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Uterine Prolapse [keywords]
- Döderlein-Krönig vaginal hysterectomy: an alternative to the traditional Heaney hysterectomy. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Dec 13.
The aim of this study was to demonstrate the surgical steps of performing the Döderlein-Krönig hysterectomy.A video recording was made of the hysterectomy using an alternative technique described by Drs. Döderlein and Krönig in 1906. The patient in the video had stage 3 prolapse and desired surgical correction. The video demonstrates an exam under anesthesia, an anterior colpotomy, delivery of the uterine fundus through the colpotomy, and completion of the hysterectomy. The surgery was performed by a urogynecologist and a resident physician. The patient tolerated the procedure well and had no symptom recurrence at her 1-year follow-up visit. This video was presented at the 2014 International Urogynecological Association Annual Meeting in Washington, DC, as a nondiscussed video poster.This video can assist and educate others in using this technique for performing a hysterectomy. Possible benefits of this approach include decreased blood loss and improved visualization, especially in women with pelvic organ prolapse.
- Routes of hysterectomy in women with benign uterine disease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis. [Journal Article]
- CMAJ Open 2014 Oct; 2(4):E273-80.
Minimally invasive hysterectomies performed vaginally or laparoscopically are associated with decreased perioperative morbidity. We examined temporal trends and patient and hospital factors associated with the routes of hysterectomy used in the Vancouver Coastal Health and Providence Health Care regions in British Columbia.We performed a retrospective cohort study of all women who had an elective hysterectomy for a benign indication between 2007 and 2011 in 8 hospitals in the region. Logistic regression modeling with mixed effects was used to estimate adjusted odds ratios and 95% confidence intervals for patient and hospital characteristics associated with the route of hysterectomy.The study involved 4372 women who underwent abdominal (52.3%), vaginal (25.5%) or laparoscopic (22.3%) hysterectomy. From 2007 to 2011, the number of abdominal hysterectomies performed decreased from 58.4% to 47.7%, the number of vaginal hysterectomies performed decreased from 27.5% to 21.1% and the number of laparoscopic hysterectomies performed increased from 14.2% to 31.2% (p < 0.001 for all trends). Patient factors associated with laparoscopic versus abdominal hysterectomy included young age, pain or prolapse indication, absence of fibroid indication, absence of concurrent gynecologic procedure, rural residence and lower socioeconomic status. Patient factors associated with vaginal hysterectomy included older age, prolapse indication and concurrent procedure for prolapse. Hospital location and size were not significantly associated with vaginal hysterectomy, but urban hospital location was associated with laparoscopic hysterectomy.The proportion of minimally invasive hysterectomies is increasing and represents approximately half of all hysterectomies performed in the Vancouver Coastal Health and Providence Health Care regions. Vaginal hysterectomies are associated with patient characteristics, whereas laparoscopic hysterectomies are associated with patient and hospital characteristics.
- Modified cervicopexy: a novel, less-invasive technique for Stages III and IV uterine prolapse. [Journal Article]
- Eur J Obstet Gynecol Reprod Biol 2014 Dec.:159-63.
To evaluate modified anterior abdominal wall cervicopexy (AWC) as a less invasive (via 3-cm minilaparotomy) and more augmented (via securing posterior vaginal wall to uterosacral ligaments) technique.Case series of 30 women with Stages III and IV apical uterine prolapse assessed by the pelvic organ prolapse quantification system.The modified AWC procedure was performed successfully for 17 cases with Stage III uterovaginal prolapse and 13 cases with Stage IV uterovaginal prolapse. The procedure was conducted safely with no operative or postoperative complications, apart from two cases with postoperative urinary retention. Operative time ranged from 45 to 70min. Follow-up was available for 1-3 years. Overall, 27 cases were satisfied with the procedure, and three cases developed recurrence after caesarean section due to cutting the supporting sutures.The modified AWC procedure is less invasive, simple and effective for Stages III and IV uterine prolapse.
- Anatomic outcomes after pelvic-organ-prolapse surgery-comparing uterine preservation with hysterectomy. [Journal Article]
- Eur J Obstet Gynecol Reprod Biol 2014 Dec.:33-6.
