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Diagnosis and Therapy of Female Pelvic Organ Prolapse. Guideline of the DGGG, SGGG and OEGGG (S2e-Level, AWMF Registry Number 015/006, April 2016). Geburtshilfe Frauenheilkd 2016; 76:1287-1301. [PMID: 28042167 PMCID: PMC5193153 DOI: 10.1055/s-0042-119648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 10/22/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
Aims: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). This is a guideline published and coordinated by the DGGG. The aim is to provide evidence-based recommendations obtained by evaluating the relevant literature for the diagnostic, conservative and surgical treatment of women with female pelvic organ prolapse with or without stress incontinence. Methods: We conducted a systematic review together with a synthesis of data and meta-analyses, where feasible. MEDLINE, Embase, Cinahl, Pedro and the Cochrane Register were searched for relevant articles. Reference lists were hand-searched, as were the abstracts of the Annual Meetings of the International Continence Society and the International Urogynecological Association. We included only abstracts of randomized controlled trials that were presented and discussed in podium sessions. We assessed original data on surgical procedures published since 2008 with a minimum follow-up time of at least 12 months. If the studies included descriptions of perioperative complications, this minimum follow-up period did not apply. Recommendations: The guideline encompasses recommendations for the diagnosis and treatment of female pelvic organ prolapse. Recommendations for anterior, posterior and apical pelvic organ prolapse with or without concomitant stress urinary incontinence, uterine preservation options, and the pros and cons of mesh placements during surgery for pelvic organ prolapse are presented. The recommendations are based on an extensive and systematic review and evaluation of the current literature and include the experiences and specific conditions in Germany, Austria and Switzerland.
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Retropubische (TVT) versus transobturatorische (TVT-O) spannungsfreie Suburethralbänder: 5-Jahres Ergebnisse einer prospektiv randomisierten kontrollierten Studie. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Dammriss III°/IV°: Intensiviertes Beckenbodentraining post partum – ja oder nein? Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Retropubic (TVT) versus transobturator (TVT-O) tension-free vaginal tape: five-year results of the Austrian randomized trial. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1374751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Episiotomy characteristics and risks for obstetric anal sphincter injuries: a case-control study. BJOG 2012; 119:1147; author reply 1148-9. [PMID: 22780819 DOI: 10.1111/j.1471-0528.2012.03390.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Career and Family - Are They Compatible?: Results of a Survey of Male and Female Gynaecologists in Germany. Geburtshilfe Frauenheilkd 2012; 72:403-407. [PMID: 25298544 DOI: 10.1055/s-0031-1298393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 02/14/2012] [Accepted: 03/01/2012] [Indexed: 10/28/2022] Open
Abstract
Purpose: Nowadays, most gynaecologists are female and the compatibility of job-related career and family life is an upcoming issue. The working group "Gender and Career" of the German Society for Gynaecology and Obstetrics (DGGG) designed a survey to reflect the present situation with a focus on the compatibility of career and family. Material and Methods: A web-based 74-item survey was filled out by members of the DGGG. In total, there were 1037 replies, 75 % female (n = 775) and 25 % male (n = 261) gynaecologists. Results: 62 % of the female and 80 % of the male respondents had already finished their doctoral theses and 2 % female and 13 % male had finished their PhD. Mean number of children was 1.06 (SD 1.08) in female and 1.68 (SD 1.34) in male gynaecologists. The majority of females desired day care for their children, but only 5 to 13 % of employers offer any day care. 88 % of the female and 72 % of the male physicians think that job-related career and family are not compatible. Conclusion: The majority of female gynaecologists wished to have professional child care, but most employers or other institutions do not offer this. This might be one of the reasons why career and family appear incompatible.
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Die larvierte Belastungsinkontinenz im Langzeit Follow-up. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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CT-Urographie bei Frauen mit primären oder rezidivierenden Beckentumoren. Radiologe 2011; 51:602-9. [DOI: 10.1007/s00117-011-2188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Objective To compare the function of the pelvic floor in primiparae before and during pregnancy with the status post partum concerning symptoms of incontinence, sphincter ruptures, bladder-neck mobility and the influence of the different modes of deliveries. Methods Questionnaire evaluating symptoms of urinary and anal incontinence in nulliparous women before and after delivery and correlating these symptoms with functional changes of the pelvic floor based on a careful gynaecologic examination as well as perineal and endoanal ultrasound. Results 112 women were included in our study and came for the first visit, 99 women returned for follow-up 6 months after childbirth. Stress and flatus incontinence significantly increased from before pregnancy (3 and 12%) to after childbirth (21 and 28%) in women with spontaneous delivery or vacuum extraction. No new symptoms occurred after c-section. There was no significant difference between the bladder neck position before and after delivery. The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section. The bladder neck in women with post partum urinary stress incontinence was significantly more mobile than in continent controls. The endoanal ultrasound detected seven occult sphincter defects without any correlation to symptoms of anal incontinence. Conclusion Several statistically significant changes of the pelvic floor after delivery were demonstrated. Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women.
