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1.
Am J Case Rep ; 23: e934745, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34982762

RESUMO

BACKGROUND Endometriosis, a common condition among women of reproductive age and infertile women, occurs when the endometrium extends outside the uterus. When this endometrial tissue grows and sheds, symptoms will develop. The presentation varies depending on the site involved; however, cyclical pain is among its most common symptoms, along with bleeding and cramping. It is frequently observed in the ovaries and fallopian tubes; in contrast, the anal canal is rarely involved. Here, we report a very unusual presentation of the disease. CASE REPORT A 33-year-old woman with a history of episiotomy presented to the Emergency Department reporting perianal swelling in the previous year. The swelling was associated with intermittent pain and difficulty passing stool. She reported no fever. On examination, there was a 3×4 cm palpable tender perianal mass extending to the anal sphincter at the 11 o'clock position. Bedside ultrasound revealed a mass. Magnetic resonance imaging showed a hemorrhagic 3×4 cm mass in the right perianal region pressing on and indenting the right aspect of the distal external sphincter. The mass was excised completely with local perianal incision over the mass at 11'o clock. Surgical pathology revealed an isolated endometrioma in the perianal area. CONCLUSIONS Isolated perianal endometrioma is a rare disease, with only 21 published cases. Its diagnosis is difficult to establish, and a wide range of tests is often needed. Laparoscopic or surgical intervention may be required in cases of rectal endometriosis for an accurate diagnosis. Careful history taking and examination along with a high index of suspicion are necessary to diagnose perianal endometrioma.


Assuntos
Doenças do Ânus , Endometriose , Infertilidade Feminina , Adulto , Endometriose/complicações , Endometriose/diagnóstico , Endometriose/cirurgia , Episiotomia , Feminino , Humanos , Períneo , Gravidez
2.
BMJ Case Rep ; 15(1)2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983809

RESUMO

A 61-year-old woman developed neorectal prolapse after laparoscopic low anterior resection, total mesorectal excision with partial intersphincteric resection and handsewn coloanal anastomosis for rectal cancer. She presented with a 3 cm full thickness reducible prolapse, with associated anal pain and bleeding. A perineal stapled prolapse resection was performed to address the rectal prolapse, with satisfactory results.


Assuntos
Laparoscopia , Neoplasias Retais , Prolapso Retal , Canal Anal/cirurgia , Anastomose Cirúrgica , Feminino , Humanos , Pessoa de Meia-Idade , Períneo/cirurgia , Prolapso , Neoplasias Retais/cirurgia , Prolapso Retal/cirurgia , Reto/cirurgia , Resultado do Tratamento
3.
J Urol ; 207(1): 86-94, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34428921

RESUMO

PURPOSE: Transperineal (TP) prostate biopsy provides an effective approach to prostate cancer (PCa) detection. Although transrectal targeted biopsy has been well described, the specific advantage of the standard TP template or TP targeted biopsy using multiparametric (mp) magnetic resonance imaging (MRI)-ultrasound (US) fusion remains less understood and without consensus. MATERIALS AND METHODS: We identified all men who underwent a transperineal standard 20-core template in addition to a targeted biopsy with mpMRI-US fusion-guided software from September 2019 to February 2021. We assessed and compared clinical, MRI and biopsy characteristics between standard TP template and fusion targeted biopsies. RESULTS: A total of 301 men underwent TP fusion biopsy during the study period. Target lesions on MRI were sampled with 3 targeted cores per patient (IQR 3-4). The overall cancer detection rate was 74.1% and 63.5% by standard template and targeted biopsy, respectively, of which 52.5% and 59.7% were clinically significant (cs) PCa. Combined csPCa detection rate was 62.2%. Of 176 cases with a cancer diagnosis by both biopsy methods, 18.8% were upgraded with targeted biopsies while 18.2% were upgraded with template biopsies. CONCLUSIONS: In men with suspicious lesions on mpMRI, TP MRI fusion-guided biopsies combined with standard template provide a higher overall cancer detection rate and higher detection rate of csPCa than the standard template or targeted biopsy alone. In the setting of a suspicious mpMRI prostate lesion, targeted plus standard template should be included as part of the TP biopsy procedure.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Ultrassonografia de Intervenção , Idoso , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Períneo , Estudos Retrospectivos
4.
J Urol ; 207(1): 25-34, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34555932

