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1.
Taiwan J Obstet Gynecol ; 58(4): 560-565, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307752

RESUMO

OBJECTIVE: Herlyn-Werner-Wünderlich syndrome (HWW) is a rare congenital malformation of the urogenital tract due to a fusion failure in the Müllerian ducts. This anomaly consists of a didelphus uterus with obstructed hemivagina and sometimes associated with ipsilateral renal agenesis. The treatment of choice is surgical, it consists of a simple procedure of resection of the vaginal septum and drainage of the obstructed hemivagina and retained collections. CASE REPORT: We report the case of a pregnancy in a 37-year-old woman with SHWW without resection of the vaginal septum. CONCLUSIONS: The early detection is important due to the possible associated complications. Women with uterine defects are subject to an increased risk of complications in pregnancy and childbirth. Therefore, each case must be treated individually.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Ductos Paramesonéfricos/anormalidades , Resultado da Gravidez , Gravidez de Alto Risco , Anormalidades Urogenitais/diagnóstico por imagem , Adulto , Feminino , Idade Gestacional , Humanos , Imagem por Ressonância Magnética/métodos , Monitorização Fisiológica/métodos , Gravidez , Doenças Raras , Síndrome , Anormalidades Urogenitais/cirurgia
2.
Urologiia ; (2): 108-112, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162911

RESUMO

The review focuses on the feminizing genitoplasty of the external genitalia in patients with disorders of sex development. The opinions of various surgeons and surgical schools on the timing, stages and methods of performing feminizing genitoplasty in girls with the virilization of the genitalia are presented. The development and improvement of surgical techniques for performing clitoroloplasty in patients with virilization of genitalia are described, as well as different types of labioplasty. The main methods of reconstruction of the urogenital sinus are given.


Assuntos
Transtornos do Desenvolvimento Sexual/cirurgia , Anormalidades Urogenitais/cirurgia , Virilismo/cirurgia , Vulva/anormalidades , Vulva/cirurgia , Feminino , Humanos , Virilismo/etiologia
3.
Folia Med Cracov ; 59(1): 127-136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31180081

RESUMO

Monorchism in children can be caused by congenital and acquired conditions, and can potentially influence the hormonal and reproductive function of an individual in the long term. Depending on the etiology, different approaches to the solitary testis have been suggested; however, studies on this topic are scarce. Prevention of anorchia is the main goal in the management of a child with monarchism. e risk of bilateral testicular loss must be weighed against the risk of performing surgery on a healthy gonad. Little is known about the long-term consequences of the various methods for fixation of the testis. This paper provides an up-to-date summary of the current literature on congenital and acquired monarchism in childhood.


Assuntos
Tomada de Decisão Clínica , Testículo/anormalidades , Testículo/lesões , Criança , Disgenesia Gonadal 46 XY , Humanos , Masculino , Orquiectomia , Procedimentos Cirúrgicos Reconstrutivos , Medição de Risco , Torção do Cordão Espermático/prevenção & controle , Torção do Cordão Espermático/cirurgia , Neoplasias Testiculares/cirurgia , Testículo/cirurgia , Anormalidades Urogenitais/cirurgia
4.
Artigo em Alemão | MEDLINE | ID: mdl-31212353

RESUMO

In a 9-month-old tomcat presented for routine castration, only the right testis was palpable in the scrotum. This tomcat was part of an inbred litter. Unilateral cryptorchism was suspected, but further diagnostic procedures (ultrasound, diagnostic laparotomy) were unsuccessful in identifying a cryptorchid left testicle. Histopathologic evaluation of the resected right testis revealed a normal organ with spermatogenesis. In tissue resected from the subcutaneous tissue of the left inguinal region side during laparotomy, only a small left epididymis with surrounding fatty tissue was identified at the proximal end of the vas deferens. Morphologic controls of the phenotype and the remaining primary sexual characteristics as well as the results of a hCG stimulation test 7 months after the surgery further established the diagnosis of monorchism. Possible causes for monorchism are unilateral testicular agenesis and testicular atrophy because of vascular insults. This case shows that even during routine procedures, like tomcat castration, the general practitioner can encounter rare anomalies like monorchism, which must be differentiated from cryptorchidism by appropriate diagnostic procedures.