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Abstract
Objective Many surgeons perform an anti-incontinence procedure during prolapse surgery in women in whom occult stress urinary incontinence has been demonstrated. Others prefer a two-step approach. It was the aim of the study to find out how many women really need a second operation and if a positive cough stress test with the prolapse reduced is associated with the development of stress urinary incontinence after prolapse surgery. Methods 233 women were operated for primary or recurrent prolapse without complaining of SUI. Preoperatively, 53/233 women had a full urogynecological workup with the prolapse reduced. Postoperatively, if the patient suffered from stress urinary incontinence, an anti-incontinence surgery was performed. Results 19/53 (35.8%) women who had a stress test with the prolapse reduced before surgery were defined as occult stress incontinent. Only 3 women (15.8%) of these 19 women developed symptoms of incontinence after prolapse surgery and had to be operated because of that. 18/233 (7.7%) complained of SUI 6 weeks to 6 months after surgery and received a TVT-tape. Conclusion The incidence of stress urinary incontinence manifesting after prolapse surgery is low in this study with 7.7%. This fact and the possible severe side effects of an incontinence operation justify a two-step approach if the patient is counseled and agrees. However, there is a small subgroup of women (3/19, 15.8%) with preoperative OSUI and SUI after surgery, who would benefit from a one-step approach. Further research is required to identify these women before surgical intervention.
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Sexualität und Lebensqualität bei Frauen in der urogynäkologischen Ambulanz. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ein eigenes Kind – bei Blasenektrophie und Beckenringteilaplasie undenkbar? Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1225162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Schwangerschaft, Geburt und postpartaler Verlauf bei einer Patientin mit Blasenektrophie – Fallbericht einer Schwangerschaft, Geburt und deren Folgen bei einer Patientin mit Blasenektrophie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vergleich von Biofeedback und Elektrostimulation in der Inkontinenztherapie im Hinblick auf die Langzeit-Effektivität. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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TVT vs. TVT-O: Eine prospektive randomisierte Studie –Österreichische Arbeitsgemeinschaft Urogynäkologie und rekonstruktive Beckenbodenchirurgie (AUB). Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Vergleich Elektrostimulation und Anticholinergika in der Langzeittherapie der Drangsymptomatik. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Titel: Duloxetin–wie viele Patientinnen profitieren durch diese Therapie? Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Relevanz der larvierten Belastungsinkontinenz in der Langzeitbeobachtung. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Relevanz der larvierten Belastungsinkontinenz in der Langzeitbeobachtung. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Duloxetin – wie viele Patientinnen sind zufrieden? Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Prä- und perinataler Verlauf bei einer Patientin mit Blasenektrophie. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Retrospektive Studie zur Effektivität und Zufriedenheit mit Elektrostimulation und anticholinerger Medikation in der Therapie der OAB im Vergleich – Vergleich Elektrostimulation und Anticholinergika in der Langzeittherapie der Drangsymptomatik. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1079227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Rezidivprolaps nach Deszensusoperation – eine relevante Komplikation? Abdominelle Sakrokolpopexie versus sacrospinale Fixation. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Handhabung und Akzeptanz des Würfelpessars in Siebform in der konservativen Therapie des Deszensus genitalis der Frau. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Endoanalsonographie post partum bei Dammrissen 3./4. Grades. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Vakuumentbindung mit Episiotomie versus Dammriss. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Langzeit-Effektivität von Biofeedback und Elektrostimulation in der Inkontinenztherapie im Vergleich. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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TVT und TVT-O: Sind die postoperativen Veränderungen der urodynamischen Messwerte beider Verfahren vergleichbar? Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-983495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Postpartale Endoanalsonographie bei Dammrissen 3./4. Grades. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Harn-, Wind- und Stuhlinkontinenz nach Vakuumentbindung mit Episiotomie versus Dammriss. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Die larvierte Belastungsinkontinenz–eine Fehldiagnose? Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ist die postpartale Levatorkontraktionskraft ein Indikator für eine später entstehende Inkontinenzsymptomatik? Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Wie valide ist der Kurzpadtest in der Diagnostik der weiblichen Harninkontinenz? Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Endoanalsonographie- ein objektives diagnostisches Verfahren in der Beurteilung der Stuhlinkontinenz. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Vakuumextraktion oder Multiparität – gleichbedeutend mit postpartaler Belastungsinkontinenz? Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Sexueller Missbrauch von Mädchen und Frauen - Ein Thema das Frauenärzte nicht betrifft? Hinweise für den gynäkologischen Alltag. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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[Female urinary incontinence]. MMW Fortschr Med 2005; 147:26-9. [PMID: 15981901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Several million women suffer from urinary incontinence in Germany. Stress and urge incontinence are especially clinically relevant. Training of the pelvic floor muscles (vaginal cones, electrical stimulation, biofeedback, and so forth) plays a central role in the conservative therapy of stress incontinence. The use of devices such as incontinence tampons and urethral pessaries is also common. A medication for the therapy of stress incontinence, which improves the closure of the urethral sphincter, has been on the market since 2004. In the operative area,the insertion of a tension-free vaginal tape (TVT) has gained acceptance in recent years. Anticholinergics are the primary medication used in the treatment of urge incontinence. Local estrogens, low frequency electrical stimulation, phytotherapeutics and the like have supportive effects.
