1/11. Gynecologic effects of tamoxifen: case reports and review of the literature.The literature regarding the gynecologic effects of tamoxifen contains very little data on the vagina and lower urinary tract. The authors present two patients receiving tamoxifen who had gynecologic surgery complications that could be associated with tamoxifen use. Both patients had poor healing which improved when the tamoxifen was discontinued. Possible explanations are given for this observation based on what is known about this unusual drug. Owing to the success of tamoxifen in breast cancer patients, its use is currently being extended to include groups of healthy women at risk for the development of breast cancer. Because the number of women receiving tamoxifen may be increasing the authors include a review of its effects, with which all health care providers caring for women should be familiar.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
2/11. Delayed presentation and successful repair of a recurrent vesicovaginal fistula after hysterectomy and primary abdominal repair.Urogenital fistulae are an uncommon consequence of gynecologic surgery. Vesicovaginal fistulae due to gynecologic surgery generally appear 1-6 weeks after surgery and recurrent fistulae within 3 months of their repair. The pathogenesis of vesicovaginal fistula formation remains unclear. We present the case of a 36-year-old woman with a spontaneously recurring vesicovaginal fistula 21 months after abdominal repair of a vesicovaginal fistula caused by a laparoscopic-assisted vaginal hysterectomy. During the repair of the fistula and excision of the vaginal cuff, two small fluid-filled cysts between the bladder mucosa and the vaginal epithelium were encountered. Vesicovaginal fistulae can occur spontaneously and remote from surgery. The finding of small fluid-filled cysts in the cuff suggests that rupture of a similar cyst may have led to the formation of the fistula.- - - - - - - - - - ranking = 1keywords = gynecologic (Clic here for more details about this article) |
3/11. vesicovaginal fistula after Irving sterilization: a case report.BACKGROUND: patients scheduled for gynecologic surgery must be informed about the development of urogenital fistulae as a possible complication. CASE: A 49-year-old woman underwent Irving sterilization with subsequent abdominal hysterectomy due to intraabdominal abscess formation. Inadvertent damage complication to the bladder during hysterectomy led to development of a vesicovaginal fistula despite intraoperative management. The fistula was repaired at once in a second session. As a sequela of bladder injury, the patient had recurrent vesical diverticula and urolithiasis with repeated removal of the diverticula and stones. A subsequent intervention performed laparoscopically led to development of a second vesicovaginal fistula. In addition, an anesthesia-induced complication resulted in cerebral hypoxia with postoperative development of Parkinson's disease. CONCLUSION: Retrospectively, there is doubt whether the proper surgical procedures were employed in this case. The fact that the patient had type 1 diabetes mellitus gives rise to the question of why no conservative method of contraception was chosen. The type of operative approach in elective surgery should always be planned on the basis of the individual patient's overall condition and in relation to the anatomic situation.- - - - - - - - - - ranking = 0.5keywords = gynecologic (Clic here for more details about this article) |
4/11. Unexpected causes of gynecological pelvic pain.During our day-to-day practice, we, as clinicians, occasionally come across patients whose symptomatology is atypical. In major teaching hospitals, it is usually easy to consult with other specialists to optimize patient management and standard of care. Our study patients were treated by the authors between January 1998 and January 2003. In this article, the authors report on 6 different cases of unexpected causes of pelvic pain, all of which were managed in a general gynecological unit at a major tertiary referral institution.- - - - - - - - - - ranking = 2.5keywords = gynecologic (Clic here for more details about this article) |
5/11. Giant supratrigonal vesicocervicovaginal fistula--a case report.vesicovaginal fistula (VVF) is prevalent in the developing world, with recent estimates suggesting that 2 million women live with fistula, mainly in sub-Saharan africa and South asia. VVF is associated with urogenital infections and ammonia dermatitis, and the psychosocial ramifications may be devastating, as women may be socially isolated from their families and community. VVF also remains a challenging condition for the gynecologic surgeon. We present a case of a giant supratrigonal VVF repaired using an abdominal (suprapubic) transperitoneal transvesical approach.- - - - - - - - - - ranking = 0.5keywords = gynecologic (Clic here for more details about this article) |
6/11. Laparoscopic repair of vesicovaginal fistula.vesicovaginal fistula (VVF) may be a complication of prolonged repair or urogynecologic surgery. Failing conservative management, it may be repaired using an abdominal or vaginal approach. We herein report laparoscopic repair of VVF following vaginal hysterectomy and detail the operative steps.- - - - - - - - - - ranking = 0.5keywords = gynecologic (Clic here for more details about this article) |
7/11. Management of the urinary tract involved by recurrent cancer.We present our experience from 1982 to the present in treating 33 patients with recurrent cancers (colorectal, 22; gynecologic, six; breast, two; melanoma, two; and lung, one) secondarily involving the genitourinary tract. All patients had severe symptoms that required palliation. Endoscopically placed stents relieved ureteral obstruction in 18 (75%) of 24 patients with widespread metastatic disease. Two patients required percutaneous nephrostomy tubes, and five required open operations. Good to excellent palliation was achieved in 23 of 24 patients. Mean survival in the group with diffuse metastases was 13 months (range, six to 29 months). Nine patients with localized recurrences underwent surgical procedures. For localized pelvic recurrences, total exenteration (with or without intraoperative radiotherapy) provided excellent palliation with low morbidity. At the time of this report, five of six such patients had no evidence of disease, and one had a small asymptomatic pelvic recurrence, with a mean follow-up of 13 months (range, five to 19 months).- - - - - - - - - - ranking = 0.5keywords = gynecologic (Clic here for more details about this article) |
8/11. Unrecognized small vesicovaginal fistula as a cause of persistent urinary incontinence.Three cases of persistent urinary incontinence from unrecognized small vesicovaginal fistula after abdominal hysterectomy for benign gynecologic disease are presented. Visualization of urine in the posterior fornix was suggestive; diagnosis was confirmed by methylene blue test and cystoscopy. Two patients had undergone interval Marshall-Marchetti-Krantz operations for suspected stress-related urinary incontinence. An extensive literature survey confirms that the vesicovaginal fistula were an unlikely complication of the Marshall-Marchetti-Krantz procedure.- - - - - - - - - - ranking = 0.5keywords = gynecologic (Clic here for more details about this article) |
9/11. Management of incurable urinary fistulas by percutaneous ureteral occlusion.women with large urinary tract fistulas in the presence of advanced incurable gynecologic cancer are a difficult problem. In the past, treatment has usually been either inadequate or highly morbid. We have palliated three women with large incurable urinary tract fistulas by occluding the distal ureters with isobutyl-2-cyanoacrylate (bucrylate) and implanting permanent bilateral percutaneous nephrostomies. This technique is easily performed and effective, and has few complications.- - - - - - - - - - ranking = 0.5keywords = gynecologic (Clic here for more details about this article) |
10/11. Full-thickness Martius grafts to preserve vaginal depth as an adjunct in the repair of large obstetric fistulas.We performed a modified bulbocavernosus full-thickness pedicle graft procedure on four patients with large obstetric fistulas in ghana, West africa. The bulbocavernosus fat pad was harvested in the usual manner, and the full-thickness skin patch was taken from the medial thigh. All grafts showed 100% take by the tenth postoperative day. Adequate vaginal depth and caliber were obtained in all patients. Sexual function resumed in all patients except one, who suffered a recurrent vesicovaginal fistula. This method of vaginoplasty may be useful in patients who have massive vaginal-wall destruction of either gynecologic or obstetric origin.- - - - - - - - - - ranking = 0.5keywords = gynecologic (Clic here for more details about this article) |
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