Assuntos
Testículo , Anormalidades Urogenitais , Animais , Gatos , Masculino , Orquiectomia , Testículo/patologia , Testículo/cirurgia , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/patologia , Anormalidades Urogenitais/cirurgia
5.
J Coll Physicians Surg Pak ; 29(6): S70-S72, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31142429

RESUMO

Pregnancy in rudimentary horn is extremely rare and usually terminates in rupture during first and second trimester of pregnancy. Diagnosis of rudimentary horn pregnancy and its rupture is difficult and can be missed in routine ultrasound scan; and in majority of cases, it is detected after rupture. It requires high index of suspicion. We present a case report of a woman who was misdiagnosed as having missed miscarriage; and termination was attempted, which ended up in failure and rupture of rudimentary horn was the consequence followed by laparotomy. With advances in prenatal ultrasound in recent decades, it is prudent to detect such a life-threatening condition earlier resulting in a lower incidence of maternal morbidity and mortality.


Assuntos
Gravidez Cornual/diagnóstico por imagem , Anormalidades Urogenitais/complicações , Ruptura Uterina , Útero/anormalidades , Adulto , Feminino , Humanos , Laparotomia , Imagem por Ressonância Magnética , Gravidez , Complicações na Gravidez , Gravidez Cornual/etiologia , Gravidez Cornual/cirurgia , Anormalidades Urogenitais/diagnóstico por imagem , Anormalidades Urogenitais/cirurgia , Ruptura Uterina/etiologia , Útero/diagnóstico por imagem , Útero/cirurgia
6.
Fertil Steril ; 112(2): 399-400, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31133386

RESUMO

OBJECTIVE: To present three different subtypes of T-shaped uterus with the use of three-dimensional (3D) ultrasound imaging and hysteroscopy. DESIGN: Video article. SETTING: Fertility center. PATIENT(S): Three cases showing the different subtypes of T-shaped uterus. INTERVENTION(S): 3D ultrasound imaging and hysteroscopy. MAIN OUTCOME MEASURE(S): Distance between the interostial line and external uterine profile at the midcoronal plane of the uterus obtained with the use of transvaginal 3D ultrasound; delineation of the external uterine contour and the length of any existing internal indentation (defined as the distance between the interostial line and the indentation's edge at the cavity). RESULT(S): It is possible to identify three different subtypes of T-shaped uterus: the most common type of T-shaped uterus, with thick lateral walls and normal fundus (without septum or subseptum appereance) and interostial distance; the Y-shaped uterus, with thick lateral walls, fundal septum or subseptum, and reduced interostial distance; and the I-shaped uterus, with very thick lateral walls (even above the isthmus) and severe reduction of the interostial distance (tubular appearance of the whole uterus). CONCLUSION(S): We solicit to investigate the occurrence of different T-shaped uterus subtypes in large cohorts, to evaluate whether they may have different reproductive outcomes and whether they may need different approaches for surgical correction through hysteroscopic metroplasty.


Assuntos
Histeroscopia/métodos , Ultrassonografia/métodos , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/cirurgia , Útero/anormalidades , Adulto , Feminino , Humanos , Imagem Tridimensional/métodos , Anormalidades Urogenitais/patologia , Útero/diagnóstico por imagem , Útero/patologia , Útero/cirurgia
7.
Fertil Steril ; 112(1): 177-179, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31126713

