Vaginal Procedure Research Articles

Surgical Recovery Among Patients With Chronic Pain Undergoing Pelvic Reconstructive Surgery

Importance Limited data exist on postoperative recovery among patients with chronic pain undergoing pelvic reconstructive surgical procedures. Objective The objective of this study was to evaluate if patients with versus without self-reported chronic pain experience different recovery after pelvic reconstructive surgery. Study Design From September 2022 to May 2023, this prospective cohort study enrolled patients with and without chronic pain, who were undergoing vaginal or laparoscopic procedures for pelvic organ prolapse. Preoperative pain was assessed using the Brief Pain Inventory (BPI) and Pepper Assessment Tool for Disability (PAT-D). Postoperative recovery was evaluated at 2, 4, and 12 weeks using the Postdischarge Surgical Recovery (PSR) scale, Global Surgical Recovery (GSR) index, and PAT-D questionnaire. The primary outcome was PSR scores at 4 weeks postoperatively. Results Ninety patients were recruited, with 43 reporting chronic pain and 47 without. Demographics were similar. Patients with chronic pain had higher preoperative BPI and PAT-D scores. Perioperative outcomes and hospital stay were similar. Patients with chronic pain used more postoperative opioids in the hospital (27.0 ± 27.8 vs 24.3 ± 60.3 morphine milligram equivalents [MME]; P = 0.03) and at home (40.1 ± 54.7 vs 19.9 ± 39.0 MME; P = 0.03). The PSR scores at 4 weeks were not significantly different. No differences were observed in PSR or GSR scores at all time points. Patients with chronic pain had a higher PAT-D score at 12 weeks. Fewer chronic pain patients returned to work by 12 weeks and desired more time off work. Conclusions Patients with and without chronic pain had similar surgical outcomes and recovery. However, chronic pain patients required more postoperative opioid pain medication and preferred more time off work.

Vaginal self-sampling for HPV in the context of cervical cancer screening

Abstract Background Effective cervical cancer screening programme has the potential to improve disease outcomes, yet women’s participation rates in Latvia remain suboptimal. Utilizing vaginal self-sampling for HPV, a convenient method, has demonstrated efficacy in boosting participation in under-screened populations. We analysed sociodemographic factors, as well as health behaviours with the preference for vaginal self-sampling procedures for early detection of cervical cancer. Methods Cross-sectional survey (2021-2022) included 1313 women in Latvia. Sampling was done in the colposcopy clinic and among GP practices. In the univariate analysis cervical cancer examination preference (self-test or by a physician) was analysed in association sociodemographic factors, participation in the screening, HPV status, study group, and health-related behaviour. Financed by “Internal consolidation of RSU and external consolidation of RSU with LSPA” (No. 5.2.1.1.i.0/2/24/I/CFLA/005), The EU Recovery and Resilience plan and the state budget, Grant Nr. RSU-PAG-2024/1-0016. Results 48.6 % (n = 538) of the women would prefer to use a vaginal self-test. Higher odds of the vaginal self-test preference were observed among Latvian (OR = 1.4 (1.1-1.8) vs other nationality women, but no other sociodemographic factors showed statistically significant associations. Women in the colposcopy study group (vs GP practices) were more likely to utilize self-sampling (OR = 1.8 (1.4-2.5). Non-participation in cervical cancer screening was related to 2.4 (1.6-3.6) higher odds of self-test preference, but knowledge about screening was related to 1.5 (1.1-2.0) times higher odds. Women who were HPV-negative were more likely to prefer vaginal self-test for HPV (OR = 1.4 (1.1-1.8) in comparison to HPV-positive women. Health-related behaviour did not show any associations. Conclusions Vaginal self-test for HPV can be effectively used to reach under-screened populations and enhance cervical cancer screening coverage. Key messages • The implementation of vaginal self-sampling for HPV testing has the potential to improve participation rates in cervical cancer screening programs among under-screened populations. • Outreach and education activities tailored to specific target groups in population could enhance level of the cervical cancer screening uptake.