RESUMO

PURPOSE: We performed a systematic review comparing the incidence of infectious complications following transperineal ultrasound-guided prostate biopsy (TPB) in cases utilizing antibiotic prophylaxis (AP) vs cases not utilizing antibiotic prophylaxis (NAP). MATERIALS AND METHODS: The incidences of complications were pooled using the Cochran-Mantel-Haenszel method with the random effect model and expressed as risk ratio (RR). RR higher than 1 indicates an increased risk of complication in patients undergoing TPB without antibiotics. Statistical significance was set at p <0.05 and 95% CI. RESULTS: A total of 1,748 papers were retrieved. After the screening process, 8 studies were included in the quantitative analysis (4 retrospective, and 4 prospective and nonrandomized), reporting on 3,662 patients. A total of 2,368 patients underwent TPB utilizing AP and 1,294 underwent TPB utilizing NAP. The pooled rates of post-biopsy fever from 6 available studies reporting this parameter were 0.69% in the AP group and 0.47% in the NAP group (RR: 1.02, 95% CI: 0.02-44.55, p=0.99). The pooled rates of post-biopsy genitourinary infections from 8 available studies reporting this parameter were 0.11% in the AP group and 0.31% in the NAP group (RR: 2.09, 95% CI: 0.54-8.10, p=0.29). The pooled rates of post-biopsy sepsis over 8 studies reporting this parameter were 0.13% in the AP group and 0.09% in the NAP group (RR: 1.09, 95% CI: 0.21-5.61, p=0.92). The pooled rates of post-biopsy readmission for infections over 8 studies reporting this parameter were 0.13% in the AP group and 0.23% in the NAP group (RR: 1.29, 95% CI: 0.31-5.29, p=0.73). Death due to post-biopsy sepsis did not occur in any study. CONCLUSIONS: This systematic review found no significant difference in infection rate, fever, sepsis or readmission rate after TPB between those cases utilizing AP and those cases without AP.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Próstata/patologia , Antibioticoprofilaxia , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/métodos , Incidência , Masculino , Períneo , Ultrassonografia de Intervenção
5.
Gac Sanit ; 35 Suppl 2: S248-S250, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34929823

RESUMO

OBJECTIVE: This research aims to determine the influence of Web-based learning media on improving perineum rupture stitching skills for D-III Midwifery students. METHOD: This study uses a Research and Development (R&D) research design with the Borg & Gall development model to test the use of this product. The Quasi-Experimental research with a non-equivalent control group design was conducted in January-February 2020 at AKBID Pelamonia Makassar. The sample in this study was the second semester of the Midwifery Academy Pelamonia VII Wirabuana Makassar, totaling 64 people who were divided into two groups of intervention and control. The intervention group I (WEB media giving) amounted to 32 people and control 32 people. The sampling technique used is purposive sampling. At the end of the meeting, a post-test was conducted. The statistical test used was the paired sample t-test and Wilcoxon test. RESULTS: The percentage of application assessment using the Technology Acceptance Model (TAM) questionnaire to assess the application's usability level is a very good category and can be interpreted that students accept WEB-based learning media. Statistical tests showed differences in the results of measurement I and measurement II in the removal of grade II perineum rupture in the control group (p<0.05) and contributed 15.6%. In the intervention group I (WEB-based learning media), there were differences in skills before and after media giving (p<0.05) and contributed 89.8% in improving the skills of the second semester Midwifery DIII students regarding the sewing of second-degree perineum rupture. CONCLUSION: The use of Web-Based Learning Media facilitates and enhances students in performing second-degree perineum rupture sewing skills.


