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1.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895764

RESUMO

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Assuntos
Parto Obstétrico/efeitos adversos , Vagina/cirurgia , Adulto , Feminino , Humanos , Lacerações/etiologia , Lacerações/cirurgia , Diafragma da Pelve/fisiopatologia , Diafragma da Pelve/cirurgia , Períneo/lesões , Períneo/cirurgia , Gravidez , Qualidade de Vida , Vagina/fisiopatologia , Vulva/cirurgia
2.
BJOG ; 127(2): 230-238, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31397072

RESUMO

Women with congenital absolute uterine factor infertility (AUFI) often need vaginal restoration to optimise sexual function. Given their lack of procreative ability, little consideration has previously been given to the resultant vaginal microbiome (VM). Uterine transplantation (UTx) now offers the opportunity to restore these women's reproductive potential. The structure of the VM is associated with clinical and reproductive implications that are intricately intertwined with the process of UTx. Consideration of how vaginal restoration methods impact VM is now warranted and assessment of the VM in future UTx procedures is essential to understand the interrelation of the VM and clinical and reproductive outcomes. TWEETABLE ABSTRACT: The vaginal microbiome has numerous implications for clinical and reproductive outcomes in the context of uterine transplantation.


Assuntos
Anormalidades Congênitas/cirurgia , Infertilidade Feminina/cirurgia , Microbiota/fisiologia , Transplante de Órgãos , Útero/transplante , Vagina/microbiologia , Feminino , Humanos , RNA Ribossômico 16S/fisiologia , Técnicas de Reprodução Assistida , Útero/anormalidades , Útero/microbiologia , Vagina/fisiopatologia
3.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289168

RESUMO

Some patients with neurological bladder dysfunction rely on suprapubic catheters (SPCs) for the management of their urinary symptoms. These catheters are usually changed without incident. However, problems can, and do, arise. We present the case of a 56-year-old woman who had a SPC change which was complicated by the catheter perforating the bladder and inflating in the vagina.


Assuntos
Cateteres de Demora/efeitos adversos , Doença Iatrogênica/prevenção & controle , Doenças da Bexiga Urinária/terapia , Bexiga Urinária/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças da Bexiga Urinária/patologia , Cateterismo Urinário/instrumentação , Vagina/fisiopatologia
4.
Biomed Res Int ; 2019: 8047924, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31236413

RESUMO

Background: In gynecological surgery, one particular area of concern after hysterectomy is the risk of developing an enterocele or vaginal apical prolapse. The aims of this study were to evaluate the safety and efficacy of prophylactic McCall culdoplasty (MC) performed during mini-total laparoscopic hysterectomy (mini-TLH), as well as to compare the differences in apical support, total vaginal length (TVL), and sexual function at one and two years postoperatively. Methods: Data were retrospectively reviewed for all women who underwent mini-TLH and mini-TLH + MC at a tertiary care center between August 2012 and January 2016 were from the hospital database. There were 18 women who underwent mini-TLH + MC and were considered as the study group, while 20 women who were treated with mini-TLH were considered as the control group. The primary outcome measures were the differences in apical support and TVL and impact on sexual function. Results: After mini-TLH + MC, the apical vaginal support difference was improved by 2.2 cm. The mean difference in C point was 1.03 cm in the mini-TLH group, which was not significant at two years after the operation. The vaginal vault descent at two years after operation was more prominent in the mini-TLH group than the mini-TLH + MC groups. Apical support changes at two years after the operation were more prominent in the mini-TLH group (0.5 ± 0.6 cm) than the mini-TLH + MC group (1.9 ± 1.2 cm). Conclusion: Prophylactic MC by a vaginal approach during mini-TLH is safe, satisfactory, and efficient for apical support without severe morbidity.