Conventional vaginal approach vs. transvaginal natural orifice transluminal endoscopic surgery for treating apical prolapse, a randomized controlled study

ObjectiveVaginal hysterectomy combined with uterosacral suspension (USLS) is a technique for treating pelvic organ prolapse. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has been described as an alternative minimal invasive approachfor treating various gynecological and non-gynecological pathologies. The aim was to compare the surgical time between conventional vaginal hysterectomy combined with USLS and vNOTES hysterectomy combined with USLS. Study designMulti-center randomized controlled trial performed 2019–2021 at Rambam Health Care Campus (Israel) and Imelda Hospital (Belgium). Thirty women underwent vNOTES procedures and 30 women underwent conventional vaginal procedures. The primary outcome was total surgical time. Secondary outcomes included hysterectomy time, USLS time, intraoperative bleeding, length of hospitalization, pain during the first 24 h postoperative, the need of analgesia, intraoperative and postoperative adverse events, and patient-reported outcomes questionnaires. Parametric statistical methods were used to analyze the data. ResultsCompared to conventional vaginal procedures, vNOTES procedures were shorter in total surgical time (77 vs. 93 min, p = 0.004), hysterectomy time (26 vs 33 min, p < 0.001), and USLS time (20 vs 26 min. p = 0.02). Blood loss was higher in conventional vaginal compared to vNOTES surgery, as reflected by the mean blood loss estimate (143 vs 60 ml. p < 0.001) and the delta-hemoglobin (pre-operation minus the post-operation hemoglobin level (1.8 vs 1.2 ml/dL, p = 0.01). There was no difference between the groups regarding analgesics used, postoperative pain, surgical objective outcomes, and scores on patient-reported outcomes questionnaires. Adverse events were significantly more frequent in the conventional vaginal group than in the vNOTES group (p < 0.001 for intraoperative events and p = 0.05 for events that occurred in the follow-up time interval). ConclusionvNOTES hysterectomy with USLS has lower surgical times than conventional vaginal hysterectomy with USLS, lower blood loss and less adverse events. Other surgical objective and subjective outcomes were similar between the approaches.

Comparison of Abdominal and Vaginal Hysterectomy: A Comparative Clinical Study at A Tertiary Hospital of Southern Part of Bangladesh

Background: Hysterectomy is indicated in several common gynecologic problems and is one of the commonly performed operations in many hospitals of Bangladesh. Though Hysterectomy is a reasonably safe operative procedure but at times minor to major complications may occur. Current study was undertaken to compare the feasibility and safety of abdominal hysterectomy (AH) and vaginal hysterectomy (VH) procedures in the treatment of benign uterine diseases, and to determine the outcomes of both procedures. Objectives: To compare outcomes of vaginal and abdominal hysterectomy procedures in women with benign gynaecological diseases. Materials and Methods: This was a prospective study of outcomes of consecutive patients who underwent AH or VH for benign gynaecological diseases. Patient characteristics before, during, and after the operations were reviewed. Patients were followed up for three months to evaluate postoperative complications. Results: This study included a total of 305 patients. 199 patients underwent AH and 106 patients underwent VH. Baseline characteristics were similar between the two groups. Mean operative time was 95.78±18.46 minutes for AH group and 76.26±19.24 minutes for VH group (p&lt;0.006). Mean hospital stay was 5.32±0.67 days for AH group and 4.08±0.19 days for VH group with p-value &lt;0.047. There was a significant lesser total operation cost in VH group than AH group (VH: 12058±386 BDT, AH: 14275±276 BDT; P &lt; 0.05). Furthermore there was no wound infection; paralytic ileus and no need to reopening any patient in case of VH group compared to AH group. Conclusion: This study showed that vaginal hysterectomy was associated with less intraoperative complications and postoperative morbidities and complications as compared to abdominal hysterectomy. KYAMC Journal Volume: 15, No: 01, April 2024: 40-45.

Navigating Hysterectomy Choices: A Retrospective Study On Non-Descent Vaginal And Total Abdominal Hysterectomy In Rural Women