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Obstetrical parameters influencing the duration of the second stage of labor. Eur J Obstet Gynecol Reprod Biol 2005; 118:17-20. [PMID: 15596266 DOI: 10.1016/j.ejogrb.2004.01.045] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2002] [Revised: 10/22/2003] [Accepted: 01/14/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the impact of parameters influencing the duration of the second stage of labor in vaginal deliveries. STUDY DESIGN 1200 consecutive vaginal deliveries were analyzed. Descriptive statistics are reported for parity, duration of first and second stage of labor, maternal age, birth weight, position of the fetal head, epidural analgesia and oxytocin augmentation. Logistic regression analysis was performed to assess the contribution of different variables to the length of the second stage of labor. RESULTS The mean length of the second stage was 70 min. In univariate analysis, parity, oxytocin augmentation and epidural analgesia, as well as occipito-posterior presentation were significant parameters associated with a prolonged second stage of labor. No correlation was found for birth weight and maternal age. In multivariate regression analysis, nulliparity and epidural analgesia were the strongest risk factors for a prolonged second stage. CONCLUSIONS The impact of epidural analgesia on the second stage of labor should be considered in obstetrical management.
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Therapie der postpartalen Blasenentleerungsstörung. Z Geburtshilfe Neonatol 2005. [DOI: 10.1055/s-2005-923139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Einfluss des Geburtstrainers Epi-No® auf die mütterliche Beckenbodenfunktion sechs Monate nach Entbindung - Follow-up einer prospektiven und randomisierten Studie. Geburtshilfe Frauenheilkd 2004. [DOI: 10.1055/s-2004-821247] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Radiologic procedures such as lateral cystography have been substituted by ultrasound in urogynecology. The techniques are standardized and reproducible. Ultrasound is also useful for evaluating the bladder neck (funneling), the urethra (diverticula) and the paraurethral tissues (vaginal cysts, vaginal fibroids). The technique is limited in patients with genital prolapse beyond the hymenal ring. Advantages include the avoidance of x-rays and catherization.
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Stuhl- und Harninkontinenz nach Geburten mit und ohne Dammriss III. und IV. Grades - eine Fallkontrollstudie. Geburtshilfe Frauenheilkd 2004. [DOI: 10.1055/s-2004-821061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Transvaginaler Verschluss einer nach Re-Sectio caesarea aufgetretenen vesico-uterinen Fistel Typ I (Jozwik). ACTA ACUST UNITED AC 2004; 126:286-8. [PMID: 15389383 DOI: 10.1055/s-2004-822839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The development of a vesico-uterine fistula is a problem which occurs with an increasing number of caesarean sections. The main symptoms are permanent urinary incontinence, cyclic hematuria ("menouria") and amenorrhoea. In only 5 % of cases, spontaneous closure with bladder catheterization over weeks and hormonal management is possible, most of the time a surgical procedure is the definitive treatment. Until now, the resection of this kind of fistula was performed using a transabdominal approach most of the time. Our procedure describes a surgical repair using a transvaginal approach by exciding the fistula out of the bladder and uterus with primary closure. In this way, a recurrent laparotomy with all known associated risks could be avoided. However, after definitive treatment of the fistula, a new pregnancy should be delivered by performing a caesarean section. In this way, a rupture of the uterus during delivery could be prevented.
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Abstract
The aim of the study was to determine the efficacy of cotrimoxazole administration after urodynamic testing to prevent urinary tract infections. In a single-blind prospective randomized study 94 women who attended for urodynamic evaluation were included. After multichannel urodynamic testing, including two catheterizations, the women received a single dose of cotrimoxazole or placebo. A clean-catch urine specimen was tested for infection after 1 week. Seventy women returned a urine specimen after 1 week: 2/37 (5.4%) in the treatment and 2/33 (6.1%) in the placebo group had acquired a new urinary tract infection after urodynamics. One major and one minor adverse reaction to cotrimoxazole were reported. The power of the sample size was unfortunately too small to draw conclusions as to the efficacy of prophylaxis.