Assuntos
Culdoscopia/métodos , Histerectomia Vaginal/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Vagina/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Prolapso Uterino/etiologia , Prolapso Uterino/fisiopatologia , Vagina/fisiopatologia
5.
Breast Cancer Res Treat ; 177(1): 185-195, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31144152

RESUMO

PURPOSE: Tamoxifen is an important targeted endocrine therapy in breast cancer. However, side effects and early discontinuation of tamoxifen remains a barrier for obtaining the improved outcome benefits of long-term tamoxifen treatment. Biomarkers predictive of tamoxifen side effects remain unidentified. The objective of this prospective population-based study was to investigate the value of tamoxifen metabolite concentrations as biomarkers for side effects. A second objective was to assess the validity of discontinuation rates obtained through pharmacy records with the use of tamoxifen drug monitoring. METHODS: Longitudinal serum samples, patient-reported outcome measures and pharmacy records from 220 breast cancer patients were obtained over a 6-year period. Serum concentrations of tamoxifen metabolites were measured by LC-MS/MS. Associations between metabolite concentrations and side effects were analyzed by logistic regression and cross table analyses. To determine the validity of pharmacy records we compared longitudinal tamoxifen concentrations to discontinuation rates obtained through the Norwegian Prescription database (NorPD). Multivariable Cox regression models were performed to identify predictors of discontinuation. RESULTS: At the 2nd year of follow-up, a significant association between vaginal dryness and high concentrations of tamoxifen, Z-4'-OHtam and tam-NoX was identified. NorPD showed a tamoxifen-discontinuation rate of 17.9% at 5 years and drug monitoring demonstrated similar rates. Nausea, vaginal dryness and chemotherapy-naive status were significant risk factors for tamoxifen discontinuation. CONCLUSIONS: This real-world data study suggests that measurements of tamoxifen metabolite concentrations may be predictive of vaginal dryness in breast cancer patients and verifies NorPD as a reliable source of adherence data.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Antineoplásicos Hormonais/farmacocinética , Neoplasias da Mama/complicações , Neoplasias da Mama/epidemiologia , Monitoramento de Medicamentos , Tamoxifeno/efeitos adversos , Tamoxifeno/farmacocinética , Vagina/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Hormonais/uso terapêutico , Biomarcadores , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Cromatografia Líquida , Feminino , Humanos , Adesão à Medicação , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Prognóstico , Inquéritos e Questionários , Tamoxifeno/uso terapêutico , Espectrometria de Massas em Tandem , Vagina/fisiopatologia , Adulto Jovem
6.
Maturitas ; 125: 57-62, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133219

RESUMO

OBJECTIVES: Treatments for genitourinary syndrome of menopause (GSM) may not be suitable for all women, may not be completely effective, and may cause adverse effects. Therefore, there is a need to explore new treatment approaches. The objectives were to evaluate the feasibility of using a pelvic floor muscle training (PFMT) program in postmenopausal women with GSM, and to investigate its effect on symptoms, signs, activities of daily living (ADL), quality of life (QoL) and sexual function. STUDY DESIGN: Postmenopausal women with GSM participated in a single-arm feasibility study embedded in a randomized controlled trial (RCT) on PFMT for urinary incontinence. This substudy was composed of two pre-intervention evaluations, a 12-week PFMT program and a post-intervention evaluation. MAIN OUTCOME MEASURES: Feasibility was defined as study completion and participation in physiotherapy sessions and in-home exercises. The effects of the PFMT program were assessed by measuring GSM symptoms ('Most Bothersome Symptom' approach, ICIQ-UI SF), GSM signs (Vaginal Health assessment scale), GSM's impact on ADL (Atrophy Symptom questionnaire), QoL and sexual function (ICIQ-VS, ICIQ-FLUTSsex) and leakage episodes. RESULTS: Thirty-two women participated. The study completion rate was high (91%), as was participation in treatment sessions (96%) and in-home exercises (95%). Post-intervention, there were significant reductions in GSM symptoms and signs (p < 0.01) as well as in its impacts on ADL, QoL and sexual function (p < 0.05). CONCLUSIONS: A study including a PFMT program is feasible, and the outcomes indicate PFMT to be an effective treatment approach for postmenopausal women with GSM and urinary incontinence. This intervention should be assessed through a RCT.


