ABSTRACT
BACKGROUND: To describe a new type of incision of the vagina during transobturator sling procedure and to evaluate by ultrasound the tape position at 3, 6 and 12 months after surgery. We conducted a prospective study including 51 patients with urinary stress incontinence who underwent sling procedure using the transversal vaginal incision. Tape position was evaluated by ultrasound at 3, 6 and 12 months after surgery and expressed as a percentage of the urethral length (the proximal third of the urethral length 0-39 %, the middle third 40-60 %, and the distal third 60-100 %). Informed consent was obtained from all patients prior to their inclusion in the study. All procedures have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments and were approved by the Institutional Review Board and Ethical Committee of "Victor Babes" University of Medicine and Pharmacy Timisoara before the beginning of the study (no 7/17.04.2012). RESULTS: At 3 months after surgery, 3.92 % of the slings were located in the proximal third of the urethra, 88.23 % in the middle third of the urethra and 7.84 % in the distal third. At 6 and 12 months after surgery we obtained similar results: 9.81 % of the slings were located in the proximal third of the urethra, 82.35 % in the middle third and 7.84 % in the distal third of the urethra. CONCLUSION: The transversal incision of the vagina offers a minimal dissection along the long axis of the urethra favoring the remaining of the tape in the middle third of the urethra.
Subject(s)
Prosthesis Implantation/methods , Suburethral Slings , Urinary Incontinence, Stress/surgery , Vagina/surgery , Adult , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Middle Aged , Prospective Studies , Prosthesis Implantation/instrumentation , Single-Blind Method , Treatment Outcome , UrethraSubject(s)
Chlamydia Infections , Chlamydia trachomatis/isolation & purification , Fallopian Tubes , Gonadal Dysgenesis , Laparoscopy/methods , Ovary , Pelvic Inflammatory Disease , Adult , Chlamydia Infections/complications , Chlamydia Infections/diagnosis , Chlamydia Infections/physiopathology , Fallopian Tubes/abnormalities , Fallopian Tubes/diagnostic imaging , Female , Gonadal Dysgenesis/complications , Gonadal Dysgenesis/diagnosis , Gonadal Dysgenesis/physiopathology , Humans , Ovary/abnormalities , Ovary/diagnostic imaging , Pelvic Inflammatory Disease/complications , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/microbiology , Pelvic Inflammatory Disease/physiopathology , Treatment OutcomeABSTRACT
UNLABELLED: The surgical treatment of complete genital prolapse must aim the restoration of the vaginal support structures. All 3 levels of the vaginal support system must be recreated. Ablation of the uterus is not useful for pelvic floor support. Sparing of the uterus offers the advantage of a reduced surgical trauma, and better pelvic floor restoration. We present the case of a 60-year old woman with complete genital prolapse where the uterus was spared, and sacrospinous fixation, anterior mesh repair,perineal body repair and suburethral sling insertion were performed. The results were very good, by means of pelvic floor statics and physiology of micturition. CONCLUSION: genital prolapse must be cured by reconstruction of the vaginal support system, not by hysterectomy.
Subject(s)
Gynecologic Surgical Procedures/methods , Ligaments/surgery , Sacrococcygeal Region , Suburethral Slings , Surgical Mesh , Uterine Prolapse/surgery , Female , Humans , Middle Aged , Perineum/surgery , Severity of Illness Index , Treatment Outcome , Uterine Prolapse/pathologySubject(s)
Abortion, Induced , Placenta Accreta , Pregnancy, Ectopic , Adult , Female , Humans , PregnancyABSTRACT
Ovarian cancer-related angiogenesis is a complex process orchestrated by many positive and negative regulators. Many growth factors are involved in the development of the tumor-associated vasculature, and from these, endocrine gland-derived vascular endothelial growth factor (EG-VEGF) seems to play a crucial role. EG-VEGF is the first organ-specific angiogenic factor and its effects are restricted to the endothelial cells of the endocrine glands. Although EG-VEGF was detected in both normal and neoplastic ovaries, its clinical significance remains controversial. In the present study, we analyzed 30 patients with epithelial ovarian cancer, and the immunohistochemical expression of EG-VEGF was compared with the conventional clinico-pathological parameters of prognosis. Neoplastic cells of the ovarian carcinoma expressed EG-VEGF in 73.33% of the cases, as a cytoplasmic granular product of reaction. We found a strong correlation between the expression of EG-VEGF at protein level and tumor stage, grade, and microscopic type. The expression of EG-VEGF was found in patients with stage III and IV, but not in stage II. The majority of serous adenocarcinoma, half of the cases with clear cell carcinoma and two cases with endometrioid carcinoma showed definite expression in tumor cells. No positive reaction was found in the cases with mucinous carcinoma. Our results showed that EG-VEGF expression is an indicator not only of the advanced stage, but also of ovarian cancer progression. Based on these data, we concluded that EG-VEGF expression in tumor cells of the epithelial ovarian cancer is a good marker of unfavorable prognosis and could be an attractive therapeutic target in patients with advanced-stage tumors, refractory conventional chemotherapy.