RESUMO

OBJECTIVE: To present a case of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome complicated with pyometra and explain tips and tricks for laparoscopic hemihysterectomy. DESIGN: A step-by-step explanation of the technique with the use of video (Canadian Task Force Classification III). Patient consent and Institutional Review Board approval were obtained. SETTING: OHVIRA syndrome is characterized by the triad of uterovaginal duplication, obstructed hemivagina, and ipsilateral renal agenesis (1). Patients with OHVIRA syndrome usually present with dysmenorrhea and a vaginal or a pelvic mass. Renal, uterine, and vaginal pathologies can be diagnosed with the use of ultrasonography and magnetic resonance imaging (MRI) (2). In cases in which the diagnosis is not delayed, treatment consists of vaginal septostomy (3). Delayed diagnosis may lead to pelvic infections in patients with microperforations in the septum, which may lead to abscess formation, pelvic inflammatory disease, pyometra, and subsequent need for hemihysterectomy and adnexectomy (4). PATIENT(S): A 21-year-old G2 P2 patient who had a history of hospitalization with the diagnosis of tubo-ovarian abscess three times previously presented to the emergency department with pelvic pain, nausea, high fever, and malodorous vaginal discharge. On physical examination, a pelvic abscess draining to the left vaginal wall and a 10-12-cm left adnexal mass were noticed. A diagnosis of OHVIRA syndrome and pyometra was made after evaluation of ultrasonographic and MRI findings. Longitudinal vaginal septum excision and drainage of the abscess was performed. Ten cubic centimeters of purulent abscess material was drained by incising the left vaginal wall. However, the mass extending from the left vaginal wall to the left adnexal area could not be drained. On hysteroscopy, no cervix was visualized belonging to the obstructed hemivagina and the left uterine cavity could not be entered. On reexamination of the MR images, the presence of a transverse vaginal septum overlying the left hemivagina was detected, preventing access to the left hemiuterine cavity. The transverse vaginal septum could have been excised and the pyometra drained; however, owing to the presence of chronic pelvic pain and dyspareunia, and a history of three failed previous attempts at treatment, the decision to perform hemihysterectomy was made. INTERVENTION(S): A laparoscopic hemihysterectomy was performed in the patient, who was diagnosed as having OHVIRA syndrome complicated with pyometra. Patient consent and Institutional Review Board approval were obtained for this report. MAIN OUTCOME MEASURE(S): On laparoscopy, the left hemiuterus on the same side as the obstructed hemivagina appeared three to four times larger than the normal hemiuterus, in which two pregnancies had occurred, and dense adhesions were present between this hemiuterus and the bowel. The left hemiuterus was densely adherent to the pelvic side wall. Laparoscopic hemihysterectomy was performed. A monofilament barbed suture were used for the repair of the paracervical area and left hemivagina. A transverse septum and cervical atresia was noticed at the distal end of the left hemiuterus. The surgical challenges encountered during treatment of this case were the difficulty in recognizing anatomic structures owing to chronic inflammatory changes, dissecting dense adhesions without injuring neighboring pelvic organs, providing adequate hemostasis during dissection of fragile and hemorrhagic tissues, gaining optimal visualization of the surgical field owing to hampered hemostasis, obtaining adequate exposure of the surgical site owing to the inability to use a uterine manipulator, and the difficulty in dissecting the left hemiuterus without damaging the right hemiuterus for fertility preservation. The ultrasonic scalpel is an energy modality that is known to cause the least amount of collateral thermal tissue damage. In the present case, an ultrasonic scalpel was used to dissect dense adhesions between the left hemiuterus and the urinary bladder to minimize the risk of thermal injury to the urinary bladder. The ultrasonic scalpel was also used when dissecting the unhealthy hemiuterus from the healthy hemiuterus owing to its ergonomic tip and to avoid thermal damage to the cervix of the healthy hemiuterus. In areas of dense adhesions and distorted anatomy, the broad tips of bipolar forceps are also helpful for blunt dissection and the creation of tissue planes, and it is also used for effective concomitant hemostasis. A vessel sealer is the most appropriate energy modality for providing effective hemostasis during dissection of the uterine artery while causing minimal collateral tissue damage (5, 6). When deciding the kind of energy modality to be used during operative laparoscopy, the source that minimized thermal injury while providing optimal hemostasis was preferred. Furthermore, additional features such as rotation, dissection, grasping, and the ergonomics of the tip of the device were also considered when choosing the energy source to be used. RESULT(S): The patient was discharged 48 hours postoperatively with no complications. No symptoms of pelvic pain, dysmenorrhea, and dyspareunia were present at the end of the third month after surgery. CONCLUSION(S): Understanding the exact nature of the uterine anomaly before hemihysterectomy is of paramount importance for a successful surgery. Laparoscopy is a safe and effective treatment modality even in the presence of dense pelvic adhesions and distorted pelvic anatomy.


