RESUMEN
This randomized double-blind placebo controlled study assessed the vaginal colonization of lactic acid bacteria and clinical outcome. Vaginal capsules containing L gasseri LN40, Lactobacillus fermentum LN99, L. casei subsp. rhamnosus LN113 and P. acidilactici LN23, or placebos were administered for five days to 95 women after conventional treatment of bacterial vaginosis and/or vulvovaginal candidiasis. Vulvovaginal examinations and vaginal samplings were performed before and after administration, after the first and second menstruation, and after six months. Presence of LN strains was assessed using RAPD analysis. LN strains were present 2-3 days after administration in 89% of the women receiving LN strains (placebo: 0%, p < 0.0001). After one menstruation 53% were colonized by at least one LN strain. Nine percent were still colonized six months after administration. Ninety-three percent of the women receiving LN strains were cured 2-3 days after administration (placebo: 83%), and 78% after one menstruation (placebo: 71%) (ns). The intervention group experienced less malodorous discharge 2-3 days after administration (p = 0.03) and after the second menstruation (p = 0.04), compared with placebo. In summary, five days of vaginal administration of LN strains after conventional treatment of bacterial vaginosis and/or vulvovaginal candidiasis lead to vaginal colonization, somewhat fewer recurrences and less malodorous discharge.
Asunto(s)
Candidiasis Vulvovaginal/terapia , Lactobacillus/fisiología , Pediococcus/fisiología , Probióticos/administración & dosificación , Vaginosis Bacteriana/terapia , Adolescente , Adulto , Antiinfecciosos/administración & dosificación , Candidiasis Vulvovaginal/tratamiento farmacológico , Candidiasis Vulvovaginal/patología , Dermatoglifia del ADN , ADN Bacteriano/genética , ADN Bacteriano/aislamiento & purificación , Método Doble Ciego , Femenino , Humanos , Lactobacillus/clasificación , Lactobacillus/crecimiento & desarrollo , Lactobacillus/aislamiento & purificación , Persona de Mediana Edad , Pediococcus/clasificación , Pediococcus/crecimiento & desarrollo , Pediococcus/aislamiento & purificación , Técnica del ADN Polimorfo Amplificado Aleatorio , Prevención Secundaria , Resultado del Tratamiento , Vagina/microbiología , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/patología , Vulva/microbiología , Adulto JovenRESUMEN
This case series aims to determine the feasibility of performing a tension-free vaginal tape procedure after failed transurethral injection treatment in women with stress urinary incontinence.
Asunto(s)
Resinas Acrílicas/uso terapéutico , Cabestrillo Suburetral , Incontinencia Urinaria de Esfuerzo/terapia , Resinas Acrílicas/administración & dosificación , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Inyecciones , Persona de Mediana Edad , Insuficiencia del Tratamiento , Resultado del Tratamiento , Uretra/fisiopatología , Incontinencia Urinaria de Esfuerzo/fisiopatologíaRESUMEN
PURPOSE: This study was a prospective evaluation of the long-term effects of hysterectomy on bowel function using self-reported outcome measures on symptoms of constipation, rectal emptying difficulties, and anal incontinence. METHODS: In this prospective cohort study, 120 consecutive patients undergoing hysterectomy for benign conditions answered a questionnaire on bowel habits and anorectal symptoms preoperatively. Forty-four patients underwent vaginal and 76 abdominal hysterectomy. Follow-up was performed one and three years postoperatively. Data were analyzed by using multivariate regression and nonparametric statistics. RESULTS: The bowel and anorectal survey was answered by 115 of 120 patients (96 percent) after one year and 107 of 120 patients (89 percent) after three years. Abdominal hysterectomy was associated with increased anal incontinence symptoms at one-year (P < 0.01) and three-year follow-up (P < 0.01). Vaginal hysterectomy was not associated with increased anal incontinence symptoms at one year follow-up, although there was a significant increase in incontinence symptoms at the three-year follow-up (P < 0.05). Risk factor analysis indicated that a reported history of obstetric sphincter injury was correlated to an increased risk of developing posthysterectomy anal incontinence (odds ratio, 2.07; 95 percent confidence interval, 1.05-2.87; P < 0.05). There was no significant rise in constipation symptoms or rectal emptying difficulties in either cohort through the follow-up. CONCLUSIONS: Neither abdominal nor vaginal hysterectomy was associated with constipation, aggravation of constipation, or rectal emptying difficulties three years after surgery. Abdominal and vaginal hysterectomy was, however, associated with an increased risk of mild anal incontinence symptoms, and patients with a reported history of obstetric sphincter injury were at particular risk for posthysterectomy fecal incontinence.