Pelvic organ prolapse (POP) is of growing importance to gynecologists, as the estimated lifetime risk of surgical interventions due to prolapse or incontinence amounts to 11-19%. Conflicting data exist regarding the effectiveness of POP surgery with and without uterine preservation. We aimed to compare anatomic outcomes in patients with and without hysterectomy at the time of POP-surgery and identify independent risk factors for symptomatic recurrent prolapses.In this single-centre retrospective analysis we analyzed 96 patients after primary surgical treatment for POP. These patients were followed up with clinical and vaginal examination six months postoperatively. For comparison of the groups, the chi-squares test were used for categorical data and the u-test for metric data. A logistic regression model was calculated to identify independent risk factors for recurrent prolapse.Of 96 patients, 21 underwent uterus preserving surgery (UP), 75 vaginal hysterectomy (HE). Median operating time was significantly shorter in the UP group (55 vs. 90min; p=0.000). There was no significant difference concerning postoperative urinary incontinence or asymptomatic relapse (p>0.05), whereas symptomatic recurrent prolapses were significantly more common in the UP group (23.8% vs. 6.7%; p=0.023). However, in multivariate analysis, only vaginal parity and sacrospinous ligament fixation were identified as independent risk factors for recurrent prolapse after POP surgery.Uterus-preservation at time of POP-surgery is a safe and effective alternative for women who wish to preserve their uterus but is associated with more recurrent symptomatic prolapses.
- Insights into potential pathogenesis mechanisms associated with Campylobacter jejuni -induced abortion in ewes. [JOURNAL ARTICLE]
- BMC Vet Res 2014 Nov 25; 10(1):274.
Background Campylobacter jejuni is commonly found in the gastrointestinal tract of many food-animals including sheep without causing visible clinical symptoms of disease. However, C. jejuni has been implicated in ovine abortion cases worldwide. Specifically, in the USA, the C. jejuni sheep abortion (SA) clone has been increasingly associated with sheep abortion. In vivo studies in sheep (the natural host) are needed to better characterize the virulence potential and pathogenesis of this clone.ResultsPregnant ewes intravenously (IV) or orally inoculated with ovine and bovine abortion-associated C. jejuni SA clones exhibited partial or complete uterine prolapse with retained placenta, and abortion or stillbirth, whereas delivery of healthy lambs occurred in pregnant ewes inoculated with C. jejuni 81¿176 or in the uninfected group. In sheep inoculated with the SA clone, histopathological lesions including suppurative necrotizing placentitis and/or endometritis coincided with: 1) increased apoptotic death of trophoblasts, 2) increased expression of the host genes (e.g. genes encoding interleukin IL-6 and IL-15) related to cellular necrosis and pro-inflammatory responses in uterus, and 3) decreased expression of the genes encoding [GATA binding protein 6, chordin, and insulin-like 3 (INSL3)] that account for embryonic development in uterus. Immunohistochemistry revealed localization of bacterial antigens in trophoblasts lining the chorioallantoic membrane of ewes inoculated with the C. jejuni SA clone.ConclusionsThe results showed that C. jejuni SA clones are capable of causing abortion or stillbirth in experimentally infected sheep. Furthermore, down- or up-regulation of specific genes in the uterus of infected pregnant ewes might implicate host genes in facilitating the disease progression. Since the C. jejuni SA strains share genotypic similarities with clones that have been isolated from human clinical cases of gastroenteritis, these strains might represent a potential public health risk.
- Is Sacrocolpopexy Adequate for Cervico-uterine Prolapse in Patients with Classical Bladder Exstrophy? [Journal Article]
- J Obstet Gynaecol India 2014 Dec; 64(Suppl 1):83-4.
- A multicenter, prospective trial to evaluate mesh-augmented sacrospinous hysteropexy for uterovaginal prolapse. [JOURNAL ARTICLE]
- Int Urogynecol J 2014 Nov 14.
Hysterectomy is often part of pelvic organ prolapse repair. However, this may offer no benefit when compared to uterine preservation. We aimed to prospectively evaluate a minimally invasive bilateral sacrospinous hysteropexy using polypropylene mesh. We hypothesized that anatomic success and patient satisfaction can be achieved with this technique.Women with uterovaginal prolapse desiring surgery who had completed childbearing were enrolled. Preoperative assessment included standardized prolapse examination and validated symptom and pain scale questionnaires. Women with prior pelvic organ prolapse repair or any contraindication to uterine preservation were excluded. Data including demographic, operative and postoperative information was collected on patients for 1 year following surgery. Continuous variables are summarized as means (standard deviation) and categorical variables are summarized as frequencies and percentages. A mixed-effects model was used to evaluate the changes in questionnaire scores and outcomes at 6 months and 12 months after surgery with random effects accounting for the center effect with adjustment for age.The study group comprised 99 women from three female pelvic medicine and reconstructive surgery (urogynecology) centers. The average age of the participants was 67.0 years (11.32 years), BMI 26.04 kg/m(2) (3.56 kg/m(2)), and the majority were multiparous (98.9 %) and menopausal (90.9 %). Overall success at 12 months, as measured by composite outcome was 97.7 % (with the Ba point as the anatomic landmark) and 96.6 % (with the C point as the anatomic landmark). The overall exposure rate was 6.52 % and reoperation rate was 7.53 %. All subjective questionnaire scores and anatomic outcomes had improved at 12 months.Sacrospinous hysteropexy using a minimally invasive polypropylene mesh kit is an effective and safe technique for addressing uterovaginal prolapse as an alternative to hysterectomy at the time of pelvic reconstructive surgery.