Assuntos
Histerectomia/métodos , Rim/anormalidades , Laparoscopia , Piometra/cirurgia , Anormalidades Urogenitais/cirurgia , Vagina/anormalidades , Vagina/cirurgia , Feminino , Humanos , Rim/diagnóstico por imagem , Piometra/diagnóstico por imagem , Piometra/etiologia , Resultado do Tratamento , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/diagnóstico por imagem , Vagina/diagnóstico por imagem , Adulto Jovem
8.
Ophthalmic Plast Reconstr Surg ; 35(5): 506-508, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31033640

RESUMO

PURPOSE: There are different techniques for medial canthoplasty in blepharophimosis syndrome where individuals have epicanthus inversus and telecanthus leading to typical facial appearances. These methods have potential problems with scarring, epistaxis, and extrusion of metal plates. METHODS: The authors describe a novel technique of medial canthal reconstruction using titanium microplates with microscrew fixation to the anterior lacrimal crest, with effective, safe, and reproducible results. RESULTS: Seven children with blepharophimosis syndrome underwent medial canthus reconstruction surgery at a single center with the collaboration of a pediatric oculoplastic surgeon and craniofacial plastic surgeon to improve eye opening through correction of the lid contours and telecanthus. CONCLUSIONS: This is a safe, effective, and reproducible technique, with minimal morbidity and rapid postoperative recovery in children. It produces cosmetically acceptable scars and a strong stable reconstruction of the medial canthal insertion.


Assuntos
Blefarofimose/cirurgia , Blefaroplastia/métodos , Aparelho Lacrimal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Anormalidades da Pele/cirurgia , Anormalidades Urogenitais/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino
9.
J Obstet Gynaecol Res ; 45(7): 1410-1413, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30977221

RESUMO

A 30-year-old woman with a bicorporeal uterus complained of abdominal pain and vaginal hemorrhage at 28 weeks and 5 days of gestation. There were no signs of placenta previa with echography in the second trimester; however, the echography showed a highly echoic area (91 × 85 mm), indicating placenta previa. Thereafter, abdominal pain and vaginal bleeding increased. Thus, we suspected placental abruption and performed cesarean section. After cesarean section, discharge of placenta-like tissue into the vagina was confirmed and pathological examination of the tissue showed only the decidua. In cases of uterine malformations, in which the uterine cavity is divided into pregnant and nonpregnant sides, the decidua on the nonpregnant side can be discharged before the onset of delivery. In addition, at the time of decidual discharge, echography findings are similar to those of placenta previa and the clinical symptoms are similar to those of placental abruption.


Assuntos
Cesárea , Complicações na Gravidez/cirurgia , Anormalidades Urogenitais/cirurgia , Útero/anormalidades , Descarga Vaginal/cirurgia , Adulto , Decídua , Feminino , Humanos , Gravidez , Complicações na Gravidez/etiologia , Anormalidades Urogenitais/complicações , Útero/cirurgia , Descarga Vaginal/congênito
10.
World Neurosurg ; 125: e612-e619, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30716497

