- A rare complication of long-term vaginal prolapse. [Case Reports]
- CGCeska Gynekol Fall 2018; 83(4):271-275
- CONCLUSIONS: Bladder stones are a rare complication of otherwise relatively frequent complete urogenital prolaps in women. Major causes include micturition disorder and chronic urinary tract infection which is caused by vaginal and uterus descensus.
- Laparoscopic management of severe ureteral obstruction after vaginal hysterectomy and colposuspension. [Case Reports]
- IUInt Urogynecol J 2018; 29(10):1557-1558
- CONCLUSIONS: Laparoscopy can be a wise alternative option to manage ureteral obstruction secondary to vaginal colposuspension for genital organ prolapse.
- Constant existence of the sensory branch of the nerve to the pyramidalis distributing to the upper margin of the pubic ramus. [Journal Article]
- ASAnat Sci Int 2018; 93(4):405-413
- Twenty-one sides of 11 adult Japanese cadavers were investigated, and 2 of 21 sides exhibited absence of the pyramidalis. We observed that all of the nerves to the pyramidalis included the sensory ne…
Twenty-one sides of 11 adult Japanese cadavers were investigated, and 2 of 21 sides exhibited absence of the pyramidalis. We observed that all of the nerves to the pyramidalis included the sensory nerve branch, which distributed to the aponeurotic tissue in the upper area of the pubic ramus. To investigate the clinical relevance and developmental process of the pyramidalis, detailed innervation patterns of the pyramidalis and the lumber plexus were examined and compared with the case of absent pyramidalis. The nerves to the pyramidalis could be classified into five types by the derivative nerves and two subtypes by their courses associated with the funiculus spermaticus. In the cases of absent pyramidalis, similar sensory branches distributed close to the upper area of the pubic ramus. We deduced that the sensory branch extended along with the muscular branch to the pyramidalis after development of the pyramidalis and that only the sensory branch remained in cases in which the pyramidalis disappeared. The two subtypes might associate with descensus testis. Surgeons performing inguinal hernia repair using a mesh and tension-free surgical technique should preserve the nerves around the funiculus spermaticus to avoid diminished proprioception in the lower abdominal wall.
- [Implants for genital prolapse : Pro mesh surgery]. [Review]
- UUrologe A 2017; 56(12):1576-1582
- There has been an overall increase in pelvic organ prolapse due to demographic changes (increased life expectancy). Increasing sociocultural demands of women require treatments that are more effectiv…
There has been an overall increase in pelvic organ prolapse due to demographic changes (increased life expectancy). Increasing sociocultural demands of women require treatments that are more effective with methods that are more successful. In the treatment of pelvic floor insufficiency and uterovaginal prolapse, pelvic floor reconstructions with mesh implants have proven to be superior to conventional methods such as the classic colporrhaphy, reconstructions with biomaterial, and native tissue repair in appropriately selected patients and when applying exact operation techniques, especially because of good long-term results and low recurrence rates. When making a systematic therapy plan, one should adhere to certain steps, for example, a pelvic floor reconstruction should be undertaken before performing the corrective procedure for incontinence. The approach, if vaginal, laparoscopic, or abdominal should be chosen wisely, taking into consideration the required space of action, in such a way that none or only minimal collateral damage related to the operation occurs. The use of instrumental suturing techniques and operation robots are advantageous in the case of difficult approaches and limited anatomical spaces. In principle, the surgeon who implants meshes should be able to explant them! The surgical concept of mesh-related interventions in the pelvis must meet established rules. "Implant as little mesh as possible and only as much suitable (!) mesh as absolutely necessary!" In the case of apical direct fixations, a therapeutically relevant target variable is the elevation angle of vagina (EAV). Established anatomical fixation points are preferable. A safe distance between implants and vulnerable tissue is to be maintained. Mesh-based prolapse repairs are indicated in recurrences, in primary situations, in combined defects of the anterior compartment, in central defects of multimorbid and elderly patients, and above all, when organ preservation is wanted. Native connective tissue structures are to be preserved, strengthened and reconstructed to restore altered functions. Practical skills for highly specialized mesh-based operations as well as effective techniques for complication management should be taught in interdisciplinary specialist courses.