Assuntos
Tocologia , Estudantes de Enfermagem , Feminino , Humanos , Internet , Aprendizagem , Períneo/cirurgia , Gravidez , Estudantes
6.
Urologiia ; (6): 118-123, 2021 Dec.
Artigo em Russo | MEDLINE | ID: mdl-34967172

RESUMO

AIM: To analyze the diagnostics results and surgical outcomes in girls with congenital urogenital sinus. MATERIALS AND METHODS: A total of 9 girls with urogenital sinus were evaluated and treated in the clinical base of the Department of Hospital Pediatric Surgery with a course of oncology at TashPMI during the period from 2009 to 2019. RESULTS: The results of diagnostics and treatment of 9 patients with various forms of urogenital sinus are presented. In 6 cases the anterior sagittal (transanal) approach was used. The karyotype in 8 girls corresponded to 46,XX, while another girl has karyotype of 46;X0, which is typical for Turner syndrome. Severe degree of virilization was found in 2 patients, which required clitoroplasty. CONCLUSION: Traditional methods of surgical correction and modified procedures provide an optimal approach and facilitate the urethral dissection from the vagina with subsequent advancement to the perineum, significantly reducing the indications for the performing a preliminary colostomy.


Assuntos
Hiperplasia Suprarrenal Congênita , Criança , Feminino , Humanos , Masculino , Períneo , Uretra/cirurgia , Vagina/cirurgia , Virilismo
8.
Enferm. foco (Brasília) ; 12(4): 739-745, dez. 2021. tab, ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1353263

RESUMO

Objetivos: conhecer os fatores maternos e neonatais relacionados à integridade perineal e relacionar a preservação do períneo com o profissional que assiste ao parto. Método: estudo retrospectivo, descritivo, quantitativo, em prontuários de 292 mulheres que tiveram parto vaginal com períneo íntegro. Incluídas mulheres que tiveram parto vaginal com períneo íntegro, de feto termo, único ou múltiplo, iniciado espontaneamente ou induzido, instrumentalizado ou não, independente de risco obstétrico. Utilizadas as variáveis: raça, idade materna, idade gestacional, paridade, número de fetos, uso de ocitocina na condução do trabalho de parto, uso de analgesia, trabalho de parto espontâneo ou induzido, apresentação e peso do recém-nascido ao nascer, posição materna no expulsivo e profissional que assistiu ao parto. Resultados: a maioria das mulheres com períneos íntegros eram pardas, multíparas com partos espontâneos; taxa de ocitocina e analgesia foi de 11,6% e 19,9%, respectivamente; o peso médio dos recém-nascidos foi de 3176g e a Enfermagem Obstétrica esteve presente em mais de 90% dos partos. Conclusão: a raça e a multiparidade permaneceram como fatores protetores de lacerações perineais, enquanto outras variáveis precisam de mais estudos para determinar seu papel na integridade perineal. A Enfermagem Obstétrica se manteve como indicadora de boas práticas ao parto e nascimento. (AU)


Objective: Knowing the maternal and neonatal factors related to perineal integrity and relating perineal integrity to the professional attending the delivery. Methods: Retrospective, descriptive, quantitative study on medical records of 292 women who had vaginal delivery with intact perineum. Including women who had a vaginal delivery with intact perineum, full-term fetus, single or multiple, started spontaneously or induced, instrumentalized or not, regardless of obstetric risk. The variables used were race, maternal age, gestational age, parity, number of fetuses, use of oxytocin in conducting labor, use of analgesia, spontaneous or induced labor, presentation and weight of the newborn at birth, maternal position in the expulsive and professional who attended the birth. Results: The majority of women with intact perineum were brown, multiparous with spontaneous births; oxytocin and analgesia rate was 11,6% and 19,9%, respectively; the average weight of newborns was 3176g and obstetric nursing was present in more than 90% of deliveries. Conclusion: Race and multiparity remained as protective factors against perineal lacerations, while other variables need further studies to determine their role in perineal integrity. Obstetric Nursing has remained an indicator of good practices in childbirth and birth. (AU)