RESUMO

OBJECTIVE: Sylvian subpial hematoma (SSH) is occasionally observed in aneurysm subarachnoid hemorrhage (aSAH) when accompanied with the thick clot in the inferior limiting sulcus (ILS). We aimed to determine whether the thickness of the clot in the ILS (TCILS) was an indicator of SSH. METHODS: Data from 150 consecutive patients with aSAH were retrospectively analyzed. The relationship between TCILS on axial computed tomography (CT) image and intraoperatively confirmed SSH was reviewed. In patients without SSH, the average of the clot thickness in the bilateral ILS was used. The primary outcome was SSH. RESULTS: The median TCILS of the SSH group (n = 18, 12%) was larger than that of the non-SSH group (n = 132, 88%) (21 vs. 2.1 mm, respectively; P < 0.001). The intraclass correlation coefficients for clot thickness in the right and left ILS between 2 observers were 0.97 (P < 0.001) and 0.85 (P < 0.001). The TCILS threshold of ≥6.0 mm was associated with SSH, with a sensitivity of 89% and specificity of 99%. The unadjusted and adjusted odds ratios of the SSH of clot thickness in the affected ILS ≥6 mm relative to clot thickness in the affected ILS <6 mm were 263 (95% confidence interval [CI], 46-5063) and 137 (95% CI, 19-3029), respectively. CONCLUSIONS: The clot thickness in the ILS on CT image was easily measured and could be a marker of SSH. SSH assessment could be useful in helping us predict the clinical course in patients with aSAH.


Assuntos
Aneurisma Roto/cirurgia , Hematoma/cirurgia , Aneurisma Intracraniano/cirurgia , Hemorragia Subaracnóidea/cirurgia , Insuficiência Adrenal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/complicações , Feminino , Retardo do Crescimento Fetal/cirurgia , Hematoma/complicações , Humanos , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Razão de Chances , Osteocondrodisplasias/cirurgia , Hemorragia Subaracnóidea/complicações , Trombose/complicações , Anormalidades Urogenitais/cirurgia
11.
J Pak Med Assoc ; 69(1): 108-112, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30623923

RESUMO

Patients who have secondary pseudohypoaldosteronism (PHA) in addition to hyponatraemia, hyperpotassaemia and high serum aldosterone levels for the age were included in this retrospective study.Among eight patients, seven patients were diagnosed with PHA secondary to obstructive uropathy (OUP), whereas one patient had PHA secondary to ileostomy. Six patients with OUP had simultaneous urinary tract infection (UTI) and in all except one patient, secondary PHA recovered with only UTI treatment before applying surgical correction. All the patients were younger than 3 months age. In three patients with PUV diagnosis, salt wasting recurred in an UTI episode under 3 months of age.


Assuntos
Aldosterona/sangue , Hiperpotassemia , Hiponatremia , Pseudo-Hipoaldosteronismo , Infecções Urinárias , Anormalidades Urogenitais , Desequilíbrio Hidroeletrolítico , Diagnóstico Diferencial , Feminino , Humanos , Hiperpotassemia/diagnóstico , Hiperpotassemia/etiologia , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Lactente , Masculino , Natriurese , Pseudo-Hipoaldosteronismo/diagnóstico , Pseudo-Hipoaldosteronismo/etiologia , Pseudo-Hipoaldosteronismo/metabolismo , Pseudo-Hipoaldosteronismo/terapia , Estudos Retrospectivos , Turquia , Infecções Urinárias/complicações , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/metabolismo , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/metabolismo , Anormalidades Urogenitais/cirurgia , Desequilíbrio Hidroeletrolítico/diagnóstico , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/terapia
12.
Urology ; 125: 205-209, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30597168

RESUMO

Herlyn-Werner-Wunderlich syndrome, defined by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis, is a rare Mullerian malformation, usually diagnosed after menarche, when symptoms related to hematocolpos arise. Rarely, this malformation is diagnosed in the neonatal period, normally following prenatal diagnosis of renal agenesis. Herein, a case recognized on prenatal imagiology that underwent surgery on the fourth day of life is reported. The records of prepubertal cases were also collected, addressing the clinical and imagiological features. In the presence of a solitary kidney and/or a pelvic mass on prenatal ultrasound, Herlyn-Werner-Wunderlich syndrome should be considered, enabling neonatal treatment.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Rim/anormalidades , Rim/diagnóstico por imagem , Ultrassonografia Pré-Natal , Anormalidades Urogenitais/diagnóstico por imagem , Útero/anormalidades , Vagina/anormalidades , Vagina/diagnóstico por imagem , Anormalidades Múltiplas/cirurgia , Feminino , Humanos , Recém-Nascido , Síndrome , Anormalidades Urogenitais/cirurgia , Útero/diagnóstico por imagem , Útero/cirurgia , Vagina/cirurgia
14.
J Laparoendosc Adv Surg Tech A ; 29(2): 286-291, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30358477