Background The aim of the study is to compare the results of non-descent vaginal and total abdominal hysterectomy procedures done in women in a tertiary care hospital. A retrospective study done by collecting the data from medical records who underwent non-descent vaginal and total abdominal hysterectomy done in women with fibroids, adenomyosis, endometrial atypical hyperplasia and abnormal uterine bleeding. Materials and Methodology This was a retrospective study done by collecting the data from medical record department of the hospital for the period of 6 months from April 2024 to September 2024. The total record of the study consisted of 400 patients out of which 200 patients underwent total abdominal hysterectomy and the rest 200 underwent non-descent vaginal hysterectomy. Those patients were pre-operatively assessed by physical, clinical, radiological evaluations as well as biochemical tests. Results The data of a total of 200 NDVH patients and 200 TAH patients was analysed which showed that NDVH patients had lower parity and BMI, smaller uterine sizes, and were more likely to have surgery for abnormal uterine bleeding. Intraoperative outcome was found to be better for NDVH, with less blood loss and shorter operative duration. The post-operative complications were significantly lower in the NDVH group, resulting in shorter hospital stays. Overall, NDVH outcomes were found to be superior to TAH. Conclusion: The non-descent vaginal hysterectomy has much advantages when compared to total abdominal hysterectomy

Chronic Uterine Inversion in a Young Adult: Case Report

Background: Uterine inversion is a rare but serious complication wherein the uterus is partially or completely turned inside out. It can either be acute or chronic. Unlike acute uterine inversion which occurs as a complication during parturition, which can be promptly managed, chronic uterine inversion poses a diagnostic difficulty even for an experienced gynecologist. We, herein, report a patient who was managed and followed up at our institution for chronic uterine inversion. Case presentation: A 30-year-old female, P4L4 previous all vaginally delivered, presented with complaints of something coming out of her vagina, per vaginal bleeding and foul-smelling discharge. On Physical examination, the patient was severely anaemic and revealed a bleeding, necrotic mass on inspection and the entrance of the cervix felt high up on per speculum and per vaginal examination. The patient was diagnosed as having chronic uterine inversion. The patient was admitted and was made hemodynamically stable with intravenous fluids and three units of blood. Manual reduction using vaginal procedure to reposition the uterus wasn’t successful, hence she was taken up for surgery. Fibroid was resected vaginally. Then Haultain rectification procedure was performed and then the definitive procedure of hysterectomy was done. Postoperatively, the patient was kept under observation and was vitally stable. Histopathology reported leiomyoma. Conclusion: Though non-puerperal uterine inversion is rare, a few cases will still have to be managed without any previous experience. This differential has to be considered as a possibility in a non-pregnant woman presenting with bleeding or mass per vagina with or without hypotension and can very rarely present as postmenopausal bleeding. Irrespective of age or parity, pre-operatively or intra-operatively, associated malignancy is to be ruled out in every case of uterine inversion. The prognosis depends on prompt diagnosis and timely intervention. Keywords: Fibroid, chronic, non-puerperal, uterus, inversion.

Exploring the rationale of performing vaginal hysterectomy under local anaesthesia: A single-centre experience

IntroductionVaginal hysterectomy (VH) is usually performed under general (GA) or regional anaesthesia. In recent years, the possibility of performing vaginal hysterectomy under local anaesthesia (LA) has also been explored. Our aim was to compare intraoperative and early postoperative outcomes in women who underwent VH under LA with intravenous sedation or GA. MethodsIn this retrospective study, we collected data of patients who underwent VH at our department from June 2021 to December 2022. For every patient, the following data was obtained: hospitalisation duration, type of anaesthesia (LA or GA), accompanying procedures, the dosage of used local anaesthetic in the LA group, maximal pain score for each day of hospitalisation after the procedure, procedure duration, intraoperative blood loss, and postoperative complication rate. Data was analysed using the SPSS Statistics programme. Statistical significance was set at p < 0.05. ResultsSeventy patients were included in the study. The mean age was significantly higher in the LA group compared to GA group (73.8 ± 8.0 years vs. 67.1 ± 9.3 respectively, p-value = 0.003). LA was associated with statistically lower pain scores in the first two days after the procedure (p = 0.003), and shorter procedure duration (p-value <0.001) as well as hospitalisation duration (p < 0.001). Furthermore, the cumulative dosage of different analgesics used during hospitalisation was higher in the GA group. ConclusionsOur results show that LA is a feasible option for patients undergoing VH. Vaginal surgical procedures under LA could be especially beneficial for older patients with medical comorbidities in whom GA would be particularly hazardous.

Development of a Consensus-Derived Synoptic Operative Report for Rectal Prolapse: A Report From the Pelvic Floor Disorders Consortium.