Assuntos
Atrofia/fisiopatologia , Terapia por Exercício/métodos , Menopausa , Diafragma da Pelve/fisiopatologia , Incontinência Urinária/reabilitação , Vagina/fisiopatologia , Atividades Cotidianas , Idoso , Atrofia/patologia , Terapia por Estimulação Elétrica , Estudos de Viabilidade , Feminino , Doenças dos Genitais Femininos/psicologia , Doenças dos Genitais Femininos/reabilitação , Humanos , Pessoa de Meia-Idade , Qualidade de Vida , Sexualidade , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária/psicologia , Vagina/patologia
7.
Biomed Res Int ; 2019: 2360185, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931323

RESUMO

Hypothesis/Aims of Study: Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea. The ESHRE/ESGE categorizes this disorder within the class 5 uterine malformation of the female genital tract anomalies. It is characterized by congenital absence of the uterus, cervix, and upper part of the vagina in otherwise phenotypically normal 46XX females. These patients have normal ovaries, biphasic ovarian cycle, and female psychosexual identification. Laparoscopic Vecchietti's operation-surgical method in which the vagina increases in size by gradually applying traction to the vaginal vault-is one of the methods used to treat MRKH. The aim of this study was to establish the urogynecological and sexual functions after Vecchietti's operation. Study Design Materials and Methods: Fifteen patients with MRKHS who underwent laparoscopic Vecchietti's operation were included. A control group of 15 age-matched, childless, sexually active women were examined during the same period. All patients underwent the basic evaluation of anatomical outcomes. Sexual outcomes were established by the Polish validated Female Sexual Function Index (FSFI) questionnaire. Continence status was assessed by Polish validated Urinary Distress Inventory (UDI-6) and the Incontinence Impact Questionnaire (IIQ-7). Results: Mean age of MRKH group was 22.06±5.13 yrs. Mean follow-up after surgery was 8.02±3.43 yrs. Mean age of women from control group was 22.4±4.35. Mean FSFI scores show good quality of sexual life in both groups. UDI-6 scores showed that patients after Vecchietti surgery have urogynecological problems significantly more often than healthy women do. Based on the IIQ-7, it is evident that one patient from the MRKH group (6,6%) suffers from stress urinary incontinence and the rest (20%) have rather irritative problems with the functioning of the lower urinary tract. Conclusion: Quality of sexual life after the Vecchietti's operation in long-term follow-up does not differ from that of healthy women, but these patients suffer more frequent from urogynecological complaints. The trial is registered with NCT03809819.


Assuntos
Transtornos 46, XX do Desenvolvimento Sexual/cirurgia , Amenorreia/fisiopatologia , Anormalidades Congênitas/fisiopatologia , Laparoscopia/efeitos adversos , Ductos Paramesonéfricos/anormalidades , Vagina/cirurgia , Transtornos 46, XX do Desenvolvimento Sexual/complicações , Transtornos 46, XX do Desenvolvimento Sexual/fisiopatologia , Adolescente , Adulto , Amenorreia/etiologia , Colo do Útero/fisiopatologia , Colo do Útero/cirurgia , Anormalidades Congênitas/etiologia , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Ductos Paramesonéfricos/fisiopatologia , Ductos Paramesonéfricos/cirurgia , Polônia , Comportamento Sexual , Saúde Sexual , Inquéritos e Questionários , Útero/fisiopatologia , Útero/cirurgia , Vagina/fisiopatologia , Saúde da Mulher , Adulto Jovem
8.
Int J Dev Neurosci ; 75: 27-35, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30954504

RESUMO

BACKGROUND: Maternal infection during pregnancy is known to adversely affect foetal development, but previous studies have rarely investigated the impact of gynaecological diseases during pregnancy on offspring during adulthood. Vaginitis is one of the most prevalent gynaecological diseases during pregnancy. METHODS: The effect of maternal vaginal inflammation on offspring was simulated by inducing maternal vaginal infection. We performed a transvaginal injection of lipopolysaccharide (LPS) in pregnant mice to induce vaginitis and investigated their offspring by means of behavioural tests and molecular and cellular measurements. RESULTS: Behavioural tests revealed that the offspring of mothers transvaginally injected with LPS exhibited sex-dependent differences. Male offspring showed increased anxiety-related behaviours, including reduced time exploring the open arm in the elevated plus maze test and light chamber in the light-dark box test. Serum levels of corticosterone were increased in LPS male offspring, indicating activation of the hypothalamic-pituitary-adrenal (HPA) axis. Corticotropin-releasing hormone (CRH) protein expression and c-Fos positive cells were increased in the hypothalamic paraventricular nucleus (PVN) in LPS male offspring, which presented with an increased number of microglia. CONCLUSION: This study suggests that prenatal vaginal infection increases anxiety-like behaviour in male offspring, possibly via activation of the HPA axis.