- Trends in bilateral salpingo-oophorectomy among Taiwanese women undergoing benign hysterectomy: a population-based, pooled, cross-sectional study. [JOURNAL ARTICLE]
- Menopause 2014 Nov 10.
This study aims to examine recent trends in the performance of elective bilateral salpingo-oophorectomy at benign hysterectomy and to identify associated patient and provider-related characteristics from 2000 to 2010.We conducted a population-based, pooled, cross-sectional study using claims data from Taiwan's National Health Insurance program. Women aged 20 years or older who underwent concurrent oophorectomy at benign hysterectomy (n = 26,419) were compared with women who did not undergo concurrent oophorectomy at benign hysterectomy (n = 153,793). A generalized estimating equation model was applied to logistic regressions, and separate models were estimated to account for age interactions.The overall oophorectomy rate declined steadily from 22.1% in 2000 to 9.9% in 2010, particularly in women aged 45 to 49 years (decreased by 80%). Women aged 55 years or older who had a comorbid illness or a catastrophic illness, underwent abdominal or laparoscopic surgical operation, and were admitted to regional hospitals or medical centers were more likely to undergo oophorectomy at hysterectomy, whereas women with a preoperative diagnosis of uterine prolapse, with a well-defined monthly wage, and undergoing vaginal hysterectomy were less likely to undergo oophorectomy.Age, socioeconomic status, presence of comorbid illness, hysterectomy approach, hospital accreditation level, and disease diagnosis influence oophorectomy rate in Taiwan, a country with national health insurance. Studies on the possible long-term health risks of elective oophorectomy and the emergence of increasing evidence on ovarian cancers of serous histology (such as tubal carcinoma) since the early 2000s may have influenced patients' and physicians' decision-making in favor of ovarian conservation, leading to the observed downward trend among Taiwanese women from 2000 to 2010.
- A case of vaginal cancer with uterine prolapse. [Journal Article]
- J Menopausal Med 2013 Dec; 19(3):139-42.
Primary vaginal cancer combined with uterine prolapse is very rare. We present a case of 80-year-old postmenopausal women complaints of something coming out per vagina for the past 20 years, along with blood stained discharge, foul odor leukorrhea, and severe pelvic pain for the last 3 months. A 4 × 5 cm ulcer was present on middle third of vaginal wall with marked edema and ulceration of surrounding tissue. The prolapse was reduced under intravenous sedation in operating room. On gynecologic examination, uterus was normal in size, no adnexal mass was examined, and both parametrium were thickened. Papanicolaou smear was normal. Biopsy of the ulcer at vaginal wall revealed invasive squamous cell carcinoma of vagina. Magnetic Resonance Imaging of abdomen and pelvis showed left hydronephrosis and liver metastasis. Positron emission tomography (PET)/computed tomography (CT) revealed metastasis to lung, liver and iliac bone. She died from progression of disease one month after diagnosis.
- The status of the pelvic floor in young primiparous women. [JOURNAL ARTICLE]
- Ultrasound Obstet Gynecol 2014 Oct 31.
To investigate the postnatal prevalence of sonographically diagnosed pelvic floor trauma, and the correlations with various antenatal/intrapartum predictors in primiparous women.A prospective cohort study, performed in a tertiary hospital with 9000 deliveries per annum. 202(23.2% of those recruited) primiparous participants were clinically assessed at least one year postnatally, with Pelvic Organ Prolapse Quantification (POPQ), 2/3D-transperineal ultrasound (TpUS) and collagen type III levels quantification.Clinically significant POP had a high prevalence on POPQ staging: uterine prolapse-63%, cystocele-42%, rectocele-23%. Ballooning of the levator ani muscle (LAM) hiatus was detected in 33.2% and LAM avulsion in 29% of participants, with partial LAM avulsion in 15% and complete in 14%. Postnatal POP symptoms were positively associated with similar prepregnancy symptoms (OR [95% CI]) (OR 7.2 [1.19-44.33]), LAM avulsion (OR 4.8 [1.99-11.34]), forceps delivery (OR 1.8 [0.96-3.25]) and negatively associated with Caesarean Section (CS) (OR-0.2 [0.09-0.63]). LAM abnormality was associated with forceps delivery (OR 4.9 [1.44-16.97]) and prolapse (OR between 6.8 and 11.7 [2.34-78.51]), where as collagen levels did not play a role 1.007 [0.99-1.02].Clinically significant POP was common in relatively young premenopausal primiparae. A partial or full levator avulsion was seen in 29% of participants, being associated with POP and symptoms related to it. Congenital factors seem to play little role in the etiology of levator muscle trauma, whereas the main risk factor seems to be forceps delivery. Avoidance of difficult vaginal deliveries may prevent severe pelvic floor trauma.