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INTRODUCTION AND HYPOTHESIS: Although colpocleisis is effective in selected women, the low-morbidity obliterative procedure for treating pelvic organ prolapse (POP) and its impact on postoperative quality of life (QOL) have rarely been studied. Our aim was to assess QOL in women after colpocleisis and compare it with that of women after reconstructive vaginal surgery. METHODS: This retrospective cohort study included women (aged 35-85 years) with POP who underwent obliterative or reconstructive surgical correction during 2009-2015. Patients who met the inclusion criteria underwent telephone interviews that included the validated Prolapse QOL questionnaire (P-QOL Thai). RESULTS: Of 295 potential participants, 197 (67%) completed the questionnaire: 93 (47%) with obliterative and 104 (53%) with reconstructive surgery. Most were Thai (95.4%), multiparous (87%), and sexually inactive (76%). Their histories included hysterectomy (12%), incontinence or prolapse surgery (11%), and POP stage 3/4 (77%). Patients undergoing obliterative surgery were significantly older than those undergoing a reconstructive procedure (69 vs 58 years, P < 0.05). The obliterative group had more children, less education, and more advanced POP. There were no significant differences in operative parameters or complications. The obliterative surgery group had a significantly shorter hospital stay: median 2 (range 1-17) days vs 3 (1-20) days (P = 0.016). P-QOL scale revealed significantly less postoperative impairment in the obliterative surgery group (1.75 vs 5.26, P = 0.023). There were no significant differences in other P-QOL domains. CONCLUSIONS: Colpocleisis improves condition-specific QOL in selected patients with advanced POP and remains an option for this group. Surgeons should consider counseling elderly women with advanced POP about obliterative vaginal surgery.
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Colpotomía/efectos adversos , Procedimientos Quirúrgicos Ginecológicos/métodos , Histerectomía Vaginal/psicología , Prolapso de Órgano Pélvico/cirugía , Calidad de Vida , Vagina/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Niño , Colpotomía/métodos , Femenino , Procedimientos Quirúrgicos Ginecológicos/psicología , Humanos , Histerectomía Vaginal/métodos , Persona de Mediana Edad , Prolapso de Órgano Pélvico/psicología , Complicaciones Posoperatorias , Embarazo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Background: Currently, there is no evidence whether local estrogen cream should always be used in conjunction with a pessary as atrophic prevention. There is still no consensus about the long-term safety of local estrogen cream. Therefore, it is recommended to use hormone for the shortest duration as possible. Objective: Evaluate the effect of local estrogen cream on vaginal health in pessary use for pelvic organ prolapse. Material and Method: Forty postmenopausal women with pelvic organ prolapse who had used a pessary in conjunction with local estrogen cream for six weeks were randomly selected to use vaginal conjugated equine estrogen (CEE) cream 0.5 g once a week (treatment group) or no treatment (control group) for 24 weeks. The primary outcome was vaginal health assessment composed of vaginal symptom score, vaginal pH, and vaginal maturation index. The secondary outcome measures were the difficulty to use pessary and the endometrial thickness. Results: No statistical differences were found for all vaginal health assessment at baseline, 12, and 24 weeks among the treatment and the control groups. There was also no significant difference between the groups about the difficulty to insert and remove the pessary or the endometrial thickness. Conclusion: Vaginal CEE cream 0.5 g once a week did not show any additional positive effect on vaginal health in pessary use.
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Estrógenos , Prolapso de Órgano Pélvico/terapia , Pesarios , Vagina/efectos de los fármacos , Cremas, Espumas y Geles Vaginales , Estrógenos/administración & dosificación , Estrógenos/farmacología , Estrógenos/uso terapéutico , Femenino , Humanos , Cremas, Espumas y Geles Vaginales/administración & dosificación , Cremas, Espumas y Geles Vaginales/farmacología , Cremas, Espumas y Geles Vaginales/uso terapéuticoRESUMEN
OBJECTIVE: To compare the effects ofthree different pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) women. MATERIAL AND METHOD: Sixty-eight eligible SUI women who could perform pelvic floor muscle contraction correctly were randomly allocated to the three diferent PFMT protocols, exercise every day (GJ), exercise three days per week (G2), and exercise plus abdominal training three days per week (G3). The primary outcome was pad test. The secondary outcomes were pelvic floor muscle strength, and treatment satisfaction. The outcomes were evaluated before and after a 12-week of exercise. RESULTS: The weights ofpad were decreased by 2.6 +/- 0.8, 2.3 +/- 1.3, and 3.1 +/- 1.3 grams for group 1, 2, and 3, respectively. There was no statistical significant difference among the three groups. The pelvic floor muscle strength was increased by 18.4 +/- 2.7, 13.9 +/- 2.9, and 17.3 +/- 3.0 cmH2O for group 1, 2, and 3, respectively, with statistical significant difference among groups (p < 0.00). The increased muscle strength in group 2 was significant less than the other two groups (p < 0.00). Treatment Satisfaction showed the leakage was improved with non-significant difference between groups (p > 0.05). No complications were seen in any of the groups. CONCLUSION: Even though the results showed non-significant decrease in pad's weight among the three training groups, the pelvic floor muscle strength were increased in all groups.