Objetivo: Conocer los factores maternos y neonatales relacionados con la integridad perineal y relacionar la preservación del perineo con el profesional que asiste al parto. Métodos: Estudio retrospectivo, descriptivo y cuantitativo sobre historias clínicas de 292 mujeres que tuvieron parto vaginal con perineo intacto. Incluidas las mujeres que tuvieron un parto vaginal con perineo intacto, feto a término, único o múltiple, iniciado espontáneamente o inducido, instrumentalizado o no, independientemente del riesgo obstétrico. Las variables utilizadas fueron: raza, edad materna, edad gestacional, paridad, número de fetos, uso de oxitocina en la realización del trabajo de parto, uso de analgesia, trabajo de parto espontáneo o inducido, presentación y peso del recién nacido al nacer, posición materna en los expulsivos y profesionales que asistieron al parto. Resultados: La mayoría de las mujeres con perineo sano eran pardas, multíparas con partos espontáneos; la tasa de oxitocina y analgesia fue de 11,6% y 19,9%, respectivamente; el peso promedio de los recién nacidos fue de 3176 gy la enfermería obstétrica estuvo presente en más del 90% de los partos. Conclusión: La raza y la multiparidad se mantuvieron como factores protectores contra las laceraciones perineales, mientras que otras variables necesitan más estudios para determinar su papel en la integridad perineal. La enfermería obstétrica se ha mantenido como un indicador de buenas prácticas en el parto y el parto. (AU)


Assuntos
Enfermagem Obstétrica , Períneo , Parto Normal
9.
Gac Sanit ; 35 Suppl 2: S216-S220, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34929815

RESUMO

OBJECTIVE: The purpose of this study will be to review several studies regarding the repair or treatment of perineal tears after vaginal delivery. This is expected to be an update for a midwife in daily caring. METHODS: Two electronic databases (PubMed and Sciencedirect) were searched to locate relevant literature about perineal tears/wound/laceration/trauma that is published in 2016-2021. 124 Pubmed articles and 452 ScienceDirect articles filtered successfully. The articles that have been obtained will be evaluated based on the inclusion criteria in this study. We summarize place and date, objective, design, samples, the measurement used, and research results. RESULTS: 9 articles were found that matched the inclusion criteria. Three articles examined the effect of the type of suture on perineal pain, and another 6 discussed therapy to reduce the adverse effects of perineal tears. The therapies used are far-infrared radiation therapy, capacitive-resistive radiofrequency therapy, pelvic floor muscle training in early postpartum, cold therapy, and treatment with TheresienOl (natural oil). CONCLUSION: Sutures and technique/suturing second-degree perineal tears or a postpartum episiotomy can affect perineal pain. Cold gel pad therapy and treatment with natural oil on perineal wounds can affect perineal pain and wound healing.


Assuntos
Lacerações , Tocologia , Complicações do Trabalho de Parto , Parto Obstétrico , Episiotomia , Feminino , Humanos , Lacerações/terapia , Complicações do Trabalho de Parto/terapia , Períneo/lesões , Períneo/cirurgia , Gravidez
10.
Obstet Gynecol Surv ; 76(10): 644-653, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34724076

RESUMO

Importance: Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic specialists. Objective: The purpose of this literature review is to provide a comprehensive, clinical source of information on HS as it relates to incidence of disease, pathophysiology, diagnosis, and overall management of this condition. Evidence Acquisition: Sources were obtained through a comprehensive literature search using PubMed and PMC. Various terms were used to query the database, including "hidradenitis suppurativa," "pathogenesis," "prevalence," "management," "surgery," "perineal," and "vulva." Results: Underreported prevalence and unknown pathogenesis have subsequently led to variable approaches in clinical management, often employing a combination of medical and surgical management. Conclusions: Early diagnosis and treatment of HS may lead to better disease control and minimize patients' associated morbidity related to disease. Relevance: Knowledge of vulvoperineal hidradenitis is necessary for gynecologists and primary care physicians to ensure early diagnosis, management, and referral for optimal patient outcomes.