Narrative operative reports may omit or obscure data from an operation. To develop a synoptic operative report for rectal prolapse that includes core descriptors as developed by an international consensus of expert pelvic floor surgeons. Descriptors for patients undergoing rectal prolapse surgery were generated through review. Members of the Pelvic Floor Disorders Consortium were recruited to participate in a 3-round Delphi process using a 9-point Likert scale. Descriptors that achieved 70% agreement were kept from the first round, and descriptors scoring 40% to 70% agreement were recirculated in subsequent rounds. A final list of operative descriptors was determined at a consensus meeting, with a final consensus meeting more than 70% agreement. This survey was administered to members of the Pelvic Floor Disorders Consortium. No patient data are included in this study. Descriptors meeting greater than 70% agreement were selected. One hundred seventy-six surgeons representing colorectal surgeons, urogynecologists, and urologists distributed throughout North America (56%), Latin America (4%), Western Europe (29%), Asia (4%), and Africa (1%) participated in the first round of Delphi voting. After 2 additional rounds and a final consensus meeting, 16 of 30 descriptors met 70% consensus. Descriptors that met consensus were surgery type, posterior dissection, ventral dissection, mesh used, type of mesh used, mesh location, sutures used, suture type, pouch of Douglas and peritoneum reclosed, length of rectum imbricated, length of bowel resected, levatoroplasty, simultaneous vaginal procedure, simultaneous gynecologic procedure, simultaneous enterocele repair, and simultaneous urinary incontinence procedure. The survey represents the views of members of the Delphi panel and may not represent the viewpoints of all surgeons. This Delphi survey establishes international consensus descriptors for intraoperative variables that have been used to produce a synoptic operative report. This will help establish defined operative reporting to improve clinical communication, quality measures, and clinical research. See Video Abstract . ANTECEDENTES:Los protocolos operativos narrativos frecuentemente pueden omitir u oscurecer datos de un procedimiento.OBJETIVO:Nuestro objetivo es desarrollar un protocolo operatorio sinóptico para el prolapso rectal que incluya descriptores básicos desarrollados por un consenso internacional de cirujanos expertos en piso pélvico.DISEÑO:Los descriptores para pacientes sometidos a cirugía de prolapso rectal se generaron mediante revisión. Se reclutó a miembros del Consorcio de Trastornos del Piso Pélvico para participar en un proceso Delphi de 3 rondas utilizando una escala Likert de 9 puntos. Los descriptores que lograron un 70% de acuerdo se mantuvieron en la primera ronda, los descriptores que obtuvieron un 40-70% de acuerdo se recircularon en rondas posteriores. Se determinó una lista final de descriptores operativos en una reunión de consenso, con una reunión de consenso final de más del 70% de acuerdo.ESCENARIO:Esta fue una encuesta administrada a miembros del Consorcio de Trastornos del Piso Pélvico.PRINCIPALES MEDIDAS DE RESULTADO:Se seleccionaron los descriptores que cumplieron más del 70% de acuerdo.RESULTADOS:Ciento setenta y seis cirujanos en representación de cirujanos colorrectales, uroginecólogos y urólogos distribuidos en América del Norte (56%), América Latina (4%), Europa Occidental (29%), Asia (4%) y África (1%) participaron en la primera ronda de votación Delphi. Después de dos rondas adicionales y una reunión de consenso final, 16 de 30 descriptores alcanzaron un 70% de consenso. Los descriptores que alcanzaron consenso fueron: tipo de cirugía, disección posterior, disección ventral, malla utilizada, tipo de malla utilizada, ubicación de la malla, suturas utilizadas, tipo de sutura, cierre del fondo de saco de Douglas y peritoneo, longitud del recto superpuesto, longitud del intestino resecado, plastía de los elevadores , procedimiento vaginal simultáneo, procedimiento ginecológico simultáneo, reparación simultánea de enterocele y procedimiento simultáneo de incontinencia urinaria.LIMITACIONES:La encuesta representa las opiniones de los miembros del panel Delphi y puede no representar los puntos de vista de todos los cirujanos.CONCLUSIONES/DISCUSIÓN:Esta encuesta Delphi establece descriptores de consenso internacional para las variables intraoperatorias que se han utilizado para producir un protocolo operatorio sinóptico. Esto ayudará a establecer protocolos operativos definidos para mejorar la comunicación clínica, las medidas de calidad y la investigación clínica. (Traducción-Dr. Felipe Bellolio ).

