- Email: [email protected]
Pelvic organ prolapse in young women
Citations from the literature /International
Journal of Gynecology & Obstetrics 60 (1998) 95-105
multidrug chemotherapy. After a follow-up period of 168 months, an event-free survival of 0.75 + 0.07 was observed. From our data we conclude that multidrug chemotherapy including cisplatin-based regimens may be useful to enhance treatment results of JGCT, especially in advanced FIG0 stages.
GYNECOLOGICAL SURGERY Comparative hysterectomy
morbidity and charges associated with route of and concomitant burch colposuspension
Sze E.H.M.; Kohli N.; Miklos J.R.; Roat T.W.; Karram M.M. USA OBSTET GYNECOL 1997 90/l (42-45) Objective: To compare the surgical morbidity, post-operative course and hospital charges of Burch colposuspension performed in conjunction with abdominal vs. vaginal hysterectomy. Methods: Power analysis indicated that 35 women would be needed in each group to detect a 20% difference in hospital charges between groups with a beta error of 20% and an alpha error of 5%. A computerized records search identified 80 women who underwent Burch colposuspension, 40 of whom underwent concomitant vaginal hysterectomy (vaginal group) and 40 of whom underwent concomitant abdominal hysterectomy (abdominal group). All procedures were performed by one of 16 surgeons at either Good Samaritan Hospital, Cincinnati, Ohio, or the Medical Center of Central Georgia, Macon, Georgia, between 1992 and 1996. Data on demographics, perioperative course, uterine weight and operative and total hospital charges were obtained for each group. Results: There was no statistically significant difference in demographics, surgical history, post-operative hemoglobin and hematocrit decrease, post-operative complications (10 vs. 23%1,operative charges ($4417 f 1200vs. $4731* 14531,mean uterine weight (113.5 * 45 vs. 125.8rt 45 g> and operative times (3.0 + 0.8 vs. 2.9 + 0.7 h) between the vaginal and abdominal groups, respectively. A post-hoc power analysis indicated that each group would require 142 patients to achieve statistical significance for post-operative complication rates. The abdominal group had significantly longer hospital stays (3.1 + 1.0 vs. 2.6 * 0.7 days) and higher hospital charges ($7337 + 1828 vs. $6342 f 1123) than the vaginal group. Conclusion: When hysterectomy is performed at the time of colposuspension, the vaginal route should be considered seriously when either surgical approach is clinically appropriate. Pelvic organ prolapse in young women
Strohbehn K.; Jakary J.A.; Delancey J.O.L. :&ET GYNECOL 1997 90/l (33-36) Objective: To determine differences in the characteristics and type of genital prolapse in young women compared with older women. Methods: A retrospective analysis was performed, identifying 647 women who underwent surgical repair of various types of genital prolapse for the years 1979-1991. One-
101
hundred and ninety-one patients met our inclusion criteria, having well-documented genital prolapse to or beyond the hymen. Patients were stratified into two age groups, those over 35 years and those 35 or younger. The patients were compared regarding ‘complexity’ of prolapse (i.e. the total number of deficient sites per patient), grade of prolapse, parity and coexistent medical conditions. Results: During the study period, 27 young women (mean age * standard deviation [S.D.] 30.3 + 3.4 years) and 164 older women (mean age f S.D., 60.6 + 11.9 years) met our criteria. Young women were more likely than older women to have: (11 potential predisposing medical conditions (congenital anomalies or neurologic or connective tissue diseases) (22.2% vs. 6.7%, P < 0.05); (2) lower mean parity (2.8 vs. 3.4, P < 0.05); (3) only one site of prolapse (56% vs. 23%, P < 0.01); and (4) lower grade of prolapse (33% vs. 87% grade 3 or higher, P < 0.001). Conclusion: Young patients undergoing surgery for genital prolapse were more likely to have lower parity and single-site and lower-grade prolapse. A higher than expected prevalence of congenital anomalies, as well as rheumatologic and neurologic diseases in the younger women is intriguing, but further study is necessary before these conditions can be implicated in the genesis of genital prolapse. Prevalence of bydronephrosis for pelvic organ prolapse
in patients undergoing
surgery
Beverly CM.; Walters M.D.; Weber A.M.; Piedmonte M.R.; Ballard L.A. USA OBSTET GYNECOL 1997 90/l (37-41) OBJECTIVE: To determine the prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse and to determine whether hydronephrosis is associated with the type and severity of prolapse. METHODS: The charts of 375 consecutive patients undergoing surgery for pelvic organ prolapse at the Cleveland Clinic Foundation between January 1, 1990 and December 31, 1993 were reviewed. Preoperative renal ultrasounds and intravenous pyelograms (IVP) were evaluated for hydronephrosis based on the final diagnosis established by the radiologists. The severity of prolapse was determined from the preoperative office examination or from the examination under anesthesia at the time of surgery. Results: Of 375 patients, 323 had either a preoperative renal ultrasound or IVP. The mean age was 66.0 f 10.2years (range 35-93) and median parity was 3.0 (range O-10). Of the 323 patients, 25 (‘7.7%, 95% confidence interval 5, 11) had hydronephrosis. Thirteen patients (4.0%) had mild hydronephrosis, nine (2.8%) had moderate hydronephrosis and three (0.9%) had severe hydronephrosis. The prevalence of hydronephrosis increased with increasing severity of prolapse. ‘Iwo patients with hydronephrosis had evidence of renal insufficiency (creatinine 5 1.6) and both had severe bilateral hydronephrosis and complete procidentia. The prevalence of hydronephrosis was lower m patients with vaginal vault prolapse vs. uterine prolapse (3.9% compared with 12.6%, P < 0.01). Conclusion: The prevalence of hydronephrosis in patients undergoing
Journal of Gynecology & Obstetrics 60 (1998) 95-105
multidrug chemotherapy. After a follow-up period of 168 months, an event-free survival of 0.75 + 0.07 was observed. From our data we conclude that multidrug chemotherapy including cisplatin-based regimens may be useful to enhance treatment results of JGCT, especially in advanced FIG0 stages.