Assuntos
Hidradenite Supurativa , Doença Crônica , Feminino , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/terapia , Humanos , Períneo , Prevalência
11.
Georgian Med News ; (319): 31-36, 2021 Oct.
Artigo em Russo | MEDLINE | ID: mdl-34749319

RESUMO

Objective - to assess the role of physical therapeutic factors in the staged medical rehabilitation of puerperas with perineal wounds after fetal vacuum extraction. A comparative analysis of the postpartum period was carried out in 154 puerperas with perineal injuries after fetal vacuum extraction. Three groups were formed by simple randomization: patients in the control group (54 women) received standard treatment only; the experimental group (51 women) received standard treatment and low-intensity magnetic laser therapy (LLLT); the main group (49 women) underwent additional extracorporeal magnetic stimulation. Staged physiotherapy provided an increase in the strength of the pelvic floor muscles in patients of the main group by 47.9% (p<0.01), experimental group - by 36.2% (p<0.01), and control - by 24.4% (p <0.05); a decrease in the number of postoperative complications was by 6.5, 4.6, and 2.63 times, respectively. The use of staged physiotherapy in puerperas with perineal wounds after delivery operations provides a statistically significant improvement in clinical and functional parameters in comparison with the use of only standard treatment and its combination with NMLT.


Assuntos
Períneo , Vácuo-Extração , Feminino , Humanos , Períneo/cirurgia , Modalidades de Fisioterapia , Período Pós-Parto , Gravidez , Cuidado Pré-Natal
12.
Medicina (Kaunas) ; 57(11)2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34833422

RESUMO

Anal canal duplication (ACD) is a very rare condition, diagnosed and treated mostly in childhood. Less than 90 cases have been reported in the literature so far. We are presenting a case of a young woman who underwent surgical excision of the duplication when she was 27 years old. The patient was unaware of her condition and was referred from a gynaecological office to the surgical department with a history of perianal discomfort and mucus discharge. Local examination showed an external orifice posterior to the anal opening, on the median line, which had the macroscopic appearance of a secondary anal orifice. The opening was about 0.5 cm in diameter. Exploration of the tract revealed a length of about 4 cm. MRI described the aforementioned tract, parallel to the anal canal, with no other anomalies mentioned. Under spinal anesthesia, with the patient in jackknife position, the accessory anal canal was surgically excised. The pathology report showed the presence of smooth muscle fibers and typical anal glands in the specimen. After a five-year follow-up, the patient showed no recurrence or any other related local symptoms. Absence of perianal abscess from the patient history, along with the macroscopic aspect of the opening similar to a secondary anal orifice on the midline, should raise the suspicion of ACD. Due to the lack of bothersome symptomatology, the patient did not seek any special investigations for her condition until she was in her late twenties. ACD is a very rare condition in adults that might pass unnoticed, but a midline opening posterior to the anus should always raise the suspicion of a secondary anal canal. Surgery is the only cure for this condition with good results after a proper pre-operative workout to reveal others simultaneous malformations.


Assuntos
Canal Anal , Imageamento por Ressonância Magnética , Abscesso , Adulto , Canal Anal/diagnóstico por imagem , Canal Anal/cirurgia , Feminino , Humanos , Períneo , Doenças Raras
13.
Br J Nurs ; 30(Sup20): S8-S16, 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-34781764

RESUMO

Perineal injury following childbirth can result in complications such as wound infection and dehiscence. The reported incidence of these complications in the literature range between 0.1-23.6% and 0.2-24.6%, respectively. However, the healing of disrupted perineal wounds is poorly understood. In addition, it is a neglected area in maternity services. In this review, the authors explore the process of wound healing in the context of infected perineal wounds following childbirth. In addition, the authors describe the management of complications including hypergranulation, perineal pain and dyspareunia.


