Distal Anterior Vaginal Wall Research Articles

Efficacy and Safety of Platelet-Rich Plasma Injections for the Treatment of Female Sexual Dysfunction and Stress Urinary Incontinence: A Systematic Review.

Introduction: There is no clear evidence in the literature that platelet-rich plasma (PRP) injections improve female sexual dysfunction (FSD) and female stress urinary incontinence (SUI). Objectives: A systematic review was performed to study the efficacy and safety of PRP injections in women with the above pathologies, as well as to explore the optimal dosing, frequency and area of injections, and duration of treatment. Methods: A systematic search on PubMed, Embase and the Cochrane Library database was performed, as well as sources of grey literature from the date of database or source creation to January 2023. After title/abstract and full-text screening, clinical studies on humans evaluating the efficacy of PRP in gynecological disorders using standardized tools were included. Risk of bias was undertaken with RoB-2 for randomized-controlled trials (RCT) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: Four prospective and one retrospective study explored FSD, while six prospective and one RCT evaluated female SUI. A total of 327 women with a mean age of 51 ± 12 years were included. For FSD, PRP significantly improved the Female Sexual Function Index (FSFI), the Vaginal Health Index (VHI) and the Female Sexual Distress score (FSDS). For SUI, PRP led to a significant improvement in the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the Urogenital Distress Inventory (UDI-6). The identified RCT reported a significantly higher mean score of ICIQ-SF (p < 0.05) and UDI-6 (p < 0.01) in the midurethral sling group compared to the PRP injections group. Regarding the risk of bias, the RCT was characterized by high risk, whereas the observational studies were of moderate risk. The protocol for PRP injections for FSD is the injection of 2 mL of PRP into the distal anterior vaginal wall once a month for 3 months. For female SUI, 5-6 mL of PRP should be injected into the periurethral area once a month for 3 months. Conclusions: Despite the promising initial results of PRP injections, the level of current evidence is low due to methodological issues in the available studies. It becomes clear that there is an emerging need for high-quality research examining PRP injections for the treatment of FSD and female SUI.

Platelet-rich plasma: An effective modality to improve sexuality in FGM/C

Now, accepted treatments for Female Sexual Dysfunction (FSD) are limited to surgical, psychological, behavioral, hormonal and psychopharmacologic interventions. Because of the complex and multifactorial nature of FSD, current therapeutic options may leave a subset of women suffering with sexual dysfunction without clinical improvement and may be with side effects of the procedures. This is a study to evaluate the effect of platelet rich plasma (PRP) in treating FSD FGM/C. PRP was administered to the anterior vaginal wall (1 session), clitoris of 45 females with FGM/C and non-FGM/C with sexual dysfunction and orgasmic disorder [Female Sexual Function Index (FSFI) total score ≤ 26 orgasmic subdomain score ≤ 3.75]. The correlation between PRP sessions and FSFI domain scores was done with Pearson's correlation and linear regression analysis. Following the application of the PRP, the total FSFI score was converted significantly in both FGM/C and non-FGM/C ( P < 0.05). A significant change was observed in all sub-domains of FSFI score after PRP ( P < 0.05). The total FSFI score increased in all 45 females [16 non-FGM/C and 29 FGM/C] ( P < 0.05). That correlations between all sub-domains of FSFI score before and after PRP injection were significantly positive ( P < 0.05). Also, there were statistically significant positive correlations between total FSFI scores before and after PRP injection, and sociodemographic and obstetric characteristics of the study population in both FGM/C and non-FGM/C. As a minimally invasive method, PRP administration to the distal anterior vaginal wall may improve female sexuality with high satisfaction in FGM/C.

VAGINAL PLATELET-RICH PLASMA ADMINISTRATION TO IMPROVE FEMALE SEXUAL SATISFACTION

Objective:To investigate the effect of platelet-rich plasma (PRP) injection to the lower one-third of the anterior vaginal wall on sexual function, orgasm, in women with sexual dysfunction by scoring with FSFI. Materials and Methods:Three sessions of PRP (platelet rich human autologous plasma) were administered to the anterior vaginal wall of fiftyfemale patients with sexual dysfunctiondiagnosed by FSFI scoring card obtained in JAM clinic in Benha city Egypt and orgasmic disorder. Female Sexual Function Index (FSFI) total score ≤26 orgasmic subdomain score ≤3.75 were considered having sexual dysfunction and recruited in the study. Results:Following the application of the PRP, the total FSFI score was observed as 27.7±4.5 and the total score was 26 and above in patients having sexual dysfunction (p&lt;0.001). Orgasm subdomain scores were found as 2.2±1.2 before the PRP treatment and 4.4±1.06 at the third dose after (p&lt;0.001). Conclusion:PRP administration to the distal anterior vaginal wall improved female sexuality with high satisfaction by using multiple sessions (three month).

