevia and non-singleton deliveries were excluded.Study included 198 cases of unstable/transverse lie. 58% were admitted before 38 weeks. The average length of admission was 7 days (IQR 4-11). There were no cases of cord prolapse or need for an immediate caesarean section from the antenatal ward. 73% of women had a caesarean section at a median gestation of 39+1 weeks (IQR 38+4 - 40+2) although almost half of these (41%) had a cephalic presentation at the time of elective caesarean sections. None of these had an absolute indication for Caesarean section.The diagnosis of unstable/transverse lie leads to a prolonged inpatient stay and a high Caesarean section rate. From our study and the evidence from the available literature, we recommend delaying admission until at least 38 weeks and awaiting spontaneous version. Future research should focus on the safety of outpatient management with consideration of utilising techniques such as cervical length and fetal fibronectin.
- [Indications and methods of hysterectomy]. [English Abstract, Journal Article]
- Orv Hetil 2014 Jul 1; 155(29):1152-7.
Hysterectomy is one of the most frequently performed gynecological operations. The most common indications for hysterectomy are symptomatic uterine fibroids, endometriosis, and uterine and pelvic organ prolapse. The procedure can be performed by vaginally or abdominally and with laparoscopic assistance. Choosing the perfect method the gynecologist should take into consideration how the procedure can be performed most safely to fulfill the needs of the patient. In the last few years the number of the laparoscopic procedures has been increasing. Orv. Hetil., 2014, 155(29), 1152-1157.
- Uterine prolapse during late pregnancy in a nulliparous woman. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Jul 8.
A pregnancy that is complicated by a uterine prolapse is rare and primarily occurs in multiparous women during their first or second trimester. In the present report, we describe a case of a 31-year-old nulliparous woman who experienced sudden uterine prolapse at 38 weeks' gestation without labor pains. The cervix was congested, the cervical mucosa was partially lacerated, and bleeding was noted; the protruding cervix could not be repositioned into her vagina. Although the cervical congestion worsened over time, she still did not experience any labor pains. She was delivered by emergency cesarean section. Following delivery, the prolapse promptly improved and did not recur before her 1-month postpartum examination. To our knowledge, this is the first case where uterine prolapse occurred in a nulliparous woman during late gestation.
- Chronic pelvic pain in Spanish women: prevalence and associated risk factors. A cross-sectional study. [Journal Article]
- Clin Exp Obstet Gynecol 2014; 41(3):243-8.
To determine the prevalence of chronic pelvic pain (CPP) symptoms and associated risk factors in Spanish women.A cross-sectional study.in Malaga and its province in Spain.women aged 18-65 years using non-probability sampling by quotas (n = 940), stratified by age and county.All the participants completed the CPPQ-Mohedo, a self-administered validated questionnaire able to discriminate between patients with and without CPP.Taking a CPPQ-Mohedo score of > or = 6 as an indication of CPP symptoms, the prevalence of CPP symptoms was 26.8% in the general population in women aged 18-65 years. After adjustment for age, those women who exercised had a lower CPPQ-Mohedo score than those who did not exercise (mean difference -3.02 +/- 4.27). Higher (worse) scores were associated with the following factors: lifting and/or moving heavy loads during activities of daily living (3.57 +/- 4.51), laxatives and/or a high-fiber diet (4.71 +/- 5.07), history of recurrent urogenital infection (vulvovaginitis, cystitis; 4.40 +/- 5.22), pelvic trauma (4.77 +/- 4.55), irritable bowel (5.10 +/- 5.50), anal fissure (7.46 +/- 6.50) or uterine prolapse (13.66 +/- 2.36).The prevalence of CPP symptoms in Spanish women is high and is associated with risk factors that should be addressed by multidisciplinary preventive, diagnostic, and therapeutic strategies. More prevalence studies are needed to determine the true situation concerning chronic pelvic pain in Spain.
- Does Bilateral Sacrospinous Fixation With Synthetic Mesh Recreate Nulliparous Pelvic Anatomy? An MRI Evaluation. [JOURNAL ARTICLE]
- Female Pelvic Med Reconstr Surg 2014 July/August; 20(4):222-227.