Vaginal colpotomy for traditional and natural orifice transluminal endoscopic surgery (NOTES) vaginal procedures

Vaginal colpotomy for traditional and natural orifice transluminal endoscopic surgery (NOTES) vaginal procedures

Obesity and Native Tissue Repairs: A Secondary Analysis of the OPTIMAL Trial.

The Operations and Pelvic Muscle Training in the Management of Apical Support Loss (OPTIMAL) Trial compared sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) surgical outcomes. Increasing body mass index (BMI) is associated with an increased risk of pelvic organ prolapse, and the prevalence of obesity is increasing worldwide. The purpose of this study was to better understand the effect of obesity on the results of native tissue vaginal apical suspension procedures. This was a secondary analysis of the OPTIMAL Trial data set. Subgroup analysis was performed to compare surgical failure rates between SSLF and ULS across BMI subgroups after 2 years. There were 75, 120, 63, and 39 patients in the normal, overweight, class 1 obesity, and class 2 obesity or greater BMI subgroups, respectively. There were no statistically significant differences in surgical failure rates between SSLF and ULS within BMI subgroups; however, failure rates increased in the ULS group between the nonobese and obese groups (normal, 35.9% SSLF vs 30.6% ULS [P = 0.81]; overweight, 38.6% vs 30.2% [P = 0.44]; class 1 obesity, 38.7% vs 40.6% [P = 0.92]; class 2 obesity or greater, 21.1% vs 45% [P = 0.21]). The risk of surgical failure between SSLF and ULS was not significant across BMI subgroups. Additional investigation is required to further elucidate whether SSLF or ULS is a more reliable option for obese patients.

Enhanced recovery after surgery (ERAS) in prolapse repair: A prospective study on pre-emptive uterosacral/cervical block.

Enhanced recovery after surgery (ERAS) protocols have been introduced in gynecology. Postoperative pain management after vaginal procedures remains a relevant issue. In the present study we aimed to evaluate the effectiveness of pre-emptive uterosacral/cervical block (PUCB) for postoperative pain control in patients with uterovaginal prolapse undergoing vaginal hysterectomy and pelvic floor repair. We also evaluated the impact on the length of recovery. This was a pilot study analyzing 40 women who underwent pelvic organ prolapse repair through uterosacral ligament suspension. Patients who chose to undergo PUCB were considered as cases, otherwise as controls. After general or spinal anesthesia induction, the treatment group received the PUCB with ropivacaine plus clonidine injections at 2, 4, 8, and 10 o'clock of the cervix. The control group did not receive additional treatment. Pain intensity was measured at rest and after forceful cough at 1, 4, 8, 12, 24, and 48 h postoperatively. We found a significant reduction in pain values at 1 h (rest and forceful cough) and 24 h (forceful cough) in the PUCB group. The incidence of moderate/severe pain was inferior in the PUCB group at 1 h (rest) and 24 h (rest and forceful cough). There were no differences in terms of the use of rescue opioids (0% vs. 5%; P = 0.311) and length of hospital stay (2.5 ± 0.6 vs. 2.3 ± 0.6; P = 0.180). For the first time, we demonstrated the impact of pre-emptive uterosacral/cervical block on pain control up to 24 h after surgery. Clonidine as a sensory blockade extender appears promising in enhancing the efficacy of local anesthetics.

Complications of obliterative versus reconstructive vaginal surgery for pelvic organ prolapse in octogenarians: A retrospective cohort study.