Assuntos
Ansiedade/fisiopatologia , Sistema Hipotálamo-Hipofisário/fisiopatologia , Inflamação/fisiopatologia , Sistema Hipófise-Suprarrenal/fisiopatologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia , Vagina/fisiopatologia , Animais , Ansiedade/psicologia , Comportamento Animal/fisiologia , Feminino , Inflamação/induzido quimicamente , Inflamação/psicologia , Lipopolissacarídeos , Masculino , Camundongos , Atividade Motora/fisiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/psicologia
9.
Int J Gynaecol Obstet ; 145(3): 278-282, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30924525

RESUMO

OBJECTIVE: To evaluate the prevalence of vaginal laxity (VL) and its correlates in a cohort of women attending a urogynecology clinic in a tertiary referral center in Saudi Arabia. METHODS: In this retrospective study, demographic information, clinical characteristics, and POP-Q system measurements for women attending the King Fahad Medical City Urogynecology Clinic (January 2013 to April 2015) were analyzed. Women with and without VL were compared across these variables. RESULTS: Out of 376 women attending the clinic for various reasons, 135 (35.9%) reported VL. VL was more common in younger women (P<0.001). Parity, menopausal status, and diabetes were not associated with this symptom. A history of cesarean delivery was protective (aOR 0.39; 95% CI, 0.17-0.90). A bulge symptom and "vaginal wind" were predictors (aOR 3.25; 95% CI, 1.46-7.23 and aOR 15.48; 95% CI, 6.93-34.56, respectively). There was no correlation between VL and POP-Q measurements. VL was not associated with the presence of clinically significant prolapse (stage 2-4), compared with nonsignificant prolapse (stage 0-1) (P=0.869, P=0.152, and P=0.783 for anterior, posterior, and central vaginal compartment, respectively). CONCLUSIONS: In this cohort, VL was common, more prevalent in younger women, and had poorly defined clinical correlates.


Assuntos
Vagina/fisiopatologia , Doenças Vaginais/epidemiologia , Adulto , Fatores Etários , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/epidemiologia , Prevalência , Estudos Retrospectivos , Arábia Saudita
10.
J Emerg Med ; 56(4): e43-e46, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30745198

RESUMO

BACKGROUND: Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT: A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1-S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities.


Assuntos
Hematoma Subdural Intracraniano/diagnóstico , Região Lombossacral/anormalidades , Dor/etiologia , Vagina/anormalidades , Adulto , Feminino , Hematoma Subdural Intracraniano/complicações , Humanos , Dor Lombar/etiologia , Região Lombossacral/fisiopatologia , Dor/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Vagina/fisiopatologia
11.
In Vivo ; 33(2): 469-472, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30804127

RESUMO

BACKGROUND: Retention of products of conception (RPOC) following delivery is rare. Clinicians often have the impression that a high proportion of patients with sonographically suspected RPOC following surgery have a negative histopathology. Hence, we aimed to report our single-center experience with suspected RPOC and histopathological outcome after surgery. PATIENTS AND METHODS: In this retrospective analysis, patients who underwent surgery due to suspected postpartum RPOC were analyzed for potential predictive clinical and sonographic parameters. RESULTS: A total of 32 patients with histopathologically-confirmed RPOC were compared with 21 patients with a negative histopathological report for RPOC. Endometrial hyperechogenic mass and clinical parameters such as pain, fever and bleedings were not predictive for RPOC. Increased age (p=0.001) and vaginal delivery (p=0.040) were significantly associated with RPOC. CONCLUSION: Clinical presentation alone is not predictive for RPOC. Vaginal delivery and younger age seem to be a risk factor and therefore have to be considered in patients with suspected RPOC.


Assuntos
Parto Obstétrico/efeitos adversos , Endométrio/cirurgia , Complicações na Gravidez/fisiopatologia , Adulto , Endométrio/fisiopatologia , Feminino , Idade Gestacional , Humanos , Gravidez , Complicações na Gravidez/cirurgia , Estudos Retrospectivos , Vagina/fisiopatologia , Vagina/cirurgia
12.
Eur J Obstet Gynecol Reprod Biol ; 235: 42-48, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30784826