Platelet-rich plasma administration to the lower anterior vaginal wall to improve female sexuality satisfaction.

Objective:To investigate the effect of platelet-rich plasma (PRP) injection to the lower one-third of the anterior vaginal wall on sexual function, orgasm, and genital perception in women with sexual dysfunction.Materials and Methods:Four sessions of PRP were administered to the anterior vaginal wall of 52 female patients with sexual dysfunction and orgasmic disorder [Female Sexual Function Index (FSFI) total score ≤26 orgasmic subdomain score ≤3.75]. Prior to the PRP administrations in each session, the FSFI validated in Turkish, the Female Genital Self-Image Scale (FGSIS), the Female Sexual Distress Scale-Revised (FSDS-R), and Rosenberg’s Self-Esteem Scale were used and in the final follow-up, and the Patient Global Impression of Improvement (PGI-I) was performed and the results were analyzed.Results:Following the application of the PRP, the total FSFI score was observed as 27.88±4.80 and the total score was 26 and above in 50% of the patients (p<0.001). Orgasm subdomain scores were found as 2.11±1.20 before the PRP treatment and 4.48±1.14 afterwards (p<0.001). A significant change was observed in all sub-domains after PRP and it was observed that this change started after the first administration (p<0.001). A statistically significant increase was determined in FGSIS genital perception scores, which was significant between the 1st and 2nd months (p<0.001). The FSDS-R scores showed a minimal increase in stress scores as the application number increased, but a statistically significant decrease was observed in the 4th administration (p<0.001). No statistically significant difference was found in Rosenberg Scale scores before and after treatment (p=0.389). High satisfaction was found in PGI-I scores.Conclusion:As a minimally invasive method, PRP administration to the distal anterior vaginal wall may improve female sexuality with high satisfaction.

The length of anterior vaginal wall exposed to external pressure on maximal straining MRI: relationship to urogenital hiatus diameter, and apical and bladder location.

In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or perineal body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation. Fifty women were selected to represent a full spectrum of AVW support. Each underwent supine, dynamic MR imaging. Most dependent bladder location and apical location were measured relative to the average normal position on the mid-sagittal plane using the Pelvic Inclination Correction System . The length of the exposed AVW and the hiatus diameter were measured as well. The relationship between exposed AVW and most dependent bladder location, apical location, and hiatus diameter were examined. A bilinear relationship has been observed between exposed vaginal wall length and most dependent bladder location (R(2) = 0.91, P < 0.001). When the bladder descents up to the inflection point (about 4.4 cm away from its normal position), there is little change in the exposed AVW length. With further descent, the exposed vaginal wall length increases significantly, with a 2 cm increase in exposed AVW length for every additional 1 cm of drop bladder location. A similar but weaker bilinear relationship exists between exposed AVW and apical location. Exposed vaginal wall length is also highly correlated with hiatus diameter (R(2) = 0.85, P < 0.001). A bilinear relationship exists between exposed vaginal wall length and most dependent bladder location and apical location. It is when the bladder descent is beyond the inflection point that exposed vaginal wall length increases significantly.

Is the Female G‐Spot Truly a Distinct Anatomic Entity?

