[Laparoscopic approach in the pelvic floor surgery]. / Technika laparoskopického prístupu v pánevní chirurgii.

Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach.

Laparoscopic sacrocolpopexy.

Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing-- and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However, it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia-- than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach.

Pain experienced during transvaginal ultrasound, saline contrast sonohysterography, hysteroscopy and office sampling: a comparative study.

OBJECTIVE: To evaluate and compare the pain experienced by women during transvaginal ultrasound, saline contrast sonohysterography (SCSH), diagnostic hysteroscopy and office sampling. METHODS: This was a descriptive study of 402 consecutive patients presenting at a 'one-stop' Bleeding Clinic between October 2004 and November 2006. Thirty-nine percent of the patients were postmenopausal. The patients underwent the following examinations transvaginally: first ultrasound with color Doppler, second SCSH, third diagnostic hysteroscopy and fourth endometrial biopsy. After completion of the examinations the patients were asked to complete a questionnaire including a visual analog scale (VAS) about their subjective appreciation of all four examinations. Two-hundred and ninety-three (72%) patients returned the questionnaire. RESULTS: The median (range) VAS scores for transvaginal ultrasound, SCSH, diagnostic hysteroscopy and endometrial sampling were 1.0 (0-8.1), 2.2 (0-10), 2.7 (0-10) and 5.1 (0-10), respectively (P < 0.0001). The patients' answers to the other questions about the pain experienced, including comparison with other minor procedures such as venous blood sampling, were all concordant with the VAS scores. CONCLUSIONS: Transvaginal ultrasound was the procedure best accepted, followed by SCSH, hysteroscopy and endometrial sampling. These results suggest that patients would prefer SCSH over hysteroscopy as an initial diagnostic approach in the evaluation of abnormal uterine bleeding.

Subjective assessment of adnexal masses with the use of ultrasonography: an analysis of interobserver variability and experience.

OBJECTIVE: The aim of the study was to evaluate the subjective assessment of ultrasonographic images for discriminating between malignant and benign adnexal masses. STUDY DESIGN: The study was prospective. Initially, one ultrasonographer preoperatively assessed 300 consecutive patients with adnexal masses. Subsequently, the recorded transparent photographic prints were independently assessed by five investigators, with different qualifications and level of experience, who were also given a brief clinical history of the patients (i.e. the age, menstrual status, family history of ovarian cancer, previous pelvic surgery and the presenting symptoms). The diagnostic performance of the observers was compared with the histopathology classification of malignant or benign tumors. The end-points were accuracy, interobserver agreement and the possible effect of experience. RESULTS: The first ultrasonographer and the most experienced investigator both obtained an accuracy of 92%. There was very good agreement between these two investigators in the classification of the adnexal masses (Cohen's kappa 0.85). The less experienced observers obtained a significantly lower accuracy, which varied between 82% and 87%. Their interobserver agreement was moderate to good (Cohen's kappa 0.52 to 0.76). CONCLUSION: Experienced ultrasonographers using some clinical information and their subjective assessment of ultrasonographic images can differentiate malignant from benign masses in most cases. The accuracy and the level of interobserver agreement are both correlated with experience. About 10% of masses were extremely difficult to classify (only < 50% of assessors were correct).

A new treatment of vaginal candidiasis: three-day treatment with econazole.

From an open comparative multicentric trial it became clear that econazole was an active and well-tolerated agent for the treatment of vulvo-vaginal mycoses. Combined treatment with pessaries and econazole cream seems to be worthwhile in order to isolate the vagina from possible Candida reservoirs or to hasten symptomatic relief.