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Terapia por Ejercicio/métodos , Diafragma Pélvico , Incontinencia Urinaria de Esfuerzo/terapia , Adulto , Anciano , Femenino , Hospitales Universitarios , Humanos , Persona de Mediana Edad , Calidad de Vida , Factores Socioeconómicos , Tailandia , Resultado del Tratamiento , Incontinencia Urinaria de Esfuerzo/rehabilitaciónRESUMEN
BACKGROUND: Ultrasound guided transvaginal aspiration of oocytes has replaced other methods of oocyte retrieval for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). However, there is controversy over whether flushing yields a larger number of oocytes and a higher potential for pregnancy than aspiration only. OBJECTIVES: To determine whether follicular aspiration and flushing increases live birth or ongoing pregnancy rates and the number of oocytes over aspiration alone in women undergoing IVF and ICSI. SEARCH STRATEGY: We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and the citation lists of relevant publications (to April 2010). SELECTION CRITERIA: Randomised controlled trials that compared follicular aspiration and flushing with aspiration alone were included. Trials were excluded if the flushing method comparison was confounded by comparisons of other methods. DATA COLLECTION AND ANALYSIS: Eligible studies were assessed for methodological quality. For dichotomous data, odds ratios (OR) and 95% confidence intervals (CI) were calculated. For continuous data, mean differences were reported. The heterogeneity of the studies was examined by using statistical tests of homogeneity and the I(2) statistic. MAIN RESULTS: No studies reported on the primary outcome of live birth. There was no evidence (3 studies, 164 patients) to suggest an association between follicular aspiration and flushing and ongoing or clinical pregnancy per woman randomised (OR 1.17, 95% CI 0.57 to 2.38). There was no evidence of a difference in adverse events reported between follicular aspiration and flushing and aspiration only. There was no evidence of significant differences in increased oocyte yield per woman randomised (1 study, 44 patients). Without flushing the operative time was significantly shorter, by 3 to 15 minutes (3 studies, P < 0.001) and the dose of pethidine required was significantly less (50 mg versus 100 mg, P < 0.00001). AUTHORS' CONCLUSIONS: There is no evidence that follicular aspiration and flushing is associated with improved clinical or ongoing pregnancy rates, nor an increase in oocyte yield. The operative time is significantly longer and more opiate analgesia is required for pain relief during oocyte retrieval. There is a lack of evidence regarding the effect of follicular aspiration and flushing on live birth rates in the identified data.
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Recuperación del Oocito/métodos , Folículo Ovárico , Femenino , Fertilización In Vitro , Humanos , Embarazo , Índice de Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto , Inyecciones de Esperma Intracitoplasmáticas , Irrigación Terapéutica , Factores de TiempoRESUMEN
AIM: To compare the outcomes of slow freezing with ultra-rapid freezing (URF) of cleavage-stage human embryos on aluminum foil. METHODS: Two-cell mouse embryos were used to test our method of ultra-rapid freezing. The embryos were randomly allocated to a non-frozen control (208 embryos), and slow (204 embryos) or ultra-rapid freezing groups (204 embryos). Immediate survival rate, further cleavage and blastocyst formation were compared. After validating our ultra-rapid freezing method on mouse embryos, we applied a similar ultra-rapid freezing protocol to human embryos. Consecutive human frozen/thawed embryo transfer (FET) cycles from October 1998 to June 2005 were reviewed. The survival rate, further cleavage rate and the pregnancy outcomes were compared between the URF and slow programmable freezing. RESULTS: Mouse embryos in the URF group survived the freezing/thawing process better than those in the slow freezing group (93.1% vs 82.8%, P = 0.001). Blastocyst and hatching blastocyst formation of the surviving embryos were comparable in the URF and slow freezing group (59% vs 58.6%, P = 0.944 and 32.6% vs 42%, P = 0.066, respectively). There were 146 human FET cycles in the URF group and 28 cycles in the slow freezing group. The immediate survival of embryos was higher in the URF group than in the slow freezing group (87.9% and 64.3%, P < 0.001). There was no significant difference in the mean number of embryos per transfer (3.7 +/- 1.3 and 3.3 +/- 1.2, P = 0.178), clinical pregnancy rate per transfer (28.5% and 21.4%, P = 0.444) and implantation rate per embryo (10.98% and 10.9%, P = 0.974) in the URF or slow freezing groups. CONCLUSION: Our in-house URF method gave comparable results to slow programmable freezing. Although the risk of potential contamination is a major drawback of the present ultra-rapid freezing technique, future refinement will minimize or entirely eliminate this concern.
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Criopreservación/métodos , Embrión de Mamíferos , Animales , Criopreservación/normas , Transferencia de Embrión , Desarrollo Embrionario , Femenino , Humanos , Masculino , Ratones , Ratones Endogámicos ICR , Embarazo , Distribución Aleatoria , Técnicas Reproductivas AsistidasRESUMEN
AIM: To study the prevalence, reproductive hormone profiles and ovarian sonographic appearance of Thai women with polycystic ovary syndrome (PCOS). METHODS: One thousand and ninety-five women were screened for oligomenorrhea/amenorrhea, and the clinical symptoms of hyperandrogenism. Ovarian morphology and volume were assessed by ultrasonography in diagnosed cases. Blood was taken for the measurement of the follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, androstenedione, dehydroepiandrosterone and 17-hydroxyprogesterone. RESULTS: The prevalence of PCOS was 5.7%. The mean age of women with PCOS was less than that of non-PCOS cases (27.4 +/- 6.5 and 31.1 +/- 6.4 years, respectively; P < 0.0001). Abnormal uterine bleeding and infertility were the leading presenting symptoms. The mean ovarian volume in women with PCO appearance was 9.22 +/- 4.36 mL compared to 6.53 +/- 3.31 mL in those without this appearance (P = 0.04). Hyperandrogenemia was confirmed in 23 of the 62 cases (37.1%). CONCLUSIONS: The prevalence and clinical presentations of Thai women with PCOS were similar to those in other reports. However, hirsutism, elevated testosterone level and acanthosis nigricans were uncommon in our population. Serum androstenedione was a more sensitive indicator of hyperandrogenemia than total testosterone. Further research is needed to clarify whether there is an ethnic difference in endocrine profiles and risks of metabolic syndrome.