RESUMO

OBJECTIVE: Laparoscopy-assisted cutaneous ureterostomy (LA-CU) is a minimally invasive approach for temporary urinary diversion in children. We describe the technique, its feasibility, potential advantages, and outcomes in 12 children treated for a variety of conditions. METHODS: Three trocars were used transperitoneally, one transumbilical, and another placed at the later stoma site. In the semilateral position, with a panoramic view, the ureter of interest is easily identified, mobilized, and exteriorized for stoma creation. We retrospectively reviewed our experience at two tertiary-care centers and included both refluxing and end ureterostomies. The study period was between October 2014 and February 2017. Renal function and growth curves were noted at follow-up. RESULTS: Twelve children underwent LA-CU: 3 end and 9 refluxing ureterostomy. Mean age was 18.75 ± 17.60 months. Mean operating time was 94.44 ± 34.86 minutes. Follow-up ranged from 10 to 38 months. No major postoperative complications occurred. Renal function and growth curves improved in the majority of children. CONCLUSIONS: Primary surgical correction of obstructive or refluxing uropathy is the gold standard; however, temporary urinary diversion is useful in specific scenarios. In these patients, laparoscopic assistance may offer better and direct visualization, achieves accurate and rapid identification of ureter, and provides adequate mobilization, tension-free exteriorization, and excision of redundant ureter in some to optimize drainage. One trocar at the eventual stoma site minimizes scarring.


Assuntos
Laparoscopia , Ureterostomia/métodos , Anormalidades Urogenitais/cirurgia , Doenças Urológicas/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Laparoscopia/efeitos adversos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Ureterostomia/efeitos adversos
15.
J Gynecol Obstet Hum Reprod ; 48(1): 39-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30355504

RESUMO

OBJECTIVE: To evaluate the long term anatomical and reproductive outcomes of hysteroscopic treatment for T shaped uterus in patients presenting with reproductive failure. METHODS: This prospective cohort study included 56 patients with a history of long-standing unexplained infertility, recurrent implantation failure (RIF), and/or recurrent pregnancy loss (RPL) who were eligible for metroplasty by office hysteroscopy. Office hysteroscopy under conscious sedation was performed. Anatomical outcomes were assessed with pre- and postoperative measurements of the transostial, isthmic and myometrial diameters and the uterine volume using three-dimensional transvaginal sonography (3D-TVS). Reproductive outcome was assessed after spontaneous or assisted conception. RESULTS: Hysteroscopic treatment significantly increased the volume of the uterus from a mean of 2.5+1mL before surgery to 3.2±1mL by the end of 1 year as measured by 3D-TVS. According to the main indication to perform metroplasty, 20 of 32 (62.5%) patients with long standing unexplained infertility, 9 of 14 (64%) patients with RIF, and 8 of 10 (80%) patients with RPL conceived either spontaneously or with assisted reproduction. CONCLUSIONS: Office hysteroscopic metroplasty results in a significant long-term expansion of the uterine cavity and improved reproductive outcomes in women presenting with a T shaped uterus and poor reproductive history.