The existence of an anatomically distinct female G-spot is controversial. Reports in the public media would lead one to believe the G-spot is a well-characterized entity capable of providing extreme sexual stimulation, yet this is far from the truth. The aim of this article was to provide an overview of the evidence both supporting and refuting the existence of an anatomically distinct female G-spot. PubMed search for articles published between 1950 and 2011 using key words "G-spot," "Grafenberg spot," "vaginal innervation," "female orgasm," "female erogenous zone," and "female ejaculation." Clinical trials, meeting abstracts, case reports, and review articles that were written in English and published in a peer-reviewed journal were selected for analysis. The main outcome measure of this article was to assess any valid objective data in the literature that scientifically evaluates the existence of an anatomically distinct G-spot. The literature cites dozens of trials that have attempted to confirm the existence of a G-spot using surveys, pathologic specimens, various imaging modalities, and biochemical markers. The surveys found that a majority of women believe a G-spot actually exists, although not all of the women who believed in it were able to locate it. Attempts to characterize vaginal innervation have shown some differences in nerve distribution across the vagina, although the findings have not proven to be universally reproducible. Furthermore, radiographic studies have been unable to demonstrate a unique entity, other than the clitoris, whose direct stimulation leads to vaginal orgasm. Objective measures have failed to provide strong and consistent evidence for the existence of an anatomical site that could be related to the famed G-spot. However, reliable reports and anecdotal testimonials of the existence of a highly sensitive area in the distal anterior vaginal wall raise the question of whether enough investigative modalities have been implemented in the search of the G-spot.

Does Tension-Free Vaginal Tape Placement at the Time of Total Prolift Colpopexy Affect Distal Anterior Vaginal Support?

: Pelvic organ prolapse (POP) and stress urinary incontinence often require concomitant procedures to treat both conditions. The purpose of this study was to determine whether tension-free vaginal tape (TVT) at the time of total Prolift colpopexy (TPC) affected distal anterior vaginal wall support. : This was a retrospective cohort study of women that had TPC (n = 62) between January 2005 and December 2007. All patients had no uterus and underwent TPC with mesh placement in the anterior and posterior vaginal compartments. A concomitant TVT was placed only in those who had a preoperative diagnosis of urodynamic stress urinary incontinence with prolapse reduction. Patients were subdivided into those with (n = 26) and without TVT (n = 36). Data were compared between groups using Student t, Wilcoxon rank sum, and Fisher exact tests (P ≤ 0.05). : There were no significant differences between groups for all preoperative variables. Patients were observed for 6 to 12 months after TPC. Postoperatively, those with and without TVT had similar anterior POP quantification measurements (points Aa and Ba; P > 0.05), although the group with TVT had significantly more patients with anterior stage 2 and 3 recurrences (23%) when compared with the group without TVT (5%, P = 0.04). : Tension-free vaginal tape does not provide additional distal anterior vaginal wall support for patients undergoing TPC.

The effect of tension-free vaginal tape placement on distal anterior vaginal wall support at the time of laparoscopic sacral colpoperineopexy

The occurrence of stress urinary incontinence and pelvic organ prolapse can often coexist resulting in the need for concomitant surgical procedures to treat both conditions. The purpose of this study was to determine if tension-free vaginal tape (TVT) at the time of laparoscopic sacral colpoperineopexy (LSCP) had an effect on distal anterior vaginal wall support. This was a retrospective cohort study of patients that had LSCP between January 2005 and December 2007 (n = 121). These patients were divided according to those with (n = 63) and without TVT (n = 58) at the time of LSCP. Pre- and postoperative information was compared between groups using Student's t tests, ANCOVA, and Fisher's exact tests (P ≤ 0.05). Preoperatively, there were no significant differences between groups for all demographic and anatomic variables (P > 0.05). Patients were followed-up until 12 months after surgery. Patients with and without TVT had similar postoperative anterior vaginal wall measurements (points Aa and Ba) and stage of prolapse (P > 0.05). There were also no differences between groups with regard to recurrent prolapse symptoms or surgical satisfaction (P > 0.05). Tension-free vaginal tape at the time of LSCP did not improve postoperative distal anterior vaginal support.

Clitoris et point G: liaison fatale

Ultrasonography is a good means for studying the clitoris and its relationship with the G spot. We used it to demonstrate that clitoral bodies have a descending movement and come close to the distal anterior vaginal wall during a voluntary or reflex contraction of levator ani muscles. This fact could explain the particular sensitivity of the G spot and its role in the orgasm.