RESUMO

OBJECTIVE: To compare the effects and complications of caesarean section (CSD) and vaginal delivery (VD) for pelvic floor function of parturients. METHODS: Multiple databases were searched for full-text articles regarding the clinical effects and complications of CSD and VD. Review Manager 5.0 was used for meta-analyses, sensitivity analysis and bias analysis. RESULTS: In total, 4491 patients were included in nine studies that met the eligibility criteria. Of these, 1527 women underwent CSD and 2944 women had a VD. The meta-analyses suggested significant differences in pelvic floor muscle strength [mean difference (MD) -11.94, 95% confidence interval (CI) -12.48 to -11.39, p < 0.00001, p for heterogeneity <0.00001, I² = 93%], vaginal muscle voltage (MD -9.45, 95% CI -9.73 to -9.16, p < 0.00001, p for heterogeneity <0.00001, I² = 94%), maximum urinary flow rate (MD -5.67, 95% CI -5.94 to -5.39, p < 0.00001, p for heterogeneity <0.00001, I² = 96%), stress urinary incontinence [odds ratio (OR) 0.45, 95% CI 0.37-0.55, p < 0.00001, p for heterogeneity = 0.79, I² = 0%] and pelvic organ prolapse (OR 0.59, 95% CI 0.50-0.70, p < 0.00001, p for heterogeneity = 0.24, I² = 23%) between the CSD group and the VD group. CONCLUSION: This study demonstrated that CSD is the preferred mode of delivery for pregnant woman in terms of pelvic floor function.


Assuntos
Cesárea/efeitos adversos , Parto Obstétrico/efeitos adversos , Distúrbios do Assoalho Pélvico/etiologia , Diafragma da Pelve/fisiopatologia , Parto Obstétrico/métodos , Feminino , Humanos , Força Muscular , Razão de Chances , Parto , Diafragma da Pelve/cirurgia , Gravidez , Vagina/fisiopatologia
13.
Biomed Res Int ; 2019: 5321864, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30723739

RESUMO

Introduction: Urinary incontinence (UI) is a health problem affecting the quality of women's lives (QOL) at various life stages. Stress urinary incontinence (SUI) can be caused by previous vaginal deliveries and is especially likely to occur in the perimenopausal period. The most commonly recommended first-choice treatment methods involve exercises for the pelvic floor muscles (PFM). The aim of this study was to assess the impact of isolated PFM exercises and combined training of the PFM and the m.transversus abdominis (TrA) muscle on the QoL of patients with SUI with regard to the number of vaginal deliveries. Material and Methods: 137 women with SUI were qualified for analysis (mean age 53,1 ± 5,5). To assess the effectiveness of PFM training QOL questionnaire was used (ICIQ-LUTS qol). PFM training for groups A (PFM+TrA) and B (PFM) was intended for 12 weeks. Statistica v. 12.0 PL, StatSoft, USA, was used for statistical calculations. Results: The analysis demonstrated that conservative treatment based on the A training program (PFM + TrA) yielded statistically significantly better results than the B program (PFM), with the improvement observed in such QoL domains as the performance of household duties, physical activity and travelling, social limitations, emotions, sleep problems and fatigue, the frequency of changing panty liners, fluid intake control, and embarrassment. Conclusion: Both the combined training of the PFM and the synergistic (TrA) muscle and the isolated PFM exercises improve the QoL of women with SUI. Nonetheless, the combined PFM and TrA muscle physiotherapy is more effective. The exercises for the PFM and the synergistic muscle give better results in women who have given birth fewer than three times than isolated PFM exercises.


Assuntos
Terapia por Exercício , Diafragma da Pelve/fisiologia , Modalidades de Fisioterapia , Incontinência Urinária por Estresse/terapia , Músculos Abdominais/fisiologia , Adulto , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Incontinência Urinária por Estresse/fisiopatologia , Vagina/fisiopatologia
14.
Gynecol Obstet Invest ; 84(2): 145-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30269139