Assuntos
Aborto Habitual/terapia , Procedimentos Cirúrgicos Ambulatórios/métodos , Histeroscopia/métodos , Infertilidade Feminina/terapia , Anormalidades Urogenitais/cirurgia , Útero/anormalidades , Adulto , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Feminino , Humanos , Histeroscopia/estatística & dados numéricos , Estudos Prospectivos , Útero/cirurgia
16.
J Pediatr Surg ; 54(3): 612-615, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30297116

RESUMO

Acquired urethrovaginal fistulae and urethral atresia are rare findings in pediatric patients, but have been described in adult patients related to trauma or iatrogenic injury. Little exists in the published literature to guide management of such conditions in children, but lessons learned from congenital causes can help. Herein we discuss the preoperative evaluation and management of a child with an acquired urethrovaginal fistula and urethral atresia likely related to in utero compression from an intrapelvic sacrococcygeal teratoma and provide several images detailing the complex anatomy.


Assuntos
Região Sacrococcígea/patologia , Teratoma/complicações , Doenças Uretrais/cirurgia , Fístula Urinária/cirurgia , Fístula Vaginal/cirurgia , Endoscopia/métodos , Feminino , Humanos , Lactente , Cuidados Pré-Operatórios/métodos , Região Sacrococcígea/cirurgia , Teratoma/cirurgia , Doenças Uretrais/complicações , Fístula Urinária/complicações , Anormalidades Urogenitais/diagnóstico , Anormalidades Urogenitais/cirurgia , Fístula Vaginal/complicações
17.
J Minim Invasive Gynecol ; 26(5): 977-980, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30553034

RESUMO

Supernumerary and accessory ovaries are collectively coined ectopic ovaries. These are rarely encountered by the benign gynecologist and are often discovered incidentally during evaluation for other gynecologic, gastrointestinal, or urologic pathologies. We report the presentation of a patient with multiple accessory ovaries in addition to a rare congenital anomaly of the splanchnic vasculature called an Abernethy malformation. Incidental identification of ectopic ovaries necessitates a search for additional malformations outside of the genitourinary tract that can have larger implications for long-term health.


Assuntos
Coristoma/diagnóstico , Ovário/anormalidades , Veia Porta/anormalidades , Anormalidades Urogenitais/diagnóstico , Malformações Vasculares/diagnóstico , Adulto , Coristoma/complicações , Coristoma/cirurgia , Feminino , Humanos , Achados Incidentais , Laparoscopia , Ovário/cirurgia , Distúrbios do Assoalho Pélvico/complicações , Distúrbios do Assoalho Pélvico/diagnóstico , Distúrbios do Assoalho Pélvico/cirurgia , Veia Porta/cirurgia , Circulação Esplâncnica/fisiologia , Anormalidades Urogenitais/complicações , Anormalidades Urogenitais/cirurgia , Malformações Vasculares/complicações , Malformações Vasculares/cirurgia
19.
J Minim Invasive Gynecol ; 26(3): 396-397, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29890355