Women of advanced age may choose between restorative or obliterative surgery for surgical management of pelvic organ prolapse. Obliterative surgery is traditionally reserved for a subset of older women with more severe medical comorbidities, since obliterative approaches are generally considered to be less morbid and older individuals have higher rates of perioperative complications than younger cohorts. This study compared perioperative complications amongst octogenarians undergoing obliterative versus reconstructive approaches. This data will help to inform perioperative counselling as previous studies have not been powered to evaluate complications in this population. The National Surgical Quality Improvement Program database was used to identify patients that had Pelvic organ prolapse surgery between 2012 and 2021, aged 80 years or older. Single-compartment procedures, vaginal mesh procedures, and oncologic surgery were excluded. The primary outcome was any complication within the first 30 days excluding urinary tract infection (UTI). UTI, readmission, and severe complications were secondary outcomes. Of the 4149 patients identified, 2514 (60.6%) underwent reconstructive surgery and 1635 (39.4%) underwent obliterative surgery. Patients undergoing reconstructive surgery were more likely to have an American Society of Anesthesiologists (ASA) class of 1 or 2 (46.1% vs. 31.3%, p = 0.002) and were less likely to be on antihypertensive medication (72.0% vs. 75.8%, p = 0.006). Further, there was an increased length of stay (1.47 ± 1.84 vs. 1.03 ± 1.31 days, p < 0.001) in hospital for reconstructive surgery which was more often performed as an inpatient (45.7% vs. 37.9%, p < 0.001). There was no difference in the primary outcome: any complication excluding UTIs. However, UTI was more common in the reconstructive group (aOR 0.48; 95% confidence interval 0.34-0.0). The rate of serious complications (Clavien-Dindo Class IV) was low overall and not different between reconstructive and obliterative approaches (1.3% vs. 1.0%, respectively). Both vaginal reconstructive and obliterative approaches have low complication rates in octogenarians, with only UTIrate being different between cohorts. When choosing surgical approach, we suggest a case-based, patient center discussion on the anatomic outcomes, durability and patient satisfaction.

Noncongenital Vaginal Obliteration: Surgical Restoration of Vaginal Patency for GVHD

SettingGenital graft-versus-host disease (GVHD) is a known possible complication of bone marrow transplant (BMT). This condition can lead to vaginal obliteration, affecting sexual performance and quality of life. ObjectivesTo provide a brief overview of non-congenital causes of vaginal obliteration and stenosis, discuss a unique case of vaginal agglutination in a patient who developed genital GVHD after receiving a BMT, and present the steps of a laparoscopic total hysterectomy and lysis of vaginal adhesions that successfully restored vaginal patency without the need for grafting. Design and InterventionsThis video gives an overview of non-congenital causes of vaginal obliteration with a focus on genital GVHD. We discuss the clinical course of a 54-year-old female with history of acute monocytic leukemia treated with chemotherapy and a BMT. She subsequently developed genital GVHD with complete vaginal obliteration, precluding penetrative intercourse and causing pain, discomfort, and decreased quality of life. We present a combined laparoscopic and vaginal surgical procedure that allowed for the creation of a neovagina with a normal length and caliber. While grafting is sometimes necessary due to inflammation and scarring, we were able to avoid a graft by using a combined laparoscopic and vaginal approach, followed by restoration of continuity between the unaffected upper and lower vaginal tissues. ConclusionGVHD can be quite debilitating for patients. A combined surgical approach is a feasible option for patients with complex pathology not amenable to simple transvaginal adhesiolysis. Surgical restoration of the vagina does not necessarily require the use of a graft if the anatomy is reestablished successfully.

Outcomes of one-stage feminizing genitoplasty in children with congenital adrenal hyperplasia and severe virilization

PurposeTo present our surgical experience and outcomes in congenital adrenal hyperplasia (CAH) patients with severe virilization using a combined technique of total urogenital mobilization (TUM) and a modified pull-through vaginoplasty to perform a safe and effective one-stage feminizing genital reconstruction for these children.MethodsFourteen CAH patients with severe virilization, defined by a Prader IV and V rating of the external genitalia, underwent TUM followed by a limited vaginal pull-through procedure from June 2016 to December 2020. Postoperative anatomical and cosmetic outcomes, and urinary continence, were evaluated.ResultsOut of the 14 cases in this study, 8 were classified as prader IV and 6 as Prader V. The median age at surgery was 11 months (range 6–36 months), and the mean urethral length was 1.4 cm (range 1.2–1.8 cm). The median follow-up period was 4 years. Our cosmetic outcomes were good in 11 (78.5%), satisfactory in 2, and poor in one case. All patients achieved age-appropriate toilet training without urinary incontinence.ConclusionAdopting our surgical approach of TUM with modified pull-through vaginoplasty has simplified feminizing surgical reconstruction in CAH cases with severe genital atypia and a very high vaginal confluence with short urethral length, yielding adequate introitus with good anatomical and cosmetic appearance and adequate urinary continence outcomes.

Patient reported outcomes after multivisceral resection for advanced rectal cancers in female patients.

