Review on Prasramsini Yonivyapad (Pelvic Organ Prolapse)

Laxity of vaginal canal and uterine descent is one of the conditions commonly seen in peri-menopausal age with predominance of vata dosha, also seen as a complication of prolonged labour. syandana-prolapse, kshobhana-irritation, dushprasuta-difficult labour and other features of vitiation of pitta dosha are seen in prasramsini yonivyapad. Local therapy play an important role in these conditions. The descent of an organ is called Sramsana and condition called Prasramsini. Prasramsini yonivyapad is enumerated in pittaja yonivyapad by Sushruta which may be co-related with 1st and 2nd degree uterine prolapse. This condition is seen in peri-menopausal or postmenopausal period although young age group with distress during labour is no exemption. Prasramsini is a vatanubandhi, pittaja yonivyapad, the drugs with the properties of vata and pitta doshahara, kashaya rasa, balya and agnideepana can be selected. Vaginal tamppon is helpful to strengthen the vagina and cervix. In Ayurveda, local treatment of Prasramsini yonivyapad is sthanapavartana, pichu dharana and veshavara pinda with gophana bandha.

Gynecologists’ perspectives on two types of uterus-preserving surgical repair of uterine descent; sacrospinous hysteropexy versus modified Manchester

Introduction and hypothesis The modified Manchester (MM) and sacrospinous hysteropexy (SSH) are the most common uterus-preserving surgical procedures for uterine descent. Little is known about gynecologists’ preferences regarding the two interventions. The study’s aim was to identify which factors influence Dutch (uro)gynecologists when choosing one of these techniques. Methods This qualitative study consists of ten semi-structured interviews with Dutch (uro)gynecologists using predetermined, open explorative questions, based on a structured topic list. An inductive content analysis was performed using Atlas.ti. Results For SSH, the majority (6/10 gynecologists) reported the more dorsal change of direction of the vaginal axis as a disadvantage and expected more cystocele recurrences (7/10). The most reported disadvantage of MM was the risk of cervical stenosis (7/10). Four gynecologists found MM not to be appropriate for patients with higher stage uterine prolapse. The quality of the uterosacral ligaments was related to the chance of recurrence according to five gynecologists. Patient counseling was biased toward one of the uterus-preserving operations (7/10). Four gynecologists stated they make the final decision while two let patient-preference lead the final decision. Conclusions Preference for one of the uterus-preserving interventions is mainly based on the gynecologist’s own experience and background. The lack of information regarding these two uterus-preserving procedures hampers evidence-based decision making, which explains the practice pattern variation. In conclusion, further research is needed to improve evidence-based counseling and shared decision making regarding the choice of procedure.

Safety and Feasibility of Non-descent Vaginal Hysterectomy in FaridpurMedical College Hospital

This Study was done to assess safety and feasibility of non-descent vaginal hysterectomy for benign gynecological disease. A prospective observational study was conducted over a sample size of 50 patients at the department of Obstetrics and Gynecology of Faridpur Medical College Hospital from 1st January 2017 to 31st December 2017. All patients requiring hysterectomy for benign gynecological disorders who did not have any uterine descent were recruited for this study. Non-descent vaginal hysterectomy was performed in cases where uterus was mobile with size not exceeding 16 weeks gestation and with adequate vaginal access. Morcellation techniques like bisection, myomectomy, wedge debulking or combinations of these were employed in bigger sized uterus. A total of 50 cases were selected for non-descent vaginal hysterectomy. Among these, 47 cases successfully underwent non-descent vaginal hysterectomy. Majority (44%) of the patients were in age group of 41-45 years. All patients were parous. Uterine size was <10 wks in 30 cases and >10 wks in 20 cases. Commonest indication was leiomyoma of uterus (46%). Mean duration of surgery was two hours. Mean blood loss was 200 ml. Reasons for failure to perform nondescent vaginal hysterectomy was difficulty in opening pouch of douglus in two cases because of adhesions and in one case there was difficulty in reaching the fundal myoma which prevented the uterine descent. The most common complication was post-operative pain in 22% of cases. Febrile morbidity was present in 4% of cases. Blood transfusion was required in 7 cases. Average duration of hospital stay was three days. Vaginal hysterectomy for benign gynecological causes other than prolapse safe, feasible and patient friendly. Faridpur Med. Coll. J. Jul 2018;13(2): 89-92

Post Hysterectomy morbidity: a suburban teaching hospital experience in Kanchipuram, Tamil Nadu, South India

