RESUMEN
We report on the feasibility, efficiency, and reproductive outcomes of hysteroscopic resection of late residual trophoblastic tissue in 50 patients in an observational study over 6 years. Complete evacuation of the uterus was achieved in all patients by hysteroscopy. The median operative time was 21 (15-30) min. Only one surgical complication was registered: a uterine perforation in a patient with previous metroplasty. Hysteroscopic resection of persistent trophoblastic tissue seems to be a safe and efficient procedure that could be proposed as an alternative to conventional non-selective blind curettage. We would also recommend systematic second-look hysteroscopy to asess the exact prevalence of post-procedure intrauterine adhesions.
Asunto(s)
Dilatación y Legrado Uterino , Histeroscopía , Trofoblastos/patología , Aborto Espontáneo , Aborto Terapéutico/efectos adversos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Proyectos Piloto , Embarazo , Índice de Embarazo , Trastornos Puerperales , Adherencias TisularesRESUMEN
Cancer is the second-commonest cause of death in women under 40 years of age in Western Europe and the US. The survival of cancer patients has, nevertheless, improved during the past two decades. During this period, and especially during the last decade, there have been ground-breaking advances in the optimization of the quality of life of patients treated for cancer, in particular by the development of fertility-enhancing and fertility-preserving procedures in young patients treated for cancer. Surgery, chemotherapy and radiation therapy affect the fertility potential of women in different ways. Surgery to remove the uterus and ovaries has a direct impact on fertility. Radiation therapy (external or brachytherapy) can affect ovarian and also uterine function. Different drugs used in chemotherapy can directly influence ovarian function. Some markers have now been evaluated that are predictive of the potential toxic injury to the gonads and uterus. Various procedures have been proposed to preserve the fertility potential in women before anticancer treatment begins or after the tumor is treated; however, such optimization of management should only be undertaken if it does not have a deleterious effect on the survival of the patient.
Asunto(s)
Fertilidad/efectos de los fármacos , Fertilidad/efectos de la radiación , Neoplasias/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Femenino , Fertilidad/fisiología , Humanos , Ovario/efectos de los fármacos , Ovario/efectos de la radiación , Ovario/cirugía , Radioterapia/métodosRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. STUDY DESIGN: One hundred and seventeen patients, who had a vaginal hysterectomy for menorrhagia, from January 1991 to December 2001, answered to a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. RESULTS: Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the two groups. Mean follow-up was 4.6+/-2.2 years (range 1.5-11) after vaginal hysterectomy and 4+/-1.8 years (range 1.5-7) after conservative treatment. The prevalence of urinary symptoms, included urge and stress incontinence, were statistically similar in the two groups. CONCLUSION: This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.
Asunto(s)
Histerectomía Vaginal/efectos adversos , Incontinencia Urinaria de Esfuerzo/etiología , Incontinencia Urinaria de Urgencia/etiología , Estudios de Casos y Controles , Recolección de Datos , Femenino , Estudios de Seguimiento , Humanos , Metrorragia/cirugía , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Incontinencia Urinaria de Esfuerzo/epidemiología , Incontinencia Urinaria de Urgencia/epidemiologíaRESUMEN
STUDY OBJECTIVE: To evaluate the efficacy of hysteroscopic adhesiolysis and subsequent fertility in patients with adhesions stage 3 and 4. DESIGN: A retrospective cohort study (Canadian Task Force classification II-2). SETTING: A tertiary referral center for hysteroscopic surgery. PATIENTS: Seventy-one patients with intrauterine permanent adhesions. INTERVENTIONS: Hysteroscopic surgery with monopolar energy (n=31) or bipolar energy (n=40). Uterine cavity with at least one free ostial area was restored after one (n=31), two (n=20), three (n=15), or four or more (n=5) surgical procedures RESULTS: Sixty-four patients were followed. Evaluation of the uterine cavity after surgery has been performed by hysteroscopy for all the patients. All patients had resumption of menses, except for two patients with a history of uterine artery embolization. Pregnancy index rate after the procedure was 28 (43.8%) of 64, and the live birth rate was 21 (32.8%) of 64. In patients 35 years of age or younger, 20 of 30 (66.6%) conceived compared with 8 of 34 (23.5%) in patients older than 35 years (p=.01). Three patients had either hysterectomy (n=2) or hypogastric arteries ligation for placenta accreta with uneventful postoperative course. CONCLUSIONS: Hysteroscopic adhesiolysis can be performed for severe adhesions stage 3 and 4 with safety and efficacy. Age is the main predictive factors of success: the pregnancies were at risk of abnormal placentation.