Asunto(s)
Estreñimiento/etiología , Defecación/fisiología , Incontinencia Fecal/etiología , Histerectomía/efectos adversos , Enfermedades Uterinas/fisiopatología , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Uterinas/cirugíaRESUMEN
OBJECTIVES: To assess the clinical outcome after abdominal sacrocolpopexy using a porcine dermal graft compared with a synthetic mesh. METHODS: Patients with vaginal vault prolapse Stage II or worse (Baden-Walker staging), underwent sacrocolpopexy using a synthetic mesh (n = 25) or porcine collagen graft (n = 27). The subjective outcome was measured using validated questionnaires. RESULTS: The mean clinical follow-up from surgery was 7.1 months for the xenograft compared with 7.4 months for the synthetic cohort. At clinical follow-up, vaginal vault prolapse Stage II was present in 8 (29%) of 27 patients in the xenograft cohort and 6 (24%) of 25 patients in the synthetic mesh cohort (no significant difference). The mean follow-up from surgery to survey was 2.5 years in the xenograft cohort and 4.3 years in the synthetic cohort. None of the patients in either cohort had undergone a secondary sacrocolpopexy. No significant differences were found between the cohorts regarding surgical morbidity other than more patients experiencing fever for 1 to 3 days in the xenograft cohort (P < 0.001). No significant differences were found in lower urinary tract symptoms, anorectal symptoms, or quality-of-life variables between the two cohorts. CONCLUSIONS: Abdominal sacrocolpopexy using a porcine dermal graft was comparable to synthetic mesh in terms of subjective and anatomic outcomes at mid to long-term follow-up.
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Trasplante de Piel , Mallas Quirúrgicas , Trasplante Heterólogo , Prolapso Uterino/cirugía , Anciano , Anciano de 80 o más Años , Animales , Cuello del Útero , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Sacro , Porcinos , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
OBJECTIVE: To prospectively evaluate clinical outcome of rectocele repair using xenograft 3 years after surgery. METHODS: Twenty-three patients who completed evaluation preoperatively and 1 year after surgery were assessed at a 3-year follow-up. Clinical examination was performed preoperatively, and at the 1- and 3-year follow-ups, with the pelvic organ prolapse quantification system. Symptom assessment was performed with a validated bowel function questionnaire including questions on sexual function. RESULTS: There were no graft-related complications during the 3 years following surgery. Preoperatively, all patients had stage II prolapse of the posterior vaginal wall and a rectocele verified at defecography. At the 1-year follow-up, 11 of 29 patients (38%) had rectocele of stage II or more, and 4 patients were reoperated. At 3-year follow-up 7 of 23 patients (30%) had rectocele of stage II or more. When including the 4 early anatomical recurrences, a total of 11 of 27 patients (41%) had rectocele of stage II or more at 3-year follow-up. Preoperatively, all patients reported varying degrees of rectal emptying difficulties and symptoms of bowel dysfunction. There was a significant decrease in rectal emptying difficulties (P < .01), sense of incomplete evacuation (P < .01), need for manually assisted defecation (P < .05), and symptoms of pelvic heaviness (P < .001) at the 3-year follow-up compared with preoperatively. Cure of rectal emptying difficulties was reported by fewer than 50% of patients. There were no significant changes in anal incontinence scores or symptoms of sexual dysfunction at the 3-year follow-up compared with preoperatively. CONCLUSION: Rectocele repair using porcine dermal graft was associated with an unsatisfactory anatomical cure rate and persistent bowel-emptying difficulties in the majority of patients 3 years postoperatively. LEVEL OF EVIDENCE: II-3.
