History Of Previous Pelvic Surgery Research Articles

The Role of Chlamydia Trachomatis Infection in Female Infertility

The incidence of positive Chlamydia cultures in females undergoing laparoscopy for tubal patency is high. We advocate routine screening for Chlamydia infection in females with infertility. Of seventy-five patients undergoing laparoscopy for infertility, 49 grew Chlamydia on tissue culture of material from the cervix, an incidence of 65.3%. of these 49 cases, 33 (67.3%) had tubal blockage. In asymptomatic patients, 22 out of 50 had positive cultures from the cervix, an incidence of 44%. Peritoneal fluid culture was negative in all infertile patients. When compared to populations studied elsewhere, the incidence of Chlamydia appears to be high in our population and significantly higher in the infertile patients. In the management of infertility, pelvic inflammatory disease, and neonatal conjunctivitis, Chlamydia should be routinely investigated and treated.

Modified Stamey procedure for bladder neck suspension.

A review of 76 patients who underwent endoscopic bladder neck suspension (EBNS) for stress incontinence is presented. Pre-operative video-urodynamic studies in 71 patients demonstrated stable stress incontinence in 61 (86%). There was a history of previous pelvic surgery in 52 patients (68%). Surgery was performed by trainee urologists in 35 cases (46%). The overall complication rate was 46%, of which 17% were per-operative and did not influence the outcome of surgery. Infection occurred in 16% and necessitated removal of the suture buffers in 9%. Follow-up ranged from 7 to 30 months (mean 18.3). Complete resolution of stress incontinence or a marked improvement in symptoms was seen in 86% of cases. Patients with no history of previous pelvic surgery were all either cured or improved by the procedure. Of the 52 patients who had undergone previous pelvic surgery, 42 (80%) were either cured or improved. All of the 10 failures were in this group. There was no difference between complication or success rates achieved by consultants or urologists in training. It was concluded that EBNS is the treatment of choice in patients with primary stress incontinence and it is an effective procedure in patients who have undergone previous unsuccessful surgery for stress incontinence.

Evaluation of patients for microsurgery.

Prior to undergoing conservative pelvic surgery for improvement of fertility, there must be meticulous preoperative evaluation. This evaluation involves a history, all previous records and operative reports, psychologic evaluation, physical examination, hysterosalpingogram, laparoscopy, and tests for male factor and ovulation. In history taking, the physician is most interested in past evidence of infection. The emotional status of the patient must be considered, especially for those individuals who are seeking sterilization reversal. Often, with a history of previous pelvic surgery the rate of success is lowered. Physical examination is usually not useful in predicting final outcome of microsurgery; however, it does determine the patient's general preoperative status. Hysterosalpingography and laparoscopy are complementary procedures which are the cornerstone of the preoperative evaluation. The 1st gives evidence of the status of the uterus and the tube proximal to the block, if 1 exists. If the block is in the isthmic portion, the hysterosalpingogram will indicate how much of the tube is patent next to the corpus. Preoperative laparoscopy is necessary for proper and complete evaluation of pelvic status; it allows the operator to visualize the distal segment of the tube. Laparoscopy indicates the extent of pelvic adhesion, ovary and tube involvement, mobility of the tube, extent of fimbrial involvement, and presence of disease. When all factors are taken are into consideration, the surgeon must determine whether the benefits of surgery will outweigh the risks. Patient age, emotional needs, other parameters of fertility, status of tubes and ovaries, etc. must all be taken into consideration.

Prior abdominal surgery does not affect length of insertion of rigid sigmoidoscope.

The relationship between length of insertion of the sigmoidoscope and previous pelvic surgery was examined in 103 outpatients. No correlation could be established in patients with a history of previous pelvic surgery, and presumably bowel fixation, those with a history of other abdominal surgery or no surgery. A major factor limiting the length of insertion of the rigid sigmoidoscope appears to be individual anatomy.

Intestinal obstruction associated with defects in the broad ligaments of the uterus: Review of literature and case report

1. 1. A case of intestinal obstruction associated with a defect in the broad ligament of the uterus is presented along with a review of the literature. 2. 2. Those cases associated with previous pelvic surgery particularly the Baldy-Webster suspension operation, were discussed only briefly. 3. 3. Defects in the broad ligaments which are not associated with previous pelvic surgery must be congenital in origin, although repeated trauma must play an important rôle. 4. 4. A definite preoperative diagnosis is difficult to make in the absence of complete intestinal obstruction and a definite history of previous pelvic surgery.