Asunto(s)
Aborto Espontáneo/prevención & control , Ginatresia/cirugía , Histeroscopía/métodos , Infertilidad Femenina/prevención & control , Aborto Espontáneo/etiología , Adulto , Estudios de Cohortes , Femenino , Ginatresia/complicaciones , Humanos , Infertilidad Femenina/etiología , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
This study reports the 2-year results of an original technique for rectocele repair by the vaginal route, using a combined sacrospinous suspension and a polypropylene mesh. Twenty-six women were successively operated between October 2000 and February 2003. Mean age was 63.7 years [range 35-92]. 19 women had had previous pelvic surgery for prolapse and/or urinary incontinence (73.1%), but none had had a previous rectocele repair. Patients underwent physical examination staging of prolapse in the international pelvic organ prolapse staging system. Eleven women had stage 2 posterior vaginal wall prolapse (42.3%), seven had stage 3 (26.9%) and eight had stage 4 (30.8%). The procedure included a bilateral sacrospinous suspension and a polypropylene mesh (GyneMesh, Gynecare, Ethicon France) attached from the sacrospinous ligaments to the perineal body. We did not perform any associated posterior fascial repair, nor myorraphy. Patients were followed up for 10-44 months, with a median follow-up (+/- SD) of 22.7 +/- 9.2 months. Functional results and sexual function were evaluated using the PFDI, the PFIQ and the PISQ-12 self-questionnaires. Twenty-five women returned for follow-up (96.2%). At follow-up, 24 women were cured (92.3%) and one had asymptomatic stage 2 rectocele. All the patients but one had symptoms and impact on quality of life improved. No postoperative infection of the mesh or rectovaginal fistula was found, but there were three vaginal erosions (12%) and one out of 13 had de novo dyspareunia (7.7%).
Asunto(s)
Colpotomía/métodos , Rectocele/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colpotomía/efectos adversos , Defecación , Femenino , Humanos , Persona de Mediana Edad , Polipropilenos , Calidad de Vida , Conducta Sexual , Mallas Quirúrgicas/efectos adversos , Resultado del TratamientoRESUMEN
We report a case series of 63 women with cystocele who underwent the same trans-vaginal procedure between October 1999 and October 2002. The polypropylene mesh (GyneMesh, Gynecare, Ethicon, France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. Patients were followed up for 24 to 60 months, with a mean follow-up of 37 months. Fifty-five patients returned for follow-up (87.3%). At follow-up, 49 women were anatomically cured (89.1%), five women had stage 2 anterior vaginal wall prolapse (9.1%), and one had a recurrent stage 3 (1.8%). Functional results and sexual function were also investigated. Fifty-three women had significant improvement in their quality of life (96.4%). There were a total of three cases of local pain around a mesh shrinkage (5.5%) and five vaginal erosions of the mesh (9.1%). Four out of 24 patients had dyspareunia (16.7%). In conclusion, the vaginal repair of anterior vaginal wall prolapse reinforced with a polypropylene mesh was efficient at 2 to 5 years follow-up. However, the first generation of polypropylene mesh we used was responsible for high rates of local complications and dyspareunia. Therefore, the polypropylene mesh has to be improved (lower weight) and the technique has to be documented by a randomized controlled trial before we could recommend its use in clinical practice.
