Does the method of dissecting in anterior colporraphy lead to a difference in thickness of removed vaginal tissue?

OBJECTIVE: To evaluate the difference in thickness of the anterior vaginal wall removed after different surgical dissecting techniques of anterior colporrhaphy. STUDY DESIGN: In patients undergoing primary anterior colporrhaphy, trimmed vaginal tissue was taken following different surgical techniques of vaginal wall dissection. Tissues were preserved in formalin and stained with hematoxylin-eosin and elastica-van Giesen stains. The examiner was an experienced pathologist blinded to the surgical technique. The specimens were examined for the epithelial thickness (ET), lamina propria thickness (LPT), muscular layer thickness (MT) and total thickness (TT). RESULTS: Tissue was analysed in 93 women who underwent anterior compartment pelvic organ prolapse surgery. There was no difference between the different surgical techniques in thickness measured in the three histological layers and for the total thickness. The use of hydrodissection was the only independent factor leading to thicker removed vaginal tissue. CONCLUSIONS: Dissecting the vaginal wall as thin as possible does not result in a thinner vaginal layer than dissecting in the most optimal surgical plane. The use of hydrodissection provides a thicker trimmed tissue.

The use of synthetic mesh in vaginal prolapse surgery: a survey of Dutch urogynaecologists.

OBJECTIVE: To evaluate the use of mesh in vaginal prolapse surgery amongst members of the Dutch Urogynaecologic Society. STUDY DESIGN: A questionnaire evaluating the use of mesh vs. native tissue repair in vaginal prolapse surgery was sent out by email to all members. Some specific questions on standard measures of infection prevention were included. RESULTS: One hundred and thirty-three completed questionnaires were received. The response rate was 65%. Seventy-one percent of respondents stated that they apply use synthetic meshes in their patients. The mean percentage of mesh use in overall vaginal pelvic organ prolapse surgery was 14%. Most responders use mesh in recurrent surgery only. Prolift is the most commonly used brand. All women received prophylactic antibiotics. Although only half of the respondents changed gloves. CONCLUSIONS: Meshes are commonly used in the Netherlands. The major indication is repair of a recurrent prolapse.

[Pregnancy termination in the second trimester with vaginally administered dinoprostone followed by intravenous sulprostone, for the indication 'foetal congenital defects'; results of a retrospective study]. / Zwangerschapsafbreking in het tweede trimester met dinoproston vaginaal gevolgd door sulproston intraveneus, op de indicatie 'foetale congenitale afwijkingen'; resultaten van een retrospectieve studie.

OBJECTIVE: To obtain insight into treatment duration and complications of the currently accepted method for pregnancy termination in the second trimester using a combination of prostaglandine-E2 medications. DESIGN: Retrospective study of medical records. METHOD: Data were collected for all second trimester pregnancy terminations performed on foetal indication in the Erasmus Medical Center in Rotterdam, The Netherlands, in the years 1998-2001. The treatment consisted of vaginal administration of dinoprostone, followed by intravenous administration of sulprostone. RESULTS: A total of 134 pregnant women were involved in the analysis. The median age was 33 years and the median pregnancy duration 19 weeks. The median duration of hospital stay was 3 days (range: 2-11 days). The median duration of treatment for the total study population was 19 hours (4-172). For nulliparae this was 23 hours, and for multiparae 17 hours (p < 0.05). Of the total study population, 91 women (68%) delivered within 24 hours. The percentage of multiparae that delivered within 24 hours was higher than the percentage of nulliparae that delivered in this time (76% compared to 53%: p < 0.05). Operative removal of a--partially--retained placenta was conducted in 51 women (38%). This percentage was higher among women with treatment duration longer than 24 hours than among women who delivered within 24 hours (51% versus 32%; p < 0.05). The treatment duration and the complication percentage were less favourable than those described in a number of publications relating to the combination mifepristone and misoprostol.