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Protecting the pelvic floor: Obstetric management to prevent incontinence and pelvic organ prolapse
Citations
from
the literature
/International
Journal
nal agenesis were diagnosed and operated on by the same surgeon in 51 years (1943 through 1994). The patients’ ages ranged from 14 to 41 years with an average of 20.5 years (SD 3.9 years). In most of the cases surgical intervention was performed when the patient desired to begin her sexual experience. The graft was taken from the thigh or gluteal region, followed by dissection of the urethrovesicorectal space. The access in this space was performed through two mutually perpendicular incisions (a modification of the Abbe-McIndoe technique). A multiholed, rigid plastic mold was inserted during surgery and was replaced after 8-10 days with a semirigid silicone mold, which remained in place at least 6 months after operation or until the patient became sexually active. Results: We retrospectively reviewed 201 cases of Mayer-RokitanskyKuster-Hauser syndrome in which vaginoplasty was performed. The data were obtained from the personal records of Dan Alessandrescu for the 76 cases operated on between 1943 and 1967 and from the medical records in the Polizu Hospital Archive, Bucharest, Romania, for 125 cases operated on between 1968 and 1994. Overall surgical mortality was null. Intraoperative and postoperative complications consisted of two rectal perforations cl%), eight graft infections (4.0%), and 11 infections of graft-site origin (5.5%). Additional information was obtained during follow-up. Sexual satisfaction was investigated with objective (depth of constructed vagina) and subjective (ability to have sexual intercourse, presence or absence of dyspareunia, vaginal lubrication, orgasm) criteria and was analyzed on a qualitative scale. In 12 patients we performed biopsies of the neovaginal wall for histologic evaluation. Conclusion: Because of the simplicity, low morbidity, and high success rate, our modified Abbe-M&doe technique is a procedure of choice for vaginoplasty. Protecting the pelvic flooc Obstetric management to prevent incontinence and pelvic organ prolapse Handa V.L.;Harris T.A.;Ostergard D.R. USA
OBSTET GYNECOL 1996 88/3 (470-478) Objectives: To review the literature regarding the effects of childbirth on the muscles, nerves, and connective tissue of the pelvic floor; review the evidence to support an association between childbirth and anal incontinence, urinary incontinence, and pelvic organ prolapse; and present recommendations for the prevention of these sequelae. Data Sources: Sources were identified from a MEDLINE search of Englishlanguage articles published from 1984 to 1995. Additional sources were identified from references cited in relevant research articles. Methods of Study Selection: We studied articles on the following topics: anatomy of the pelvic floor; association of childbirth with neuromuscular injury, biomechanical and morphologic alterations in muscle function, and connective tissue structure and function; the long-term effects of childbirth on continence and pelvic organ support; and the effects of obstetric interventions on the pelvic floor. Tabulation, Integration, and Results: Articles were reviewed and summarized. An overview of the structure and function of the
of Gynecology
& Obstetrics
56 (1997) 99-109
107
pelvic floor was developed to provide a context for subsequent data. Childbirth was found to be associated with a variety of muscular and neuromuscular injuries of the pelvic floor that are linked to the development of anal incontinence, urinary incontinence, and pelvic organ prolapse. Risk factors for pelvic floor injury include forceps delivery, episiotomy, prolonged second-stage of labor, and increased fetal size. Cesarean delivery appears to be protective, especially if the patient does not labor before delivery. Conclusion: The pelvic floor plays an important role in continence and pelvic organ support. Obstetricians may be able to reduce pelvic floor injuries by minimizing forceps deliveries and episiotomies, by allowing passive descent in the second stage, and by selectively recommending elective cesarean delivery. A randomized comparison of Burch colposuspension and ahdominal paravaginal defect repair for female stress urinary incontinence Colombo M.; Milani R.; Vitobello D.; Maggioni A. ITA
AM J OBSTET GYNECOL 1996 175/l (78-84) Objective: Our aim was to compare Burch colposuspension and paravaginal repair for success rates, complications, and urodynamic effects when the procedures arc used in the treatment of stress urinary incontinence. Study Design: Thirty-six patients were enrolled. A full urodynamic evaluation was repeated 6 months postoperatively. Results: Twelve (67%) and 17 (94%) subjects (Burch colposuspension vs paravaginal repair) voided spontaneously before discharge (P = 0.04). One patient receiving the Burch procedure underwent urethral dilation for urinary retention. Follow-up was for l-3 years. Differences in subjective and objective cure rates favored the Burch colposuspension over the paravaginal repair: 100% versus 72% (P = 0.02) and 100% versus 61% (P = 0.0041, respectively. The paravaginal repair did not produce significant modifications in prolilometry. Postoperatively, cotton swab tests had negative results in all patients with the Burch operation and in 33% of those with the paravaginal repair (P = 0.01). Conclusion: Paravaginal repair is not recommended for the treatment of stress incontinence, although it was accompanied by a more immediate resumption of voiding. How effective are contraceptives? The determination and measurement of pregnancy rates Potter L.S. USA OBSTET GYNECOL 1996 88/3 SUPPL. (13S-23s) Objectives: To provide an overview of contraceptive effectiveness and its determinants as well as reasons for the gap between the actual and expected number of unplanned pregnancies for various categories of users; to provide some guidelines for more precise, consistent terminology and measurements for use in future research; and to provide specific counseling guidelines; usingcombined oral contraceptives (OCs) as the example. Data Sources: Fifty-three articles on contraceptive effectiveness were reviewed, with a particular