RESUMO

BACKGROUND: Determining biomechanical changes in vaginal tissue with tissue stretch is critical for understanding the role of mechanotransduction on vaginal tissue healing. Noncontact dynamic optical coherence elastography (OCE) can quantify biomechanical changes in vaginal tissues noninvasively. Improved vaginal tissue healing will reduce postoperative complications from vaginal surgery. AIMS: (1) To complete dimensional assessments (DAs) of the vaginal tract. (2) To elucidate biomechanical properties (BMP) of porcine vaginal tissues (PVT). (3) Compare BMPs of piglet and adult PVTs after placement of customized vaginal dilators (VD) by OCE and uniaxial mechanical testing (MT). METHODS: Pilot study using adult nulliparous pig and piglet PVTs (n = 20 each). DA of PVTs was performed using silicone molding. 3D-printed VDs were used to achieve different Relative Diameter Change (RDC) of the PVTs (no dilatation, and -50%, 0%, 50% RDC). Elastographic testing using OCE and MT. RESULTS: Using OCE, no significant differences (SD) were noted between adult and piglet PVT (p = 0.74) or by stretch direction (p = 0.300). SD was noted with increasing RDC (p = 0.023). Using MT, there were SD in tissue stiffness between adult and piglet PVT (p = 0.048), but no SD as a function of RDC (p = 0.750) or stretch direction (p = 0.592). CONCLUSIONS: This study quantified biomechanical changes in PVT with customized stretching by 3D printed VD using both OCE and MT. This work has implications for the mechanotransduction of vaginal wound healing and noninvasive assessment of vaginal diseases.


Assuntos
Impressão Tridimensional , Vagina/fisiopatologia , Doenças Vaginais/fisiopatologia , Cicatrização/fisiologia , Animais , Fenômenos Biomecânicos , Cicatriz/fisiopatologia , Técnicas de Imagem por Elasticidade/métodos , Feminino , Mecanotransdução Celular , Projetos Piloto , Sus scrofa , Tomografia de Coerência Óptica , Vagina/patologia , Doenças Vaginais/patologia
15.
Int Urogynecol J ; 30(3): 455-464, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29313089

RESUMO

INTRODUCTION AND HYPOTHESIS: Animal models are useful for investigating the genesis of pelvic floor dysfunction and for developing novel therapies for its treatment. There is a need for an alternative large-animal model to the nonhuman primate. Therefore we studied the effects of the first vaginal delivery, ovariectomy and systemic hormonal replacement therapy (HRT) on the biomechanical and structural properties of the ovine vagina. METHODS: We examined the gross anatomical properties of nulliparous, primiparous, ovariectomized multiparous, and ovariectomized hormone-replaced multiparous sheep (six animals per group). We also harvested mid-vaginal and distal vaginal tissue to determine smooth muscle contractility and passive biomechanical properties, for morphometric assessment of the vaginal wall layers, to determine collagen and elastin content, and for immunostaining for α-smooth muscle actin and estrogen receptor-α. RESULTS: There were no regional differences in the nulliparous vagina. One year after the first vaginal delivery, stiffness and contractility of the distal vagina were decreased, whereas the elastin content increased. The mid-vagina of ovariectomized sheep was stiff, and its epithelium was thin and lacked glycogen. HRT decreased the stiffness of the mid-vagina by 45% but had no measurable effect on contractility or elastin content, and increased epithelial thickness and glycogen content. HRT also increased the epithelial thickness and glycogen content of the distal vagina. At this location, there were no changes in morphology or stiffness. CONCLUSION: In sheep, life events including delivery and ovariectomy affect the biomechanical properties of the vagina in a region-specific way. Vaginal delivery mainly affects the distal region by decreasing stiffness and contractility. HRT can reverse the increase in stiffness of the mid-vagina observed after surgical induction of menopause. These observations are in line with scanty biomechanical measurements in comparable clinical specimens.


Assuntos
Músculo Liso/fisiopatologia , Ovariectomia/efeitos adversos , Parto , Distúrbios do Assoalho Pélvico/etiologia , Vagina/patologia , Vagina/fisiopatologia , Actinas/metabolismo , Animais , Fenômenos Biomecânicos , Colágeno/metabolismo , Modelos Animais de Doenças , Elastina/metabolismo , Epitélio/metabolismo , Epitélio/patologia , Receptor alfa de Estrogênio/metabolismo , Feminino , Glicogênio/metabolismo , Terapia de Reposição Hormonal , Contração Muscular , Paridade , Ovinos
17.
Drugs Today (Barc) ; 54(11): 667-677, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30539166

RESUMO

Many women suffer from the genitourinary syndrome of the menopause (GSM), in particular pathological changes that occur in the vagina due to the reduction in their production of estrogens. TherapeuticsMD has developed Imvexxy, small softgel capsules that contain solubilized estradiol and that are inserted vaginally by women twice a week, every 3 to 4 days. These vaginal inserts have been found to readily supply estradiol to the vagina and to result in significant improvement in the GSM signs and symptoms these women had been experiencing. At the same time, pharmacokinetic studies have demonstrated that the small doses of estradiol used do not increase systemic blood levels of estrogens above baseline values, thus greatly reducing the likelihood of unwanted systemic effects of estradiol. The placebo used in clinical trials, which only contained the 'inactive' ingredients in Imvexxy, had partial efficacy, the result either of a placebo effect or of the use of MIGLYOL 812 N to keep the estradiol in solution.