RESUMO

STUDY OBJECTIVE: To introduce a creation that combines laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using a small intestinal submucosa (SIS) graft in a patient with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome who had a rudimentary cavity (U5aC4V4) [1]. DESIGN: A video article introducing a new surgical technique. SETTING: A university hospital. PATIENTS: A 24-year-old patient had primary amenorrhea and irregular lower abdominal pain for 9 years. The patient was Tanner stage 3 for pubic hair and Tanner stage 4 for breast development. The physical examination revealed no vagina. A primordial uterus and a uterus with a rudimentary cavity were detected by magnetic resonance imaging [2,3]. However, the rudimentary cavity had no hematometra. Magnetic resonance imaging also found a left solitary kidney. The diagnosis was MRKH syndrome with a rudimentary cavity (U5aC4V4) [4]. The patient desired resumption of menses and possible future fertility. INTERVENTIONS: Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft was performed. MEASUREMENTS AND MAIN RESULTS: With the Wharton-Sheares-George neovaginoplasty, a vaginal mold with a surrounding SIS graft was inserted into the newly created cavity [5]. Using laparoscopy, the lower uterine segment was incised by shape dissection. The proximal segment of the SIS graft to the lower uterine segment was sutured. A T-shaped intrauterine device with a Foley catheter was fixed in the uterine cavity by the delay of absorbed sutures to prevent cervical or vaginal stenosis. The distal segment of the SIS graft was sutured with the high vaginal or vestibular mucosa vaginally. The operation was successfully completed. The operating time was 2 hours. Hospitalization was 4 days. There were no blood transfusions or complications. The patient had resumption of menses for 2 cycles postoperatively, and she had no dysmenorrhea. The patient did not have sexual intercourse because of the mode in the vagina to prevent vagina stenosis. No cervical stenosis occurred because of the Foley catheter. CONCLUSION: In the past, a uterus with a rudimentary cavity in patients with MRKH was always excised, and patients lost the chance of menstrual onset and fertility. Combined laparoscopic and Wharton-Sheares-George cervicovaginal reconstruction using an SIS graft provided a minimally invasive, safe, and effective surgical option for the young patient with MRKH syndrome with a rudimentary cavity. The technique is not complex, is easy to learn and perform, and provided a result with functional and anatomic satisfaction. No special surgical apparatus is needed with this technique.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Anormalidades Congênitas/cirurgia , Mucosa Intestinal/transplante , Intestino Delgado/transplante , Laparoscopia/métodos , Ductos Paramesonéfricos/anormalidades , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/cirurgia , Amenorreia/etiologia , Amenorreia/cirurgia , Animais , Colo do Útero/anormalidades , Colo do Útero/cirurgia , Terapia Combinada , Feminino , Humanos , Ductos Paramesonéfricos/cirurgia , Suínos , Tecidos Suporte , Transplante Heterólogo , Anormalidades Urogenitais/cirurgia , Vagina/anormalidades , Adulto Jovem
20.
J Minim Invasive Gynecol ; 26(3): 401, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29908340

RESUMO

STUDY OBJECTIVE: To demonstrate techniques of ureterolysis during complex laparoscopic hysterectomy. DESIGN: Technical video demonstrating different approaches to ureterolysis for complex benign pathology during laparoscopic hysterectomy (Canadian Task Force classification III). SETTING: Benign gynecology department at a university hospital. INTERVENTION: Performance of ureterolysis during laparoscopic hysterectomy for benign pathology. CONCLUSION: Ureteric injury has significant morbidity and is the most common reason for litigation following hysterectomy, with an estimated risk of 0.02% to 0.4%. [1,2]. Ureterolysis is infrequently practiced by benign gynecologists; however, it may be necessary during complex surgery. Benign pathology requiring hysterectomy, such as endometriosis, myomas, large uteri, and adnexal masses, are recognized risk factors for ureteric injury [3]. Most injuries occur during division of the uterine artery at the level of the internal cervical os. The average distance between the ureter and cervix is 2 cm, but it is only 0.5 cm in 3.2% of the population with a normal pelvis [4]. Preventive strategies, such as the use of a uterine manipulator, may increase this distance, although it still might not be sufficient to prevent injury in women with normal anatomic variants and complex pathology. Visualizing the ureter at the pelvic brim and side wall without retroperitoneal dissection may be inadequate because the segment of ureter between the intersection of the uterine artery and the bladder is not visible. The ureter can be safely dissected up to 15 cm without compromising its viability. In this educational video, we demonstrate various simple, quick, and reproducible techniques to perform ureterolysis for complex benign pathology. These techniques can be used by both expert and novice surgeons to perform and teach ureterolysis. Our method determines the course of the ureter throughout the pelvis and relation to the uterine artery to reduce intraoperative injury. We have performed more than 350 cases with no injuries.


Assuntos
Doenças dos Genitais Femininos/cirurgia , Histerectomia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/prevenção & controle , Ureter/cirurgia , Doenças dos Anexos/cirurgia , Adulto , Endometriose/cirurgia , Feminino , Humanos , Histerectomia/efeitos adversos , Doença Iatrogênica/prevenção & controle , Ureter/lesões , Bexiga Urinária/lesões , Anormalidades Urogenitais/cirurgia , Artéria Uterina/patologia , Útero/anormalidades , Útero/cirurgia
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