Background: Hysterectomy is the removal of uterus for benign uterine tumor and uterine descent in perimenopausal women. Post hysterectomy and follow up morbidity in rural women is studied over a period of 1 year. They were reviewed during hospital stay to identify morbidity and risk factors for prolonged hospital stay and formulate modalities to reduce morbidity. Risk factors assessed were fever, wound sepsis, anemia, previous post-operative adhesions and injury to other organs. Follow up was done at 4 weeks. 72% women were morbidity free. 46% women had more than one morbidity. The aim of this study is to analyse immediate and late post hysterectomy morbidity in a rural setup and to identify risk factors for prolonged hospitalization and formulate modalities to reduce morbidity and duration of hospital stay.Method: Perimenopausal women who underwent hysterectomy for benign uterine conditions and uterine descent were studied for post-operative morbidity at SSSMCRI over a period of one year. Post hysterectomy morbidity was clinically assessed from day one of surgery till discharge, for early and late morbidity. Abdominal skin incision smear, vault smear, urine culture and USG pelvis for collection of fluid was done in woman who developed fever. Follow-up morbidity was done at 4 weeks. Hysterectomy done for malignant conditions were excluded from the study.Results: In rural women, postoperative morbidity was assessed in 81 abdominal, 32 vaginal hysterectomy. Post-operative pain was felt by all 113 women for first 3 days. Fall of hemoglobin due to haemorrhage was seen in 43 (38%) women. 33 needed post-operative blood transfusion. Surgical site infection was seen in 13, needed re-suturing in 7. Fever was seen in 50 women (44%) due to UTI (E coli 13, Klebsiella 5). Pelvic fluid collection was seen in 9 with vault infection. We had one burst abdomen, one re-laparotomy, 3 bladder injuries. Prolonged hospital stay was seen in 41 women. 46% had more than one morbidity. Follow-up at 4 weeks, 72% were morbidity-free. Prolene granuloma 2, Stitch abscess 9, vaginal discharge 14, vault granuloma 3 were observed. Vaginal smear showed 9 Staphylococcus aureus and 5 bacterial vaginosis infection. 12 women had E. coli and 6 Klebsiella infection in urine culture.Conclusion: Pre-operative risk factors for post op morbidity like anemia, urinary and vaginal infection should be properly treated prior to surgery. Awareness of risk factors for morbidity, anticipation of complications due to size, site, nature of tumour and previous surgery adhesions, timely intervention by experienced surgeons and adequate blood transfusion will reduce morbidity and prolonged hospital stay.

Urinary Complication Following Cystocele Repair in Pelvic Organ Prolapse

Aims: Pelvic organ prolapse is a common condition in our country which affects the quality of life of many women. After vaginal operations for genital prolapse, there is increased chance of urinary tract infections, retention of urine and re-catheterization.The objective of this study is to evaluate women with cystocele in terms of clinical profile, different modalities of treatment and the complication following repair.Methods: It is a descriptive study carried out amongst 80 cases of cystocele irrespective of associated uterine descent and stress incontinence of urine in College Of Medical Sciences – Teaching Hospital, Nepal from 1/9/201l to 30/10/2013.Results: During the study, 80 women with cystocele were enrolled. Majority of the women (66.3%, n =53) with cystocele were within 15 to 45 years and 53.8% (n=43) of them had parity beyond 5. Among these women, 51.4% (n=41) had second degree cystocele and 23.8% (n=19) had stress urinary incontinence. Majority of the women (58.8%, n=40) underwent vaginal hysterectomy with pelvic floor repair. Following surgery, the most common complication was urinary tract infection (14.7%, n = 10).Conclusions: In this study, majority of the cases with cystocele were in the reproductive age with parity beyond 5 while maximum number of the women with cystocele had associated third degree uterocervical descent. Urinary tract infection was the commonest complication following surgical treatment followed by retention of urine.

Urinary Complication Following Cystocele Repair in Pelvic Organ Prolapse

Aims: Pelvic organ prolapse is a common condition in our country which affects the quality of life of many women. After vaginal operations for genital prolapse, there is increased chance of urinary tract infections, retention of urine and re-catheterization.The objective of this study is to evaluate women with cystocele in terms of clinical profile, different modalities of treatment and the complication following repair.Methods: It is a descriptive study carried out amongst 80 cases of cystocele irrespective of associated uterine descent and stress incontinence of urine in College Of Medical Sciences – Teaching Hospital, Nepal from 1/9/201l to 30/10/2013. Results: During the study, 80 women with cystocele were enrolled. Majority of the women (66.3%, n =53) with cystocele were within 15 to 45 years and 53.8% (n=43) of them had parity beyond 5. Among these women, 51.4% (n=41) had second degree cystocele and 23.8% (n=19) had stress urinary incontinence. Majority of the women (58.8%, n=40) underwent vaginal hysterectomy with pelvic floor repair. Following surgery, the most common complication was urinary tract infection (14.7%, n = 10).Conclusions: In this study, majority of the cases with cystocele were in the reproductive age with parity beyond 5 while maximum number of the women with cystocele had associated third degree uterocervical descent. Urinary tract infection was the commonest complication following surgical treatment followed by retention of urine.