Assuntos
Parto Obstétrico , Períneo , Feminino , Humanos , Parto , Gravidez , Cicatrização
14.
Acta Chir Plast ; 63(3): 96-101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34814690

RESUMO

BACKGROUND: Fournier's gangrene is necrotizing fasciitis of the genitalia, perineal and perianal region associated with a significant mortality rate. The potentially fatal disease is caused both by aerobic and anaerobic bacteria and primarily occurs in men. The majority of Fournier's gangrene cases is idiopathic or derived from perineal and genital skin infections. Early surgical debridement of necrotic tissues and antibiotics are fundamental. CASE: We report a rare case of Fourniers gangrene of a 57-year-old man secondary to circumcision. The patient presented due to painful swelling of the scrotum and perineum associated with high-grade fever. The patient received broad-spectrum antibiotics and underwent immediate surgical debridement; a total of five other debridements were performed during the recovery until the wounds healed. On a second recovery phase, we performed a penile reconstruction with full thickness skin graft with satisfactory cosmetic and functional results. CONCLUSION: FG remains an urgent condition associated with a high mortality rate, requiring immediate treatment. More statistical reports and standard guidelines are necessary to improve the rate of its survival.


Assuntos
Circuncisão Masculina , Gangrena de Fournier , Gangrena de Fournier/etiologia , Gangrena de Fournier/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Períneo , Escroto/cirurgia , Transplante de Pele
15.
A A Pract ; 15(11): e01548, 2021 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-34807870

RESUMO

The pudendal nerve (PN) block is an effective regional technique for providing analgesia to the perineum. However, when the surgical site involves dermatomal areas lateral to the PN dermatome, additional blocks are necessitated. We present a case report of a 6-year-old female who presented for surgical resection of widespread condylomata accuminata involving the perineum and buttocks. Analgesia was achieved using a combined PN and inferior cluneal nerve block. To our knowledge, this is the first report of this combined technique used for perioperative analgesia.


Assuntos
Bloqueio Nervoso , Nervo Pudendo , Nádegas , Criança , Feminino , Humanos , Dor , Períneo/cirurgia , Nervo Pudendo/cirurgia
16.
BMC Pregnancy Childbirth ; 21(1): 781, 2021 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-34794417

RESUMO

BACKGROUND: To examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI. Several interventional trials showed that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI. Previously, we found that only the element "hand on the fetal head" in itself was protective, although the risk of a type 2 error was calculated to be 50%. METHODS: A prospective follow-up study in an obstetric department in Denmark with 3200 deliveries per year. We included a cohort of 10,383 women giving birth vaginally from gestational week 22 + 0 from 2016 through 2019. We documented on a person-level the five elements of the care bundle together with maternal and obstetrical characteristics. The elements were 1) communication, 2) visible perineum, 3) hand on fetal head, 4) perineal support and 5) certification. Regression analysis was used for analysis of associations. The primary outcome measure was OASI. RESULTS: The total rate of OASI in vaginally delivering women was 1.9%. The incidence was 3.2% in nulliparous women giving birth vaginally. The rate of cesarean section was 16.5% and for episiotomy 2.4%. The reduction in the incidence of OASI was sustained since 2013. Hand on the fetal head and perineal support both were protective factors for OASI. In case of a nulliparous woman with a neonate weighing 3500 g giving birth spontaneously, the relative risk (RR) for OASI was 0.50 (95% CI 0.49- 0.51) with use of hand on the fetal head together with perineal support against no use. Similarly, with a nulliparous woman giving birth to a neonate of 3500 g by vacuum extraction, the RR for OASI was 0.65 (95% CI 0.62-0.68) against no use. CONCLUSIONS: Both hand on the fetal head and perineal support were associated with a reduced risk of OASI.