Assuntos
Estradiol/administração & dosagem , Estrogênios/administração & dosagem , Doenças Urogenitais Femininas/tratamento farmacológico , Terapia de Reposição Hormonal/métodos , Menopausa , Vagina/efeitos dos fármacos , Administração Intravaginal , Atrofia , Cápsulas , Composição de Medicamentos , Estradiol/efeitos adversos , Estradiol/química , Estradiol/farmacocinética , Estrogênios/efeitos adversos , Estrogênios/química , Estrogênios/farmacocinética , Feminino , Doenças Urogenitais Femininas/sangue , Doenças Urogenitais Femininas/diagnóstico , Doenças Urogenitais Femininas/fisiopatologia , Géis , Terapia de Reposição Hormonal/efeitos adversos , Humanos , Síndrome , Resultado do Tratamento , Vagina/metabolismo , Vagina/patologia , Vagina/fisiopatologia
18.
Dermatol Ther ; 31(6): e12678, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30411455

RESUMO

Vulvovaginal atrophy is a condition that affects women, although it is mainly associated with the onset of menopause mainly due to hormonal changes vulvovaginal laxity and mucosal atrophy can also affect women at different life stages such as after pregnancy or for cancer patients who have undergone chemo or endocrine therapy. This condition negatively influence quality of life, sexual desire, and self-confidence. Many therapies have been considered mainly with inconclusive or transient results in terms of benefit factor. Recently, a new non-invasive product, containing hyaluronic acid, oligopeptides, and antioxidants was introduced to the market. Its name is "Primavera," by Renaissance, Italy. The aim of this product is to allow a vulvo-vaginal biostimulation and considered simple, safe, and satisfactory.


Assuntos
Rejuvenescimento , Vagina/efeitos dos fármacos , Doenças Vaginais/tratamento farmacológico , Vulva/efeitos dos fármacos , Doenças da Vulva/tratamento farmacológico , Antioxidantes/efeitos adversos , Antioxidantes/uso terapêutico , Atrofia , Feminino , Humanos , Oligopeptídeos/efeitos adversos , Oligopeptídeos/uso terapêutico , Recuperação de Função Fisiológica , Resultado do Tratamento , Vagina/patologia , Vagina/fisiopatologia , Doenças Vaginais/patologia , Doenças Vaginais/fisiopatologia , Vulva/patologia , Vulva/fisiopatologia , Doenças da Vulva/patologia , Doenças da Vulva/fisiopatologia
19.
Int Urogynecol J ; 29(11): 1681-1687, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30069729

RESUMO

INTRODUCTION AND HYPOTHESIS: An adequate pelvic floor muscle contraction (PFMC) elevates the bladder neck (BN) and stabilizes it during increased intra-abdominal pressure (IAP). A maximal PFMC may increase the IAP and thereby prevent BN elevation. The aim of this study was to assess BN elevation during submaximal and maximal PFMC and their achievable duration. METHODS: We recruited 68 women with stress urinary incontinence and 14 vaginally nulliparous continent controls who were able to perform a PFMC on vaginal palpation. Women were upright and performed a maximal PFMC as long as possible, followed by a submaximal PFMC, controlled by vaginal electromyogram (EMG). BN position was measured with perineal ultrasound, IAP and urethral pressure with a microtip catheter, and breathing with a circular thorax sensor. RESULTS: A submaximal PFMC elevated the bladder neck 4 mm in continent and incontinent women (p = 0.655) and 4.5 vs. 5 mm during maximal PFMC (0.528). Submaximal PFMC was maintained significantly longer than a maximal PFMC (33 vs 12 s) with no difference between groups. A maximal PFMC resulted in BN descent in 29% of continent and 28% of incontinent women, which was not observed during submaximal PFMC. Breathing was normal in 70% of continent and 71% of incontinent women during submaximal PFMC but stopped completely in 21 and 50%, respectively, during maximal PFMC (p = 0.011). IAP increase was significantly greater with maximal PFMC in both groups (24 vs. 9.6 cmH2O and 17 vs. 9 cmH2O, respectively). CONCLUSION: Submaximal PFMC are sufficient to elevate the bladder neck, can be maintained longer, and breathing was not influenced.