- Vaginal cystocele repair and hysteropexy in women with anterior and central compartment prolapse: efficacy and safety after 30 months of follow-up. [Journal Article]
- IUInt Urogynecol J 2018; 29(6):831-836
- CONCLUSIONS: Vaginal repair and hysteropexy appear to be an effective and safe option for women with advanced uterovaginal prolapse.
- Mini access guide to simplify calyceal access during percutaneous nephrolithotomy: A novel device. [Journal Article]
- IJIndian J Urol 2017 Oct-Dec; 33(4):319-322
- CONCLUSIONS: The MAG is a simple, portable, cheap, and novel assistant to achieve successful PCNL puncture. It would be of great help for novices to establish access during their learning phase of PCNL. It would also be an asset toward significantly decreasing the radiation dose during PCNL access.
- Pregnancy outcomes after transvaginal sacrospinous hysteropexy. [Journal Article]
- EJEur J Obstet Gynecol Reprod Biol 2017; 216:204-207
- CONCLUSIONS: Transvaginal sacrospinous hysteropexy is an appropriate surgical treatment method for symptomatic uterovaginal descensus in women who wish to preserve their uterine and future childbearing. And cesarean section is a reliable and satisfactory delivery route for women who underwent transvaginal sacrospinous hysteropexy.
- Use of a Boari flap and renal descensus as treatment for proximal ureteral rupture in a cat. [Case Reports]
- JAJ Am Vet Med Assoc 2016 Aug 15; 249(4):406-10
- CASE DESCRIPTION A 6-year-old neutered male domestic shorthair cat was evaluated because of signs of abdominal pain and anuria of 12 hours' duration after vehicular trauma. CLINICAL FINDINGS Letharg…
CASE DESCRIPTION A 6-year-old neutered male domestic shorthair cat was evaluated because of signs of abdominal pain and anuria of 12 hours' duration after vehicular trauma. CLINICAL FINDINGS Lethargy, mydriasis, bradycardia, abdominal distension, and signs of pain on abdominal palpation were observed. Abdominal ultrasonography revealed moderate urinary bladder distension without evidence of free abdominal fluid; hematologic evaluation revealed leukocytosis with high BUN and serum creatinine concentrations. TREATMENT AND OUTCOME The patient was hospitalized, medical stabilization was attempted, and an indwelling urinary catheter was placed. Urinary output was < 1 mL/kg/h (< 0.45 mL/lb/h), and signs of abdominal pain persisted despite treatment. The next day, ultrasonographic examination revealed fluid in the retroperitoneal space, and ureteral rupture was suspected. Exploratory laparotomy confirmed retroperitoneal fluid accumulation; a large hematoma surrounded the right kidney and perirenal structures. An abdominal drain was placed to aid patient stabilization. Three days later, IV pyelography revealed rupture of the proximal part of the right ureter. Ureteroneocystostomy was performed with elongated cystoplasty through a Boari flap and caudal transposition of the right kidney (renal descensus). On follow-up examination 18 months after treatment, the cat was free of clinical signs, and results of ultrasonography, CBC, and serum biochemical analysis were unremarkable. CLINICAL RELEVANCE Results suggested that a Boari flap procedure with renal descensus could be a feasible alternative in the management of proximal ureteral rupture in cats, but research is needed in this area.
- Laparoscopic Versus Abdominal Sacrocolpopexy: A Randomized, Controlled Trial. [Randomized Controlled Trial]
- JUJ Urol 2016; 196(1):159-65
- CONCLUSIONS: Laparoscopic sacrocolpopexy provides outcomes as good as those of abdominal sacrocolpopexy for anatomical correction but not for anterior pelvic organ prolapse.
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- Possible role of perineal ultrasound in the diagnosis of cystocele. [Journal Article]
- CEClin Exp Obstet Gynecol 2015; 42(3):321-6
- CONCLUSIONS: In conclusion, the present data show the excellent potential role of perineal ultrasound in the diagnosis of cystocele, but it is necessary to perform randomized studies to standardize the method.