Faculty Opinions recommendation of Randomized comparison of three surgical methods used at the time of vaginal hysterectomy to prevent posterior enterocele.

Author(s):  
Dudley Robinson
Medicina ◽  
2009 ◽  
Vol 45 (6) ◽  
pp. 440
Author(s):  
Rosita Aniulienė ◽  
Agnė Stankevičienė ◽  
Justina Kačerauskienė ◽  
Povilas Aniulis ◽  
Vitalija Druktenytė

Objective. To compare surgical methods, complications, and outcomes in the treatment of female pelvic organ prolapse at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine, and to disclose the risk factors that influence female pelvic organ prolapse. Material and methods. A retrospective analysis of surgeries for pelvic organ prolapse performed during the period of 2003–2007 was carried out. A total 823 women were operated on for pelvic organ prolapse. Results. During 2003–2007, 823 surgical procedures for the correction of female pelvic organ prolapse were performed at the Clinic of Obstetrics and Gynecology, Hospital of Kaunas University of Medicine. Eighty (9.7%) patients underwent vaginal hysterectomy; 372 (45.3%), vaginal plastic operations (out of them, 23 were combined with TVT and 47 with TVT-O procedure); 360 (43.7%), vaginal hysterectomy with vaginal plastic surgeries; and 11 (1.3%), Prolift operations. The mean age of females was 62 years. Mean blood loss during operations was 162.1 mL. Patients undergoing vaginal plastic operations lost significantly less blood than those undergoing vaginal hysterectomy or combined operations (P<0.05). Mean time in surgery was 60.3 min. The duration of Prolift operations and vaginal plastic operations was significantly shorter than that of vaginal hysterectomy or combined procedures (vaginal hysterectomy + vaginal plastic surgery) (P<0.05). Mean hospital stay was 8.1 days. Hospital stay after vaginal plastic operations was significantly shorter than after vaginal hysterectomy or combined operations. The shortest hospital stay was after Prolift operation (P<0.05). Complications were related to the type of operation performed. Conclusions. The most common operations in the surgical treatment of female pelvic organ prolapse were vaginal plastic operations and combined operations. The shortest time in surgery and lowest blood loss was in case of vaginal plastic operations. The shortest hospital stay was after Prolift operations. The highest rate of complications was observed in patients who underwent vaginal hysterectomies, the lowest – after Prolift operations.


2014 ◽  
Vol 95 (3) ◽  
pp. 341-347 ◽  
Author(s):  
A S Gasparov ◽  
I A Babicheva ◽  
E D Dubinskaya ◽  
N V Lapteva ◽  
M F Dorfman

Aim. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. Methods. 120 patients with stage 4 of pelvis organ prolapse were included in the study. The different types of surgical procedures were performed («Manchester» surgery, vaginal hysterectomy, sacropexy, laparoscopic ventrosuspension). Surgical method was selected accounting the patient’s age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. For long-term outcomes evaluation, patients were followed up for 6-36 month after surgery. Results. The long-term outcomes of the different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable. Minimal surgery time, blood loss and the hospital stay were registered in patients, in whom laparoscopic ventrosuspension combined with colpoperineorrhaphy and levatorplasty was performed, compared to «Manchester» surgery, vaginal hysterectomy and sacropexy with colpoperineoplasty. No cases of serious complications were registered. Patients with stress incontinence observed before surgery reported improvement in urination, although 6 patients (10%) still reported rare episodes of incontinence. Conclusion. In elderly patients with stage 4 of pelvis organ prolapse, laparoscopic ventrosuspension of uterus or vaginal stump with further colpoperineorrhaphy and levatorplasty could be performed; this type of surgery is technically simple, not time-consuming, and it’s results are comparable with the effectiveness of sacropexia. Thus, it could be recommended to under-trained young surgeons.


2007 ◽  
Vol 177 (4S) ◽  
pp. 314-314 ◽  
Author(s):  
Joon-Yang Kim ◽  
Hoon Seog Jean ◽  
Beom Joon Kim ◽  
Kye Yong Song

Skull Base ◽  
2009 ◽  
Vol 19 (01) ◽  
Author(s):  
Deepa Nair ◽  
Prathamesh Pai ◽  
Aliasgar Moiyadi ◽  
Pankaj Chaturvedi ◽  
Devendra Chaukar ◽  
...  

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.


2018 ◽  
pp. 10-20
Author(s):  
Н.А. Глотов ◽  
Н.Е. Соколов ◽  
Ю.Б. Смоляков

Представлены результаты внедрения в хирургическую практику урологического отделения Дорожной клинической больницы г. Ярославль биполярной техники трансуретральной резекции (БТУР) и энуклеации простаты (ТУЭБ) для лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) средних и больших размеров. В сравнительное исследование включено 164 пациента, разделенных по методам операции на 2 основные группы (ТУЭБ - 33 человека, БТУР - 49) и 2 контрольные (открытая простатэктомия - ОПЭ - 38 и монополярная ТУР - 44). Для новых эндоскопических методов установлено значимое снижение объема кровопотери, частоты геморрагических осложнений, сроков послеоперационной катетеризации и госпитализации. Для количественной оценки различий средних и относительных показателей использо-вали непараметрический критерий Манна-Уитни, оценка качественных признаков проводилась с применением критерия Пирсона (χ2), уровень значимости различий для исследования выбран р ≤ 0,05. Анализ послеоперационной динамики клинических показателей в среднесрочной перспективе показал сходную радикальность и эффектив-ность сравниваемых методов. Установленные меньшая инвазивность, большая безопасность и лучшая переносимость биполярных эндоскопических операций демонстрируют перспективность их внедрения взамен бывших стандартных хирургических методов, что позволит повысить качество оперативного лечения и сократить затраты стационара. The results of the introduction into surgical practice of the urological Department of the road clinical hospital of Yaroslavl bipolar technique of transurethral resection (BTTR) and enucleation of the prostate (EOTP) for the treatment of benign prostatic hyperplasia (BPH) of medium and large sizes are presented. The comparative study included 164 patients, divided by the methods of surgery into 2 main groups (EOTP - 33 people, BTTR - 49) and 2 control (open prostatectomy - OPE - 38 and monopolar TTR - 44). For new endoscopic methods, a significant reduction in the volume of blood loss, the frequency of hemorrhagic complications, the timing of postoperative catheterization and hospitalization was established. Nonparametric Mann-Whitney test was used to quantify the differences in mean and relative indicators, qualitative characteristics were evaluated using Pearson test (χ2), the significance level of the differences for the study was chosen p ≤ 0.05. Analysis of postoperative dynamics of clinical parameters in the medium term showed similar radicality and effectiveness of the compared methods. The lower invasiveness, greater safety and better tolerability of bipolar endoscopic operations demonstrate the prospects of their implementation instead of the former standard surgical methods, which will improve the quality of surgical treatment and reduce the costs of the hospital.


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