GYNECOLOGICAL SURGERY Comparative hysterectomy
morbidity and charges associated with route of and concomitant burch colposuspension
Sze E.H.M.; Kohli N.; Miklos J.R.; Roat T.W.; Karram M.M. USA OBSTET GYNECOL 1997 90/l (42-45) Objective: To compare the surgical morbidity, post-operative course and hospital charges of Burch colposuspension performed in conjunction with abdominal vs. vaginal hysterectomy. Methods: Power analysis indicated that 35 women would be needed in each group to detect a 20% difference in hospital charges between groups with a beta error of 20% and an alpha error of 5%. A computerized records search identified 80 women who underwent Burch colposuspension, 40 of whom underwent concomitant vaginal hysterectomy (vaginal group) and 40 of whom underwent concomitant abdominal hysterectomy (abdominal group). All procedures were performed by one of 16 surgeons at either Good Samaritan Hospital, Cincinnati, Ohio, or the Medical Center of Central Georgia, Macon, Georgia, between 1992 and 1996. Data on demographics, perioperative course, uterine weight and operative and total hospital charges were obtained for each group. Results: There was no statistically significant difference in demographics, surgical history, post-operative hemoglobin and hematocrit decrease, post-operative complications (10 vs. 23%1,operative charges ($4417 f 1200vs. $4731* 14531,mean uterine weight (113.5 * 45 vs. 125.8rt 45 g> and operative times (3.0 + 0.8 vs. 2.9 + 0.7 h) between the vaginal and abdominal groups, respectively. A post-hoc power analysis indicated that each group would require 142 patients to achieve statistical significance for post-operative complication rates. The abdominal group had significantly longer hospital stays (3.1 + 1.0 vs. 2.6 * 0.7 days) and higher hospital charges ($7337 + 1828 vs. $6342 f 1123) than the vaginal group. Conclusion: When hysterectomy is performed at the time of colposuspension, the vaginal route should be considered seriously when either surgical approach is clinically appropriate. Pelvic organ prolapse in young women
Strohbehn K.; Jakary J.A.; Delancey J.O.L. :&ET GYNECOL 1997 90/l (33-36) Objective: To determine differences in the characteristics and type of genital prolapse in young women compared with older women. Methods: A retrospective analysis was performed, identifying 647 women who underwent surgical repair of various types of genital prolapse for the years 1979-1991. One-
101
hundred and ninety-one patients met our inclusion criteria, having well-documented genital prolapse to or beyond the hymen. Patients were stratified into two age groups, those over 35 years and those 35 or younger. The patients were compared regarding ‘complexity’ of prolapse (i.e. the total number of deficient sites per patient), grade of prolapse, parity and coexistent medical conditions. Results: During the study period, 27 young women (mean age * standard deviation [S.D.] 30.3 + 3.4 years) and 164 older women (mean age f S.D., 60.6 + 11.9 years) met our criteria. Young women were more likely than older women to have: (11 potential predisposing medical conditions (congenital anomalies or neurologic or connective tissue diseases) (22.2% vs. 6.7%, P < 0.05); (2) lower mean parity (2.8 vs. 3.4, P < 0.05); (3) only one site of prolapse (56% vs. 23%, P < 0.01); and (4) lower grade of prolapse (33% vs. 87% grade 3 or higher, P < 0.001). Conclusion: Young patients undergoing surgery for genital prolapse were more likely to have lower parity and single-site and lower-grade prolapse. A higher than expected prevalence of congenital anomalies, as well as rheumatologic and neurologic diseases in the younger women is intriguing, but further study is necessary before these conditions can be implicated in the genesis of genital prolapse. Prevalence of bydronephrosis for pelvic organ prolapse
in patients undergoing
surgery
Beverly CM.; Walters M.D.; Weber A.M.; Piedmonte M.R.; Ballard L.A. USA OBSTET GYNECOL 1997 90/l (37-41) OBJECTIVE: To determine the prevalence of hydronephrosis in patients undergoing surgery for pelvic organ prolapse and to determine whether hydronephrosis is associated with the type and severity of prolapse. METHODS: The charts of 375 consecutive patients undergoing surgery for pelvic organ prolapse at the Cleveland Clinic Foundation between January 1, 1990 and December 31, 1993 were reviewed. Preoperative renal ultrasounds and intravenous pyelograms (IVP) were evaluated for hydronephrosis based on the final diagnosis established by the radiologists. The severity of prolapse was determined from the preoperative office examination or from the examination under anesthesia at the time of surgery. Results: Of 375 patients, 323 had either a preoperative renal ultrasound or IVP. The mean age was 66.0 f 10.2years (range 35-93) and median parity was 3.0 (range O-10). Of the 323 patients, 25 (‘7.7%, 95% confidence interval 5, 11) had hydronephrosis. Thirteen patients (4.0%) had mild hydronephrosis, nine (2.8%) had moderate hydronephrosis and three (0.9%) had severe hydronephrosis. The prevalence of hydronephrosis increased with increasing severity of prolapse. ‘Iwo patients with hydronephrosis had evidence of renal insufficiency (creatinine 5 1.6) and both had severe bilateral hydronephrosis and complete procidentia. The prevalence of hydronephrosis was lower m patients with vaginal vault prolapse vs. uterine prolapse (3.9% compared with 12.6%, P < 0.01). Conclusion: The prevalence of hydronephrosis in patients undergoing