Assuntos
Canal Anal/lesões , Parto Obstétrico/métodos , Lacerações/prevenção & controle , Pacotes de Assistência ao Paciente/métodos , Períneo/lesões , Adulto , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Gravidez , Estudos Prospectivos , Fatores de Risco
17.
Artigo em Inglês | MEDLINE | ID: mdl-34770005

RESUMO

Romania is a country with high rates of adolescent births, associating scarce comprehensive obstetrical management with this specific population. This research aims to assess soft tissue trauma after vaginal birth in teenage mothers compared to their adult counterparts. A retrospective case-control study was conducted for one year in two hospitals. All vaginal deliveries were considered; the age cut-off value was considered at 20 years old for case and control groups. Lacerations were divided into three subgroups, considering the involved anatomical region; group I: labial and periurethral lacerations, group II: vaginal and perineal lacerations, and group III: cervical lacerations. There were 1498 women included in the study: 298 young mothers and 1200 adults. Teenagers were more likely to have an episiotomy during vaginal delivery compared to adult women: 56% versus 26.7% (p = 0.00, Pearson Chi-square) and a 1.89 times increased risk for developing additional group II lacerations: p = 0.01, Pearson Chi-square test with Bonferroni correction: OR = 1.89, 95% CI: 1.18-3.02. Group II lacerations were the most frequent type of birth trauma in both study groups. Fetal weight ≥4000 g was associated with a two times higher risk for vaginal and perineal lacerations when age criterion was not considered (OR = 1.98, 95% CI: 1.13-3.47, p = 0.01). The incidence of group I and II lacerations increased with age: from 0% and 9.1% between 10 and 14 years old to 6% and 26.2% between 18 and 19 years old. All groups of lacerations were more often identified in the case group, compared to the adult group. Fetal macrosomia and spontaneously ruptured membranes at admission could not be documented as risk factors for obstetrical injury in young mothers. Episiotomy performed in teenagers was not a protective procedure for group II lacerations.


Assuntos
Complicações do Trabalho de Parto , Períneo , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Parto Obstétrico , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Fatores de Risco , Romênia/epidemiologia
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(10): 910-918, 2021 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-34674467

RESUMO

Objective: To compare the morbidity of perineum-related complication between biological mesh and primary closure in closing pelvic floor defects following extralevator abdominoperineal excision (ELAPE). Methods: A literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, Wanfang database, Chinese National Knowledge Infrastructure, VIP database, and China Biological Medicine database for published clinical researches on perineum-related complications following ELAPE between January 2007 and August 2020. Literature inclusion criteria: (1) study subjects: patients undergoing ELAPE with rectal cancers confirmed by colonoscopy pathological biopsy or surgical pathology; (2) study types: randomized controlled studies or observational studies comparing the postoperative perineum-related complications between the two groups (primary perineal closure and reconstruction with a biological mesh) following ELAPE; (3) intervention measures: biological mesh reconstruction used as the treatment group, and primary closure used as the control group; (4) outcome measures: the included literatures should at least include one of the following postoperative perineal complications: overall perineal wound complications, perineal wound infection, perineal wound dehiscence, perineal hernia, chronic sinus, chronic perineal pain (postoperative 12-month), urinary dysfunction and sexual dysfunction. Literature exclusion criteria: (1) data published repeatedly; (2) study with incomplete or wrong original data and unable to obtain original data. Two reviewers independently performed screening, data extraction and assessment on the quality of included studies. Review Manager 5.3 software was used for meta-analysis. The mobidities of perineum-related complications, including overall perineal wound (infection, dehiscence, hernia, chronic sinus) and perineal chronic pain (postoperative 12-month), were compared between the two pelvic floor reconstruction methods. Finally, publication bias was assessed, and sensitivity analysis was used to evaluate the stability of the results. Results: A total of five studies, including two randomized controlled studies and three observational controlled studies, with 650 patients (399 cases in the biological mesh group and 251 cases in primary closure group) were finally included. Compared with primary closure, biological mesh reconstruction had significantly lower ratio of perineal hernia (RR=0.37, 95%CI: 0.21-0.64, P<0.001). No significant differences in ratios of overall perineal wound complication, perineal wound infection, perineal wound dehiscence, perineal chronic sinus and perineal chronic pain (postoperative 12-month) were found between the two groups (all P>0.05). Conclusion: Compared with primary closure, pelvic floor reconstruction following ELAPE with biological mesh has the advantage of a lower incidence of perineal hernia.