A Randomized, Controlled Trial Comparing Fascia Lata and Synthetic Mesh for Sacral Colpopexy

One hundred women with posthysterectomy vaginal vault prolapse who were scheduled for sacral colpopexy at the University of Louisville Health Sciences Center participated in this double-blind, randomized trial comparing the use of cadaveric fascia lata and polypropylene mesh. The Pelvic Organ Prolapse Quantification system (POP-Q) was used for patient evaluation preoperatively and at 3 months, 6 months, and 1 year postoperatively. Fascial lata was used in 46 patients and polypropylene mesh was used in 54. Eighty-nine women, 44 in the fascia group and 45 in the mesh group, completed the 1-year study period. The 2 groups were similar in social demographics, clinical characteristics, and operative data. Adverse events possibly related to the graft were experienced by 26% of women who received mesh and 15% of women who received fascia (P = .19). Other surgical procedures, in tension-free tape procedures, posterior repairs, and paravaginal repairs were performed frequently and at similar rates in the 2 groups. At the 1-year examination, the rate of objective anatomic failure, as defined by Weber et al, was greater in the women who received fascia (14 of 44; 32%) compared with those who received mesh (4 of 45; 9%) (P = .007). There were 15 instances of POP-Q point Aa (point along the distal anterior vaginal wall) and 3 of POP-Q point Ap (posterior vaginal wall) reaching at least the −1 position. There were no point C (vaginal cuff) failures. The results of the POP-Q evaluations changed over the year of observation. At the end of 12 months, significant differences in between the 2 groups were seen for the mean values of point Aa (P = .02), point C (P = .04), and prolapse stage (P = .03). No differences were seen in total vaginal length, genital hiatus, perineal body, or points Ap or Bp (points along the posterior vaginal wall). When risk factors for surgical failure of sacral colpopexy, other than graft material (age, body mass index, prior prolapse or continence surgery), were subjected to univariate analysis, no significant predictors of failure were seen.

Urethral avulsion injury during vacuum extraction delivery

Vacuum extraction is one of the common methods used for assisted vaginal delivery. The common maternal complications of the devise are cervical vaginal and perineal lacerations. Isolated avulsion injury of the vagina and urethra is unusual. A 24-year-old primigravida underwent induction of labor with oxytocin for postdated pregnancy at a district level hospital. Vacuum extractor with metallic cup was used to assist the second stage of labor. However the method was unsuccessful and on release of the cup there was pervaginal and periurethral bleeding. She underwent cesarean section and a normal baby was delivered. Subsequently she was referred to our hospital on the first postoperative day for further management. General examination revealed pallor tachycardia and low blood pressure. Local examination revealed avulsion of distal posterior urethral wall with the distal anterior vaginal wall. She was resuscitated with intravenous fluids and blood transfusion. She received antibiotics and underwent suprapubic cystostomy. (excerpt)

URETHRAL DIVERTICULUM: AN UNUSUAL PRESENTATION OF WEGENER'S GRANULOMATOSIS

No AccessJournal of UrologyClinical Urology: Case Report1 Mar 1999URETHRAL DIVERTICULUM: AN UNUSUAL PRESENTATION OF WEGENER'S GRANULOMATOSIS HOWARD B. GOLDMAN, BRIAN F. MANDELL, EMILY E. VOLK, RAYMOND R. RACKLEY, and RODNEY A. APPELL HOWARD B. GOLDMANHOWARD B. GOLDMAN More articles by this author , BRIAN F. MANDELLBRIAN F. MANDELL More articles by this author , EMILY E. VOLKEMILY E. VOLK More articles by this author , RAYMOND R. RACKLEYRAYMOND R. RACKLEY More articles by this author , and RODNEY A. APPELLRODNEY A. APPELL More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)61807-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "URETHRAL DIVERTICULUM: AN UNUSUAL PRESENTATION OF WEGENER'S GRANULOMATOSIS." The Journal of Urology, 161(3), pp. 917–918 References 1 : Urogenital manifestations of Wegener granulomatosis. Medicine1995; 74: 152. Google Scholar 2 : Necrotising urethritis in Wegener's granulomatosis. Brit. J. Urol.1982; 54: 434. Google Scholar 3 : Wegener granulomatosis. Unusual cause of necrotizing urethritis. Urology1979; 14: 66. Google Scholar From the Departments of Urology, Rheumatology and Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 161Issue 3March 1999Page: 917-918 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information HOWARD B. GOLDMAN More articles by this author BRIAN F. MANDELL More articles by this author EMILY E. VOLK More articles by this author RAYMOND R. RACKLEY More articles by this author RODNEY A. APPELL More articles by this author Expand All Advertisement PDF downloadLoading ...