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Procedimientos de Cirugía Plástica/métodos , Rectocele/cirugía , Trasplante Heterólogo , Adulto , Anciano , Animales , Colonoscopía/métodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Paridad , Embarazo , Cuidados Preoperatorios/métodos , Probabilidad , Estudios Prospectivos , Rectocele/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Porcinos , Factores de Tiempo , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
PURPOSE: This study was designed to evaluate rectocele repair using collagen mesh. METHODS: 32 female patients underwent surgical repair using collagen mesh. Outcome was assessed in 29 patients and preoperative assessment included standardized questionnaire, clinical examination, and defecography. At the six-month follow-up, patients answered a standardized questionnaire and underwent clinical examination. At the 12-month follow-up, patients answered a standardized questionnaire, underwent clinical examination, and defecography. RESULTS: Preoperatively, 26 patients had a Stage II and 3 patients had a Stage III rectocele. At the 6-month follow-up, five patients had rectocele > or = Stage II (P < 0.001) and at the 12-month follow-up, seven patients had rectocele > or = Stage II (P < 0.001) at clinical examination. At the preoperative defecography, all patients presented a rectocele. At the 12-month defecography, 14 patients had no rectocele (P < 0.001) and 15 had a rectocele. At the six-month follow-up, there was a significant decrease in rectal emptying difficulties, need of digital support of the posterior vaginal wall at defecation, and defecation frequency. At the 12-month follow-up, symptom improvement remained, but was less pronounced. CONCLUSIONS: Rectocele repair using collagen mesh improved anatomic support, but there is a substantial risk for recurrence with unsatisfactory anatomic and functional outcome one year after surgery. Rectocele repair using mesh was not associated with an increased risk of dyspareunia. Rectocele repair using biomaterial mesh reinforcement needs further evaluation before adopted into clinical practice.
Asunto(s)
Materiales Biocompatibles , Colágeno , Rectocele/cirugía , Recto/diagnóstico por imagen , Recto/fisiopatología , Mallas Quirúrgicas , Adulto , Anciano , Anciano de 80 o más Años , Defecografía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Rectocele/diagnóstico por imagen , Rectocele/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: Persistent defects after primary sphincter repair and occult sphincter tears are common after vaginal deliveries. Anal incontinence may be associated with these morphological defects. MATERIAL AND METHODS: Forty-six primiparous women were evaluated with ultrasonography, manometry and electrophysiology. Twenty-four women had undergone primary repair of obstetric sphincter tears (sphincter group), 16 women had no clinical sphincter tear but developed anal incontinence postpartum (symptom group), and six were delivered by elective cesarean section (cesarean group). RESULTS: In the sphincter group, 50% had anal incontinence at follow-up. At ultrasonography, 70% had injuries anteriorly in the midanal canal. At manometry, 4% had decreased resting pressure and 50% decreased squeeze pressure. At electrophysiology, 19% had pathologic pudendal latency and 25% pathologic fiber density. In the symptom group, 44% had injuries anteriorly in the midanal canal at ultrasonography. At manometry, all women had normal resting pressure and 19% had a decreased squeeze pressure. At electrophysiology, 46% had pathologic pudendal latency and 29% pathologic fiber density. In the cesarean group, 33% had mild anal incontinence at follow-up. Ultrasonography and manometry were normal in all women. At electrophysiology, 33% had pathologic pudendal latency and 17% pathologic fiber density. CONCLUSION: Anal sphincter injuries at childbirth are often inadequately diagnosed and primary repair frequently results in persisting defects in the anal sphincter. Anatomic injuries to the anal sphincter play an important role in the development of anal incontinence after delivery, but a significant proportion of symptomatic women also demonstrate neurologic impairment at electrophysiologic testing.
Asunto(s)
Canal Anal/lesiones , Parto Obstétrico/efectos adversos , Incontinencia Fecal/epidemiología , Trastornos Puerperales/epidemiología , Adulto , Canal Anal/diagnóstico por imagen , Canal Anal/inervación , Canal Anal/fisiología , Electrofisiología , Incontinencia Fecal/diagnóstico por imagen , Incontinencia Fecal/etiología , Incontinencia Fecal/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Manometría , Paridad , Embarazo , Estudios Prospectivos , Trastornos Puerperales/diagnóstico por imagen , Trastornos Puerperales/fisiopatología , Encuestas y Cuestionarios , Suecia/epidemiología , UltrasonografíaRESUMEN
Coreceptor use was determined for human immunodeficiency virus type 1 (HIV-1) isolates of various subtypes from 11 women during pregnancy and their infected children. Isolates from peripheral blood mononuclear cells (n=79) and from plasma (n=59) were available. The clinical and immunological stages of HIV-1 infection were recorded. Coreceptor use was tested on human cell lines expressing CD4 and different chemokine receptors. The R5 virus predominated, and only 9 isolates from 2 mothers used CXC chemokine receptor 4. All children carried the R5 virus at the time of diagnosis of HIV-1 infection. In 2 children of mothers carrying the X4 virus, the virus switched from R5 to X4 or to R5X4 by age 18 months (child no. 9) and age 48 months (child no. 10), whereas no children followed up to a similar age whose mothers were carrying the R5 virus experienced such a switch (P=.048). This points to a link between the presence of X4 virus in the mother and the emergence of X4 virus in her child.