The aim of this study was to determine whether the bilateral sacrospinous vault fixation (BSSVF) with synthetic, polypropylene mesh arms restores the nulliparous anatomic relationships of the vaginal vault in women with and without uterus using magnetic resonance imaging (MRI).This was a prospective case series of women with symptomatic pelvic organ prolapse (POP) who, after BSSVF, underwent a pelvic MRI (1-13 months postoperatively). Postsurgical pelvic distances were measured from MRI scans and compared with measurements from a group of 11 nulliparous women with adequate pelvic support who underwent MRI in a previous study. Our primary outcome measure was the difference in average distance from the vault to the ischial spine among women after BSSVF when compared with the average nulliparous distances. The secondary outcome measures were the difference in average distance from the posterior fornix to the sacrum and the change in apical POP quantification parameters 6 weeks after surgery.Ten women underwent MRI post-BSSVF-4 women with and 6 women without uterine preservation. In the BSSVF group, similar to the nulliparous group measurements, the average distance between the vaginal apex and the spine was 5.2 cm (SD, 0.8) (95% confidence interval, -0.6 to 0.5; P = 0.92). There was an anterior-inferior displacement of the line between the vaginal apex and the sacrum in women who underwent BSSVF. The posterior fornix was 7.4 cm (SD, 1.2) from the second sacral vertebra versus 5.6 cm (SD, 1.5) in women without POP (P < 0.01). Adequate clinical resolution of apical prolapse was confirmed in all women 6 weeks post-BSSVF.The BSSVF with synthetic mesh restores the anatomy between the vagina and the ischial spines. Clinical studies are underway to compare BSSVF with standard techniques of vaginal vault prolapse repair.
- Laparoscopic versus vaginal hysterectomy for benign indications in women aged 65 years or older: propensity-matched analysis. [JOURNAL ARTICLE]
- Menopause 2014 Jun 23.
The present study aimed to evaluate surgical operation-related outcomes of laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) for the treatment of benign uterine diseases, other than pelvic organ prolapse, in women aged 65 years or older.Data of women who underwent LH and VH between 2000 and 2013 were compared using propensity-matched analysis. Postoperative complications were graded according to the Accordion Severity Grading. Martin criteria were applied to improve the quality of complications reporting.The study group included 40 propensity-matched participant pairs (80 women) who underwent VH and LH. No significant differences in baseline characteristics were observed between groups. A trend toward longer median operative time was observed in the LH group, in comparison with the VH group (75 [range, 20-340] vs 60 [range, 30-140] min; P = 0.09), whereas LH correlated with shorter hospital stay and lower blood loss in comparison with VH (P < 0.05). One intraoperative complication occurred during VH (bladder injury); no intraoperative complications were recorded in the LH group. No differences in Accordion grade 2 (or worse) postoperative complications were observed (1 of 40 [2.5%] in the LH group vs 3 of 40 [7.5%] in the VH group; P = 0.61; odds ratio, 3.1; 95% CI, 0.3-31.8), and no postoperative deaths occurred.Our findings suggest the noninferiority of LH to VH. LH improves the postoperative course of older women undergoing surgical operation for benign uterine diseases. If an appropriate indication exists, LH should not be denied based on mere chronological age.
- Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: A pilot study. [JOURNAL ARTICLE]
- Neurourol Urodyn 2014 Jun 29.
The primary outcome was to evaluate the subjective success rates of two laparoscopic POP operation techniques: uterine-sparing surgery versus a subtotal hysterectomy plus cervicopexy.Prospective cohort of 45 women with symptomatic POP recruited between January and December 2010 who self-selected surgery group: group A (n = 15), sacral laparoscopic hysteropexy was performed and group B (n = 30), laparoscopically conducted subtotal hysterectomy plus cervicopexy. All patients had a positive answer in the "Epidemiology of prolapse and incontinence" questionnaire (EPIQ, question number 35) and also had a POPQ ≥2nd degree. The primary outcome was the subjective success rate, measured by a negative answer to the Q35 of EPIQ: "Do you have a sensation that there is bulge in vagina or that something is falling out from your vagina" and also by rating their symptoms improvement by the "Patient Global Impression of Improvement". The secondary outcome was the objective success rate assessed by pelvic examination: cure was considered when POPQ <2nd degree in all vaginal compartments at 6 and 12 months.Baseline demographic characteristics were similar between groups. Subjective success rate was significantly superior in group B both after 6 and 12 months (P = 0.001). Similarly, objective pelvic examination led to a significantly higher rate of successful apical outcome in group B after 6 and 12 months (P = 0.009 and P = 0.002, respectively). Neither major complications nor vaginal mesh erosions were registered.The overall success rate was significantly higher in the laparoscopic subtotal hysterectomy plus cervicopexy group, compared with the laparoscopic sacral hysteropexy group. Neurourol. Urodynam. © 2014 Wiley Periodicals, Inc.