Asunto(s)
Cistocele/terapia , Polipropilenos/metabolismo , Mallas Quirúrgicas , Vagina/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Persona de Mediana Edad , Pelvis/patología , Periodo Posoperatorio , Prolapso , Factores de TiempoRESUMEN
BACKGROUND: To evaluate the tension-free vaginal tape (TVT) in both stress urinary incontinence (SUI) and occult SUI as an associated procedure at the time of tension-free polypropylene mesh repair for the treatment of genitourinary prolapse. METHODS: Forty-eight consecutive women undergoing surgery for genital prolapse and concurrent SUI from November 1999 to September 2002. Preoperatively, SUI was symptomatic in 29 women and occult in 19, with a positive stress test during repositioning of the prolapse. All patients had urethral hypermobility and none had intrinsic sphincter deficiency. The cystocele repair was performed in all patients according to the technique of tension-free polypropylene mesh. Twenty-six women had an associated TVT and 22 had no associated procedure for SUI (control group). The main outcome measures were postoperative SUI, voiding dysfunction, and recurrence of prolapse. RESULTS: The median follow-up was 20 +/- 10.1 months (range 7-41). Patient characteristics and preoperative urodynamic evaluation were similar in the two groups. In patients with preoperative SUI, postoperative SUI occurred in 1/15 of the TVT group (6.7%) vs. 5/14 (35.7%) in the control group (p < 0.05), and voiding dysfunction occurred in 2/15 patients of the TVT group (13.3%) vs. 0/14 in the control group (p > 0.05). In patients with preoperative occult SUI, postoperative SUI occurred in 0/11 of the TVT group vs. 1/8 (12.5%) in the control group (p > 0.05), and voiding dysfunction occurred in 3/11 patients of the TVT group (27.3%) vs. 0/8 in the control group (p < 0.05). Anatomic success on prolapse was 88.5% (23/26) and 86.4% (19/22) in the TVT and the control group, respectively (p > 0.05). CONCLUSION: In patients with preoperative SUI, TVT is more efficient than prosthetic cystocele repair alone to prevent postoperative SUI, without differences in voiding dysfunction. In patients with preoperative occult SUI, prosthetic cystocele repair is as efficient as TVT, with a decreased risk of voiding dysfunction.
Asunto(s)
Alquenos , Mallas Quirúrgicas , Incontinencia Urinaria de Esfuerzo/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Prolapso Uterino/cirugía , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Incontinencia Urinaria de Esfuerzo/complicaciones , Urodinámica , Prolapso Uterino/complicaciones , Vagina/cirugíaRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the prevalence of urinary symptoms at long-term follow-up after vaginal hysterectomy. STUDY DESIGN: One hundred seventeen patients who had a vaginal hysterectomy for menorrhagia from January 1991 to December 2001 answered a self-report questionnaire about de novo urinary symptoms. The control group was a population of 116 patients who had a conservative treatment for dysfunctional uterine bleeding by endometrial thermocoagulation from January 1994 to December 2001. RESULTS: Patient characteristics (mean age, mean parity, menopausal status, smoking status, drink habits) were similar in the 2 groups. Mean follow-up was 4.6+/-2.2 years (range, 1.5-11 years) after vaginal hysterectomy and 4+/-1.8 years (range, 1.5-7 years) after conservative treatment. The prevalence of urinary symptoms, which included urge and stress incontinence, was statistically similar in the 2 groups. CONCLUSION: This study reveals no risk of urge or stress urinary incontinence at long-term follow-up after vaginal hysterectomy, compared with conservative treatment.
Asunto(s)
Histerectomía Vaginal , Menorragia/cirugía , Incontinencia Urinaria de Esfuerzo/epidemiología , Adulto , Anciano , Consumo de Bebidas Alcohólicas , Oclusión con Balón , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Humanos , Histerectomía Vaginal/efectos adversos , Menorragia/terapia , Persona de Mediana Edad , Periodo Posoperatorio , Prevalencia , Riesgo , FumarRESUMEN
OBJECTIVE: The purpose of this study was to prospectively and randomly compare tension-free vaginal tape (TVT) with transobturator suburethral tape (T.O.T.) for the surgical treatment of stress urinary incontinence (SUI) in women. STUDY DESIGN: Sixty-one women with SUI were randomly assigned to either TVT (n=31) or T.O.T. (n=30). The preoperative evaluation included a quality-of-life questionnaire and a comprehensive urodynamic examination. The 1-year outcome included a detrusor pressure-uroflow study to compare bladder outlet obstruction. RESULTS: Patient characteristics, preoperative quality of life, and urodynamic evaluation were similar in the 2 groups. Mean operative time was significantly shorter in the T.O.T. group (15 min+/-4 vs 27 min+/-8, P<.001). No bladder injury occurred in the T.O.T. group versus 9.7% (n=3) in the TVT group (P>.05). The rate of postoperative urinary retention was 25.8% (n=8) in the TVT group versus 13.3% (n=4) in the T.O.T. group (P>.05). The rates of cure (83.9% vs 90%), improvement (9.7% vs 3.3%), and failure (6.5% vs 6.7%) were similar for the TVT and T.O.T. groups, respectively. The 1-year outcome data were collected in 29 women of the TVT group and 27 women of the T.O.T. group. No vaginal erosion occurred in either of the groups. In terms of bladder outlet obstruction, no differences were found after TVT and T.O.T. CONCLUSION: T.O.T. appears to be equally efficient as TVT for surgical treatment of stress urinary incontinence in women, with no reduction of bladder outlet obstruction at 1-year follow-up.