from
the literature
/International
Journal
nal agenesis were diagnosed and operated on by the same surgeon in 51 years (1943 through 1994). The patients’ ages ranged from 14 to 41 years with an average of 20.5 years (SD 3.9 years). In most of the cases surgical intervention was performed when the patient desired to begin her sexual experience. The graft was taken from the thigh or gluteal region, followed by dissection of the urethrovesicorectal space. The access in this space was performed through two mutually perpendicular incisions (a modification of the Abbe-McIndoe technique). A multiholed, rigid plastic mold was inserted during surgery and was replaced after 8-10 days with a semirigid silicone mold, which remained in place at least 6 months after operation or until the patient became sexually active. Results: We retrospectively reviewed 201 cases of Mayer-RokitanskyKuster-Hauser syndrome in which vaginoplasty was performed. The data were obtained from the personal records of Dan Alessandrescu for the 76 cases operated on between 1943 and 1967 and from the medical records in the Polizu Hospital Archive, Bucharest, Romania, for 125 cases operated on between 1968 and 1994. Overall surgical mortality was null. Intraoperative and postoperative complications consisted of two rectal perforations cl%), eight graft infections (4.0%), and 11 infections of graft-site origin (5.5%). Additional information was obtained during follow-up. Sexual satisfaction was investigated with objective (depth of constructed vagina) and subjective (ability to have sexual intercourse, presence or absence of dyspareunia, vaginal lubrication, orgasm) criteria and was analyzed on a qualitative scale. In 12 patients we performed biopsies of the neovaginal wall for histologic evaluation. Conclusion: Because of the simplicity, low morbidity, and high success rate, our modified Abbe-M&doe technique is a procedure of choice for vaginoplasty. Protecting the pelvic flooc Obstetric management to prevent incontinence and pelvic organ prolapse Handa V.L.;Harris T.A.;Ostergard D.R. USA
OBSTET GYNECOL 1996 88/3 (470-478) Objectives: To review the literature regarding the effects of childbirth on the muscles, nerves, and connective tissue of the pelvic floor; review the evidence to support an association between childbirth and anal incontinence, urinary incontinence, and pelvic organ prolapse; and present recommendations for the prevention of these sequelae. Data Sources: Sources were identified from a MEDLINE search of Englishlanguage articles published from 1984 to 1995. Additional sources were identified from references cited in relevant research articles. Methods of Study Selection: We studied articles on the following topics: anatomy of the pelvic floor; association of childbirth with neuromuscular injury, biomechanical and morphologic alterations in muscle function, and connective tissue structure and function; the long-term effects of childbirth on continence and pelvic organ support; and the effects of obstetric interventions on the pelvic floor. Tabulation, Integration, and Results: Articles were reviewed and summarized. An overview of the structure and function of the
of Gynecology
& Obstetrics
56 (1997) 99-109
107
pelvic floor was developed to provide a context for subsequent data. Childbirth was found to be associated with a variety of muscular and neuromuscular injuries of the pelvic floor that are linked to the development of anal incontinence, urinary incontinence, and pelvic organ prolapse. Risk factors for pelvic floor injury include forceps delivery, episiotomy, prolonged second-stage of labor, and increased fetal size. Cesarean delivery appears to be protective, especially if the patient does not labor before delivery. Conclusion: The pelvic floor plays an important role in continence and pelvic organ support. Obstetricians may be able to reduce pelvic floor injuries by minimizing forceps deliveries and episiotomies, by allowing passive descent in the second stage, and by selectively recommending elective cesarean delivery. A randomized comparison of Burch colposuspension and ahdominal paravaginal defect repair for female stress urinary incontinence Colombo M.; Milani R.; Vitobello D.; Maggioni A. ITA
AM J OBSTET GYNECOL 1996 175/l (78-84) Objective: Our aim was to compare Burch colposuspension and paravaginal repair for success rates, complications, and urodynamic effects when the procedures arc used in the treatment of stress urinary incontinence. Study Design: Thirty-six patients were enrolled. A full urodynamic evaluation was repeated 6 months postoperatively. Results: Twelve (67%) and 17 (94%) subjects (Burch colposuspension vs paravaginal repair) voided spontaneously before discharge (P = 0.04). One patient receiving the Burch procedure underwent urethral dilation for urinary retention. Follow-up was for l-3 years. Differences in subjective and objective cure rates favored the Burch colposuspension over the paravaginal repair: 100% versus 72% (P = 0.02) and 100% versus 61% (P = 0.0041, respectively. The paravaginal repair did not produce significant modifications in prolilometry. Postoperatively, cotton swab tests had negative results in all patients with the Burch operation and in 33% of those with the paravaginal repair (P = 0.01). Conclusion: Paravaginal repair is not recommended for the treatment of stress incontinence, although it was accompanied by a more immediate resumption of voiding. How effective are contraceptives? The determination and measurement of pregnancy rates Potter L.S. USA OBSTET GYNECOL 1996 88/3 SUPPL. (13S-23s) Objectives: To provide an overview of contraceptive effectiveness and its determinants as well as reasons for the gap between the actual and expected number of unplanned pregnancies for various categories of users; to provide some guidelines for more precise, consistent terminology and measurements for use in future research; and to provide specific counseling guidelines; usingcombined oral contraceptives (OCs) as the example. Data Sources: Fifty-three articles on contraceptive effectiveness were reviewed, with a particular