Assuntos
Eletromiografia/métodos , Contração Muscular , Diafragma da Pelve/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Cavidade Abdominal/diagnóstico por imagem , Cavidade Abdominal/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Diafragma da Pelve/diagnóstico por imagem , Períneo/diagnóstico por imagem , Pressão , Ultrassonografia/métodos , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Vagina/diagnóstico por imagem , Vagina/fisiopatologia , Manobra de Valsalva
20.
Prog. obstet. ginecol. (Ed. impr.) ; 61(4): 347-353, jul.-ago. 2018. tab, graf
Artigo em Inglês | IBECS | ID: ibc-174975

RESUMO

Objective: To assess the incidence of cervical stenosis in women treated with conization and to identify risk factors for its occurrence. To determine the rate of medical and surgical complications due to conization. Methods: We performed a retrospective study of 113 women who underwent conization over a 1-year period at Hospital Universitario Puerta de Hierro Majadahonda in order to evaluate the frequency of and factors involved in cervical stenosis. Cervical stenosis was defined as a narrowing that prevented the insertion of a 3-mm endocervical curette through the endocervical canal. Univariate analysis was used to identify predictors of cervical stenosis. Statistical significance was set at 0.05. Results: A total of 14 patients were diagnosed with cervical stenosis (12.4%). The risk of cervical stenosis was greater when conization was performed in menopausal women (p = 0.047), when it was performed with laser excision (p = 0.046), when the height of the cone was ≥ 20 mm (p = 0.013), and when the ectocervical margins of the cone were affected by dysplasia after conization (p = 0.038). The variables age, previous treatment of cervical intraepithelial neoplasia (CIN), smoking, parity, human papillomavirus, histologic classification of CIN, postoperative bleeding, and second conization were not associated with an increased risk of cervical stenosis. Conclusions: The main risk factors for cervical stenosis were menopausal status, laser excision, cone height ≥ 20 mm, and involvement of exocervical surgical margins


Objetivo: Evaluar la incidencia de estenosis cervical en mujeres tratadas mediante conización e identificar factores de riesgo en su desarrollo. Determinar la tasa de complicaciones médico-quirúrgicas derivadas de la conización. Material y métodos: Estudio retrospectivo en el que se revisó una cohorte de 113 pacientes a las que se había realizado una conización a lo largo del año anterior en el Hospital Universitario Puerta de Hierro Majadahonda para evaluar la frecuencia y factores implicados en la estenosis cervical. La estenosis cervical se definió como el estrechamiento cervical que impide el paso de una microlegra endocervical de 3 mm de diámetro a través del canal endocervical. Se utilizó un análisis univariante para identificar factores predictores de estenosis. El nivel de significación se fijó en 0,05. Resultados: Se diagnosticaron 14 casos de estenosis cervical (12.4%). El riesgo de estenosis cervical fue mayor cuando la conización se realizó en mujeres menopaúsicas (P = 0,047), cuando se realizó conización con láser (P = 0,046), cuando la altura del cono fue ≥ 20 mm (P = 0,013) y cuando los márgenes exocervicales quedaron afectos tras las conización (P=0.038). Las variables edad, tratamiento previo de neoplasia intraepitelial cervical (CIN), tabaquismo, paridad, virus del papiloma humano (VPH), clasificación histológica de CIN, sangrado postoperatorio y reconización no demostraron aumentar el riesgo de estenosis cervical. Conclusiones: Las variables estado menopáusico, láser, altura del cono ≥ 20 mm y la afectación del margen exocervical fueron los principales factores de riesgo para la estenosis cervical


Assuntos
Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/cirurgia , Conização/efeitos adversos , Constrição Patológica/epidemiologia , Margens de Excisão , Complicações Pós-Operatórias , Fatores de Risco , Vagina/fisiopatologia , Colo do Útero/fisiopatologia , Estudos Retrospectivos
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