Multivisceral resections for rectal cancer can lead to long-term functional disturbances. This study aims to evaluate the quality-of-life outcomes in female patients who underwent multivisceral resection for rectal cancer, specifically focusing on urinary and sexual functions. A cross-sectional study was conducted on female patients who underwent multivisceral rectal resections. Quality of life was assessed using the EORTC QLQ-CR29. Out of 198 female patients that underwent multivisceral resections, 69 were assessable for functional outcomes. The uterus was removed in 42 patients (61%), and the posterior vaginal wall in 34 (49%). A vaginal reconstructive procedure was carried out in 30% (21 patients). Patients reported the most troubles with urinary frequency (mean:69.6; SD:9.9), hair loss (mean:64.7; SD:13.9), pain during intercourse (mean:44; SD:40.7), and bowel frequency (mean:36.9; SD: -10.7) in this order. Amongst the functional scales, anxiety about future health (mean:42.5; SD:-018.9) and interest in sex (mean:57.2; SD:33.2) scored the lowest. Multivisceral rectal resections in female patients are associated with physical and psychosocial changes resulting in urinary and bowel complaints, anxiety about future health, poor sexual health, and pain.

What is the applicability of tubal ligation with the vaginal natural orifice transluminal endoscopic surgery technique and its value in patient comfort?

The aim of this study was to observe the feasibility of the tubal/adnexal approach using vaginal natural orifice transluminal endoscopic surgery and compare its contribution with surgeon ergonomics and postoperative patient comfort with that of conventional laparoscopy. We completed this study retrospectively with 47 patients. Patients were followed at their postoperative first month. We analyzed the usability of the vaginal natural orifice transluminal endoscopic surgery method over conventional laparoscopy by comparing the demographics, surgical data, and postoperative findings collected between the two groups. Patients in the conventional laparoscopy group were older (39.1±3.3 years) than those in the vaginal natural orifice transluminal endoscopic surgery patient group (p=0.005). Pain intensity 24 h after surgery was lower in the vaginal natural orifice transluminal endoscopic surgery group (p=0.003), while sexual function and dyspareunia did not differ between the two groups in the first month. Patients in the vaginal natural orifice transluminal endoscopic surgery group were more relieved about painlessness and the comfort it brought than the conventional laparoscopy group (p=0.027, χ2=12.56). Patients subjected to the vaginal natural orifice transluminal endoscopic surgery procedure showed higher levels of satisfaction, less postoperative pain, and greater comfort than those subjected to conventional laparoscopy.

Modified Vaginal Mesh Procedure with DynaMesh®-PR4 for the Treatment of Anterior/Apical Vaginal Prolapse.

(1) Background: Treating female pelvic organ prolapse (POP) is challenging. Surgical meshes have been used in transvaginal surgeries since the 1990s, but complications such as mesh exposure and infection have been reported. Polyvinylidene fluoride (PVDF) mesh, known for its stability and non-reactive properties, has shown promise in urogynecological surgeries. (2) Methods: A retrospective analysis was conducted on 27 patients who underwent a modified PVDF vaginal mesh repair procedure using DynaMesh®-PR4 and combined trans-obturator and sacrospinous fixation techniques. Additional surgeries were performed as needed. (3) Results: The mean operation time was 56.7 min, and the mean blood loss was 66.7 mL. The average hospitalization period was 4.2 days with Foley catheter removal after 2 days. Patients experienced lower pain scores from the day of the operation to the following day. Postoperative follow-up revealed that 85.2% of patients achieved anatomic success, with 14.8% experiencing recurrent stage II cystocele. No recurrence of apical prolapse was observed. Complications were rare, with one case (3.7%) of asymptomatic mesh protrusion. (4) Conclusions: The modified vaginal mesh procedure using DynaMesh®-PR4 showed favorable outcomes with a short operation time, low recurrence rate, rare complications, and improved functional outcomes. This surgical option could be considered for anterior and apical pelvic organ prolapse in women.