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Abstract
The aim of the study was to evaluate whether four different techniques were able to correctly measure pelvic floor muscle strength only. Sixteen volunteers performed a set of muscle contractions using the pelvic floor muscles (PFM) only, the abdominal muscles with and without PFM, gluteal muscles with and without PFM, adductor muscles with and without PFM and Valsalva maneuver with and without PFM. Pelvic floor muscle strength was evaluated by digital palpation, intravaginal EMG, pressure perineometry and perineal ultrasound. A 'non-pelvic muscle induced' reading was defined as a significant increase even though the pelvic floor muscles were not contracted. Results were as follows: isolated abdominal muscle contraction: non-pelvic muscle induced readings in 3/8 women with EMG and in 3/8 with pressure perineometry; isolated gluteal muscle contraction: non-pelvic muscle induced readings in 1/2 women with EMG perineometry; isolated adductor muscle contraction: non-pelvic muscle induced readings in 6/11 women with EMG perineometry and in 2/11 women with pressure perineometry; Valsalva maneuver: non-pelvic muscle induced readings in 4/9 women with EMG perineometry and 9/9 women with pressure perineometry. It was concluded that EMG and pressure perineometry do not selectively depict pelvic floor muscle activity.
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Abstract
The aim of the study was to evaluate the relationship between Valsalva leak-point pressure (VLPP) and cough leak-point pressure (CLPP). Sixty women with stress urinary incontinence were included. One woman was excluded from evaluation because of detrusor instability. At a bladder volume of 200-300 mL (mean, 284; standard deviation, 29) CLPP and VLPP were measured in the sitting position. Intra-abdominal pressure was recorded with a rectal balloon catheter. A standardized pad test and multi-channel urodynamics were performed. VLPP was significantly lower than CLPP (58.9+/-27.6 versus 112.5+/-46.9 cm H(2)O, P<0.0001). Although CLPP was negative in two women only, VLPP was negative in 24 of 59 women (40.1%). If intrinsic sphincter deficiency was defined as a leak-point pressure of 65 cm H(2)O, 16.9% of women fulfilled this criterion using the CLPP compared to 35.6% if the VLPP is used. In conclusion, coughing and Valsalva seem to result in a different reaction of the pelvic floor.
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Abstract
BACKGROUND/AIMS The aim of the study was to assess the impact factor of HCV and HGV in fulminant hepatic failure. METHODS The 5'-untranslated regions of HCV RNA and HGV RNA and a segment of the core antigen sequence of HBV were amplified after extracting the nucleic acids from snap-frozen tissue aliquots from explanted livers of 26 consecutive patients undergoing orthotopic liver transplantation for fulminant hepatic failure preoperatively diagnosed as either autoimmune (n=2), HAV/HBV (n=8), toxic (n=4) or aetiologically unknown (n=12). RESULTS HCV RNA was detected in five of 26 (19.2%) livers with fulminant hepatic failure. All five HCV RNA-positive livers belonged to the group of non-toxic, non-autoimmune liver failure (n=20), three of them were found in the group of liver failure with unknown aetiology (n=12) and two in the group of HBV-associated liver failure (n=7), making an HCV incidence of 25%, 25% and 28.6%, in the different groups, respectively. HGV RNA was detected in 10 of 17 (58.8%) explants and in all four groups of fulminant hepatic failure as defined preoperatively. HBV DNA was identified in six livers of 26 patients (23.1%) with fulminant hepatic failure. Neither HCV RNA nor HBV DNA was detected in the livers of patients with toxic or autoimmune fulminant hepatic failure. CONCLUSIONS These results indicate that HBV and HCV, but not HGV, play an aetiologic role in fulminant hepatic failure. HCV-positive cases were concentrated either in the group of otherwise unexplained fulminant hepatic failure or in the group of HBV fulminant hepatic failure. HGV-positive cases, on the other hand, were found within all four preoperatively defined groups, indicating a role as cofactor rather than as single aetiologic agent.
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Gastric epitheloid leiomyomas, pulmonary chondroma, non-functioning metastasizing extra-adrenal paraganglioma and myxoma: a variant of Carney's triad. Report of a patient. KLINISCHE WOCHENSCHRIFT 1985; 63:282-4. [PMID: 3990171 DOI: 10.1007/bf01731476] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A female suffering from a complete Carney's triad (two gastric epithelioid leiomyomas, recurrent and metastasizing laryngeal paraganglioma, and pulmonary chondroma or hamartoma), and from a myxoma is described. The time elapsed between the detection of the gastric tumors and the metastases of the paraganglioma was 19 years.
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