Assuntos
Períneo , Protectomia , Humanos , Diafragma da Pelve/cirurgia , Períneo/cirurgia , Reto/cirurgia , Telas Cirúrgicas
19.
Gynecol Obstet Invest ; 86(5): 454-459, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34689138

RESUMO

OBJECTIVES: Rectocele is common in female patients. To date, there is no literature comparing outcomes of rectocele repairs in combination with other perineal surgeries. We aim to analyze perioperative morbidity and mortality as well as long-term outcome of rectocele repair in combination with other perineal surgeries (RR combination) and compare this with solo rectocele repair (solo RR). DESIGN: The type of study was case-control. Data of patients who received solo rectocele repair or rectocele repair in combination with other perineal surgeries between January 2011 and December 2015 were identified and reviewed in a prospectively maintained and IRB-approved database. Ninety-eight patients were included, including 41 patients in the solo RR group and 57 patients in the RR combination group. The demographics, characteristics of patients, short-term complications, long-term complications, and morbidity of the 2 groups were observed. METHODS: The demographics, characteristics of patients, short-term complications, long-term complications, and morbidity of the 2 groups were compared, respectively. Covariate adjustment was analyzed by multivariate logistic and Cox regression analysis. RESULTS: Ninety-eight patients with a median age of 57 were included, involving 41 patients in the solo RR group and 57 patients in the RR combination group. Other than the operative approach (p < 0.01), demographics and preoperative characteristics of the 2 groups were comparable. All variables, including length of stay, estimated blood loss, self-limiting rectal bleeding, transfusion, urinary retention, rectal stricture, rectal and perineal infection, rectovaginal abscess, reoperation, effective resolution of obstructive defecation symptoms, residual symptoms rate, and recurrence rate, were comparable among the 2 groups except for operative time (p = 0.03). LIMITATIONS: This study is a single-center study, which may cause bias. In addition, the sample size is limited. Staging of rectocele and routine imaging studies were not performed. CONCLUSIONS: Rectocele repair in combination with other perineal surgeries is feasible, and outcomes are comparable with solo rectocele repair. Transanal versus transvaginal repairs appear to have no influence on outcomes.


Assuntos
Retocele , Reto , Biópsia , Constipação Intestinal , Feminino , Humanos , Períneo/cirurgia , Retocele/cirurgia , Resultado do Tratamento
20.
Rev Med Suisse ; 17(755): 1792-1797, 2021 Oct 20.
Artigo em Francês | MEDLINE | ID: mdl-34669294

RESUMO

Obstetric anal sphincter injury (OASI) is a complication of vaginal delivery. Its potential consequences are numerous and include anal and/or fecal incontinence, sexual problems and perineal pain, which can be aggravated by future pregnancies and childbirth. One common issue after OASI is the assessment of anorectal function to discuss the delivery modalities during the next pregnancy. This dedicated assessment includes a clinical and paraclinical evaluation, with an ultrasound and/or a manometry. This personalized assessment for each patient with a history of sphincter injury allows for a detailed discussion to decide on the route of delivery in an informed manner.


Assuntos
Canal Anal , Incontinência Fecal , Parto Obstétrico , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Feminino , Humanos , Parto , Períneo , Gravidez
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