RESPECTFUL MATERNITY CARE AND THEIR POSTPARTUM EFFECTS IN WOMEN

Aim:To recognise the benefits of Respectful Maternity Care during labor and encouraging the practice of the same. Design: Cross Sectional Study Methodology : Sample Size : 100 patients Inclusion Criteria :Antenatal patients in Active Phase of Labor proceeding for Normal Vaginal Delivery Procedure : The study is a questionnaire based study. The study population will be antenatal patients admitted in a Tertiary Care Hospital. After getting informed consent , the procedure will be explained thoroughly to the participants and only the participants who are willing to take part in the study will be selected. The participants were observed in the labor ward and the post natal ward during their stay in the hospital .They were asked to answer a questionnaire postnatally . The questionnaire contains questions related to the WHO recommendations of the Respectful Maternity Care which includes topics like dignity, privacy and confidentiality, ensuring freedom from harm and mistreatment, and enabling informed choice and continuous support during labour and childbirth. This study is complelety a non invasive study. Study Duration: 4 Months Results: The study population included 100 participants admitted for labor in a tertiary care hospital where they received proper Respectful Maternity Care both antenatally and Postnatally. It was observed that women who were treated with proper RMC had more bonding with their babies and were able to breastfeed more effectively. The participants did not have common complaints of post partum depression, hesitancy to breastfeed, insomnia, lack hesitancy to Breast feed and reduced incidence of Traumatic Deliveries. Conclusion: Providing Respectful Maternity Care to antenatal patients has more positive outcomes in both antenatal and postnatal periods of a patient. It reduces common post partum ailments and promotes maternal and neonatal well being by reducing maternal and neonatal morbidity and mortality rate.

Surgery for women with apical vaginal prolapse.

Surgery for women with apical vaginal prolapse.

(002) Neuroproliferative Vestibulodynia as a Cause of Persistent Genital Arousal Disorder: A First-Ever Case Series

Abstract Introduction Persistent Genital Arousal Disorder (PGAD), a condition of unwanted, unremitting feelings of genital arousal, is associated with significant morbidity including catastrophizing, depression, anxiety, and/or suicidal ideation. There are multiple diverse triggers of PGAD that may originate in one or more of five regions in a patient: end organ, pelvis/perineum, cauda equina, spinal cord, and/or brain. Regarding the contributions to PGAD in the end-organ region, it is hypothesized that vestibulodynia may be a trigger for PGAD. The vestibule has unique sensory qualities, as this region receives sensory innervation from branches of both the somatic pudendal and visceral pelvic nerves. Objectives Neuroproliferative vestibulodynia is a disorder of excess deposition of mast cells with resultant excess c-afferent nociceptors in the vestibule. To the best of our knowledge, vestibulodynia, specifically neuroproliferative vestibulodynia, has not been reported in the literature as a cause of PGAD. The purpose of this study was to report on four women with lifelong PGAD suspected of having neuroproliferative vestibulodynia. Methods These women underwent: i) a detailed biopsychosocial assessment including sex therapy and diagnostic testing, evaluation of baseline PGAD intensity, vulvoscopy, cotton swab testing of the vestibule, PGAD intensity post-cotton swab test, and vestibular anesthesia testing (VAT); ii) treatment by complete vestibulectomy with vaginal advancement flap reconstruction; iii) staining of vestibular tissue with CD 117 (for mast cells) (Figure 1) and PGP 9.5 (for nerves) (Figure 2) and iv) measurement of clinical outcome with patient global impression of improvement. The VAT was performed with a topical anesthetic carefully applied to the vestibule between Hart’s line and the hymen. Complete anesthesia was assessed by cotton swab testing. Pre- and post-VAT intensity levels were compared. Results These patients had lifelong PGAD with a history of frequent masturbation at a very young age and feelings of catastrophizing, depression, anxiety, and/or suicidal ideation. Three patients had experienced sexual trauma, eating disorders, and had stressful relationships with family members. All four used various SSRI medications for depression/anxiety disorders and PGAD management from a young age. The youngest patient presented at 13 years with a presumptive diagnosis, primarily based on VAT, of neuroproliferative vestibulodynia. Surgery was delayed until she stopped growing at age 18. The other three presented at ages 20, 24, and 24. All four had full, although temporary, resolution of PGAD symptoms post-VAT. Each underwent a complete vestibulectomy with vaginal advancement flap procedure; the mean age at time of surgery was 22 +/− 3 years. Stained vestibular tissues showed in excess of 20 mast cells and nerves per high power field, consistent with neuroproliferative vestibulodynia. Curiously, post-operatively, none of the patients required the usual post-op opioid pain medications typical of patients undergoing vestibulectomy. While all four still experience mild PGAD symptoms when stressed, their PGAD symptoms are very much improved post-op with significant symptom resolution, with a mean follow-up of 11 months, range 4 – 26. Conclusions This is the first case series to document that neuroproliferative vestibulodynia is a treatable cause of PGAD, although more research is needed. Disclosure No.